Anesthesiologist Paul Garcia and his colleagues are presenting two posters at the Society of Neuroscience meeting this week, whose findings may raise concerns about two non-stimulant drugs Emory sleep specialists have studied for the treatment of hypersomnia: flumazenil and clarithromycin.
For both, the data is in vitro only, so caution is in order and more investigation may be needed.
With flumazenil, Garcia and colleagues found that when neurons are exposed to a low dose for 24 hours, the cells increase expression of some GABA receptor forms.
This could be part of a mechanism for tolerance. I heard some anecdotes describing how flumazenil’s wake-promoting effects wear off over time at the Hypersomnia Foundation conference in July, but it’s not clear how common the phenomenon is.
Flumazenil’s utility in hypersomnia became known after the pioneering experience of Anna Sumner, who has reported being able to use the medicine for years. See this 2013 story in Emory Medicine. Read more
From Emory Medicine, Spring 2013
A small clinical study of clarithromycin for the sleep disorder hypersomnia shows that the antibiotic can combat patients’ subjective experience of sleepiness, but it does not seem to improve reaction time measured in a video-game-type vigilance task.
The effects of clarithromycin in hypersomnia were first observed by Emory doctors when a pioneering patient (Anna Sumner, whose story is told in this Emory Medicine article) unexpectedly experienced sleeplessness when taking it for a respiratory infection.
The results of the study were published online by Annals of Neurology on June 10.
Lynn Marie Trotti, MD, David Rye, MD, PhD and colleagues from the Department of Neurology and Emory Sleep Center conducted the study, which involved 23 patients.
Advantages of clarithromycin:
- It’s inexpensive and widely available.
- It’s an option for people dealing with hypersomnia for whom other medications, such as modafinil, are not helpful or tolerable.
- It represents an alternative to flumazenil, the benzodiazepine antidote that has been shown to help some hypersomnia patients. Flumazenil used to be very scarce, and shortages occur (Hypersomnia Foundation/American Society of Health System Pharmacists).
Disadvantages of clarithromycin:
- It’s an antibiotic, so it probably changes intestinal bacteria.
- Chronic use could promote the growth of antibiotic-resistant bacteria.
- Most patients reported an altered sense of taste or smell. Some describe this as a metallic mouth sensation.
It’s not sleep apnea. It’s not narcolepsy. Hypersomnia is a different kind of sleep disorder. There’s even an “apples and oranges” T-shirt (see below) that makes that point.
This weekend, your correspondent attended a patient-organized Living with Hypersomnia conference. One of the main purposes of the conference was to update sufferers and supporters on the state of research at Emory and elsewhere, but there was also a lot of community building — hence the T-shirts.
The story of how sleep took over one young lawyer’s life, and how her life was then transformed by flumazenil, a scarce antidote to sleeping pills she was not taking, has received plenty of attention.
Now an increasing number of people are emerging who have a condition similar to Anna Sumner’s, and several questions need answers. Read more
Sleep expert David Schulman, MD, MPH, assistant professor of medicine, pulmonary, Emory School of Medicine, and medical director for the Emory Sleep Disorders Laboratory, talks with Emory patients every day about how to get a good night’s sleep.
Get more sleep than a cat nap
Here, in his own words, Schulman discusses the topic of sleep:
There is growing evidence that sleeplessness can contribute to illness such as diabetes or heart disease, and many problems can arise when someone has not gotten a good nightâ€™s sleep â€“ such as falling asleep while driving or while on the job. We all want to be as healthy as we can â€“ eating right, exercising â€“ and I can tell you that getting a good nightâ€™s sleep is just as important to overall health. If you have regular sleep problems, discussing this problem with your doctor may be the first step to finding a solution.