Zepbound: Injection for Sleep Apnea Treatment

By Brandon Peters, M.D.

Zepbound (tirzepatide) is a prescription drug used to treat obesity, diabetes, and obstructive sleep apnea. As it induces weight loss, this may improve crowding of the upper airway that may contribute to snoring and sleep apnea. Research suggests that it may be an effective tool in long-term management. Zepbound may have side effects, however, and careful consideration of the risks and benefits may inform its use.

Use of Zepbound

Zepbound is available via prescription only. One of the glucagon-like peptide-1 (GLP-1) receptor agonist medications, Zepbound is self-administered via a weekly injection. The 2.5 mg dose is started once weekly for 4 weeks. If tolerated, it may be increased by 2.5 mg monthly to a maximum dose of 15 mg via weekly injection. Due to the gradual increase, it will take 5 months to reach the maximum dose.

It may reduce excess body weight in adults who are overweight or obese (the latter defined as a body mass index, or BMI, above 30 kg/m2). It is also approved to treat moderate-to-severe obstructive sleep apnea (OSA)—with an apnea-hypopnea index (AHI) >15 events per hour—in adults with obesity. It is meant to be used in combination with a reduced-calorie diet and increased physical activity.

It is the first medication to be approved for the treatment of sleep apnea. The use of Zepbound to treat sleep apnea was approved by the U.S. Food and Drug Administration (FDA) on December 20, 2024. This approval was based on the results of the SURMOUNT-OSA trial, reported in the New England Journal of Medicine in June 2024. This pivotal trial showed that people on Zepbound for 1 year reduced, on average, their weight by 20% and their sleep apnea severity by 50.7%. This means that a lot of study subjects with moderate to severe sleep apnea were able to normalize their breathing, although sleep apnea persisted to a lesser degree in many.

How It Works

More research is needed to fully understand how these medications work. Generally, Zepbound selectively binds to and activates glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. This may help to reduce appetite and caloric intake. As weight loss occurs, fat tissue that is deposited at the base of the tongue and along the upper airway may be reduced and this will gradually increase airflow. It may also reduce pressure on the lungs, increasing lung capacity and allowing more air movement. These changes may resolve snoring and sleep apnea.

Pros

• It may address excessive weight, the most reversible and frequent root cause of sleep apnea in certain people.

• It may reduce the severity of sleep apnea, allowing for other treatment options (i.e., oral appliance, Inspire placement) or the cessation of treatment if the condition resolves.

• It may benefit weight-related medical conditions, including diabetes, hyperlipidemia, hypertension, fatty liver disease, and cardiovascular (i.e., heart attack, heart failure, heart arrhythmia) and cerebrovascular (i.e., stroke, dementia) disease.

Cons

• Weight loss is gradual and benefit may not be derived for months or years into treatment.

• It may reduce sleep apnea severity, but the condition may persist.

• It may not resolve sleep apnea in people who have other anatomy or risk factors contributing to the condition.

• It must be used long-term (lifelong) to maintain the reduced weight. If stopped, the excessive weight may come back.

• It may be expensive and not covered by insurance.

• It may be inaccessible due to demand and production/inventory issues.

Who Should Not Use Zepbound

Zepbound should not be used in people with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The signs of thyroid tumors include a mass in the neck, difficulty swallowing or breathing, and persistent hoarseness.

Anyone with a prior hypersensitivity reaction, such as anaphylaxis or angioedema, to the medication should also abstain from use.

Due to the delay of gastric emptying, Zepbound may reduce the efficacy of oral hormonal contraceptives for 4 weeks after initiating, or changing the dose of the medication, and barrier contraceptive (i.e., condom) use is recommended during this interval. Weight loss is not recommended during pregnancy. There are no data on its use during breastfeeding.

The medication should not be taken with other tirzepatide-containing products or with any glucagon-like peptide-1 (GLP-1) receptor agonists.

Side Effects

Common

The most common side effects relate to gastrointestinal complaints, and the adverse reactions (listed from most to least common) may include:

• Nausea

• Diarrhea

• Vomiting

• Constipation

• Stomach pain

• Upset stomach

• Injection-site reactions

• Fatigue

• Hypersensitivity

• Belching

• Hair loss

• GERD

• Flatulence (farting)

• Bloating

• Dizziness

• Hypotension (low blood pressure)

Severe

At the highest dose (15 mg), 3.1% of people report severe gastrointestinal issues. Vomiting may contribute to dehydration and volume depletion, potentially triggering acute kidney injury or failure. Gallstones (cholelithiasis or cholecystitis) affected 1.1% of people, compared to 1% of controls. Acute pancreatitis, which may be fatal, has rarely been observed with GLP-1 treatment.

Hypersensitivity to the medication, including anaphylaxis, has been noted in 0.1% of users.

As Zepbound lowers blood glucose levels, this can lead to hypoglycemia, especially when used with other medications to treat diabetes. It may also worsen diabetic retinopathy and caution is advised in this condition.

As it delays gastric emptying, there may be an increased risk of pulmonary aspiration in the context of surgery.

Suicidal thoughts or behaviors have been reported with other weight management products and monitoring for mood changes may be indicated.

When to Check With Your Healthcare Provider

If you are experiencing side effects, especially with the initiation of the medication or an increase in its dose, check in with the prescribing provider. It may be necessary to lower the dose or discontinue the use of Zepbound. Any medication changes should be made in consultation with your medical professional.

