1: Sleep. 2007 Jan 1;30(1):35-41. Links
    Efficacy of mirtazapine in obstructive sleep apnea syndrome.

        * Carley DW,
        * Olopade C,
        * Ruigt GS,
        * Radulovacki M.

    Center for Narcolepsy, Sleep and Health Research, Department of Medical-Surgical Nursing, University of Illinois, M/C 719, Room 910, 40 South Wood Street, Chicago, IL 60612, USA. dwcarley@uic.edu

    STUDY OBJECTIVES: Decreased serotonergic facilitation of upper-airway motor neurons during sleep has been postulated as an important mechanism rendering the upper airway vulnerable to obstruction in patients with obstructive sleep apnea syndrome (OSA). Although serotonin reuptake inhibitors have been shown to produce modest reductions in the apnea-hypopnea index (AHI) during non-rapid eye movement (NREM) sleep, they have not been proven to be generally effective as treatments for OSA. Conversely, antagonists of type 3 (5-HT3) serotonin receptors effectively have been shown to reduce the frequency of central apneas during rapid eye movement (REM) sleep in a rodent model of sleep-related breathing disorder. We sought to determine whether mirtazapine, a mixed 5-HT2/5-HT3 antagonist that also promotes serotonin release in the brain would effectively reduce AHI during both NREM and REM sleep in patients with OSA. DESIGN: A randomized, double-blind, placebo-controlled, 3-way crossover study of mirtazapine in patients with OSA. SETTING: Laboratory studies were conducted in the Center for Sleep and Ventilatory Disorders at the University of Illinois Medical Center. PATIENTS: Seven adult men and 5 adult women with newly diagnosed (treatment-naive) and medically uncomplicated OSA were randomized into the study. INTERVENTIONS: Each subject self-administered oral medications 30 minutes before bedtime each night for 3 consecutive 7-day treatment periods. These treatments comprised (1) placebo, (2) 4.5 mg per day of mirtazapine, and (3) 15 mg per day of mirtazapine. The order of treatments was randomized for each subject, and orders were counterbalanced for the overall study. MEASUREMENTS AND RESULTS: Each subject charted his or her sleep-wake schedule throughout the study and completed the Stanford Sleepiness Scale every 2 hours during the seventh day of each treatment period. Subjects were studied by laboratory polysomnography on the seventh night of each treatment period. With respect to placebo treatment, 4.5 mg of mirtazapine significantly reduced the AHI in all sleep stages to 52%, with 11 of 12 subjects showing improvement over placebo; 15 mg of mirtazapine reduced the AHI to 46%, with 12 of 12 subjects showing improvement over placebo. Sleep fragmentation was reduced only by the higher dose of mirtazapine. Gross changes in sleep architecture were unremarkable. CONCLUSIONS: Daily administration of 4.5 to 15 mg of mirtazapine for 1 week reduces AHI by half in adult patients with OSA. This represents the largest and most consistent drug-treatment effect demonstrated to date in a controlled trial. These findings suggest the therapeutic potential of mixed-profile serotonergic drugs in OSA and provide support for future studies with related formulations. Mirtazapine also is associated with sedation and weight gain-2 negative side effects in patients with OSA. In view of the above, we do not recommend use of mirtazapine as a treatment for OSA.

    PMID: 17310863 [PubMed - in process]

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Mirtazapine for OSA -

I am currently experimenting with Mirtazapine to treat my sleep apnea. I have been on a CPAP with Moderate to severe OSA for about 10 years. I have had UPPP, Genioglossus advancement and Radio therapy to no avail. I no longer get a restful sleep with CPAP which may be due to a loss of Delta sleep that occurs after long treatment with CPAP. I have been taking Mirtazapine for one week at a dose of 7.5 mgs and experience a much deeper and more restful sleep than normal with much less fatigue and sleepiness in the daytime. This could be due to the placebo effect and so I will continue this treatment for at least a month before reaching conclusions. I also hope to increase to 15 mgs but am waiting for side effects to abate before increasing dosage. Side effects are minimal after a week. Initially I felt very sedated and bloated/constipated but this has subsided. Now my apetite is great and the sedation effect is minimal except that it takes me a while to get going in the morning.

Please let me know if anyone else is or has tried mirtazapine and provide results.

Drew, mirtazapine has a reputation for boosting the appetite, so be careful not to overeat.

I take mirtazapine for anxiety, depression and difficulty sleeping but I don't have OSA so my results are not relevant to you.  However, it was helpful in getting to sleep which was a big problem.  It does not give me the munchies!