Long Islanders suffering from sleep apnea inundated the sleep center at St. Charles Hospital in Port Jefferson with phone calls earlier this year after the Food and Drug Administration approved Zepbound, one of the new weight loss medications, as the first drug to treat the condition.
“Patients were really curious about this,” said David Warkentin, system director for Catholic Health Sleep Service.
Six months later, Long Island sleep experts said Zepbound has given patients a promising treatment option, but emphasized it is not a cure-all for a disorder that is estimated to impact 30 million adults in the U.S. Roughly 80% are not diagnosed.
“It really opens up a lot of new avenues for personalized sleep medicine,” he said.
WHAT TO KNOW
- Since the FDA approved Zepbound to help treat obstructive sleep apnea in some patients with obesity six months ago, Long Islanders have been flooding sleep centers with questions and interest about the medication.
- Experts say the drug can help people lose weight which may ease the symptoms of their obstructive sleep apnea, but it is not necessarily a cure for everyone.
- People with obstructive sleep apnea should speak with sleep medicine experts and undergo an evaluation before starting any new treatment.
It also marks another step in the use of the increasingly popular — and pricey — GLP-1 (glucagon-like peptide-1) medications to tackle chronic health issues including diabetes, weight management, and cardiovascular disease.
Experts said that by losing weight, obese patients may get some relief from their obstructive sleep apnea — a condition in which people stop breathing dozens of times a night because their airway becomes narrowed or blocked when the muscles of the throat relax.
In response to these events, the brain sends a signal to wake the person up so they can start breathing again, a cycle that repeats while their sleep. This often leaves them exhausted and unfocused throughout the day.
David Warkentin, system director for Catholic Health Sleep Service at St. Charles Hospital in Port Jefferson, outfits a mannequin head with a CPAP mask and EEG electrodes on Thursday. Credit: Newsday/Drew Singh
Losing weight can help reduce fatty deposits in the airway, said Dr. Gary Wohlberg, director of the South Shore University Hospital Sleep Center, reducing the chance it will become blocked during sleep. Obese sleep apnea patients may struggle with dieting and exercise and the drug can give them a “head start.” In addition, he added, “you really want to change your behavior and it should be coupled with nutritional information and activity.”
Dr. Avram Gold, medical director of Stony Brook University’s Sleep Disorders Center, said he is skeptical of the claims that weight loss will make lasting changes for people with obstructive sleep apnea.
“It can make a difference in how they feel,” he said. “But it won’t bring them back to normal.”
Beyond weight loss, the drugs may also be interacting with the body in other ways to reduce sleep apnea.
“There is a theory that some of these drugs, particularly Zepbound, may also reduce inflammation and thereby improve airflow,” Wohlberg said.
Warkentin said researchers are also looking into whether the drug has a protective effect on brain cells that could improve the brain’s ability to regulate breathing during sleep.
Accessing medication can also be challenging for patients. Not all health insurance companies cover weight-loss drugs and those that do may require participants have a body mass index considered overweight with certain chronic illnesses or be obese. The medicine costs about $1,000 a month for those who must pay out of pocket. Just because Zepbound was approved to treat sleep apnea doesn’t guarantee insurance coverage.
A patient’s experience
Back in late 2023, Diana Bonilla, 34, of Patchogue was diagnosed with mild sleep apnea, a condition she said started in recent years as she got older and gained weight.
She wanted to try something other than traditional treatments, which involve use of a continuous positive airway pressure machine, also known as a CPAP machine, or oral appliances worn in a person’s mouth while they sleep. People who use CPAP machines wear a mask connected to a machine that sends a stream of pressurized air which keeps the airway from closing during sleep.
“I was going to try weight loss,” said Bonilla. “I was at 203 pounds, the heaviest I have ever been. And I’m only 4-foot-11 so that’s a lot.”
She started Zepbound in May 2024 and is down to 134 pounds. Bonilla, an administrative assistant at Northwell Health, said she has more energy, her husband reports she no longer snores, and follow-up tests showed no signs of sleep apnea.
“I think it’s the best thing invented,” Bonilla said of the medication. “But you also have to change your eating habits and try to be healthier.”
Warkentin and other sleep medicine experts emphasized Zepbound is not a “magic bullet” and any treatment must look at numerous factors in a person’s health.
Not everyone with obstructive sleep apnea is obese. Patients may have physiological issues — such as a large tongue or tonsils — that make breathing during sleep more difficult.
Losing weight can ease symptoms. However, a person needs sleep tests and to work with specialists to determine the best treatment plan, Warkentin said.
“Everybody’s hoping for that quick fix but it’s a journey,” he said. “I think as providers we have to make sure we educate our patients and that we are transparent and we temper expectations.”
Sleep apnea warning signs
Many people with sleep apnea may not recognize the warning signs or dismiss them, experts said.
“Often, people relate their tiredness and fatigue to a lot of other things,” said Dr. Andrew Namen, a pulmonologist and sleep apnea expert at the Wake Forest University School of Medicine in North Carolina and a spokesman for the American Academy of Sleep Medicine.
“Having symptoms like snoring, choking, gasping for breath should alert you to talk to your provider,” Namen said. “People think it’s not a serious condition but we now know sleep apnea has been associated with significant heart- and stroke-related events.”
Gold said he believes sleep apnea is actually linked to chronic stress and that his research has associated sleep apnea with chronic fatigue, irritable bowel syndrome and, possibly, long COVID.
Some sleep apnea patients who are obese have also tried weight loss surgery to bring down their weight and the extra pressure on their bodies that can make it hard to breathe well while they rest.
Eric Spronz’s bout with sleep apnea was just part of a lifelong battle with sleep disorders. He had his first sleep test at the age of 14 after years of being on stimulants for the bursts of hyperactivity that came when he wasn’t tired or distracted.
They diagnosed him with “REM behavior disorder.” Rapid Eye Movement or REM is the stage of sleep that involves dreaming.
“You act out whatever you are dreaming,” said Spronz, 42, a nurse practitioner in psychiatry who lives in Port Jefferson. “You are never actually hitting REM sleep.”
Sleep medicine didn’t work and in time he gained weight, going up to 247 pounds. After falling asleep behind the wheel of his car while stopped at a light, Spronz realized he needed more help. Another sleep study led to the use of a CPAP machine, bariatric surgery and use of a weight loss drug that helped him drop 100 pounds.
He is still following up with treatments due to the complexity of his sleep disorders, and doctors have told him he no longer needs the CPAP machine.
Losing weight was “one piece of the puzzle,” Spronz said. “It certainly is not the cure to sleep apnea.”
Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.
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