If you're concerned about your sleep quality or consistently feel excessively tired during the day, it’s a good idea to talk to your doctor about your symptoms. Your doctor can help determine if a sleep disorder, such as obstructive sleep apnea (OSA), might be preventing you from getting the quality sleep that you need. Obstructive sleep apnea (OSA) is a prevalent and serious sleep disorder that involves the airway becoming repeatedly blocked during sleep, leading to paused breathing and oxygen deprivation. It is often marked by loud snoring, gasping for air, and daytime fatigue. The condition affects an estimated 2% to 4% of the population.
Understanding Sleep Apnea and Its Connection to Weight
Sleep apnea is the most common sleep-related breathing disorder. It interrupts breathing when the throat muscles relax and block the airway. When you go to sleep, everything relaxes, and that includes the muscle tone that controls the back of the throat. For people who are predisposed to this, whether it's just how they are genetically, or weight plays a role in many patients as well, the back of the throat overly relaxes and can even collapse when you're sleeping, and you're basically choking in the back of the throat.
The term ‘apnea’ means that you stop breathing for at least 10 seconds. ‘Hypopnea’ is when you have a partial blockage of your airway, so your breath is more shallow than normal. An at-home or in-lab sleep test will provide your apnea-hypopnea index (AHI), which tells you how many apneas and hypopneas you have per hour while you sleep and gives you an average. The apnea-hypopnea index is an index used to indicate the severity of sleep apnea, and, if you go on CPAP therapy, one of the likely goals will be to reduce your apnea-hypopnea index score to a healthy level.
Obesity is one of the important risk factors for sleep apnea, and often go hand-in-hand; one study found that 40% of those with BMI >40 have OSA and 50% of those with BMI>50 have OSA. If you’re carrying too much weight, especially around your neck, it can interfere with your breathing while you sleep.
Traditional Treatments for Sleep Apnea
Positive airway pressure (PAP) therapy-which includes continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapies-gently flows air into your lungs while you sleep. It helps people improve their breathing while they sleep and experience fewer nighttime disruptions. When people with sleep apnea use their CPAP as prescribed by their doctor, they may notice improvements in their mood, focus, memory, productivity and daytime energy levels.
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CPAP (continuous positive airway pressure) devices have long been considered the gold standard in sleep apnea care, and they still are. The CPAP requires a person to wear a mask while sleeping, making it potentially uncomfortable and hard to sleep. For this reason, a lot of apnea patients don’t use it.
However, while losing weight can be helpful for managing obstructive sleep apnea (OSA), CPAP therapy is the most used, most understood and most successful method of treating OSA.
The Emergence of Weight Loss Medications
In recent years, glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide and tirzepatide have made headlines for their impressive ability to promote weight loss and improve glycemic control among people with type 2 diabetes. Weight loss drugs known as GLP1s are all the rage right now. They were originally developed for diabetes and weight management, but other "off label" uses are becoming more mainstream.
Twin trials Eli Lilly & Co., the pharmaceutical company that makes both Zepbound and Mounjaro, funded a pair of clinical trials that found that tirzepatide reduces the severity of sleep apnea by almost 66% in adults with both apnea and obesity. The year-long studies included 469 people from nine countries. All participants were obese and had moderate to severe obstructive sleep apnea. They were either unable or unwilling to use a CPAP machine (Study 1) or used their CPAP therapy - or planned to - during the trial (Study 2). In both trials tirzepatide achieved its primary and key secondary endpoints, with a mean reduction of up to 63% on the apnea-hypopnea index (AHI), or about 30 fewer obstructive sleep apnea events per hour of sleep. Multiple studies in the past showed significant improvement in sleep apnea with weight loss; one of the studies showed 10% weight gain was associated with a 32% increase in obstructive events. In the other, 10% weight loss was associated with a 26% decrease in obstructive events. Not surprisingly, patients who received tirzepatide also lost 18-20% of their body weight and had improved blood pressure and blood oxygen levels while sleeping. Fewer sleep apnea episodes were most likely a secondary effect of the weight loss. Studies show that as sleep apnea patients lose weight, their condition improves. However, for a group of patients whose sleep apnea is due to their upper airway anatomy, redundant soft palate, enlarged tonsils or an enlarged tongue, some sleep apnea may persist despite weight loss.
At first, Dr Rodriguez saw these improvements among patients who were prescribed GLP-1 receptor agonists for diabetes or weight loss and happened to also be under his care for sleep apnea. “I’m prescribing GLP-1 medications regularly now, and the results so far have been encouraging,” he says. “We’ve had patients who went from needing CPAP machines every night to barely needing them at all after significant weight loss. Indeed, while the weight loss benefits of GLP-1 receptor agonists remain central to their effectiveness against sleep apnea, researchers are increasingly finding that their positive impact on sleep may run deeper.
