Technology is reshaping sleep apnea treatment

Inspiration Therapy — a hypoglossal nerve stimulation implant — has been approved by the U.S. Food and Drug Administration (FDA) for more than 11 years, and has treated more than 100,000 patients across the United States, Europe and Asia. Data shows a reduction in daytime sleepiness, a 79 percent reduction in the severity of sleep apnea, and a 90 percent reduction in snoring, says Ruchir Patel, MD, chief medical officer at Inspire. Early US data suggests average nighttime use of more than 6.5 hours. “This is an exciting time because there are more treatment options available than in the past,” he says.

Pharmaceutical methods also began to appear. In 2024, the F.D.A consent Zepbound (tirzepatide), for the treatment of moderate to severe obstructive obstructive sleep apnea in adults with obesity, is the first weight-loss medication with a specific indication for sleep apnea.

Meanwhile, startup Apnimed, based in Cambridge, Massachusetts, has developed a night pill that targets neuromuscular pathways that affect upper airway tone. Instead of opening the airway mechanically, the drug aims to stabilize it biologically.

“For a long time, sleep apnea was primarily understood as an anatomical problem, so the logical solution was mechanical,” says John Cronin, chief medical officer at Apnimed. As understanding has evolved, the question has become: “Can we design a treatment that directly targets the biology of the condition, rather than relying solely on mechanical support?” The company has completed two Phase III trials and plans to submit a new drug application to the FDA this year.

Despite all the innovations, Steier remains practical. “I couldn’t be happier to find someone with sleep apnea receiving CPAP treatment,” he says. Modern machines automatically adjust pressure according to airway resistance. “One night can make a difference.” Patients come back and tell him they have their lives back.

Sleep medicine is still relatively new, and research is only beginning to recognize the diversity of this condition. This complexity also supports efforts to improve rather than abandon CPAP device use.

Amanda Satyabala, an assistant professor at the National Heart and Lung Institute at Imperial College London, led the research that showed 62% of patients do not use their CPAP machine enough to have a beneficial health effect. Her team has studied the psychology of adherence and found that factors such as understanding the risks and confidence in using the device shape long-term use.

Drawing on behavioral science, she developed CPAP Buddy, an app that offers video-based behavioral therapy, peer support, and around-the-clock answers to patients’ questions. The project received £2.2 million from the UK Medical Research Council, along with support from CPAP machine manufacturer Fisher & Paykel.

“Continuous positive airway pressure is probably the most effective treatment you can get because it gives air directly into your airway,” Sathyapala says. “CPAP is always going to be most effective once a person is using it, so it’s helpful to try to get people to use it.”

For her, the problem is not the machine, but the behavior. “I don’t like to give up if we don’t try the right things,” she says. Using a continuous positive pressure (CPAP) machine is no different than “losing weight, stopping smoking, starting a long-term physical activity program — it’s a behavior change,” she adds.