Can Losing 20 Pounds Cure Sleep Apnea?
This page is general information. It is not medical advice. Only your doctor and a sleep study can tell you whether your sleep apnea has improved or gone away. Do not stop or change CPAP or any other treatment on your own. If you have chest pain, signs of a stroke or severe trouble breathing, call 911.
For some people, yes. For most, 20 pounds makes sleep apnea milder but does not make it go away. In a one year trial of 264 adults with obesity and type 2 diabetes, the weight loss group lost about 24 pounds on average, and 13.6 percent of them had no sleep apnea left on their next sleep study (Foster and others, 2009). Only a doctor and a new sleep study can tell you which group you are in.
The short version.
- Twenty pounds is a big change at 180 pounds and a small one at 320. Think in percent of your body weight, not pounds.
- In a large Wisconsin study, a 10 percent weight loss went with about a 26 percent drop in breathing pauses per hour, on average.
- Weight loss works best when sleep apnea is mild to start with and the weight loss is large.
- Since December 20, 2024 one weight loss drug, Zepbound, is FDA approved for moderate to severe sleep apnea in adults with obesity.
- Keep using your treatment until a repeat sleep study and your doctor say otherwise.
What Cure Means on a Sleep Study
Sleep apnea is scored by a number called the AHI, the apnea hypopnea index. It counts how many times per hour your breathing stops or gets very shallow while you sleep. A higher number means worse sleep apnea.
When doctors say sleep apnea is gone, they mean the AHI has dropped below 5 events an hour. That is the line the Sleep AHEAD trial used for what it called remission (Foster and others, 2009). An AHI of 15 or more is moderate to severe, the line used in the Wisconsin study below (Peppard and others, 2000).
So the honest question is not did I lose enough. It is where did my AHI start, and where is it now. You cannot feel that number. You can only measure it.
Do the Math for Your Own Body
Most pages answer this question as if everyone weighs the same. They do not. The research tracks weight loss as a percent of body weight, and 20 pounds is a very different percent for different people.
| Starting weight | 20 pounds is |
|---|---|
| 180 pounds | 11 percent |
| 200 pounds | 10 percent |
| 240 pounds | 8 percent |
| 280 pounds | 7 percent |
| 320 pounds | 6 percent |
Why does the percent matter? The Wisconsin Sleep Cohort followed 690 working adults and tested them twice, four years apart. Compared with people whose weight stayed the same, a 10 percent weight loss predicted about a 26 percent drop in AHI. A 10 percent weight gain predicted about a 32 percent rise (Peppard and others, 2000).
A worked example, not a promise. Say you weigh 200 pounds and your AHI is 30. Losing 20 pounds is 10 percent. If you matched the study average, a 26 percent drop would take your AHI to about 22. That is better, but still moderate. Now say your AHI is 8. The same average drop lands near 6. That is close to the line, and some people would cross it. This is why people with mild sleep apnea have the best odds.
Those are averages from a group. Your own airway may respond more or less. Only a repeat test shows your number.
What the Weight Loss Trials Actually Found
We read the abstracts of the main trials ourselves. Here is each one in plain words, with the effect size the authors reported.
| Study | Who was in it | Weight lost | What happened to sleep apnea |
|---|---|---|---|
| Wisconsin Sleep Cohort, JAMA, 2000 | 690 working adults, tested 4 years apart | Tracked natural weight change | Each 10 percent loss went with about a 26 percent lower AHI |
| Finnish diet trial, 2009 | 72 overweight adults with mild sleep apnea | About 23.6 pounds (10.7 kg) with a very low calorie diet and coaching | Odds of still having mild sleep apnea were much lower than in the control group after one year |
| Sleep AHEAD, 2009 | 264 adults with obesity and type 2 diabetes, average AHI 23 | About 24 pounds (10.8 kg) vs about 1 pound in the control group | AHI fell 9.7 more events an hour than in the control group. Remission in 13.6 percent vs 3.5 percent |
| SURMOUNT-OSA, 2024 | Adults with obesity and moderate to severe sleep apnea, average AHI about 50 | About 18 to 20 percent of body weight on tirzepatide | AHI fell about 25 to 29 events an hour, vs about 5 on placebo |
Look at the middle two rows. Those trials got people to lose about 20 to 25 pounds over a year. Sleep apnea got clearly better on average. But in Sleep AHEAD, roughly 6 out of 7 people in the weight loss group still had some sleep apnea at the end (full text). The authors also found that starting AHI and the amount of weight lost were the strongest predictors of change, and people who lost 10 kg, about 22 pounds, or more saw the biggest drops.
