For those who don’t enjoy sleeping with what looks like the equivalent of a MiG fighter pilot mask, there’s possible relief with new medication approved to treat sleep apnea.

Sleep apnea is a disorder in which the airway either closes off completely or becomes so narrowed that breathing repeatedly stops and starts during sleep, often causing brief awakenings that disrupt restful sleep. A common treatment includes wearing a CPAP, or continuous positive airway pressure, mask to deliver air pressure into the airways to keep them open.

But now there’s a new option. The FDA recently approved tirzepatide (Zepbound) for adults with obesity and moderate-to-severe obstructive sleep apnea (OSA). The drug is typically prescribed for type 2 diabetes and is among the class of drugs known as GLP-1 receptor agonists, meaning they work on hormones that control appetite and insulin levels and can help promote weight loss.

Sarah Zallek, MD, a neurologist and vice president and chief medical officer for OSF HealthCare St. Joseph Medical Center in Bloomington, Illinois, is also medical director of OSF Sleep in Peoria. Dr. Zallek calls the approval of Zepbound for treatment of sleep apnea a significant and important development. She points out there have been few new developments for the treatment of OSA, and this is the first medication.

Could this let some people ditch their CPAP machines? Dr. Zallek says if their sleep apnea is caused by obesity, potentially yes.

“So, if you’re wearing CPAP and you have weight-related sleep apnea, weight loss is a great idea. The approval of Zepbound (tirzepatide) is a new avenue for us to look for treating overweight or obesity and to treat sleep apnea.”

Dr. Zallek says for some people with weight-related apnea, losing about 10% or more of overall body weight can significantly reduce or eliminate the sleeping disorder.  However, she warns that with GLP-1 agonists, it’s important to maintain a healthy diet and exercise because the medication carries significant risk of muscle loss.

 “It's really important for people who are using GLP-1s to maintain adequate nutritional intake, particularly with high quality protein, and maintain exercise, so that they get muscle resistance exercise and build and maintain muscle.”

Treatment of sleep apnea with CPAP is still the gold standard. Dr. Zallek says if switching to Zepbound to address sleep apnea, a doctor should continue to monitor weight loss and then test again to see if a person’s airway has opened up.

“Keep using that treatment until you successfully lose weight and get rid of the sleep apnea. It's not time to stop the CPAP and switch to Zepbound, for example. To treat sleep apnea, it's time to continue what you're doing, approach weight loss and then see if the sleep apnea has resolved.”

Studies have shown that people who have lost weight with GLP-1 drugs, tend to regain the weight once they quit taking the medication. This is because GLP-1s mimic natural hormones that regulate blood sugar, slow digestion, and make you feel full. So, Dr. Zallek stresses the need for lifestyle changes regardless of the approach to treating sleep apnea.

Dr. Zallek is board certified in Lifestyle Medicine, which means she incorporates therapeutic lifestyle interventions to treat and reverse chronic conditions. That includes a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections.

It’s possible other GLP-1 drug makers for Wegovy, Ozempic or Mounjaro will seek similar approval for use as treatment of sleep apnea. But, Dr. Zallek says people also need to talk with their provider and weigh the side effects with the benefits. Some of the side effects of the GLP1s include nausea, vomiting, diarrhea, delayed gastric emptying, low blood sugar, fatigue, and more serious complications such as gallstone disease, and pancreatitis.

As they say in the ads, “Ask your doctor if it's right for you."

Dr. Sarah Zallek

Most of us like the idea of turning back time, figuratively … but not so much literally. Some people relish the idea of turning back clocks one hour, marking an end to Daylight Saving Time (DST) which officially happens at 2 a.m. this Sunday. But, if given the option, a 2020 study reveals a majority of adults (66%) support the elimination of seasonal time changes in support of a national, fixed, year-round time. The American Association of Sleep Medicine (AASM) study included more than 2,000 US adults.

The ending of daylight saving time means that the sun will be out earlier in the morning and the evenings will get darker sooner. OSF HealthCare Clinical Director of Sleep Medicine Dr. Kaninika Verma says research shows most people don’t make good use of the extra hour of sleep in the fall, but simply stay up later and watch a little more TV, play on their computers, or in some cases drink more alcohol because bars stay open later.

She says light has a huge impact on our body's circadian rhythm, otherwise known as a sleep/wake cycle. So when that changes, it throws the body out of sync. When we "fall back," Dr. Verma says stress hormones start booting up the body's systems hours in advance of waking and when the clock changes, they are out of sync.

"You've got more stress hormones than what you're used to for that time period because you're starting to wake up or your alarm clock is going off when you think you should be sleeping a little bit longer. So that's why we see that bump in the number of heart attacks around that time," she says.  

In fact, many scientists see an increased risk for heart attack and stroke during the days following a time change. In addition, studies show that traffic fatalities have increased as much as six percent in the first few days following the return to daylight saving time in the spring. Because of this, the AASM recommends federal legislation be enacted to adopt a permanent standard time.

Meanwhile, Dr. Verma suggests preparing for the time change by going to bed 15 minutes later each of the four days leading up to the change.

