GHB and Sleep Apnea

QuestionsGHB and Sleep Apnea
Dr. Ward Dean, MD asked 6 years ago
Dr. Dean,

I read an article of yours on Dr. Weeks’ blog about GHB. I wondered whether it would have any positive benefit for sleep apnea, and did a PubMed search. This article suggested that it might cause some issues for people with narcolepsy. And yet in one paragraph of the article it stated that it had been reported to be beneficial for people with sleep apnea, yet I could not find info on PubMed to show this, unless I missed it.

See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227715/#B5.1

In one of the paragraphs of this link, it mentions that GHB has been reported to have benefit for some with sleep apnea. If it does, I am wondering if you can verify this.

As well, is there any way to get the body to naturally produce enough GHB so we are able to fall asleep quickly, stay asleep, and get into a delta wave sleep stage for deep restorative sleep?

Thanks.

Best,

Eric W.

1 Answers
Dr. Ward Dean, MD answered 6 years ago
Eric,
 
Thanks for the link to the article, “Sodium Oxybate and Sleep Apnea: A Clinical Case”—I hadn’t seen that one before. However, the confusion about the effects of GHB on respiration is not new. We discussed this at length in our book, GHB—the Natural Mood Enhancer.2
Henri Laborit, who discovered GHB, described that “hypnotic doses” (i.e., sleep-inducing doses” of GHB) do, in fact, slow the breathing rate. However, in parallel with the slowed breathing rate is an increase in the depth of respiration. “Both in animals and man, the sleep induced by 4-hydroxybutyrate [GHB] is not accompanied by a decrease in O2 consumption. In our opinion, this finding sets 4-hydroxybutyrate apart from any other known agent used in anesthesia.”3 [Italics in original]
 
Laborit noted that people who take GHB sometimes exhibit a pattern of breathing known as Cheyne-Stokes respiration, which consists of waxing and waning of the depth of respiration, with regular periods of apnea (temporary cessation of breathing). Laborit found that the respiration never completely stops because the centers of the brain that control respiration remain sensitive to high levels of blood CO2, which always trigger a new breath.3
 
The incidence of obstructive sleep apnea (OSA) in those with narcolepsy ranges from 9-50%.4 Although the Xyrem (prescription GHB) packaging claims that “[GHB] is a central nervous system and respiratory depressant,” and carries a black box warning,5 I believe the warning is a hysterical carry-over from the misconception that GHB is/was “the date rape drug.”
 
A number of studies have documented the benefits of GHB/SXB (sodium oxybutyrate) on those with sleep apnea. In one patient with OSA, GHB use resulted in a decrease in the frequency of sleep apnea events (from 307 to 117), and a decrease in the severity of hypoxic events (Oxygen saturation events less than 85% from 361 to 71). Although GHb did not stop OSA events, it appeared to improve the OSA condition in this patient.6
 
Dr. Mortimer Mamelak of the University of Toronto provided another positive report indicating improvement of OSA with GHB. Dr. Mamelak has published extensively on GHB, and he states emphatically that GHB is not a respiratory depressant—that it acts by promoting the integration of sleep, and has a stabilizing effect on respiration. He agreed with Laborit that GHB slows the respiratory rate, but increases its amplitude, and that “GHB can be used to advantage in the management of patients with narcolepsy-cataplexy and central-type obstructive sleep apnea.”7
 
I believe that those with sleep apnea would benefit by adding the use of Xyrem (GHB/SXB) to their nightly positive pressure CPAP devices.
 
Unfortunately, I don’t know of any ways to increase the normal amounts of GHB in the body, other than by taking GHB or its precursors (which are now quasi- or outright illegal to use for this purpose). However, an alternative is to use the GHB analog, Neurontin.
 
Neurontin (gabapentin) shares many of the sleep-inducing benefits of GHB, including increased slow wave sleep, with instant awakening without a “drug hangover.” I’ve found doses from as little as 100 mg at bedtime (for drug-sensitive “little old ladies”) to as much as 3200 mg (for “card-carrying insomniacs”) to be very effective—although doses ranging from 600-800 mg are adequate for most people.
 
Ward Dean, MD
 
References

  1. Hartley S, Quera-Salva, M-A, and Machou M. Sodium Oxybate and Sleep Apnea: A Clinical Case. J Clin Sleep Med. 2011 Dec 15; 7(6): 667–668. doi:  10.5664/jcsm.1480
  2. Dean W, Morgethaler J, and Fowkes S. GHB—The Natural Mood Enhancer, Smart Publications, 1997.
  3. Laborit H. Sodium 4-hydroxybutyrate. Int J Neuropharmacol. 3: 433-452. 1964’
  4. George CF, Feldman N, Zheng Y, et al. A 2-week, polysomnographic safety study of sodium oxybate in obstructive sleep apnea syndrome. Sleep Breath. 2011; 15(1):13-20.
  5. Package Insert, Xyrem (sodium oxybate) oral solution. Jazz Pharmaceuticals, Inc., Palo Alto.
  6. Scrima L, Hoddes E, Johnson F, and Hiller FC. Effect of Gamma-Hydroxybutyrate on a Patient with Obstructive Sleep Apnea. Sleep Res, 16: 1987: 137.
  7. Mamelak M, and Webster P. Treatment of Narcolepsy and Sleep Apnea with Gammahydroxybutyrate: A Clinical and Polysomnographic Case Study. Sleep. 4(1): 1981; 105-111.
  8. Lo HS, Yang CM, Lo HG, Lee CY, Ting H, Tzang BS.Treatment effects of gabapentin for primary insomnia. Clin Neuropharmacol. 2010 Mar-Apr;33(2):84-90.
  9. Karam-Hage M, and Kirk J. Brower KJ. Open pilot study of gabapentin versus trazodone to treat insomnia in alcoholic outpatients. Psychiatry and Clinical Neurosciences, Volume 57, Issue 5, pages 542–544, October 2003.