The Finnish trial is the most hopeful one for a 20 pound goal. It only took people with mild sleep apnea. The authors called the diet program an effective treatment for the majority of those patients (Tuomilehto and others, 2009).
Why 20 Pounds Fixes It for Some People and Not Others
Extra weight is the top risk factor, but it is not the only one. The American Academy of Sleep Medicine says plainly that losing weight is no guarantee your sleep apnea will go away, though it may help (AASM Sleep Education). It explains that overweight people often have extra tissue in the throat that can block the airway. Losing weight can shrink that.
What weight loss cannot change is how you are built. NHLBI lists large tonsils, a large tongue or neck, and the size and shape of your skull, face and upper airway among the things that can narrow the airway (NHLBI). Those can keep sleep apnea going after weight loss. Our post on whether sleep apnea can go away covers those other causes.
Put together, you have the best shot at 20 pounds being enough when
- your sleep apnea is mild to start with,
- it started or got worse when you gained weight,
- 20 pounds is a large share of your weight, around 10 percent or more,
- and you keep the weight off.
The American Thoracic Society patient sheet says losing as little as 5 to 10 percent of body weight can improve or resolve sleep apnea in people whose sleep apnea comes from extra weight (ATS, 2020). Note the words improve or resolve. Both happen. Improve is more common.
How People Actually Lose the Weight
The American Thoracic Society guideline makes a strong recommendation for a full lifestyle program for overweight or obese adults with sleep apnea. That means three parts together, a lower calorie diet, more physical activity and behavior coaching. It says medicine and weight loss surgery fit selected people who need more help (Hudgel and others, 2018).
Exercise alone is not the answer. The ATS patient sheet says studies in people with sleep apnea found exercise alone gave little to no improvement in weight or sleep apnea severity. It has to go with a better diet (ATS, 2020). The same sheet suggests a goal of 1 to 2 pounds a week. At that pace, 20 pounds takes about 10 to 20 weeks.
Talk to your doctor before you start any weight loss plan, more so if you have diabetes or heart disease.
What About Zepbound and Other Weight Loss Shots?
On December 20, 2024, the FDA approved Zepbound (tirzepatide) for moderate to severe obstructive sleep apnea in adults with obesity. It is meant to be used with a lower calorie diet and more activity (FDA). NHLBI also notes the approval and warns the medicine may cause serious side effects in some cases (NHLBI).
The approval came from two 52 week trials called SURMOUNT-OSA. People on tirzepatide lost about 18 to 20 percent of their body weight. Their AHI fell by 25.3 events an hour in one trial and 29.3 in the other. Placebo groups fell by about 5. About 42 to 50 percent of people on the drug ended with an AHI under 5, or an AHI of 5 to 14 without daytime sleepiness, compared with about 14 to 16 percent on placebo (Malhotra and others, 2024). The trials were paid for by the drug's maker, Eli Lilly.
Two things to notice. First, that weight loss is about twice the 10 percent that 20 pounds is for a 200 pound person. Second, even with that much weight off, many people still had sleep apnea. The FDA lists side effects such as nausea, diarrhea and vomiting, and warnings that include thyroid C cell tumors seen in rats. Whether this drug fits you, and whether your plan covers it, is a question for your doctor and your insurer.
