CPAP alternative is available on Cape Cod
You may have seen the ad.
At a fictitious support group meeting for CPAP users, where the members wear the masks and hoses normally worn only during sleep, a member shows up without his equipment. When challenged by the group leader, he announces he no longer needs the cumbersome gear as he has switched to Inspire®, and just presses a button on a small handheld remote when he’s ready to sleep. The leader insists equipment must be worn as the other members strip off theirs and follow the rebel member out of the meeting to learn more about Inspire®.
Inspire® is an alternative method to treat obstructive sleep apnea, which occurs when the tongue slides backward in the throat during sleep, blocking air from entering the lungs. This triggers the sleeper to partially wake to take a breath. The pattern repeats, causing interrupted sleep.
Sleep apnea can cause daytime sleepiness and fatigue. Untreated, it may result in heart arrhythmia or heart failure, said otolaryngologist Courtney B. Miller, MD, of Cape Cod Ear, Nose and Throat Specialists, in Hyannis. It also can cause loud snoring and gasping during sleep, morning headaches, forgetfulness, anxiety, depression, mood changes, coronary heart disease, high blood pressure, and heart attack, according to the National Institute of Neurological Disorders and Stroke. Treatments may begin with patients being advised to lose weight, stop smoking and avoid alcohol, sedatives and muscle relaxants.
Dr. Miller was trained in the procedure during residency and also by Inspire® representatives in Boston and has been performing surgical implantation of the device at Cape Cod Hospital in Hyannis for about one year. Since September, the number of procedures has increased as people have become aware of the option.
For many years, people who have sleep apnea had been prescribed a CPAP machine, or continuous positive airway pressure. The machine helps sleep apnea sufferers by supplying a constant adjustable flow of air through tubing to a mask that covers the patient’s nose and mouth. Despite being the standard treatment, a substantial number of patients discontinue use or don’t maintain regular use of their CPAP machines. A Sept. 1, 2023, article in BMC Pulmonary Medicine said CPAP users who stick with their machines long-term may be as few as 30 percent.
CPAP as Gold Standard
Despite the TV ad that implies that any CPAP user could switch to the implant, there are restrictions. Patients must have a sleep test showing moderate to severe sleep apnea done within the past two years, Dr. Miller said. They must either:
- Get no benefit from CPAP, or
- Be unable to tolerate using CPAP
“It’s our gold standard,” Dr. Miller said of CPAP. “If you can tolerate it and see benefit, I would not recommend the procedure.”
While the procedure is covered by insurance, providers set maximum BMI (Body Mass Index, an indicator of body fat based on weight and height) limits for eligibility. Medicare and some private insurers cap coverage at a BMI of 35 or less; other insurers have a BMI ceiling of 40, Dr. Miller said. A BMI of 30 or more is considered obese and one of 40 or more is considered severely obese, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Obesity contributes to many health problems, including sleep apnea. Potential patients who exceed those limits may have to lose weight to qualify, said Dr. Miller.
“We always get approval (from insurers) beforehand,” she added.
What To Expect
Implantation of Inspire® is an outpatient procedure that takes about 90 minutes, Dr. Miller said. Prior to scheduling implantation, patients undergo an airway evaluation under sedation to ensure that where their airway collapses when snoring is appropriate for the device. About 5 percent occur in a location where the device would not help, she estimated.
The implant creates pulses of electrical stimulation to airway muscles in the pharynx (lower back of the throat) and tongue, causing the tongue to move forward, which relieves the obstruction and opens their airway. An Inspire® representative is present throughout the surgery, Dr. Miller said. Representatives stay involved post-operatively, as well, for patient education and device programming.
Once she is satisfied the device is properly installed and works well, it is deactivated for a month to allow healing, Dr. Miller said. The device is implanted on the right side of the upper neck, with wires running down under the skin to a generator battery implanted on the right side of the chest, somewhat similar to a cardiac pacemaker. The battery will need to be replaced after about 10 years. The device is operated with a remote control and a phone app to collect and share sleep data and is the first and only device using neurostimulation approved by the FDA, according to the American Academy of Sleep Medicine.
About four months after the operation, another sleep study is done to check on the device’s effectiveness. It can be adjusted to lower the strength of the electrical pulses, if they feel uncomfortable to a patient.
Positive Results
Inspire® is available to qualified patients 18 and older, Dr. Miller said.
According to the Inspire® website, 91 percent of patients find the device superior to CPAP, and see a 79 percent decrease in apneas, while 90 percent of their partners say patients no longer snore or snore softly.
“It’s a really good option for patients with untreated sleep apnea,” Dr. Miller said.
