CPAP vs. Medication: Which Obstructive Sleep Apnea (OSA) Treatment Is More Effective?

If you have obstructive sleep apnea (OSA), you might be offered a choice between instant breathing support and a long-term approach to target the condition’s root causes.

Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for OSA; this breathing device can correct the condition literally overnight. The newest treatment for OSA, on the other hand, the medication tirzepatide (Zepbound), does not offer immediate relief, but it helps drive weight loss and better metabolic health, tackling one of OSA’s major root causes.

• Improved blood pressure
• Reduced risk of heart disease, heart attack, and stroke
• Protected cognitive function (including memory and thinking)

CPAP: The Downsides

While effective, CPAP therapy has its drawbacks.

“There is some stigma associated with CPAP machines,” says Dr. Malhotra. “Some people don’t want others to know they’re wearing it to bed at night. It’s not perceived as good for intimacy, and there could be irritation on the nose and face from the mask.”

Despite these drawbacks, CPAP therapy is often well tolerated and can have transformative benefits for people with OSA, says Malhotra.

Though not everyone who has obstructive sleep apnea is overweight or has obesity, excess weight is a major risk factor for the condition. “When people gain weight, they can deposit fat around the tongue, upper airway, in the abdomen, and other areas that can contribute to airway collapse,” says Malhotra. Reducing body weight with the help of medications like tirzepatide is one approach to treating OSA: “If the weight comes down, it can help improve sleep apnea.”

• Weight loss
• Improved blood sugar control
• Reductions in total and low-density lipoprotein (LDL, or “bad”) cholesterol and triglycerides

Tirzepatide: The Downsides

“There are also cost considerations, because weight loss medications can be expensive,” says Malhotra.

“If a patient has sleep apnea, they should be considered for CPAP,” says Malhotra. People with obesity should focus on diet and exercise to lower body weight, as well as be considered for tirzepatide use, he says. Some doctors will recommend using both treatments at the same time, to improve sleep quality immediately while also treating OSA’s root causes.

“Some people who use Zepbound for moderate or severe apnea who start with a body mass index over 30 will not need to use CPAP once they’ve decreased their weight,” says Chafen Hart, MD, a sleep medicine specialist at National Jewish Health in Denver.

• Experience severe nausea and vomiting
• Find the mask claustrophobic
• Have conditions like chronic obstructive pulmonary disease
• Have facial injuries or burns
• Recently underwent facial, airway, or stomach surgery

CPAP and tirzepatide aren’t the only options available for treating sleep apnea. Alternative treatments that may work for certain people include the following:

• Dental Devices These are worn in your mouth and pull your jaw or tongue forward to keep your airway open while you sleep.

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  “Dental devices can be useful in people with mild apnea who ... [have] a bit of an underbite, a small or narrow palate, or for whom the tongue is the major issue preventing them from breathing at night,” says Dr. Hart.
• Hypoglossal Nerve Stimulators These are surgically implanted devices that shock the tongue to move it away from your airway during sleep. This is a major surgery, says Hart, and is only used for people with severe sleep apnea who haven’t tolerated other treatments.

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• ENT Surgery There are multiple ear, nose, and throat surgeries that can be used to treat OSA, including tissue removal, jaw repositioning, and the creation of a new airway.

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  “ENT surgery is limited to those with a very obvious area for intervention in the upper airway and is often our last recommendation,” says Hart.

Discuss your options with your healthcare provider to find the best treatment or combination of treatments for your situation.

Healthy lifestyle changes, including exercising regularly, prioritizing sleep quality, and eating a balanced diet that limits or excludes alcohol, can supplement traditional OSA treatments. Diet and exercise are especially important if obesity or excess weight is contributing to your OSA, says Malhotra.

Side-sleeping positions may also help keep your airway open, though Malhotra says the benefit is likely marginal.

• CPAP therapy is considered the most effective method for immediately reducing breathing disruptions and improving daytime sleepiness in people with OSA, though some users find the machines cumbersome or uncomfortable.
• The second most effective treatment for reducing breathing disruptions, tirzepatide (Zepbound) treats sleep apnea by promoting weight loss to reduce airway obstruction, although the results take months to appear, as opposed to the overnight relief provided by CPAP therapy.
• Doctors generally recommend CPAP for most sleep apnea patients, but those with obesity may eventually eliminate the need for a machine if they achieve significant weight loss through medication and lifestyle changes.