Summary

Zepbound may be an effective long-term treatment for moderate to severe obstructive sleep apnea in people with obesity. The side effects are generally tolerable, and the gradual loss of weight may provide other health benefits. Due to the slow effects, people should initiate treatment with continuous positive airway pressure (CPAP) therapy for immediate relief of the condition. The CPAP pressure settings may be gradually reduced and a repeat sleep study may be indicated once weight loss plateaus to evaluate whether the condition has resolved. Insurance coverage may vary, and cost and access issues are common barriers to treatment. If stopped, gradual weight gain is likely to occur. Those who use Zepbound in combination with a reduced-calorie diet, increased physical activity, and ongoing CPAP therapy will derive the greatest benefit from its use.

Why Do I Feel Sleepy After Eating Lunch?

Feeling sleepy after eating lunch is a common experience, and it can be attributed to a combination of physiological, psychological, and dietary factors. This post-lunch drowsiness, often referred to as "postprandial somnolence" or "food coma," can be attributed to several underlying mechanisms.

Physiological Processes

Circadian Rhythms: Your body has a natural circadian rhythm that influences periods of wakefulness and sleepiness throughout the day. Most people experience a dip in energy levels in the early to mid-afternoon, commonly known as the "afternoon slump." This dip is a normal part of the circadian rhythm and can be exacerbated by eating a meal, especially a large one.

Digestion and Blood Flow: When you eat, your body directs a significant amount of blood to your digestive system to aid in breaking down and absorbing nutrients. This process, known as "postprandial digestion," requires energy and can lead to reduced blood flow to other parts of your body, including your brain. The decrease in cerebral blood flow might contribute to feelings of fatigue and drowsiness.

Hormonal Changes: Certain hormones are released during and after eating that can influence your alertness. For instance, the hormone insulin is secreted to help regulate blood sugar levels. Insulin helps cells absorb glucose from the bloodstream, which can affect levels of other hormones like serotonin and melatonin. Serotonin, which can be converted into melatonin, is involved in regulating sleep and mood. Elevated serotonin levels after a meal can make you feel more relaxed and sleepy.

Dietary Factors

Meal Composition: The type of food you eat plays a significant role in how sleepy you feel afterward. Meals high in carbohydrates can lead to a more pronounced drop in energy levels. Carbohydrates cause a rapid rise in blood sugar, followed by a swift decline. This fluctuation can result in feelings of fatigue. Additionally, foods rich in tryptophan (like turkey and dairy) can lead to increased serotonin production, which may promote drowsiness. Alcohol will also make you more sleepy due to its effects on adenosine levels within the brain.

Portion Size: Large meals require more energy to digest and can exacerbate feelings of tiredness. Consuming a substantial amount of food forces your digestive system to work harder, leading to greater energy expenditure and potential drowsiness.

Nutrient Balance: A meal that lacks balance, such as one high in refined sugars and low in protein and fiber, can lead to a rapid rise and fall in blood glucose levels. This can leave you feeling lethargic as your body deals with the sugar crash. Including a mix of protein, fiber, and healthy fats in your lunch can help stabilize blood sugar levels and maintain more consistent energy levels throughout the afternoon.

Psychological and Behavioral Factors

Psychological Relaxation: Eating can induce a state of relaxation and comfort. The act of taking a break to enjoy a meal might signal to your body that it's time to wind down. This psychological relaxation can contribute to physical drowsiness.

Lifestyle Factors

Sleep Quality: Your overall sleep quality can influence how you feel after meals. Poor sleep or insufficient rest can lead to greater fatigue after eating. If you are already tired from a lack of sleep, the added effect of digestion can make you feel even sleepier.

Hydration: Dehydration can contribute to feelings of tiredness and sluggishness. Sometimes, the drowsiness you experience after lunch might be due to inadequate hydration rather than just the meal itself. Drinking water throughout the day can help maintain energy levels and reduce feelings of fatigue.

Activity Levels: Post-lunch drowsiness can also be influenced by your activity levels. A sedentary lifestyle may contribute to feelings of tiredness after eating, as physical activity helps boost energy and alertness. Incorporating light physical activity, like a short walk, after lunch can help counteract feelings of sleepiness.

Potential Health Issues

Blood Sugar Imbalance: For individuals with conditions like diabetes or insulin resistance, blood sugar levels can be more difficult to manage, leading to significant fluctuations that can cause drowsiness. Eating balanced meals and managing blood sugar levels can be crucial for preventing excessive tiredness.

Digestive Disorders: Certain digestive disorders, such as irritable bowel syndrome (IBS) or food intolerances, can affect how you feel after eating. If you frequently experience drowsiness along with other symptoms like bloating or discomfort, it might be worth consulting a healthcare professional to rule out any underlying conditions.

Strategies to Combat Post-Lunch Drowsiness

Balanced Meals: Aim to include a balance of protein, healthy fats, and complex carbohydrates in your lunch. This balance helps maintain steady blood sugar levels and provides sustained energy throughout the afternoon.

Portion Control: Avoid overeating by paying attention to portion sizes. Eating smaller, more frequent meals can help prevent the energy crash associated with larger meals.

Hydration: Ensure you are drinking enough water throughout the day. Staying hydrated can help maintain energy levels and combat feelings of lethargy.

Physical Activity: Incorporate light physical activity, such as a brisk walk or stretching, after lunch to help increase alertness and reduce feelings of sleepiness.

Sleep Hygiene: Prioritize good sleep hygiene by maintaining a consistent sleep schedule and creating a restful sleep environment. Quality sleep can help reduce overall fatigue and improve energy levels throughout the day.

Conclusion

In conclusion, feeling sleepy after lunch is a multifaceted issue involving physiological responses, dietary choices, psychological factors, and lifestyle habits. By understanding the underlying causes and implementing strategies to address them, you can mitigate the effects of post-lunch drowsiness and maintain better energy levels throughout the day.

This article was created using OpenAI’s ChatGPT on September 13, 2024 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.