Inspire Therapy – a hypoglossal nerve stimulation implant – has been approved by the FDA for over 11 years and has treated over 100,000 patients in the US, Europe and Asia. Ruchir Patel, senior medical director of Inspire, says the data shows a reduction in daytime sleepiness, a 79% reduction in the severity of sleep apnea and a 90% reduction in snoring. Early data from the US puts average nighttime usage at over 6.5 hours. “It’s an exciting time because there are more treatment options available than in the past,” he says.
Pharmaceutical approaches are also emerging. In 2024, the US Food and Drug Administration approved Zepbound (tyrzepatid) for moderate to severe OSA in obese adults – the first weight loss drug with a specific indication for the treatment of sleep apnea.
Meanwhile, Cambridge, Massachusetts-based startup Apnimed has developed a night pill that targets neuromuscular pathways that influence upper respiratory tract tone. Instead of mechanically opening the airways, the drug aims to biologically stabilize them.
“For a long time, OSA was understood primarily as an anatomical problem, so the logical solution was mechanical,” says John Cronin, medical director at Apnimed. As understanding evolved, the question arose: “Could we design a therapy that directly targets the biology of the condition, rather than relying solely on mechanical support?” The company has completed two Phase 3 trials and plans to submit a recent drug application to the FDA this year.
Despite all the innovations, Steier remains pragmatic. “I couldn’t be happier than to find someone who has typical sleep apnea and uses CPAP therapy,” he says. Up-to-date machines automatically adjust the pressure to the resistance of the respiratory tract. “One night can change everything.” The patients return full of energy, telling him that they have their lives back.
Sleep medicine is still a relatively teenage field, and research is just beginning to reveal the diversity of the disease. This complexity also underlies efforts to improve the employ of CPAP rather than abandon it.
Amanda Sathyapala, an associate professor at the National Heart and Lung Institute, Imperial College London, led the study, which found that 62 percent of patients did not employ CPAP enough to make a significant impact on their health. Her team studied the psychology of adherence and found that factors such as understanding the risks and confidence in using the device influence long-term employ.
Drawing on behavioral science, she developed CPAP Buddy, an app that offers video-based behavioral therapy, peer support and 24/7 answers to patient questions. The project received £2.2 million from the UK’s Medical Research Council and support from CPAP device manufacturer Fisher & Paykel.
“CPAP will likely be the most effective treatment method that can be used because it allows air to be delivered directly into the airway,” says Sathyapala. CPAP “will always be most effective when a person uses it, so it’s worth trying 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 I haven’t tried the right things,” she says. He adds that using CPAP is no different than “losing weight, quitting smoking, starting a long-term physical activity program – it’s a behavior change.”