Inspire therapy—a hypoglossal nerve stimulation implant—has been FDA-approved for more than 11 years, with over 100,000 patients treated across the US, Europe, and Asia. Ruchir Patel, Inspire’s senior medical director, says data show reductions in daytime sleepiness, a 79 percent drop in sleep apnea severity, and a 90 percent reduction in snoring. Early US data report average nightly usage 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 approaches are also emerging. In 2024, the US Food and Drug Administration approved Zepbound (tirzepatide) for moderate to severe OSA in adults with obesity—the first weight-loss drug to carry a specific sleep apnea indication.
Meanwhile, Cambridge, Massachusetts–based startup Apnimed has developed a nightly pill targeting neuromuscular pathways that influence upper airway tone. Rather than mechanically splinting the airway open, the drug aims to stabilize it biologically.
“For a long time, OSA was understood primarily as an anatomical problem, so the logical solution was mechanical,” says John Cronin, chief medical officer at Apnimed. As understanding evolved, the question became: “Could we design a therapy that targets the biology of the condition directly, rather than relying solely on mechanical support?” The company has completed two phase three trials and plans to submit a New Drug Application to the FDA this year.
For all the innovation, Steier remains pragmatic. “I couldn’t be happier than finding someone who’s got typical sleep apnea and gets CPAP therapy,” he says. Modern machines automatically adjust pressure to airway resistance. “A single night can make all the difference.” Patients return reenergized, telling him they’ve got their lives back.
Sleep medicine is still relatively young, and research is only beginning to capture the diversity of the condition. That complexity also underpins efforts to improve CPAP use rather than abandon it.
Amanda Sathyapala, an associate professor at Imperial College London’s National Heart and Lung Institute, led the research showing 62 percent of patients were not using CPAP enough to make a meaningful health impact. Her team has studied the psychology of adherence, finding that factors such as understanding risk and confidence using the device shape long-term use.
Drawing on behavioral science, she developed CPAP Buddy, an app offering video-based behavioral therapy, peer support, and round-the-clock answers to patient questions. The project has received £2.2 million from the UK’s Medical Research Council, alongside backing from CPAP manufacturer Fisher & Paykel.
“CPAP is likely to be the most effective treatment that you can get because it’s giving air directly into the airway,” Sathyapala says. CPAP “is always going to be the most efficacious once the person’s using it, therefore it’s worth trying to get people to use it.”
For her, the problem is not the machine but behavior. “I don’t like to give up if we haven’t tried the right things,” she says. Using CPAP, she adds, is no different from “losing weight, stopping smoking, starting up a long-term physical activity program—it’s a behavior change.”
