Key takeaways:
Zepbound (Tirzepatide) is FDA approved to treat moderate-to-severe obstructive sleep apnea (OSA).
In clinical trials, people with OSA who took Zepbound had much better sleep, with far fewer episodes of breath holding.
The benefits of Zepbound for OSA are likely driven mainly by weight loss — about 20% of body weight in trials.
People who could potentially benefit from tirzepatide for OSA may have already been eligible for it as a weight-loss treatment.
Tirzepatide has been making lots of headlines. Under the brand name Mounjaro, it was approved by the FDA in May 2022 to lower blood glucose (sugar) levels in people with Type 2 diabetes. Then, in November 2023, another version of this medication, Zepbound, was approved for weight loss in people with and without diabetes.
In late 2024, the multitasking medication was approved as a treatment for moderate-to-severe obstructive sleep apnea (OSA). With this common sleep disorder, a person experiences episodes of apnea — pauses in breathing — during sleep. It’s more common in people with higher body mass index (BMI), because of fat deposits and excess weight in the tongue, airway, and neck.
OSA has a significant impact on health beyond extreme daytime sleepiness. It can cause a range of problems, from headaches and high blood pressure to heart disease, stroke, and diabetes — even dementia.
Until now, treatments for OSA have centered on mouthguards and continuous positive airway pressure (CPAP) breathing machines — along with the usual recommendations for weight loss.
But weight loss can be hard to achieve — especially weight loss significant enough to decrease excess fat in the neck, tongue, and airways. This is why Zepbound and other similar medications could be such a breakthrough for OSA.
So, how does it work? Are its effects on OSA symptoms determined by weight loss alone, or are there other factors at play?
How does Zepbound work?
Zepbound (tirzepatide) belongs to a newer class of weekly injectable weight-loss medications. Other similar injectable medications include semaglutide, sold under the brand names Ozempic (for diabetes) and Wegovy (for weight loss).
Tirzepatide and other similar medications work by mimicking hormones naturally released after eating (called incretin hormones).
This causes the following effects:
Signals to your brain you’re full
Reduces your appetite
Makes you feel fuller for longer
Lowers blood glucose levels by increasing insulin and lowering glucagon hormones
Could Zepbound help with OSA?
Research shows that Zepbound significantly improves OSA. The research was published in June 2024 in the New England Journal of Medicine (and funded by the drug manufacturer Eli Lilly). The focus is a pair of year-long studies in people with high BMI and moderate-to-severe OSA.
The studies compared sleep quality in two groups:
One group took the maximum tolerated dose of Zepbound (10 mg or 15 mg).
The other group took a placebo (a fake injection).
Curious how Zepbound works and what it does? Zepbound (tirzepatide) is an injectable medication approved for weight loss that works by mimicking gut hormones to reduce appetite and boost weight loss.
Best Zepbound (tirzepatide) dose: Learn how Zepbound is dosed, from starting dose to the ideal maintenance dose, including how the dosage schedule might differ based on your response and side effects.
How does CPAP help your sleep apnea? CPAP is a common first-choice treatment that keeps airways open overnight, improving breathing, sleep quality, and daytime alertness.
Why does sleep apnea give you brain fog? Persistent daytime fogginess and memory issues are common when sleep apnea interrupts restful sleep. Here’s what’s behind it and how better sleep can help.
None of the included participants had diabetes.
One study (SURMOUNT-OSA Study 1) looked at people with OSA who wouldn’t or couldn’t use a CPAP breathing machine to treat OSA.
In the other study (SURMOUNT-OSA Study 2), participants did use a CPAP machine as treatment for OSA. And they were encouraged to continue using it throughout the year-long trial.
Zepbound helps ‘resolve’ OSA
Both studies showed that people with OSA who received 10 mg or 15 mg Zepbound had improved sleep quality. This was measured using overnight sleep studies to count the number of apnea (breath-holding) episodes during sleep — the apnea-hypopnea index (AHI). The AHI is used to grade the severity of OSA. It’s also used to assess how well treatment works.
The researchers were looking at two things:
The number of breath-holding episodes per hour
The level of daytime sleepiness, measured using the Epworth Sleepiness Scale
They considered a person had met the “criteria for disease resolution” if the number of breath-holding episodes fell below 5 per hour. Or, if the number of breath-holding episodes was between 5 and 14, and their level of daytime sleepiness was within a normal range. In other words, the person’s symptoms had improved so much that OSA had “resolved.”
