Zepbound for Zzz’s: Exploring Tirzepatide for Sleep Apnea

In this episode, TRC Healthcare editor, Sara Klockars, PharmD, BCPS unpacks the newly approved use of tirzepatide (Zepbound) for obstructive sleep apnea (OSA)—a first-in-class pharmacologic option for a condition long managed with devices and lifestyle changes.

You’ll hear a concise review of sleep apnea pathophysiology, how tirzepatide works to reduce airway obstruction, and what the latest clinical trials reveal about its efficacy and safety. Plus,  you’ll get practical pharmacy-focused insights on side effect management, payer considerations, and how to avoid duplicate GLP-1 therapy. 

This is an excerpt from our April 2025 Pharmacy Essential Updates continuing education webinar series.

The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Watch for Tirzepatide for Sleep Apnea
• Chart: GLP-1 and GIP/GLP-1 Receptor Agonist Interactive Comparison Chart

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Transcript

This transcript is automatically generated. 

0:00:04 Narrator

Welcome to Clinical Capsules from TRC Healthcare, your go-to podcast for fast, evidence-based insights. 

0:00:10 Narrator

Today, Associate Editor and Clinical Pharmacist Sara Klockars unpacks how tirzepatide is reshaping the treatment landscape as the first-ever medication approved to treat obstructive sleep apnea—in an excerpt from our popular Pharmacy Essential Updates webinar series.  

0:00:25 Narrator

For four decades, we’ve helped healthcare professionals stay ahead of the curve—and now we’re delivering those vital updates right to your ears every 2nd and 4th Tuesday, in bite-sized, actionable episodes… Clinical Capsules. Let’s dive in… 

00:00:45 Sara Klockars

Now let's talk about the first new prescription Med approved for treating obstructive sleep apnea.

00:00:52 Sara Klockars

We're used to dispensing the GIP/GLP-1 agonist tirzepatide, to treat overweight or obesity. Now, tirzepatide is also approved for adults with obesity and moderate to severe obstructive sleep apnea.

00:01:09Sara Klockars

So, let's look briefly at what obstructive sleep apnea is. It causes people to repeatedly stop and start breathing while sleeping. 

00:01:19 Sara Klockars

The upper airway is either narrowed or closed, so air can't get through and breathing can be briefly cut off, and those lapses and breathing can lead to lower quality sleep affect how much oxygen the body is getting.

00:01:33 Sara Klockars

And perhaps some of you are familiar with its symptoms, such as snorting, snoring or choking sounds, and excessive tiredness or difficulty concentrating during the day.

00:01:44 Sara Klockars

Obstructive sleep apnea can also lead to high blood pressure and ultimately increase the risk of cardiovascular disease such as heart attack and stroke.

00:01:54 Sara Klockars

Up until now, there were no medications approved to treat obstructive sleep apnea, and we relied on lifestyle changes and devices such as continuous positive airway pressure, or CPAP, which blows pressurized air through the airway to keep the throat open to help patients breathe.

00:02:15 Sara Klockars

But now tirzepatide is approved for moderate to severe sleep apnea, and the thought is that tirzepatide, reduces weight, including the fat around the upper airway, which can lessen obstruction. 

00:02:25 Sara Klockars

And then in turn that improves air flow and apnea symptoms. So when looking at the clinical trials using tirzepatide, 10 milligrams or 15 milligrams once weekly for one year,

00:02:37 Sara Klockars

can reduce breathing interruptions by about 20 episodes per hour, more than patients who are not using tirzepatide. And it was studied in patients who were also using CPAP and also patients who were not using nightly CPAP.

00:02:54 Sara Klockars

Researchers also found that tirzepatide can reduce systolic blood pressure by about four to 8 mm of mercury.

00:03:04

So if we look at moderate to severe sleep apnea. These patients start out with 15 or more breathing events per each hour of sleep, and so I just mentioned that tirzepatide can improve breathing by about 20 events per hour. So we'd expect to see good results.

00:03:22 Sara Klockars

And studies about half of patients taking tirzepatide achieved remission, meaning they weren't having any breathing events or they have mild to no sleep apnea symptoms after a year of using the medication.

