An estimated 18 million Americans live with sleep apnea, often using a continuous positive airway pressure (CPAP) machine to get a better night's sleep. But now there's a novel approach for treating sleep apnea – and we're the only facility in Kansas, Missouri, Nebraska, Oklahoma or Arkansas to offer it.
Inspire is an innovative way to treat patients who find the CPAP machine difficult or impossible to use. We're excited to give patients an alternative for their obstructive sleep apnea. It's an implantable device that demonstrates just how far treatment in this field has come. – Suzanne Stevens, MDSleep medicine specialist
What is sleep apnea?
Obstructive sleep apnea occurs when breathing is repeatedly stopped and started due to a narrowed or closed airway. As the throat muscles relax, the airway closes, limiting the oxygen intake to the lungs. The brain senses a drop in the oxygen levels and arouses or wakes the sleeper, causing the airway to open. Patients often awake with a gasp or snort, with the pattern occurring 5-30 times an hour all night long.
"We see people who are exhausted, even though they were in bed all night," says Dr. Stevens. In addition to daytime tiredness and irritability, people with sleep apnea are at higher risk for stroke, type 2 diabetes, metabolic syndrome and liver problems. Other complications can include memory problems, mood disorders, heart attacks and heart rhythm disorders.
"The gold standard treatment is the CPAP machine," says Dr. Stevens. "But it doesn't work for everyone. It can be inconvenient and uncomfortable. In addition, there is maintenance and it is not aesthetically pleasing."
The Inspire device monitors your breathing while you sleep and opens your airway. It is for those with moderate sleep apnea who are 22 years or older and not significantly obese. You control the device, which is surgically implanted, with a handheld remote.
How Inspire works
Those who qualify for Inspire have a minor outpatient procedure. The physician implants the small nerve stimulator device and battery pack under the skin in the chest. One electronic lead, or wire, connects the device to the nerve that stimulates the tongue. The other lead connects to a space in the ribs near the diaphragm. Once connected, the device monitors the patient's breathing. The device sends an impulse to the tongue during every breath while sleeping, keeping the airway open for oxygen.
After the procedure, patients wait for 30 days to heal. Then they return to the physician, who activates the device. Once activated, patients can use a handheld remote control device to turn Inspire on before they go to sleep each night. They can also pause, and turn it off in the morning. The battery pack is designed to last 7-10 years, much like a pacemaker.
"With only the remote to keep track of, this treatment is so much more convenient than the CPAP machine," Dr. Stevens says. "There are no hoses or masks to clean or maintain. It's not uncomfortable or unappealing to wear. It's also much better for patients who travel frequently."
Dr. Suzanne Stevens: We have a new technology, which is very exciting, called the hypoglossal nerve stimulator that is offering an alternative to the CPAP therapy for patients that can't tolerate CPAP.
Dr. Suzanne Stevens: Well, if you've tried the machine and have difficulty with compliance or tolerating the machine, some people go through many masks and can't find the right mask to make a seal for the air to be delivered correctly, those are people that would benefit greatly from this device.
Dr. Chris Larsen: We have three year data now following patients that have had the implant, and 90% of patients are still using the implant three years later. Whereas most patients that use CPAP or the statistics on CPAP, there's about a 40% to 50% compliance, meaning that 60% of patients don't use the CPAP adequately to treat their disease.
Dr. Chris Larsen: This device stimulates the nerve that moves the back of the pallet or the back of the throat and the back of the tongue forward to relieve that obstruction when a patient is sleeping.
Dr. Chris Larsen: The device is implanted in a pocket below the skin, and then you can see these two places where the electrodes can come in. One is tunneled down below the skin to between the ribs, and the other one is tunneled up into the neck and wraps around the hypoglossal nerve.
Dr. Chris Larsen: It's got a remote control so patients can turn it on before they go to bed, and then it's also programmed to start working at X minutes past turning it on. So depending how long it takes the patient typically to fall asleep, it's programmed to start working at that interval.
Ron Hofmann: Typically I was waking up about two o'clock in the morning and staying awake until four or five o'clock with all sorts of problems or just bizarre things to think about while you're laying there with nothing to do.