Lost the Weight? Here Is How to Find Out Where You Stand
Feeling better is a good sign. It is not proof. Many people feel better because their treatment is working, not because their sleep apnea is gone. Here is a plan to bring to your doctor.
- Keep using CPAP or your mouth guard. Do not stop because you feel fine or lost weight. That call belongs to your doctor.
- Write down your numbers. Your starting weight, your weight now, and the AHI from your first sleep study.
- Note any changes. Less snoring your partner noticed, less daytime sleepiness, new medicines.
- Ask about a repeat sleep study. The ATS patient sheet says to have a repeat sleep study after you lose the weight, and to work with your provider on when (ATS, 2020). AASM says a doctor can use an in lab study or a home sleep apnea test (AASM).
- Compare the two results with your doctor. If your AHI has dropped enough, your doctor may change or stop your treatment. If not, you still got healthier, and your treatment may get easier.
Our guide to a home sleep test or a night in the lab explains the two kinds of test. Our post on what to expect at a sleep study walks through the night itself.
Finding a Sleep Doctor for the Retest
If you need a sleep specialist to order and read your repeat study, our directory lists sleep apnea providers by state and city across Ohio, Michigan, Indiana and Kentucky, and the lookup lets you search by name or place. A listing is not a referral, and we do not give medical advice.
Common Questions
How much weight do you need to lose to get rid of sleep apnea?
There is no single number. The American Thoracic Society says losing as little as 5 to 10 percent of body weight can improve or resolve sleep apnea caused by extra weight. People with mild sleep apnea and larger weight loss have the best odds. Only a repeat sleep study shows whether yours is gone.
Can I stop using CPAP if I lose 20 pounds?
Not on your own. Many people still have sleep apnea after losing 20 pounds, even if they feel better. Keep using CPAP and ask your doctor about a repeat sleep study. Your doctor decides if treatment can change.
Can gaining 20 pounds cause sleep apnea?
It can raise the risk. In the Wisconsin Sleep Cohort, a 10 percent weight gain predicted about a 32 percent rise in AHI and about six times the odds of developing moderate to severe sleep apnea.
Does exercise alone help sleep apnea?
Not much by itself. The American Thoracic Society says studies found exercise alone gave little to no improvement in weight or sleep apnea severity. It works best with a lower calorie diet and coaching.
Is Zepbound approved for sleep apnea?
Yes. On December 20, 2024 the FDA approved Zepbound for moderate to severe obstructive sleep apnea in adults with obesity, used with a lower calorie diet and more activity. Ask your doctor if it fits you and your insurer if it is covered.
Keep Reading
- Is sleep apnea curable
- Sleep apnea treatment options explained
- Home sleep test or a night in the lab
- Find a provider with our lookup
- Sleep apnea providers by state
Sources
- Peppard and others, a long term study of weight change and sleep disordered breathing, JAMA, 2000 (PubMed)
- Foster and others, the Sleep AHEAD study, Archives of Internal Medicine, 2009 (PubMed)
- Sleep AHEAD full text (PubMed Central)
- Tuomilehto and others, Lifestyle intervention with weight reduction in mild obstructive sleep apnea, 2009 (PubMed)
- Malhotra and others, Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity, NEJM, 2024 (PubMed)
- SURMOUNT-OSA full text (PubMed Central)
- Hudgel and others, The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea, ATS guideline, 2018 (PubMed)
- American Thoracic Society, Weight Loss and Sleep Apnea, patient sheet, 2020
- FDA, FDA Approves First Medication for Obstructive Sleep Apnea, December 20, 2024
- NHLBI, Sleep Apnea Treatment
- NHLBI, Sleep Apnea Causes and Risk Factors
- American Academy of Sleep Medicine, Obstructive Sleep Apnea, Sleep Education
NightWells publishes information, not medical advice. Nothing here replaces being seen by a clinician who can examine you.
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