AZ Sleep

CNS Depressants and Sleep Apnea

Sleep apnea is a condition that affects the good night sleep of an estimated 25 million people in the U.S. Because so many cases of sleep apnea remain undiagnosed, many people who suffer may be in a kind of double jeopardy if they are using any kind of depressants. From alcohol to sleep medications, here’s how depressants affect your sleep apnea.

What is sleep apnea?

There are two kinds of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea. The more common form of the two is obstructive sleep apnea, affecting approximately 22 million people in the U.S. (men more frequently than women).

In OSA, the muscles of the jaw and throat relax so completely that the sleeper’s airway is completely blocked. When the brain realizes that oxygen is not coming into the body, it awakes the sleeper, often with a loud choking or gasping breath.

Central sleep apnea involves the brain as well. The central nervous system essentially forgets to breathe. Why this occurs is not entirely clear, but this form can be most dangerous because there is no reminder to breath as a reflexive action.

A rare few sleepers have both forms of sleep apnea concurrently, making getting a full night’s rest nearly impossible.

Why do depressants affect sleep apnea symptoms?

Because all forms of sleep apnea involve the central nervous system, it stands to reason that any medications that act directly on that system could influence the prevalence and severity of the condition.

As the name would indicate, depressants slow (depress) the rate of response in the central nervous system. They increase the efficacy of gamma-aminobutyric acid (GABA) in the brain, a chemical that depresses the brain’s activity. While this can be very useful for calming anxiety and inducing sleep, for patients with sleep apnea, this lack of quick response could be fatal.

In some cases, patients who are taking depressants under the supervision of a doctor may not realize they have sleep apnea until a medical emergency occurs. Here’s how specific classes of depressants can affect sleep apnea.

Sleep apnea and alcohol

Alcohol is a depressant that can not only increase the severity of sleep apnea symptoms, it can actually be a primary cause of this condition.

Drinking alcohol dampens the body’s natural urge to breathe. Additionally, the breaths that do come are short and shallow, with longer pauses in between. For patients with sleep apnea, this can be just a pause too long. As blood oxygen levels drop, carbon dioxide builds in the blood. This condition is called hypercapnia, a condition that can be fatal.

Those who suffer from chronic alcohol use and abuse are also more likely to be overweight, another risk factor for obstructive sleep apnea. Snoring is also a risk factor for sleep apnea. Further, people with a higher BMI (body-mass index) are more likely to snore. This triumvirate of factors – obesity, snoring, and alcohol – can be lethal.

Finally, alcohol use increases the incidence of sleep apnea in men, regardless of amount.

Sleep apnea and pain medications

Pain medications are a class of depressants that can be vitally useful for a variety of conditions. Imagine receiving surgery without an IV drip and no way of managing post-operative pain! While pain medications can allow you to go on with your life, they also carry profound risks in surgery for patients with sleep apnea.

Patients with sleep apnea are harder to intubate and struggle to come awake in the recovery room more than patients without it. But that’s not all. Other significant risks of pain medications on patients with sleep apnea include greater sensitivity to anesthesia and less of a natural physiological reflex to keep the airway open even when awake. For undiagnosed patients, these risks can cause sudden, inexplicable complications that can be fatal.

When it comes to the use of other pain relievers such as prescription opioids, the complications continue.

One study found that fully 46% of all opioid users also suffered from sleep apnea. Other studies find this rate to be much higher, but all studies found that a higher percentage of these patients had central sleep apnea that directly involved an inactive or slow-to-act central nervous system. Combine this with a low compliance rate of treatment with CPAP machines (see below for treatments) for a chronic pain population that is especially challenging to treat.

Sleep apnea and muscle relaxers

In normally healthy patients without sleep apnea, muscle relaxers produce side effects such as snoring. For those with sleep apnea, this can intensify the risk of snoring and sleep apnea.

Patients may also experience more frequent pauses in breathing.

Sleep apnea and benzodiazepines

Benzodiazepines work as anti-anxiety medications that are also used as anti-convulsant (anti-seizure) medications.

They also work specifically on the GABA receptors, depressing brain activity and increasing the pauses between breaths (and the frequency of those pauses).

Sleep apnea and sleep medications

As with all other depressants that slow the central nervous system, sleep medications (including barbiturates) make it very difficult for the brain to receive the “wake up” reflexive signal when an otherwise-healthy patient stops breathing.

Working on the sodium and potassium transporters in cells, these depressants can lead to heavy sedation and even coma with significant effects on breathing. For patients already with sleep apnea, you should not use prescription sleep medications or do so only under a doctor’s care.

How to treat sleep apnea

Treating sleep apnea in patients who also use depressants is possible. It is vital to consult with your doctor before stopping any medications. This is especially true if you are being treated for a comorbid condition that requires that medication.

For non-prescription depressants such as alcohol, there really is no guaranteed safe level of use. If alcohol dependence is present, working with your doctor to safely treat and monitor any possible withdrawal symptoms is important.

Traditional treatments for sleep apnea such as CPAP machines and dental sleep apnea devices can be used in conjunction with any changes made to your medications. In addition, lifestyle changes like committing to more activity and a healthy BMI are positive steps. This can manage sleep apnea and any conditions that are prompting the use of depressants (e.g., anxiety or chronic pain).

In Scottsdale and at locations all across the Phoenix Valley, contact the sleep apnea dentists at AZ Sleep for more information on depressants and treatment for sleep apnea. We can help!

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