The results were as follows for people receiving tirzepatide:
First study (no CPAP): 40% of people had disease resolution
Second study (using CPAP): 50% of people had disease resolution
In contrast, only about 14% of people receiving a placebo met “criteria for disease resolution.”
Zepbound reduces severity of OSA
Some people didn’t have “disease resolution.” But still, many people receiving Zepbound had a 50% (or more) improvement in the number of nightly breath-holding episodes (the AHI). These improvements were as follows:
A little over 60% in the first study
About 75% in the second study
This compares to about 20% of people in the placebo group.
Overall, people taking Zepbound had on average 30 fewer breath-holding episodes per hour. That’s compared to 5 or 6 fewer episodes in the placebo group.
Zepbound resulted in significant weight loss
In both studies, people who received Zepbound lost about 20% of their starting body weight. That’s compared to between 1% and 2% weight loss for those taking the placebo.
How does Zepbound help with sleep apnea?
The main way that Zepbound improves OSA is through weight reduction.
Weight loss has long been a “lifestyle change” recommended for people with OSA. But losing large amounts of weight is hard to achieve through lifestyle alone. And it’s even harder to maintain the weight loss.
Weight isn’t the only factor, though, in OSA. The studies mentioned above didn’t include people with Type 2 diabetes. But in reality, excess body weight, Type 2 diabetes, and sleep apnea are deeply interlinked.
Each is a risk factor for the other, and the risks go in both directions. So, if you have excess body weight, you’re more likely to have both Type 2 diabetes and OSA. But OSA can increase your risk for Type 2 diabetes. And both Type 2 diabetes and sleep disturbances can increase your risk of excess weight.
So, the fact that Zepbound is now approved for OSA is a big deal. It’s likely that losing significant amounts of weight with medications like Zepbound kicks off a chain of events that results in improvements in OSA. These improvements are:
Reduced amounts of fat deposits in the neck and airway
Reduced waist size
Improved blood glucose levels
Improved metabolic function
Lower levels of inflammation
Losing weight can help with more than OSA though. Other, more long-term benefits of weight management are lower risk of:
High blood pressure, heart disease, heart attacks, strokes, and death
Dementia
Depression
Who can use Zepbound for sleep apnea?
Many people with OSA also have a higher BMI. Because of this overlap, some people with OSA may have already been eligible for Zepbound. That’s because the FDA previously approved the medication to be used for weight loss or Type 2 diabetes, as follows.
Zepbound: adults with excess body weight, with a BMI of 27 or more
Mounjaro: adults with Type 2 diabetes
That said, insurance coverage for Zepbound specifically for OSA may still come with additional requirements. Some plans may only cover it if you have:
A diagnosis of moderate-to-severe OSA, confirmed through sleep studies and clinical assessments
A BMI of 30 or more
Some insurers may also require proof that other treatments, like CPAP ventilation or mouth devices, have been tried or prescribed before approving Zepbound as treatment for OSA.
This FDA approval doesn’t mean Zepbound replaces CPAP or other treatments for OSA. But it may help more people access the medication through their health plans.
What are the side effects of tirzepatide?
Tirzepatide can cause some typical side effects, though not everyone experiences them.
Common side effects include:
Nausea
Vomiting
Bowel disturbance, like diarrhea or constipation
Abdominal pain
Headache
Side effects tend to be worse when starting out on this medication, although most are mild and ease with time. Still, these medications may not be a good fit for everyone. Like with all medications, it’s important to balance risks with benefits and decide what’s right for you and your health.
Serious side effects with tirzepatide
Serious side effects with tirzepatide are rare, but they can happen. They include:
Serious allergic reactions: Examples of these are hives, trouble breathing, and swelling of the lips, tongue, throat, or face.
Very low blood sugar: Also known as hypoglycemia, this can happen whether you have diabetes or not. You may feel hungry, shaky, anxious, sweaty, or notice your heart racing. Also, you may feel tingling, dizziness, weakness, drowsiness, or even confusion.
Pancreatitis: This is inflammation of the pancreas, with symptoms including severe abdominal pain, vomiting, fever, or yellowing of the skin or eyes (jaundice).
Gallbladder problems: Ongoing stomach pain, nausea, vomiting, fever, or jaundice could be a sign of gallstones or gallbladder inflammation.
Kidney problems: Sudden kidney injury can happen as a result of dehydration from severe vomiting or diarrhea.
