Could tirzepatide solve your sleep apnea?

If you've ever been told you snore loudly or gasp for air during sleep, besides being slightly embarrassed or surprised by this news, you might also feel...exhausted. In fact, are you constantly tired despite getting what seems like enough rest? If so, you might be experiencing obstructive sleep apnea (OSA). This common but serious sleep disorder affects millions of people worldwide — approximately 10-30% of adults, according to the American Academy of Sleep Medicine. But there hasn’t been a medication to treat it — until now. The FDA recently approved the use of the dual agonist GLP-1/GIP drug Zepbound (tirzepatide) for sleep apnea, giving a lot of hope for those struggling with this condition. Let's dive into what sleep apnea is, how it affects your health, and explore the potential role of tirzepatide in its treatment.

What is obstructive sleep apnea?

Imagine trying to drink through a straw that keeps getting pinched — that's similar to what happens with obstructive sleep apnea. During sleep, the muscles in your throat relax naturally, but in people with OSA, these muscles relax too much, causing the airway to collapse or become blocked. This blockage can happen dozens or even hundreds of times per night, leading to interrupted sleep and reduced oxygen levels in your blood.

Each time your airway becomes blocked, your brain senses the danger and briefly wakes you up to restore normal breathing. While you might not remember these wake-ups, they prevent you from getting the deep, restorative sleep your body needs. It's like having someone gently shake you awake every few minutes.

How sleep apnea can affect your health

“High-quality sleep is important for a score of health measures and outcomes,” says Eduardo Grunvald, MD, medical director at University of California San Diego (UCSD) Center for Advanced Weight Management. When left untreated, sleep apnea can lead to a range of serious health problems — and not just because you’re tired.

Multiple episodes of low oxygen during sleep raises hormones and neurological responses that elevate blood pressure, heart rate, and adrenaline responses. Over the long term, those can increase your risk for a variety of conditions:

• High blood pressure
• Heart problems
• Type 2 diabetes
• Liver problems
• Depression and anxiety
• Memory and concentration difficulties
• Increased risk of accidents due to daytime sleepiness

What causes sleep apnea?

Several factors can contribute to the development of sleep apnea. The most common include:

• Physical characteristics: Your body's natural build can play a role. Having a larger neck circumference, enlarged tonsils, or a small jaw can make you more prone to airway collapse during sleep.
• Weight: Excess weight is one of the most significant risk factors. Excess fat surrounding the upper airway causes compression of the structures that allow air movement during sleep. “The reason it manifests during sleep is that muscles in those areas tend to relax during sleep,” says Grunvald. This is why weight loss is often recommended as part of sleep apnea treatment.
• Age and gender: As we age, our muscle tone decreases, including in the throat. Men are also more likely to develop sleep apnea than women, though the risk for women increases after menopause (due to changes in hormones and body composition).
• Family history: If your parents or siblings have sleep apnea, you might be more likely to develop it too. This suggests there could be inherited traits that affect airway structure or body fat distribution.

How is sleep apnea diagnosed?

If you suspect you have sleep apnea, the first step is usually talking to your healthcare provider. They'll likely ask about your symptoms and medical history, and might have you fill out a questionnaire about your sleep habits and daytime alertness. It’s not always easy to get diagnosed, says Shelby Harris, PsyD, a clinical psychologist specializing in behavioral sleep medicine. “People don’t want to get it treated or diagnosed, and women very often are missed, as well as those who don’t meet the stereotypical apnea type of an overweight, older, white male. You can be thin and have apnea too.”

The gold standard for diagnosing sleep apnea is a sleep study, or polysomnography. This can be done in a sleep lab or, increasingly, at home with portable monitoring devices. During the study, various sensors monitor your breathing patterns, heart rate, blood oxygen levels, brain waves, eye and leg movements, and sleep stages. Think of it like having a detailed health dashboard for your sleep — it gives doctors a comprehensive picture of what's happening when you're asleep.

