Eszopiclone During the First Two Weeks of CPAP

If a sleep clinician suggests a temporary sleeping pill while you start CPAP, ask which problem it should address and when the prescription will be reviewed.

What the trial measured

The 2009 study¹ randomized 160 adults starting CPAP; 154 began medication and entered the analysis. Participants were predominantly men under 65. Participants received 3 mg eszopiclone or placebo for the first 14 nights; device use was monitored over 24 weeks. The estimated difference favored eszopiclone by 1.3 hours per night across all study nights (95% confidence interval, 0.4–2.2 hours).¹

Only 120 completed six-month follow-up. This specialized center provided mask fitting, education and follow-up; later open-label sedatives were allowed. Sepracor supplied funding and medication, with no sponsor role in design or interpretation reported. The finding concerns CPAP use, without establishing an apnea cure.¹

Ask whether your clinician is addressing trouble falling asleep, waking with the mask or another difficulty, and how they will check both device use and next-day functioning.

The old dose needs current safety context

The current US label approves eszopiclone for insomnia; CPAP adherence is not a labeled indication. It recommends starting at 1 mg, immediately before bed with 7–8 hours available for sleep. Higher doses increase next-day impairment risk; people taking 3 mg are cautioned against driving or hazardous activities the following day. The label also calls for caution with compromised breathing and warns about additive effects with alcohol, opioids and other sedating medicines.²

Its boxed warning covers potentially fatal activities while incompletely awake, including sleepwalking or sleep-driving. If such behavior occurs, stop eszopiclone and contact your prescriber immediately. A previous episode after this medicine is a contraindication to taking it again.²

The research dose is not an instruction to increase your prescription. Bring your medication list and describe morning driving, caregiving or machinery responsibilities before agreeing to a course.

Keep equipment support in the plan

Current NHLBI advice recommends contacting your provider about leaks, poor mask fit, claustrophobia, difficulty sleeping or dry mouth. The response may involve a different mask, humidification or clinician-directed pressure adjustments. Use prescribed PAP for all sleep, including naps.³

For the first follow-up, record when you remove the mask, what woke you and what felt uncomfortable. Ask who can review those notes and the machine’s data before the next scheduled appointment. Request a specific review date for any temporary medicine.

Did I Do That in My Sleep? includes “The First Treatment Conversation,” with questions about mask comfort, dryness and support after fitting. Use those prompts alongside the medication discussion.