00:03:37 Sara Klockars

There are some considerations for tirzepatide use.

00:03:40 Sara Klockars

It must be paired with lifestyle changes such as healthy eating and increasing physical activity.

00:03:47 Sara Klockars

And I mentioned earlier that sleep apnea can lead to risks such as high blood pressure, and that tirzepatide might reduce that systolic blood pressure. But we don't have long term data yet with tirzepatide’s effects on other health outcomes that matter, such as heart attack or stroke. And we also don't know how tirzepatide compares to patients who are only using.

00:04:09 Sara Klockars

CPAP alone, since the studies were using the medication with or without CPAP.

00:04:17 Sara Klockars

Other considerations include the side effects. These can be tough at first and injection site reactions since it's a weekly injection.

00:04:26 Sara Klockars

And then we have the rare risks, such as pancreatitis or gallbladder disease, that can present severe abdominal pain. So, we want to ensure patients get counseling to promptly report any severe GI pain.

00:04:38 Sara Klockars

And we also need to consider that it's likely a long-term med if patients are willing to start and stay on this option.

00:04:43 Sara Klockars

So, part of that discussion might be cost and payer coverage. We can anticipate more payers to covers Zepbound now since sleep apnea is another approved use and it's not just for weight loss.

00:04:57 Sara Klockars

But to tirzepatide prefilled pens still cost over $1000 a month, and many payers may require a trial of other sleep apnea treatments first.

00:05:07 Sara Klockars

For instance, patients might need to try CPAP first, so we may need to help gather details for prior auths if needed.

00:05:16 Sara Klockars

Also be aware that patients may pay out of pocket to get single dose vials from the manufacturer and those cost about 350 to $700.00 a month depending on the strength. So if patients do report using the vials include that med in the patient profiles to help pharmacists screen for interactions.

00:05:37 Sara Klockars

And then reinforce that the tirzepatide vials should only be used once. They do not contain preservatives.

00:05:46

So, when do we expect to see tirzepatide for sleep apnea?

00:05:51 Sara Klockars

It may be used as an add on to CPAP or as an alternative option, especially for patients with other comorbidities like diabetes who may benefit from the Med, or it's a good option for those who refuse or who cannot tolerate wearing CPAP and about half of patient stops using CPAP within a year of starting it.

00:06:13 Sara Klockars

And when it comes to dosing, think of it as you do for other indications and be ready to enter more than one prescription for tirzepatide. So just like patients using tirzepatide for obesity, they'll start low and go slow.

00:06:27 Sara Klockars

1st injecting 2.5 milligrams subcutaneously once weekly, then they'll increase the dose by 2.5 milligrams every four weeks to a Max of 15 milligrams a week.

00:06:41 Sara Klockars

And make sure these patients get pharmacist counseling, especially with the first fill to learn some general nutrition tips.

00:06:48 Sara Klockars

For instance, pharmacists can explain to them that the med will likely decrease their appetite and often cause nausea or vomiting. Patients can try eating smaller meals, consuming food more slowly, stopping before they feel full.

00:07:02 Sara Klockars

And these tips can help improve tolerability and set patients up for success with this Med.

00:07:08 Sara Klockars

So let's take a few minutes just to review other treatments for sleep apnea.

00:07:13 Sara Klockars

We want to reinforce key lifestyle changes that can help improve symptoms and really emphasizing weight loss for patients who are overweight.

00:07:23 Sara Klockars

Exercise can also help, as can quitting smoking and then limiting alcohol, especially before bed.

00:07:30 Sara Klockars

So moving on to devices for sleep apnea, we mentioned CPAP.

00:07:36 Sara Klockars

And historically this has been used first line and we want patients to use CPAP for at least 4 hours a night for the best outcomes. But it might be hard for people to stick with CPAP. And as I said earlier, up to 50% of patients stop it within the first year and it's because that mask might be uncomfortable or they may not.

00:07:56 Sara Klockars

Like the inconvenience of having to use the machine.