Thyroid tumors: Specifically, this involves thyroid C-cell tumors. People with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2) shouldn’t take tirzepatide.
Other treatments for sleep apnea
For most people with OSA, Zepbound is unlikely to work as a standalone treatment. It’s likely the best improvement in OSA symptoms will come from combining Zepbound with other OSA treatments.
Here are the current recommended treatment options for OSA:
CPAP therapy: CPAP remains the “gold standard” for treating moderate-to-severe OSA. Using a CPAP machine during sleep helps keep the airway open by delivering a continuous flow of air through a mask.
Weight-management strategies: In addition to Zepbound’s weight-reducing effects, exercising and eating a nutritious diet can also help with weight management to improve OSA symptoms.
Positional therapy: In some people, certain sleeping positions can help reduce OSA. Positional therapy techniques include using special pillows or devices to encourage side sleeping.
Mouth devices: Mouth guards can help keep the airway propped open during deep sleep.
Surgical options: Upper-airway surgery may be an option for people with moderate or severe OSA, or specific anatomical issues causing airway obstruction.
Frequently asked questions
You’ll need a prescription from a healthcare professional. To qualify, you must have moderate-to-severe OSA, confirmed by a sleep study. Your healthcare team will also review your weight, medical history, and what other OSA treatments you have tried. Zepbound is typically used alongside, not instead of, other sleep apnea therapies.
It depends. Medicare doesn’t cover medications prescribed only for weight loss. But now that Zepbound is FDA approved to treat OSA, coverage may be possible under some Medicare plans. Availability and requirements can vary, so it’s best to check directly with your plan.
Insurance coverage for weight-loss medications is evolving. The FDA approval for OSA may make coverage more likely than when Zepbound was prescribed for weight loss alone. Many plans still require prior authorization and proof of moderate-to-severe OSA. You may also need to show you have tried other OSA treatments like CPAP or mouth appliances.
Mounjaro is the brand of tirzepatide the FDA approved to treat Type 2 diabetes. It’s not FDA approved to treat sleep apnea. But because Mounjaro causes significant weight loss, people taking it will probably see improvements in their OSA symptoms.
You’ll need a prescription from a healthcare professional. To qualify, you must have moderate-to-severe OSA, confirmed by a sleep study. Your healthcare team will also review your weight, medical history, and what other OSA treatments you have tried. Zepbound is typically used alongside, not instead of, other sleep apnea therapies.
It depends. Medicare doesn’t cover medications prescribed only for weight loss. But now that Zepbound is FDA approved to treat OSA, coverage may be possible under some Medicare plans. Availability and requirements can vary, so it’s best to check directly with your plan.
Insurance coverage for weight-loss medications is evolving. The FDA approval for OSA may make coverage more likely than when Zepbound was prescribed for weight loss alone. Many plans still require prior authorization and proof of moderate-to-severe OSA. You may also need to show you have tried other OSA treatments like CPAP or mouth appliances.
Mounjaro is the brand of tirzepatide the FDA approved to treat Type 2 diabetes. It’s not FDA approved to treat sleep apnea. But because Mounjaro causes significant weight loss, people taking it will probably see improvements in their OSA symptoms.
The bottom line
Sleep, weight, and metabolic health are closely related, and obstructive sleep apnea (OSA) often sits right in the center. Until now, treatment has focused mainly on continuous positive airway pressure (CPAP), mouth devices, and lifestyle changes to achieve weight loss. With FDA approval for OSA, tirzepatide (Zepbound) introduces a medication-based option that targets a major cause of the condition. For some people, that could mean better sleep — and broader health benefits — at the same time.
Why trust our experts?
References
American Academy of Sleep Medicine. (2008). Obstructive sleep apnea.
Eli Lilly and Company. (2024). Lilly’s tirzepatide reduced obstructive sleep apnea (OSA) severity, with up to 51.5% of participants meeting the criteria for disease resolution.
Kurnool, S., et al. (2023). Sleep apnea, obesity, and diabetes — An intertwined trio. Current Diabetes Reports.
Malhotra, A., et al. (2024). Tirzepatide for the treatment of obstructive sleep apnea and obesity. The New England Journal of Medicine.
Nauck, M. A., et al. (2018). Incretin hormones: Their role in health and disease. Diabetes, Obesity and Metabolism.
Sultana, R., et al. (2022). The case for early use of glucagon-like peptide-1 receptor agonists in obstructive sleep apnea patients with comorbid diabetes and metabolic syndrome. Life.
