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Johns Hopkins Health Alert

Viagra and Sleep Apnea

Johns Hopkins Health Alerts | Lung Disorders | Viagra and Sleep Apnea

Johns Hopkins doctors advise men with a history of sleep apnea to consider the risks and benefits before taking Viagra.

Sleep apnea is a disorder characterized by repeated episodes of breathing cessation (apnea) during sleep. These episodes last from 10 seconds to nearly a minute, ending with a brief partial arousal. Episodes of sleep apnea can occur (and disrupt sleep) hundreds of times throughout one night. An estimated 18 million Americans have obstructive sleep apnea, yet 95% of them are undiagnosed and untreated. Sleep apnea is about twice as common among men as among women.

And now there’s news that Viagra (sildenafil) may worsen severe sleep apnea.

A report in the Archives Internal Medicine (Volume 166, page 1763 ) suggests that taking Viagra at bedtime may worsen severe obstructive sleep apnea. This may be disturbing news to many men, because erectile dysfunction is particularly common among those with sleep apnea. Viagra prolongs the action of nitric oxide, which promotes upper airway congestion, thereby contributing to sleep apnea. The researchers studied 14 men with severe sleep apnea, who spent a night in a sleep lab having their breath and blood oxygen monitored after they took a single 50- mg dose of Viagra or a placebo.

Just one dose of Viagra significantly increased the amount of sleep time with a lower blood oxygen saturation level; while asleep, men who took Viagra weren’t getting as much oxygen as those who took a placebo. They also had more breathing pauses per hour.

Bottom line advice on Viagra and sleep apnea: If you take Viagra and have sleep apnea, talk with your doctor about whether the pleasures you derive from taking the drug outweigh the risks of worsening your nighttime breathing problems.

Johns Hopkins Health Alerts | Lung Disorders | Viagra and Sleep Apnea

Posted in Lung Disorders on September 13, 2007

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Users and editors may post comments here at their own discretion. The views expressed do not constitute medical advice and do not represent the position of Johns Hopkins Medicine or University Health Publishing, which has no responsibility for its content.


I thoroughly enjoy your publications and would appreciate any information on sleep apnea including the "continuous positive airway pressure" equipment which is available. I have just been diagnosed with sleep apnea but don't see the specialist until late November.

Posted by: mywayfiona | September 15, 2007

I can offer some anecdotal information based on personal experience. I have sleep apnea. I have used both the b-pap (modulated airflow) and c-pap machines. I prefer the simpler (and less costly) c-pap machine. It does work and it does help and I awake better rested after fewer hours in bed. My wife certainly prefers the hum to my snoring. For all of that, I seldom use it: I feel like an ostrich with my head in the sand, but my logic seems to be that since I am asleep when it occurs and don't remember the apnea episodes the next morning, I'll just leave it untreated. Dumb, but real. The mask/headgear seems the most important. Get one that fits well and comfortably, regardless of its cost. Consider a mask with the air hose leading out the top. Sounds goofy, but there is less tangling with bedclothes and less sense of claustrophobia. Good luck.

SIDEBAR: Although the systems do seem to work, I believe there is a kickback scam going on, at least in Reno, NV: The physician steered me to a specific vendor, that vendor rented the b-pap machine for 4 months at $600/mo, then my insurance paid 80% of an outrageous $10,000 charge to purchase the machine (yup, I got to pay the other $2,000 - about what the machine might be worth as a medical device). It just isn't that special; it's a fan with some logic driving it. I expect to read one day of an investigation into kickbacks throughout the industry.

In the meantime, I suggest going online to E-Bay and purchasing a used machine for 10% or less of vendor retail.

Posted by: fred@reno | September 15, 2007

Further to my "anecdotal" comments above: My physician just happened to operate his own sleep study institute. Once other conditions were ruled out (sinus CT scan, chest x-ray), he prescribed a sleep study at his institute. His fees ran close to $3,000 not including the scan & x-ray. Carry a little cynicism into your appointment especially if your doctor owns the sleep study clinic. It will simply confirm what is already a foregone conclusion: you need the bpap/cpap machine. And get clear confirmation from your insurance company: they rejected most of the diagnosis fees, including the sleep study - even though they subsequently purchased the b-pap machine for me. Go figure.

Posted by: fred@reno | September 15, 2007



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