Mirtazapine (Remeron) 15mg for sleep apnea?

[Spreech]

I've been trying to get acclimated to my masks; I can't seem to get comfortable enough to have my CPAP on all night. I read a research study that suggests 15mg of the anti-depressant Remeron is effective for treating sleep apnea (up to 52% reduction in AHI). I took it for a few days and feel too tired to function. I think eventually I'll get used to the medicine, but I'm wondering if anyone else has taken this medicine and if it has helped them any.

Study 1: http://www.ncbi.nlm.nih.gov/pubmed/17310863
Study 2: http://www.ncbi.nlm.nih.gov/pubmed/15341898

[Julie]

Why don't you see what Sleepyhead says when you take the Remeron?

[Goofproof]

It's good if you're delusional, I doubt if it's a cure for Sleep Apnea, I don't think it will stop you boat from sinking in De-Nile. Jim

[ChicagoGranny]

Study 1: http://www.ncbi.nlm.nih.gov/pubmed/17310863

"... we do not recommend use of mirtazapine as a treatment for OSA."

Study 2: http://www.ncbi.nlm.nih.gov/pubmed/15341898

"This successful case appears to be the first report with mirtazapine in human SAHS and supports the need for an appropriate clinical trial with this drug."

So, you found one study that recommends against it, and another study where they found one case where it seemed to work in an 82-year old male?

[sventory]

I took Mirtazapine on and off the past year before my apnea got diagnosed and even after to help me sleep with mask on. It's the only sleeping pill that actually helped me sleep without wiping me out, but after a few months of on and off of only taking 7.5mg the smallest pill. I got weird sensations like a feeling I wet myself. Not sure if it's related to the pill or not, I was on benzos before that and they REALLY mess you up would not recommend. I haven't taken any for a month now and the peed myself sensation has stopped, but man my sleep is also horrible. However, how can this pill help your OSA? OSA is physical, does mirtazapine make your tongue more rigid or widen your airway? I don't think so.

[ChicagoGranny]

widen your airway?

That's "kinda" what the claim is:

Decreased serotonergic facilitation of upper-airway motor neurons during sleep has been postulated as an important mechanism rendering the upper airway vulnerable to obstruction in patients with obstructive sleep apnea syndrome (OSA). ... We sought to determine whether mirtazapine, a mixed 5-HT2/5-HT3 antagonist that also promotes serotonin release in the brain would effectively reduce AHI during both NREM and REM sleep in patients with OSA.
Study 1: http://www.ncbi.nlm.nih.gov/pubmed/17310863

[chunkyfrog]

And the last line contains the words,"we do not recommend . . ."

[norestfortheweary]

I have had OSA/CSA for 12+ years. I took Remeron (mertazapine) to help me sleep, which it did, but the MD NEVER gave it to me to treat OSA. I don't even know how that would be possible. It may sound strange but 15 mg works better for sleep than 30 mg. I'm not sure why the lower dose works better but it does. One unfortunate side effect of Mertazapine is weight gain. I gained 15 lbs when I took it so I decided to stop it after tapering off of it. It has been several years since I took it and would not take it again due to weight gain. Good luck!

[story1267]

One of my complicated children took remeron for a while. The specialist who prescribed it told me it was not a great anti-depressant but did seem to work well in some people to help with sleep and also to gain weight (two goals I had at the time for said complicated young person).

She also explained to me that many drugs have very different effects at different dosages... i.e. amitryptilline, etc.

So, my take would be sleep aid? Maybe. OSA treatment? Not so much.

[ChicagoGranny]

but the MD NEVER gave it to me to treat OSA. I don't even know how that would be possible.

Duh.

That's "kinda" what the claim is:


wrote:

Decreased serotonergic facilitation of upper-airway motor neurons during sleep has been postulated as an important mechanism rendering the upper airway vulnerable to obstruction in patients with obstructive sleep apnea syndrome (OSA). ... We sought to determine whether mirtazapine, a mixed 5-HT2/5-HT3 antagonist that also promotes serotonin release in the brain would effectively reduce AHI during both NREM and REM sleep in patients with OSA.
Study 1: http://www.ncbi.nlm.nih.gov/pubmed/17310863

[chunkyfrog]

The weight gain would bump it right OFF the short list.

[49er]

Remeron was one of my psych med cocktails for years and was used for sleep. I also found a lower dose more sedating for several years until I had to switch to the generic brand which wasn't as effective at the same dose. I ended up having to increase it which seemed to work for a few more years until it pooped out and I needed the addition of Doxepin.

The "gifts" from this med were weight gain and extremely difficulties in getting off of the drug in spite of a very slow taper. Even if it cured apnea, h--l would freeze over because I ever took it again.

49er

[sleepstar]

Interesting paper. Thanks for the link.

Basically says that the benefits do not outweigh the potential side effects though.

Sometimes doctors may consider using a small dose of a sleeping tablet (like temazepam) for a few days while they begin to use the machine. Perhaps ask about this.

I don't think Ive ever heard of a doctor prescribing an antidepressant for sleep apnea. There's no treatment in a pill.

In saying that though, antidepressants could technically reduce the amount of obstructive events a night. This would be because they suppress REM sleep. REM sleep is often when people have the most obstructions. But what are the implications of reducing REM sleep? It sacrificing REM sleep to potentially (and who knows, maybe only slightly) reduce AHI, doctors would be prescribing them for it. But they aren't - CPAP remains the gold standard.

[49er]

Interesting paper. Thanks for the link.

Basically says that the benefits do not outweigh the potential side effects though.

Sometimes doctors may consider using a small dose of a sleeping tablet (like temazepam) for a few days while they begin to use the machine. Perhaps ask about this.

I don't think Ive ever heard of a doctor prescribing an antidepressant for sleep apnea. There's no treatment in a pill.

In saying that though, antidepressants could technically reduce the amount of obstructive events a night. This would be because they suppress REM sleep. REM sleep is often when people have the most obstructions. But what are the implications of reducing REM sleep? It sacrificing REM sleep to potentially (and who knows, maybe only slightly) reduce AHI, doctors would be prescribing them for it. But they aren't - CPAP remains the gold standard.

Interesting sleepstar. I am wondering once I was completely off of all the meds in 2010 if my apnea symptoms started getting worse as I was diagnosed about a year and a half later. Obviously, I can't offer proof of anything but your comments about Rem sleep have made me quite curious.

[ChicagoGranny]

There's no treatment in a pill.

You are overlooking the fact that there is often in OSA patients below-normal upper-airway motor neuron activity. If a drug is available that improves upper-airway motor neuron activity, OSA could be improved.

For now, no effective drug is available. Only electrical stimulation devices are available, such as http://www.inspiresleep.com/what-is-ins ... apy-works/ .