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Zepbound: A New Hope for Sleep Apnea Patients
The FDA recently approved the first ever medication for obstructive sleep apnea, and it's a drug many have been using to lose weight recently. The FDA recently approved tirzepatide for treatment of obstructive sleep apnea, which occurs when a person stops breathing while sleeping.
Food and Drug Administration approved Zepbound (tirzepatide) for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity, to be used in combination with a reduced-calorie diet and increased physical activity. “Today’s approval marks the first drug treatment option for certain patients with obstructive sleep apnea,” said Sally Seymour, M.D., director of the Division of Pulmonology, Allergy, and Critical Care in the FDA’s Center for Drug Evaluation and Research. “This is a major step forward for patients with obstructive sleep apnea.” Zepbound is an injectable prescription medication that targets GIP and GLP-1 hormones to regulate appetite and metabolism. By reducing body weight, studies show that Zepbound also improves OSA.
Zepbound (tirzepatide) is an FDA-approved medicine used for weight loss and weight management to help you lose weight and keep weight off, and it is also used for obstructive sleep apnea (OSA) with obesity. Zepbound works by reducing your appetite and making you feel full more quickly and for a longer period of time, so you eat less and lose weight. When Zepbound was used for obstructive sleep apnea 42% of adults had no sleep apnea or mild, non-symptomatic OSA after 1 year of treatment, compared to 16% using placebo (SURMOUNT-OSA phase 3 clinical trials). Zepbound works like two natural hormones in our bodies, called GIP and GLP-1, which help control appetite, blood sugar levels, and digestion. When Zepbound binds to GIP and GLP-1 receptors, it slows the rate food passes through your body, making you feel full longer, and the pancreas releases more insulin, lowering the amount of sugar your liver makes.
The approval followed the success of the SURMOUNT-OSA trial, a pivotal study designed to evaluate the impact of tirzepatide on sleep apnea. “We were already seeing patients taking these medications for diabetes or weight loss report better sleep, but the trial showed us it’s more than just shedding pounds,” he says.
After a year of treatment, participants receiving tirzepatide vs placebo showed statistically significant reductions in AHI. Many saw their sleep apnea improve to mild or even remission, along with relief from symptoms such as daytime fatigue. The trial also measured levels of high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation and cardiovascular risk. Chronic low-grade inflammation is a common issue among people with obesity and sleep apnea, contributing to airway swelling and frequent breathing interruptions during the night.
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Zepbound’s approval for moderate to severe OSA in adults with obesity is based on two randomized, double-blind, placebo-controlled studies of 469 adults without type 2 diabetes. One study enrolled participants using positive airway pressure (PAP), the standard of care for moderate to severe OSA, and one study enrolled participants unable or unwilling to use PAP. In both studies, participants randomly received either 10 or 15 milligrams of Zepbound or placebo once weekly for 52 weeks. The primary measure of efficacy was the change from baseline in the apnea hypopnea index (AHI), a measurement of how many times a person stops breathing (apnea) or breathes shallowly (hypopnea) per hour during sleep, at week 52. After 52 weeks of treatment in both studies, participants who received Zepbound experienced a statistically significant and clinically meaningful reduction in events of apnea or hypopnea as measured by AHI compared with placebo, and greater proportions of participants treated with Zepbound achieved remission or mild OSA with resolution of symptoms compared to placebo. Participants treated with Zepbound had a significant decrease in body weight compared with placebo at 52 weeks. The improvement in AHI in participants with OSA is likely related to body weight reduction with Zepbound.
Dosing and Administration of Zepbound
Mounjaro is used for type 2 diabetes, and Zepbound is used for weight loss, weight management, and sleep apnea, but they both contain the same active ingredient and are both made by Eli Lilly and Company. They are both given as weekly injections under the skin and are available as single-dose pens in the same strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg per 0.5 mL.
Zepbound is usually given once a week and can be given with or without meals at any time of the day. Zepbound is injected under the skin (subcutaneously) using a pre-filled pen or a single-dose vial with a syringe. Caregivers or patients should be trained on proper injection techniques. You should follow the directions on your prescription label carefully and ask your pharmacist or doctor to explain any part you do not understand. It is important to use this medicine exactly as directed. Take the missed dose as soon as you remember it within 4 days after the missed dose. However, if more than 4 days have passed, skip the missed dose and continue your regular dosing schedule.
Potential Side Effects and Precautions
Zepbound can cause side effects such as nausea, diarrhea, vomiting, constipation, abdominal (stomach) discomfort and pain, injection site reactions, fatigue, hypersensitivity (allergic) reactions (typically fever and rash), burping, hair loss and gastroesophageal reflux disease.
Zepbound causes thyroid C-cell tumors in rats. It is unknown whether Zepbound causes such tumors, including medullary thyroid cancer, in humans. Zepbound should not be used in patients with a personal or family history of medullary thyroid cancer or in patients with Multiple Endocrine Neoplasia syndrome type 2.
