Barbara Phillips, MD, MPH, FCCP: CPAP, Marijuana for Sleep Apnea

Continuous positive airway pressure (CPAP) is the more than just the first-line treatment for patients with sleep apnea. It’s sometimes their only option. Though dental-based therapies to resolve jaw placement have progressed to the market, not many treatments addressing the primary symptoms of the common condition are in clinical consideration.

That resolves Barbara Phillips, MD, MPH, FCCP, to look elsewhere. Phillips, from the University of Kentucky College of Medicine, sat down with MD Magazine® at the 2018 CHEST Annual Meeting in San Antonio, TX, to share what she learned in sessions focusing on alternative medicines for sleep apnea. More specifically, she discussed the potential of marijuana.

MD Mag: What is the role of CPAP in sleep apnea treatment?

Phillips: CPAP is the primary treatment that we have right now for obstructive sleep apnea. I would like to say that there are other treatments, and I think the second most commonly used treatment is the use of a dental device sometimes called a mandibular lower jaw advancement device. It pulls the lower jaw forward to keep the tongue out of the throat so that the patient can breathe and sleep at the same time. And the dental organizations have gotten their act together, and they've produced research that shows that these devices can improve blood pressure, can improve sleepiness overall.

The trend in the literature I've read suggests that they don't improve anything as well as CPAP does—except maybe quality of life, which is important. But they are way better than nothing, they are way better than placebo, and they are way better than any surgical intervention that we've come up with so far.

MD Mag: Are there any potentially new therapies in clinical development?

Phillips: One of the most interesting sessions that I went to at CHEST was this is “Your Sleep on Drugs” session. I went because I'm disturbed by how many medications are prescribed without much thought about the long-term effects or the addiction potential. I mean, our current

opioid epidemic is an example of this. And there was an entire talk dedicated to marijuana and sleep and, you know, I'm a child of the ‘70s. That's when I was at college, right, so I was interested in this topic and didn't know much about it.

There is some data to suggest that marijuana could improve mild sleep apnea. I was interested in this there is little data about other pharmacologic treatment in general. The positive effect is not robust but it's there, and again, it's better than nothing—which is what a lot of patients are going to get if the only option you give them is a CPAP. Now I'm not recommending that we all go out and recommend that our patients smoke a few joints before bedtime to help their sleep apnea, but that's a promising area.

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