Treating Sleep Apnea When CPAP Masks Don't Help.

Obstructive sleep apnea (OSA) is a medical condition that occurs when your breathing slows or stops while you sleep. This happens if the tissues in the head and neck collapse and block your airway, causing you to wake up repeatedly throughout the night. These breathing interruptions result in poor sleep, affecting concentration, energy, and overall quality of life. Left untreated over a long period of time, moderate or severe OSA can also lead to heart failure, stroke, and other serious medical conditions. 

Many people are familiar with continuous positive airway pressure (CPAP) masks as the first line of sleep apnea treatment. However, nearly 50 percent of people who try wearing a mask while sleeping can’t tolerate the mask and therefore don’t experience relief. Fortunately, there are CPAP alternatives, including the Inspire device. This FDA-approved implantable device is proven to be effective for over 90 percent of patients, leading to life-changing improvement in sleep quality.

What is the Inspire sleep apnea treatment?

The Inspire implant is a device the size of a pacemaker that stimulates the nerve to the tongue and opens up the airway. By keeping the airway open, breathing remains continuous and patients can get a good night’s rest. Surgery for the Inspire implant involves incisions in the chest and neck. A sensor in the chest monitors when you’re breathing in and out as you sleep, while a stimulator connected to the nerve in your neck delivers subtle signals to the nerves in your tongue to push it forward and prevent obstruction while you breathe.

The entire procedure takes about two to three hours and most patients can go home the same day. While the incisions heal, patients should avoid strenuous activity and heavy lifting for three to four weeks. It’s normal to experience some soreness after the surgery, but the procedure is generally well-tolerated, especially in comparison to other traditional sleep apnea surgeries—and far more effective. 

Around 30 days after surgical placement, patients come back to meet with their sleep physician who will turn on the device and help them adjust the nerve stimulation based on their comfort level. The device is controlled with a remote control that allows you to turn it on before going to sleep and after awakening. You can also delay the start of the stimulation, giving yourself a chance to fall asleep first so you may not even notice the stimulation during your sleep. You can also pause it if you need to get up in the middle of the night.

Your doctor will continue to monitor your sleep progress through regular follow-up visits over the next several months. The device itself is battery operated, and the battery lasts approximately ten years. When the battery needs to be replaced, it involves a simple procedure to swap out the old one for the new one.

Does the Inspire work?

The Inspire implant was introduced in 2010 through a multi-institutional study called the STAR trial. In 2014, published results in the New England Journal of Medicine verified that it’s an effective tool for helping patients who are unable to tolerate the CPAP mask get better sleep. Current studies demonstrate over a 90 percent patient satisfaction rate. Inspire has continued to be widely accepted as a successful, safe option for managing sleep apnea.

Who is a candidate for the Inspire implant?

Sleep apnea treatment should always begin with a conversation with a sleep expert who can help you understand your condition as well as the risks and benefits for each treatment option. The patients that do the best with the Inspire device are those who have tried and exhausted their ability to use or tolerate the CPAP machine.

In addition, other specific criteria for determining candidacy for the Inspire implant includes:

• Over 18 years of age
• Having a documented diagnosis of moderate to severe sleep apnea based on a sleep study (Apnea-Hypopnea Index of 15-65)
• Having a documented history of difficulty tolerating CPAP therapy
• Body-mass index (BMI) or 32 or lower

There are other considerations as well, including the pattern of collapse in your airway. Patients who meet preliminary eligibility for the procedure will undergo a drug-induced sleep endoscopy (DISE), which is a short outpatient procedure used to assess how the throat closes during sleep. This can be a good predictor of whether or not you would benefit from the Inspire implant. 

Thanks to its success rates and widespread adoption, most health insurances now cover the procedure. Check with your insurance company to determine if they will provide standing approval or if you need to submit paperwork for authorization.

Don’t let your sleep suffer.

If you persistently feel like you can’t get a good night’s sleep and feel tired throughout the day, it’s always helpful to talk to a sleep expert to get to the bottom of it. At MedStar Health, our goal is to identify and address the underlying cause leading to your sleep apnea. This allows us to pinpoint the best treatment option that can help you improve your sleep quality at night. And when you sleep better, it can feel like the fog is lifted and you have a renewed zest for life.