Medicines for treating Central Apnea

Would somebody kindly post/repost the names of medicines that may possibly be effective in treating central apneas? I tried to search here and was not able to come with many useful hits. Perhaps there was already some threads here that some of you may remember?

When I know the drug names, I can try to do online research on the medical study reports or side effects. As of a few years ago, a text book I have on apnea, indicated there were almost no effective drugs for centrals.

Thank you for your help!

Since central apnea is a usually a brain problem it might be hard to treat with drugs. Jim

Below is a Google Scholar search for the Boolean-combined phrases "central apnea" and "respiratory stimulants":
http://scholar.google.com/scholar?hl=en ... a=N&tab=ws

-SWS wrote:Below is a Google Scholar search

Thank you, my friend!

Gabapentin is a drug sometimes used to create more REM sleep. If your doc gives it to you, try to NOT get generic.

Crest wrote:Gabapentin is a drug sometimes used to create more REM sleep. If your doc gives it to you, try to NOT get generic.

Crest, Thanks. Curious: Is there any particular reason to avoid the generic for this drug, or is that because of a general distrust of generics on your part?

BTW, Gabapentin seems to be only for treating RLS restless leg syndrome? I could not find any reference to that drug's usesage for any other type of sleep disorders.

There was an earlier study that indicated that Remeron (mirtazapine) may have been helpful in treating SA. However, follow up studies have been less than encouraging:

Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea.
Marshall NS, Yee BJ, Desai AV, Buchanan PR, Wong KK, Crompton R, Melehan KL, Zack N, Rao SG, Gendreau RM, Kranzler J, Grunstein RR.

NHMRC Centre for Sleep Medicine, Woolcock Institute of Medical Research, University of Sydney, NSW Australia.

OBJECTIVE: Mirtazapine is an a2A antagonist and mixed 5-HT2/5-HT3 antagonist that has been proposed as a potential treatment for obstructive sleep apnea (OSA). A small, randomized, controlled trial has previously found an approximate halving in the severity of OSA with daily doses of 4.5 and 15 mg. We aimed to confirm and extend these findings in 2 randomized placebo-controlled, proof-of-concept trials. METHODS: Two randomized, double-blind, placebo-controlled trials of mirtazapine for OSA (apnea-hypopnea index 10-40/h). Study 1: 3-way crossover, dose-finding study testing the self-administration of mirtazapine (7.5, 15, 30, and/or 45 mg) or placebo 30 minutes prior to bedtime for 2 weeks at each dose. Twenty patients were randomly assigned to 1 of 6 different dose-sequence groups, with each patient exposed to a maximum of 3 doses. Study 2: 3-arm, randomized, parallel-group trial of mirtazapine at 15 mg or mirtazapine 15 mg + Compound CD0012 or placebo for 4 weeks in 65 patients with OSA. RESULTS: Two patients withdrew from Study 1 after complaints of unacceptable lethargy. Fifteen patients were withdrawn from study 2, 7 after complaints of unacceptable lethargy or other side-effects. No measurement of sleep apnea improved due to mirtazapine in either study. Weight gain was significantly greater on mirtazapine than on placebo in both trials. CONCLUSIONS: Mirtazapine did not improve sleep apnea in either trial. Mirtazapine caused weight gain, which may further worsen OSA. Therefore, mirtazapine is not recommended for the treatment of OSA.

I think feeling_better is asking about medications (I haven't heard of any) specifically to treat Central Sleep Apnea and/or an increased number of central apneas that can crop up when CPAP is applied to someone with CSDB -- complex sleep disordered breathing, or "CompSAS"(complex sleep apnea syndrome.) CSDB is not to be confused though with "mixed apneas" showing up on a sleep study.

Central apneas are a neurological rather than "obstructed airway" problem.

Links to Central Apnea discussions
viewtopic.php?p=22702

feeling_better wrote:Would somebody kindly post/repost the names of medicines that may possibly be effective in treating central apneas?

Carbon Dioxide?

LoQ wrote:Carbon Dioxide?

Yes, increasing CO2 retention, will decrease CA for many. But CO2 has to be very closely controlled, very difficult to do. I am not thinking of co2 as a medicine

Actually Co2 rebreathing is a proven technique to assist in helping with CSDB and centrals.
true -- it is not a medicine per se, but the technique is used successfully by adding deadspace for controlled CO2 rebreathing.

Research may be underway for more controlled CO2 applications.

It is my understanding that introduction of very small percentage of CO2 aids in the control of centrals

Lubman

Lubman wrote:Actually Co2 rebreathing is a proven technique to assist in helping with CSDB and centrals.
true -- it is not a medicine per se, but the technique is used successfully by adding deadspace for controlled CO2 rebreathing.

Research may be underway for more controlled CO2 applications.

It is my understanding that introduction of very small percentage of CO2 aids in the control of centrals

Lubman

Hey I got a bottle of that out in my shop hooked up to my MIG welder, of course it may have a bit of Argon in the mix, I used to use straight CO2 and it is way cheaper

But I couldn't agree more, and I disagree with the assumption that it is some neurological disorder it isn't. What else can the human body do when it is not retaining enough Co2, it does the only thing it can do, stop you from breathing, nothing retains Co2 faster than stopping you from breathing.

I think one is out fishing looking for a drug to eliminate it. This is really all the specialized machines do found to address it, they control your breathing so you retain a tiny bit more Co2 with each breath and those events go away on their own.

The problem as I see it is the doctors that are supposed to be addressing this usually don't know enough about the devices to effectively set a patient up correctly to resolve it.

I think that when a patient has a complex disorder like CSDB or CSR they should be given the machine they are to use and they should be titrated on that machine by the sleep lab tech who fine tunes it to the patients effective therapy. They should also be certified meaning if they are going to set up a Adapt SV on a patient they attend the manufacturers training on how to set it up correctly.

Hell I had to go to Irvine years ago and attend Toshiba Perception training before I could install a telephone system, by contrast, to setup a Adapt SV for a patient all I have to do is flip burgers one day and go to work for Billy-Bob's DME service and I'm programming an Adapt SV. Ask the doctor and half of them don't even know how to turn the machine on much less how to set it up. Half the patients leave with a machine incorrectly set up to treat them effectively. Get beyond "I'm still tired" and its back to the sleep lab for another titration.

Sure are a lot of those Adapt SV machines on the used market, wonder why that is.

Answering my own question at the beginning of this thread:

When I searched around, these are the medicines that were mentioned as those having some possible effects to reduce central apneas. None appears conclusive or in any general use.

1. Acetazolamide
2. Clomipramine
3. Doxapram

The above were mentioned in the text book Snoring and Sleep Apnea by Ralph A. Pascualy, MD and Sally Warren Soest.

4. Buspirone
http://clinicaltrial.gov/ct2/show/NCT00 ... %22&rank=1

5. Ambien
viewtopic/t20758/Ambien-Appears-to-Reme ... ml#p178203

6. Various Meds (could not get the full article)
http://www.ingentaconnect.com/content/b ... 2/art00007