Zepbound should not be used in patients with a history of severe allergic reaction to tirzepatide (its active ingredient) or to any of its other ingredients. Patients should stop Zepbound immediately and seek medical help if a severe allergic reaction is suspected.
Zepbound also contains warnings for inflammation of the pancreas (pancreatitis), gallbladder problems, hypoglycemia (blood sugar that is too low), acute kidney injury, diabetic retinopathy (damage to the eye’s retina) in patients with type 2 diabetes mellitus, suicidal behavior or thinking, and pulmonary aspiration during general anesthesia or deep sedation. Patients should discuss with their health care provider if they have symptoms of pancreatitis or gallstones. If Zepbound is used with insulin or a medication that causes insulin secretion, patients should speak to their health care provider about potentially lowering the dose of these other medicines to reduce the risk of hypoglycemia. Health care providers should monitor patients with kidney disease, diabetic retinopathy and depression or suicidal behaviors or thoughts.
Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Birth control pills may not work as well while receiving this medicine. Your doctor may suggest you use another form of birth control for 4 weeks after starting this medicine and for 4 weeks after each dose change. Taking Zepbound with other medicines to treat diabetes, like insulin or sulfonylureas, may increase your risk of hypoglycemia. Zepbound slows gastric emptying and so may change the absorption of other oral medicines that you take.
Tell your healthcare provider if you are pregnant, you become pregnant, or plan to become pregnant while using this medicine. Tell your doctor if you become pregnant while taking this medicine. There will be a pregnancy exposure registry for women who have taken Zepbound during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Zepbound can make birth control pills less effective. Ask your doctor about other birth control options such as an injection, implant, skin patch, vaginal ring, condom, diaphragm, cervical cap, or contraceptive sponge. Tell your healthcare provider if you are breastfeeding or plan to breastfeed while using this medicine. It is not known whether Zepbound passes into your breast milk.
Cost and Availability
A Zepbound coupon or Zepbound savings card may be available that you could be eligible for. With the Zepbound coupon or Zepbound savings card, people with insurance may be eligible to pay as low as $25 for a one-month or three-month prescription. Those who are commercially insured but without coverage for Zepbound may be eligible for savings for a one-month prescription of Zepbound. Zepbound vials cost has been reduced making them more cost effective for self-pay patients.
Zepbound vs. Other Medications
Ozempic, Mounjaro, Wegovy and Zepbound can all lead to long-term weight loss, but only Wegovy and Zepbound are approved by the FDA for this use. Research is ongoing to determine whether patients lose more weight with Zepbound or Wegovy.
The Broader Impact of Weight Loss on Sleep Apnea
“Weight loss medication is treating obesity, which has complications that contribute to sleep apnea - or cause it,” says Dr. “Reducing fat deposit and inflammation, specifically around your airway and neck area, can lessen the obstruction of the airway and improve oxygen levels,” he says.
Improving sleep apnea isn’t as simple as just starting weight loss medication. As part of its recommendation, the FDA advises people with obesity to use the medication along with a reduced-calorie diet and increased physical activity.
“Anyone with sleep apnea who is very overweight and wants help getting excess weight off is a great candidate,” says Dr. Since obesity is different from person to person, the drug’s effect on sleep apnea can vary. Some people carry more weight on their belly and others have more in their chest, shoulders and neck.
Even modest weight loss of 10 to 15 percent of your body weight can significantly reduce the severity of sleep apnea, even if it doesn’t resolve all of the symptoms.
The Future of Sleep Apnea Treatment
“Sleep apnea is now entering an era where medications, not just devices like continuous positive airway pressure (CPAP), can play a role in treatment,” says Atul Malhotra, MD, a leading sleep researcher at University of California at San Diego Health.
Researchers are also investigating the potential for GLP-1s to affect rapid eye movement (REM) sleep, the phase of sleep associated with memory consolidation and emotional regulation. Another intriguing benefit is the medication’s potential to improve mental health.
“This is just the beginning,” Dr Malhotra says. “We have a new tool for managing sleep apnea, but we’re also learning how it may help with insomnia, anxiety, and even neurodegenerative conditions.
Lifestyle Changes and Comprehensive Care
For optimal results, patients who are prescribed GLP-1s still need to combine the therapy with lifestyle changes like regular exercise and healthy eating. “The goal is to help patients lose weight and potentially come off CPAP, but that doesn’t happen overnight,” he adds.
“Obesity is a disease, and it requires a comprehensive approach,” Dr Rodriguez says. “They should be working with a nutritionist, increasing physical activity, and thinking long-term. It’s not just about losing weight quickly - it’s about maintaining that weight loss and improving overall health. We know that once patients stop taking these medications, they can regain a significant portion of the weight.