00:08:01 Sara Klockars

Oral appliances are another device you might get questions about, and these devices often work by moving the lower jaw forward.

00:08:09 Sara Klockars

Or by holding the tongue in place, or sometimes strengthening the tongue muscles. And regardless of how they work, they're all trying to help keep that airway open during sleep, but generally advise saving these oral appliances for more mild cases of sleep apnea, or if CPAP isn't tolerated, since these appliances have less evidence of benefit than CPAP.

00:08:31 Sara Klockars

And they may need to be replaced frequently due to wear and tear and if patients ask about the OTC appliances, I would discourage these. There's a risk these may change, dentition cause jaw pain or dry mouth or lead to other problems and so recommend they see a dentist for a custom fitting.

00:08:51 Sara Klockars

Of an oral appliance. If they choose to go this route.

00:08:55 Sara Klockars

You also might get questions about other meds, such as modafinil, since there are a few approved to improve daytime sleepiness due to sleep apnea, but advise saving these for that rare patient who still has daytime sleepiness despite adhering to other sleep apnea treatments. These don't treat the underlying problem.

00:09:18 Sara Klockars

These are also controlled substances and can be costly and have their own side effects, such as increasing blood pressure, heart rate, anxiety or even trouble sleeping. So if a patient does use one of these meds to help with daytime drowsiness, advise monitoring pulse and blood pressure, I recommend avoiding these altogether.

00:09:38 Sara Klockars

Patients with recent cardiovascular events, such as a heart attack or stroke.

00:09:43 Sara Klockars

And then on the other hand, we have some meds that we can be on the lookout for that can actually worsen sleep apnea or these may contribute to daytime drowsiness. And we know those common culprits, basically most of the meds that can cause sedation or depression of the central nervous system. 

00:10:00 Sara Klockars

So think along the lines of benzodiazepines and gabapentin, muscle relaxants, opioids, so we can watch for these medications as well.

00:10:11 Sara Klockars

So to wrap up this topic, this new indication for tirzepatide is a good reminder to check incoming tirzepatide prescriptions closely for clues about why the med is being used. Look for that diagnosis code or notes that say for sleep apnea and we want to update the patient profile with this info. 

00:10:29 Sara Klockars

Zepbound and Mounjaro, which is for type 2 diabetes, are not equivalent or interchangeable.

00:10:37 Sara Klockars

And another thing to stay alert for is unintended duplicate therapy with GLP-1 and GIP/GLP-1 agonists.

00:10:45 Sara Klockars

As these meds get approved for more indications, so for instance, a patient may get a new prescription from a sleep specialist for tirzepatide for sleep apnea, but maybe they're taking liraglutide for diabetes from their primary care doctor. 

00:11:00 Sara Klockars

Alert your pharmacist, since doubling up may cause more side effects such as nausea, vomiting or diarrhea like we had mentioned earlier.

00:11:09 Sara Klockars

Since information for tirzepatide and other GLP-1 agonists continues to change regularly, be sure to search our website for answers to your questions. 

00:11:18 Sara Klockars

So for example, type the medication name or simply GLP dash 1 in the search bar to find the latest articles and graphics on this topic.

00:11:29 Narrator

We hope you enjoyed and gained practical insights from listening to this presentation! 

00:11:33 Narrator

Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. Or find the show on YouTube by searching for ‘TRC Healthcare’ or clicking the link in the show notes. While you’re there, check out our other TRC podcasts like Medication Talk and Rumor vs Truth.

00:11:50 Narrator

Also in the show notes, we’ve linked directly to a few of the excellent resources mentioned today available to subscribers of Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights. On those websites you’ll also find a lot more evidence-based, concise, yet comprehensive resources on this and other medication therapy topics. 

00:12:10 Narrator

And don’t forget to check out our full Pharmacy Essential Updates webinar series for deeper dives into topics that matter to your practice.

00:12 :19 Narrator

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00:12 :32 Narrator

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00:12:54 Narrator

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00:12:59 Narrator

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00:13:06 Narrator

Thanks for listening, stay sharp, stay current, and we’ll catch you next time on Clinical Capsules!