Traditional treatment options for sleep apnea

Treatment for sleep apnea typically depends on the severity of your condition and your personal preferences. Here are the most common approaches:

• CPAP Therapy
  Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for moderate to severe sleep apnea. A CPAP machine delivers a constant stream of air pressure through a mask you wear while sleeping, keeping your airway open. While highly effective, some people find it uncomfortable or difficult to adjust to, says Harris. “It can be hard for some to tolerate, but is effective and well-tolerated by others. Some people don’t like the idea of having to wear a mask and hosing nightly.”
• Oral Appliances
  For some mild to moderate cases, dental devices that hold your jaw in a position that keeps your airway open might be recommended. These are usually more comfortable than CPAP machines but may not be as effective for severe cases.
• Lifestyle changes
  Simple changes can make a big difference, but are not always easy or feasible. They include weight loss (if you carry overweight or obesity), regular exercise, and avoiding alcohol and sedatives before bedtime. In fact, these steps are recommended no matter what other course of treatment you take. Trying to sleep on your side instead of your back can also help. “Positional therapy can help some people who have apnea only in specific positions. You need to train yourself to sleep in a different position, though,” notes Harris.
• Surgery
  In rare cases, surgical procedures might be recommended to remove excess tissue, reposition the jaw, or implant devices that stimulate airway muscles.

How tirzepatide works for sleep apnea

Now, doctors have another treatment in their toolkit. For the first time, there’s a medication that’s approved to treat sleep apnea. Originally developed for type 2 diabetes and weight management, the GLP-1/GIP medication tirzepatide — under the brand name Zepbound — is now FDA-approved to treat obstructive sleep apnea.

Tirzepatide is a unique medication that mimics two natural hormones in your body: GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). These hormones play important roles in regulating appetite and blood sugar. By imitating these roles, the medication helps stimulate insulin to lower blood sugar while also curbing appetite and increasing feelings of fullness.

The link between tirzepatide and obstructive sleep apnea primarily comes through its powerful weight loss effects. “It makes sense that if you have a high degree of weight loss, you would improve OSA,” says Grunvald. This is because losing weight can reduce pressure on the airway, decrease neck circumference, improve overall breathing during sleep, and reduce inflammation throughout the body.

How effective is tirzepatide for sleep apnea?

In the study trials published in June 2024, people with OSA who received 10 mg or 15 mg tirzepatide had improved sleep quality (fewer breath holding episodes) and improved measurements of daytime sleepiness. (Participants met the criteria for disease resolution if breath-holding episodes fell below 5 per hour.) Other key findings:

• For people receiving tirzepatide who did not already use a CPAP machine, 40% of people had disease resolution. For those using a CPAP, 50% had disease resolution. (Of those getting a placebo, only 14% had resolution.)
• In terms of weight loss, people who received tirzepatide lost about 20% of their starting body weight. (The weight loss for the placebo group was about 1% and 2%.)
• Participants also showed improvements in blood pressure and blood oxygen levels while sleeping.
  

According to Grunvald, “this is the first high-quality study showing the benefits of medical weight loss and benefits on OSA, at least to this degree.” Grunvald also notes that there’s the potential for people to improve their OSA with medication alone — possibly getting rid of their CPAP machines. (As it is, adherence to CPAP machines can be low — as low as 30%, he says.)

Who might benefit from tirzepatide for sleep apnea?

Tirzepatide might be particularly helpful for people who:

• Have sleep apnea related to excess weight
• Haven't had success with traditional weight-loss methods
• Find CPAP therapy challenging to use
• Want to address both their weight and sleep apnea simultaneously

Considerations and side effects

Like any medication, tirzepatide isn't right for everyone. It's important to discuss with your healthcare provider whether it's appropriate for you. Common side effects from GLP-1 medications can include nausea and digestive issues (sometimes significant, but not always), changes in appetite, potential injection site reactions, and the risk of low blood sugar in certain situations. You find the full list of side effects on the Zepbound (tirzepatide) site.

The bottom line

The emergence of medications like tirzepatide represents an exciting development in sleep apnea treatment. While it's not a replacement for CPAP therapy in many cases, it offers a new tool, particularly for those whose sleep apnea is related to excess weight.

The best treatment approach is often a combination of different methods, tailored to your specific situation. Working closely with your healthcare team to find the right combination of treatments — whether that includes CPAP, tirzepatide, lifestyle changes, or other approaches — is key to successfully managing sleep apnea and improving your quality of life.