Sleep Apnea Treatments and Medications

Quality sleep matters. And, for the more than 22 million Americans who live with sleep apnea, restful nights are few and far between. The condition occurs when the airway is blocked repeatedly during sleep, or the brain does not send a message to the muscles to breathe. Meaning, you'll likely wake with extreme fatigue, irritability, and headaches. It's a challenging condition to deal with, but there are effective treatments.

What is sleep apnea?

Sleep apnea is a common sleep disorder that affects millions of people in the U.S., ranging from mild sleep apnea to severe obstructive sleep apnea (OSA). Common sleep apnea symptoms include snoring or gasping during sleep, or “apnea events,” which occur when there is reduced or no breathing during sleep, and sleepiness.

Left untreated or undiagnosed, people with sleep apnea often experience extreme daytime fatigue. Unable to have a restful sleep, people with sleep apnea may experience other health complications, including heart disease, heart attacks, high blood pressure, depression, and car/heavy machinery accidents.

“People suffering from sleep apnea tend to snore at night and may experience symptoms such as mood swings, trouble learning, sleepiness, and a low sex drive,” explains Chirag Shah, MD, co-founder of Push Health, an online healthcare platform.

Fortunately, there are treatment options available, the most common of which is a combination of lifestyle changes and the use of a continuous positive airway pressure machine (CPAP). New research into the specific causes of OSA is creating improved pathways for more effective, targeted therapy.

How is sleep apnea diagnosed?

To properly diagnose sleep apnea, it helps to understand the different types of the condition. There are three types of sleep apnea, each caused by different mechanisms. They are:

1. Obstructive sleep apnea (OSA): This condition occurs when something physically blocks the airway. The most common cause of blockage is when the tongue collapses against the soft palate and the palate collapses against the back of the throat during sleep.

2. Central sleep apnea: This type of sleep apnea is not a physical blockage; rather, it occurs when the brain fails to signal to the relevant muscles how to breathe.

3. Complex sleep apnea: This occurs when there is a combination of both a physical block and an issue with the brain signal for muscles to breathe.

In all cases of sleep apnea, when an apnea event (the complete absence of airflow) occurs, the brain partially wakes the sleeper to resume breathing. This waking throughout the sleep cycle is what causes fatigue, especially in people with severe sleep apnea, as they can be disturbed hundreds of times a night. Apnea events occur most commonly when a person has fallen into the rapid-eye-movement (REM) stage of the sleep cycle.

As there are a number of types of sleep apnea, there are also numerous potential causes. Understanding what is causing the sleep apnea is essential in forming a diagnosis and effective treatment plan.

“Obesity is the most common cause of obstructive sleep apnea,” explains Bernard Ashby, MD, MPP, FACC, a vascular cardiologist at Comprehensive Vascular Care in South Florida.

“There are a number of possible causes for sleep apnea, including smoking, alcohol use, being overweight, and having certain anatomical features such as a small upper airway/jaw or a large neck,” agrees Dr. Shah.

In order to be properly diagnosed, the best place to start is with a visit to your primary care physician. Your healthcare provider may be able to form an accurate diagnosis based on your medical history and physical exam. Or, your healthcare provider may refer you to a certified sleep medicine specialist or neurologist for a sleep study.

Questions your healthcare provider may ask include:

• What are your symptoms?

• When did they start?

• Do you have a family history of sleep disorders?

• Are you taking any medications?

According to the National Heart, Lung, and Blood Institute (NHLBI), your physician may also perform a physical exam, looking for any signs of conditions that may increase your risk of sleep apnea. These physical signs include obesity, a large neck circumference, large tonsils, and a narrow upper airway.

Participating in either an at-home or in-clinic sleep center study, supervised by a sleep specialist, may be necessary to form an accurate diagnosis and to determine the severity of your condition. These studies are designed to monitor for apnea events, including how often they occur, and general breathing patterns. Your blood oxygen levels and muscle, brain, and heart activity are likely to also be monitored during the study.

According to NHLBI, the severity of your sleep apnea is determined based on the following number of apnea events per hour:

• Mild: Five to 14 apnea events in an hour

• Moderate: 15 to 29 apnea events in an hour

• Severe: 30 or more apnea events in an hour

Sleep apnea treatment options

Continuous positive airway therapy (CPAP) is the most common treatment device for sleep apnea according to the Food and Drug Administration (FDA). This is because it’s safe and effective.

“The optimal therapy is CPAP (continuous positive airway therapy). This involves wearing a nasal or face mask connected to a small machine that delivers air pressure to the throat, thereby keeping one's airway open during sleep,” explains Ashgan Elshinawy, DO, the director of the Center for Sleep and Breathing Disorders at Saint Peter’s University Hospital, New Brunswick, New Jersey.

However, some people struggle to stick with the CPAP therapy, as it requires sleeping with a mask or nasal cannula and being tethered to a machine. However, when properly adhered to, these CPAP machines are extremely effective sleep apnea treatments.

Aside from recommending a breathing device, your healthcare provider may also suggest making some lifestyle changes to reverse sleep apnea. Most commonly, this includes exercising regularly and eating a healthy diet, losing excess pounds, cutting back on alcohol, and quitting smoking.

Other treatment options include:

• Mouthpieces: Worn while you sleep, these are designed to keep your upper airway open.

• Implants: These require surgery and are used in severe cases of OSA and central sleep apnea. They deliver mild stimulation to throat muscles during sleep to keep the airway open.

• Orofacial therapy: Some children and adults find this therapy an effective treatment. Physical therapy for the mouth and face helps strengthen muscles that contribute to a closed airway.

• Removal of obstructions: This requires surgery. Some patients have their tonsils removed, have their upper airway enlarged by moving their lower jaw, or have a tracheostomy. A tracheostomy is when a hole is cut into your windpipe (trachea), and a breathing tube is inserted to allow airflow.

Sleep apnea medications

In 2024, the FDA approved the first medication for OSA: Zepbound (tirzepatide). Initially approved as a weight loss medication, Zepbound is intended to be used in combination with a reduced-calorie diet and increased physical activity in adults with obesity.

Some medications—like Nuvigil (armodafinil) and Provigil (modafinil)—are prescribed to ease daytime sleepiness caused by obstructive sleep apnea; however, they do not treat sleep apnea itself.

Sleeping pills and medication like benzodiazepines are rarely recommended for the treatment of sleep apnea, a surprising fact for many patients. This is because many prescriptions work by relaxing the airway tissue. As sleep apnea is often caused by airway blockages due to already-relaxed throat muscles, the use of sleeping pills is likely to block a person's airway even more.

Breathing devices and lifestyle changes are the most recommended treatment options for sleep apnea.

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Medications for daytime sleepiness caused by sleep apnea