"If you want to switch your clock, do it in 15 minute increments and don't expect it to happen overnight. You can't just go to bed an hour ahead and expect it to work. It's just not going to happen," she advises.

So, if you go to bed at 9 p.m., she suggests starting to go at 9:15 p.m., then 9:30 p.m., then 9:45 p.m. and finally 10 p.m. which will then be your usual 9 p.m. sleep time when you set your clock back over the weekend.

Dr. Verma says sleep is not a luxury. It is a vital sign and not getting enough sleep, or getting poor-quality sleep, increases the risk of high blood pressure, heart disease, obesity, and diabetes. Sleep deprivation also hurts the body's immune system so you can get sick more easily.

At Home Sleep Study

If you've been hesitant to do anything about your trouble sleeping, this might be an incentive. Dr. Verma says technology has advanced so many people can do an at-home sleep study to determine if a more advanced study in a sleep lab is needed. A patient who meets certain criteria can take equipment home to record critical measurements.

"It's looking at air flow from the nose; how much air you're moving. Bands around the chest to see if you're moving. An oximeter to see what oxygen levels are and also there is a snore mic so we know if someone's storing, we can hear the snoring too."

Regardless of the twice a year movement of the clock by one hour, lots of people have trouble getting to sleep or staying asleep. Between 50 and 70 million U.S. adults have some type of sleep or wakefulness disorder and the impact is affecting people’s quality of life.

Results from the world’s largest sleep study to date, involving 40,000 people from around the globe, found participants who slept four hours or less performed cognitively as if they were almost nine years older. Participants' reasoning and verbal abilities were two of the actions most strongly affected by sleep.

In addition to sleep apnea, OSF HealthCare Sleep Medicine doctors can evaluate conditions characterized by disturbances of sleep patterns and conditions such as restless leg syndrome or narcolepsy that can cause sleep abnormalities.

Many sleep disorders go undiagnosed and Dr. Verma points out that can affect not only your health, but personal relationships impacted by changes in mood, motivation and productivity. Learn more about sleep disorders to determine whether you should discuss sleep challenges with your primary care provider.

Video clips

The popularity of entertainment app TikTok continues to skyrocket. It has been installed on devices over three billion times worldwide, and has surpassed Google and Facebook as the world’s most popular web domain.

The video sharing app seems to have something for everyone – from makeup trends and relationship advice to comedy sketches and life hacks. In fact, the company’s tagline in TV commercials is even, “TikTok taught me.” While recipes, fashion finds or cleaning hacks found on the app can certainly provide a smile, improve your life or save you time – sometimes the advice from TikTok influencers can fall flat, especially when that advice is medical in nature.

One of the latest TikTok trends that has medical professionals concerned is mouth taping, which is being touted as a sleep treatment. It is exactly what it sounds like; people are taping their mouths closed before bed. Dr. Kaninika Verma, the clinical sleep director for OSF HealthCare, explains.

“So this started with this TikTok challenge, where people would tape their mouth before they went to sleep,” she says. “They thought they were sleeping better because it prevented them from opening their mouth, and somehow or another made them sleep better because they were forced to breathe through their nose.”

But before you reach for that tape, be aware that many medical providers, including Dr. Verma, believe the risks of mouth taping far outweigh the benefits. Taping one’s mouth shut while sleeping could exacerbate breathing problems, worsen some risk factors of sleep apnea or simply cause sleep disruption.

“Most of us physicians when we when we first saw this, we thought this was a joke. But clearly it's not. You can buy these mouth tapes on Amazon and CVS, and all these places. So it's clearly a real thing, but it is not safe at all,” Dr. Verma warns.

Mouth taping enthusiasts claim that the practice helps with dry mouth, bad breath, oral hygiene and snoring prevention. Dr. Verma disagrees, and says taping your mouth shut to improve shuteye is not only dangerous, but could mask the root cause of a sleep problem.

“So the bigger question is, why are you using that mouth tape? Is it because you're snoring? Is it because you're a mouth breather? Is it because your nasal passages are blocked, or what is going on that's making you do this? So there needs to be a bigger question that needs to be asked, and to take a deeper dive about that issue with a physician or a trained professional,” says Dr. Verma.

Mouth taping is just the most recent TikTok trend branded as health or wellness advice. Dr. Verma warns that health trends popularized via sites like TikTok can have significant consequences, and any health advice coming from these platforms should be interpreted with caution. When in doubt, ask a professional.

“A lot of these are just fads. There are people doing this for entertainment. So be very cautious and very careful what you believe. If you have an issue – any health care issue – please reach out to your health care professional. You know, most of us – we've trained our whole lives to do this. We've dedicated our lives to this.”

Sleep disorders are serious medical conditions. Running on a sleep deficit compromises your ability to learn, hinders the immune system, and may raise your risk for other health conditions.

If you think you are having issues with snoring or mouth breathing you should consult your doctor or a sleep specialist. Visit osfhealthcare.org/sleep to learn more about OSF Sleep, including programs and services available.

Interview Clips - Dr. Kaninika Verma