Don’t hop aboard the medical marijuana train for sleep apnea

Lately we have been seeing a lot of news articles about medical marijuana. We have new states popping up every month in support of the legalization of marijuana. While we continue to learn more about the benefits and hear various opinions, let’s look at sleep apnea. Many people believe medical marijuana is a good option for patients with sleep apnea. It might be possible, but I don’t think we’re ready to jump on that train just yet.

Medical marijuana and sleep apnea

According to the American Academy of Sleep Medicine (AASM), medical marijuana should not be used to treat sleep apnea. The AASM warned that the drug and its synthetic extracts have not been shown to be safe, effective or well-tolerated by patients with sleep apnea.                     

The important thing to note here is that, until further research and evidence is found on the use of medical marijuana for treatment of sleep apnea, we should be avoiding this subject. Be sure to discuss proven treatment options with your patients. However, if your patient does bring this idea up for treatment of sleep apnea, provide proper education and inform them that there has been no proof just yet.

This does not mean it will never be approved, but, for now, we need to do our due diligence to protect our patients and have their best interest in mind.

States discuss qualifying conditions

Many states have discussed adding obstructive sleep apnea as a new qualifying condition for their medical marijuana program, such as the Minnesota Department of Health. However, the AASM’s statement in the Journal of Clinical Sleep Medicine, urged states to exclude sleep apnea from the list of chronic health issues that might be included in medical marijuana programs.

Current treatments for sleep apnea still include CPAP therapy and oral appliance therapy, but should not include medical marijuana (at least not yet). While medical marijuana runs the risk of daytime sleepiness and other side effects, further studies are needed to determine the effectiveness.

Until there is significant scientific evidence of the safety and efficacy of medical marijuana, we should avoid this as a potential treatment for sleep apnea.

Study suggests hypoxia is the main cause of BP rise in sleep apnea

Patients who had previously used continuous positive airway pressure (CPAP) for the treatment of sleep apnea, found that it helped to eliminate their morning blood pressure elevations. It also substantially reduced hypoxia. In a recent study in the American Journal of Respiratory and Critical Care Medicine, relative to treatment with supplemental air, pure oxygen was associated with a 6.6 mm Hg decrease in systolic and 4.6 mm Hg decrease in diastolic pressure.

What is the connection?

Obstructive sleep apnea has been known as a risk factor for hypertension and cardiovascular disease. However, it was not clear if that risk was associated with recurrent arousal or intermittent hypoxia, according to the study.

Understanding that supplemental oxygen reduced intermittent hypoxia but had only a minor effect on markers of arousal, makes a strong case for intermittent hypoxia being the dominant cause of daytime BP increases in patients with sleep apnea.

This study shows us that by blunting the dips in oxygen levels, the use of oxygen can have a positive effect on a person’s BP. We can start to look at patients with sleep apnea who have experienced high blood pressure that is not adequately treated with hypertension medication. According to this study, that specific group of patients should benefit from the use of oxygen therapy.

Oxygen improves BP

In this double-blinded study, CPAP was withdrawn for 14 nights during each treatment arm. During this time, participants received supplemental oxygen or regular air overnight through a face mask. The primary outcome was the change in home morning BP following the withdrawal of CPAP. Secondary outcomes included oxygen desaturation index, apnea hypopnea index, and subjective and objective sleepiness.

The use of supplemental oxygen significantly improved measures of intermittent hypoxia. There was also a significant reduction in heart rate rises index. While additional studies are needed to determine the best candidates for supplemental oxygen therapy, it is important to note these findings.

We, as dentists, can continue to treat sleep apnea patients with oral appliance therapy, but we should be mindful to other treatment options and what a sleep physician suggests for the best outcomes.

Teenagers are not getting enough sleep

 

When we think about teenagers, we often think that they sleep too much. However, in reality, this is not the case at all. Teenagers are actually not getting enough sleep, which can negatively impact their health and wellbeing–they struggle to get the recommended eight to nine hours per night.

According to the Centers for Disease Control and Prevention, about one-third of American adults don’t get the recommended seven hours of sleep per night. This might be because of their jobs or hectic schedules, including working long shifts and then having to take their kids to school every day of the week. To add to that, about 50 to 70 million Americans suffer from a chronic sleep disorder, such as sleep apnea, according to a study by the  Institute of Medicine (US) Committee on Sleep Medicine and Research.

The benefits of sleep for our patients

There is an abundance of research out there that suggests sleep helps us perform a range of vital functions including:

  • Restoring damaged tissues.
  • Boosting learning.
  • Improving memory.
  • Flushing toxins from the brain.

Sleep can also help our patients to remain motivated throughout the day, while also remaining safe behind the wheel of a car. Too little sleep can also have serious consequences on our patients’ health, such as an increased risk for obesity, diabetes and cardiovascular disease.

A lack of sleep for teenagers

In the journal Pediatrics, a recent study highlighted the importance of sleep for teenagers. With such busy lives, teenagers often struggle to meet the recommended eight to nine hours of sleep a night. More than 800 teens participated in this study and only 2.2 percent got enough sleep. And less than half of participants achieved desirable rates of sleep efficiency, which is the percentage of total time in bed that they are actually asleep.

As a result, teens that missed out on key amounts of sleep were more likely to be obese and scored higher on several other risk factors for cardiovascular disease, such as high blood pressure. For teens who were able to sleep for longer and better quality, tended to have less fat around their waists, lower systolic BP and higher levels of “good” cholesterol. These were all signs of cardiovascular health.

We need to be on the lookout for various signs and symptoms in our teenage patients so we can take preventive steps. By understanding how sleep apnea can negatively affect their health, we can better care for our patients.

ADHD can exacerbate sleep apnea symptoms

Our patients should not have a problem sleeping–it should be a simple solution. When it’s nighttime and you get tired, going to bed should be the least of our patients’ worries. However, when attention deficit disorder (ADD or ADHD) is in the picture, it can be even more difficult. Sleep apnea and other sleep disorders and ADHD have a significant connection.

Patients with ADHD are more prone to sleep problems than anyone, and they often go undiagnosed. Sleep apnea, restless leg syndrome and even delayed sleep phase syndrome exacerbate ADHD symptoms. And, other times, patients might even be misdiagnosed with ADHD when they really have a sleep disorder.

Tips to help patients sleep

Sleep apnea can often mimic ADHD symptoms, which can cause inattentiveness and restlessness in those who do not have ADHD. At the same time, sleep apnea can also worsen symptoms in patients who do have ADHD.

Before we dive into some tips to share with your patients, let’s look at primary and behavioral sleep problems. Primary sleep disorders are physical conditions that disrupt sleep. This would include sleep apnea. For behaviorally based sleep problems, it is linked to ADHD and are common in children who cannot make the transition to bedtime without commotion that ends up disrupting sleep.

If the sleep condition is related to behavior, try to encourage your patients to do the following:

  • Remove all screens from the bedroom. If they remain, try to turn off all screens at least two hours before bedtime.
  • Go to bed at the same time every night.
  • Get up at the same time every morning.
  • Don’t do work in your bed. Avoid working in your bedroom.
  • Exercise regularly.
  • Reduce alcohol and caffeine intake.
  • Review ADHD medications with their doctor.
  • Establish a “winding down” routine before bedtime.

These tips can potentially help patients with ADHD and sleep apnea, but the use of an oral appliance will significantly improve sleep as well. What other tips do you have for your patients that have worked?