treatment for sleep apnea

Sleep Apnea Treatment

More than 18 million Americans have sleep apnea. Depending on the degree of severity, OSA can be a potentially life-threatening condition. Recent research shows that a person with poorly managed sleep apnea is at increased risk for heart attack, stroke, weight gain, high blood pressure and heart failure. While CPAP is often successful, studies show that roughly half of all patients that start CPAP eventually become non-compliant.

Types of Sleep Apnea

There are three main types of sleep apnea, the most common of which is called obstructive sleep apnea (OSA).

  1. Obstructive sleep apnea - breathing repeatedly stops and starts due to the throat muscles periodically relaxing.
  2. Central sleep apnea - the brain doesn't send the necessary signals to the the muscles that control breathing, allowing for lapses in breathing.
  3. Complex sleep apnea syndrome - this is a combination of the first two types of sleep apnea, also known as treatment-emergent central sleep apnea.

Symptoms of Sleep Apnea

How do you know if you have sleep apnea? Here are the most common symptoms to watch for:

  • Loud and chronic (ongoing) snoring that may include pauses, choking or gasping
  • Snoring that worsens over time – happens more often and grows louder
  • Fighting sleepiness during the day, at work or while driving
  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Feeling irritable, depressed or having mood swings or personality changes
  • Waking up frequently to urinate
  • Dry mouth or sore throat when you wake up

“Sleep apnea is significantly underdiagnosed,” said Dr. David Morris. “Overall, it’s about as common as diabetes, and like diabetes, it’s connected to weight. We used to think about 5 percent of the population had OSA, but with our obesity epidemic, it’s now thought to be about 25 percent.”

Health Risks of Sleep Apnea

A person with sleep apnea literally stops breathing multiple times throughout the night. This puts extreme stress on the body, especially the cardiovascular system. This stress can lead to other health problems and dangerous medical issues over time, such as daytime fatigue, heart problems, high blood pressure, type 2 diabetes, metabolic syndrome, liver problems, complications with medications and general anesthesia from surgery.

Treatment Options for Sleep Apnea at Firelands Center for Sleep Disorders

Continuous Positive Airway Pressure (CPAP)

Continuous positive airway pressure (CPAP) machines use air pressure to create an air cushion at the back of the throat. This allows patients to keep breathing.

The Firelands sleep lab seamlessly coordinates a patient's sleep apnea treatment plan with Firelands Durable Medical Equipment (DME), who works with the patient to fit him/her with a device and teach him/her how to properly use it. The sleep apnea treatment process utilizing CPAP is smooth and simple, and the patient can begin sleeping with the CPAP machine every night, after which the sleep center team has immediate, digital access to the results.

Inspire® Upper Airway Stimulation

For patients who have moderate-to-severe sleep apnea, have either failed or not tolerated CPAP treatment, are free of complete concentric collapse at the palate, do not have certain diseases or conditions that will disqualify them as a candidate, and have a body-mass index (BMI) of 32 or less, Inspire upper airway stimulation can be an alternative sleep apnea treatment.

Inspire therapy is the first implantable device for treating OSA. In contrast to CPAP, Inspire therapy works from inside the body and with a patient’s natural breathing process. The implantable system includes a small generator, a sensing lead and a stimulation lead. Turned on by a handheld remote, it delivers mild stimulation to key airway muscles, which keeps the airway open during sleep. The remote allows you to turn Inspire therapy on before bed and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed.

“In our practice we see many patients who have stopped using or are unable to tolerate CPAP,” said Dr. Morris. “Inspire therapy represents a significant advance in sleep apnea treatment. It is clinically proven to reduce sleep apnea events and also has a high level of patient satisfaction and therapy adherence. We are excited to now offer this promising therapy to sleep apnea patients who struggle with CPAP.

The safety and effectiveness of Inspire therapy has been measured in over  37 peer-reviewed articles. Studies show patients using Inspire therapy  experience significant reductions in sleep apnea events, increased daytime activity levels, and reduced daytime sleepiness. For example, snoring is one of the most common symptoms of sleep apnea. Bed partners were asked to report how intensely their partner snored and if they ever had to leave the room due to snoring both before and after their partner began using Inspire therapy. After four years of use, both snoring and the need to leave the room due to snoring decreased significantly.

Are you a candidate for Inspire upper airway stimulation?

To determine if this minimally invasive surgical sleep apnea treatment is right for you, complete the following steps:

  1. Schedule an initial clinic visit at the Firelands Center for Sleep Disorders for a general physical examination.
  2. Have a sleep study that confirms Apnea Hypopnea Index (AHI) severity. This is determined by the number of sleep apnea events per hour. Sleep studies can be done at home or in the sleep lab at Firelands South Campus.
  3. Have a surgical consultation after referral to the Cleveland Clinic.
  4. Undergo an airway exam so the sleep disorders specialist can check your airway anatomy. The exam will help your doctor find the airway blockage that is causing your sleep apnea.

If you are a candidate for this sleep apnea treatment, you will undergo the outpatient procedure at the Cleveland Clinic and return to Firelands Regional Medical Center for follow-up appointments beginning one week after the procedure. 

During the minimally invasive procedure, the Inspire system is placed under the skin of the neck and chest through three small incisions. Some pain and swelling can be expected at the incision sites for a few days after the procedure, however patients are able to return to normal activities within two weeks, under the direction of a physician.

What is the cost of Inspire upper airway stimulation?

Inspire therapy is being reviewed and approved by insurance providers on a case-by-case basis. As of January 2018, over 230 insurance providers have covered the cost of the procedure, while Medicare is approving Inspire therapy based on medical necessity.

Inspire is also on the Federal Supply Schedule, making it available for active military members, veterans, and their beneficiaries at select VA and military hospitals across the U.S.

The insurance team at Inspire Medical Systems will work with your doctor to submit a request for insurance approval before the procedure. If you are given approval, the surgery will be scheduled. Patients can typically expect to pay the cost of any unmet deductible for the year, along with any required copay or coinsurance fee for a surgery.

Three to four weeks after the implantation, the patient will return to Firelands to activate the device. This is when the doctor will turn on the system for the first time, and walk you through your personal therapy settings and how to use the device. After periodic check-ins via phone, you will return to Firelands after three months to undergo another sleep study and ensure the sleep apnea treatment is working. Patients will usually check in with their doctor one to two times per year moving forward.

Watch the video below to see an animation of the Inspire sleep apnea treatment in action.

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