Ron Hofmann: It was getting really, really bad, and I said, "I don't know what else to do, and I'm going to give the CPAP one more chance." And I found a doctor here that took the machine in and said, "You know, this machine is not programmed right for what you're going through," and everything else. And we got that set up, and I still couldn't get used to the mask. And then I was referred to this program and said they may be able to help you. I was elated that there was something out there because I had no other choice.
This was just a godsend that we found out about this. Right place, right time. And being at KU and working with the doctors here, the best.
New treatment, positive results
Approximately 1,000 devices have been implanted in patients throughout the world so far, and the data is very promising. "Over 36 months, the data indicate this device eliminates sleep apnea or significantly reduces snoring and daytime sleepiness," says Dr. Stevens. "With our interdisciplinary approach involving ear, nose and throat professionals and sleep specialists to treat these disorders, we are one of the few facilities that can offer this high level of treatment to our patients."
Frequently asked questions
How does Inspire therapy work?
Inspire therapy is an implantable treatment option for people with obstructive sleep apnea who are unable to use or get consistent benefit from continuous positive airway pressure (CPAP). While you're sleeping, Inspire monitors every breath you take. Based on your unique breathing patterns, the system delivers mild stimulation to the hypoglossal nerve, which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep. Inspire is controlled by a small handheld remote. The remote allows you to turn Inspire therapy on before bed and off when you wake up, adjust stimulation strength and pause during the night if needed.
Who is eligible for Inspire therapy?
You might be a candidate for Inspire therapy if:
- You have moderate to severe obstructive sleep apnea (AHI of 20-65).
- You are unable to use or get consistent benefit from CPAP.
- You are not significantly overweight.
- You are over the age of 22.
An Inspire therapy-trained doctor will also evaluate your overall health status and perform a physical examination of your airway to determine if Inspire therapy might be a suitable CPAP alternative for you.
How much will I have to pay out of pocket for this procedure?
Every insurance plan is different. Generally, the copay costs for Inspire therapy should be similar to copays for other surgical procedures. Some patients may have secondary benefits or supplemental coverage that will offset their copay. Your Inspire therapy-trained doctor can help you through this process.
Do I need to get approval from my insurance before my first visit?
No, you do not need to have approval from your insurance company for the therapy prior to your first clinic visit. Your medical care team will work together to determine if Inspire therapy might be right for you. If you qualify for Inspire therapy, your Inspire therapy-trained doctor will work with you, the hospital and your insurance company for approval.
What does the surgical procedure involve?
The Inspire system is typically implanted during an outpatient procedure under general anesthetic. The system is placed under the skin of the neck and chest through three small incisions. Specifics and any risks should be discussed with your doctor.
How long will the battery last on the Inspire generator?
Most batteries last 8-11 years. The generator battery cannot be recharged, so once the battery runs out, you will need to have the generator replaced. This is a very common procedure with many implants.
What does the stimulation feel like?
You should feel a mild sensation from the stimulation. Typically, patients feel a tingling sensation or mild contraction in their tongue muscles. The stimulation should not be painful or uncomfortable and the level is adjustable. Your Inspire therapy-trained doctor will make any adjustments as needed.
Will Inspire therapy help with snoring?
Data from the Inspire clinical trial showed that 85% of bed partners reported either no snoring or soft snoring by their partners using Inspire therapy.
Are there medical imaging technologies that should be avoided once I have my procedure?
Once you have Inspire therapy, you should not undergo an MRI. The magnetic fields of MRI scanners may cause harm to components of the Inspire system and may also cause tissue damage. It is best to discuss your options with your doctor if an MRI is suggested. Alternative imaging technologies such as CT, ultrasound or others may be most suitable for you.
Is it safe to use a microwave oven and common household appliances after my procedure?
Yes, you may use a microwave oven and any common household appliances that do not emit strong magnetic fields. If you have concerns, consult with your Inspire therapy-trained doctor.
Will Inspire limit my activities?
Generally, Inspire will not limit normal daily activities. However, you should ask your Inspire therapy-trained doctor about any activities that are particularly strenuous, like weight lifting, or those that entail a large or unpredictable range of motion in your upper body and/or arms, such as working as a firefighter.