By: Robert Mignone, D.O.
At least 25 million adults across the United States suffer from obstructive sleep apnea, a chronic condition that can leave you feeling tired during the day and lead to serious health complications, according to the American Academy of Sleep Medicine.
Moreover, there are many other people with sleep apnea who have not been diagnosed or received treatment.
The Sleep Center at Penn Medicine Princeton Medical Center (PMC) provides comprehensive care for sleep disorders and now offers Inspire therapy, a surgical procedure to help certain patients gain relief from obstructive sleep apnea.
Fragmented Sleep
Obstructive sleep apnea occurs when the muscles relax during sleep, causing the soft tissue in the back of the throat to collapse and block the upper airway.
When this happens, it limits the amount of air that reaches your lungs and deprives your brain and body of oxygen. In response, your brain alerts your body, causing you to wake up briefly so that you can breath normal again.
These interruptions in sleep, which can occur multiple times throughout the night, can cause you to feel sleepy during the day and can increase the risk for high blood pressure, heart disease, type 2 diabetes, stroke, cancer and depression.
Loud and Frequent Snoring
The most common sign of obstructive sleep apnea is loud and frequent snoring. However, not everyone who snores has sleep apnea. Snoring is likely to be a sign of sleep apnea when it is followed by periods of silence when airflow is reduced or blocked.
Additionally, people with sleep apnea will often make choking, snorting or gasping sounds when their airway reopens. Other symptoms of sleep apnea include:
- Daytime sleepiness or fatigue
- Unrefreshing sleep
- Insomnia
- Morning headaches
- Waking during the night to go to the bathroom
- Difficulty concentrating
- Memory loss
- Decreased sexual desire
- Irritability
Though sleep apnea can occur in men and women who are a healthy weight, the most common risk factor is being overweight or obese. Middle-aged and older men as well as post-menopausal women are also at greater risk, as are people with large neck sizes. Additionally, people with a family history of sleep apnea are also more likely to develop the condition.
If you experience signs of sleep apnea, talk to your doctor. He or she will likely refer you to a sleep specialist for a correct diagnosis and appropriate treatment.
New Treatment Option
The first step in treating obstructive sleep apnea is diagnosis through a sleep study that charts vital signs such as brain waves, heartbeat and breathing. Typically, studies are performed during an overnight stay at the Sleep Center at PMC. However, home sleep studies are also available for individuals who are unable to spend the night at the Sleep Center.
Once sleep apnea is diagnosed, there is a range of options for treatment depending on the severity.
For patients with mild sleep apnea, losing weight can help relieve the condition as can changing sleep position. It is recommended that patients with sleep apnea sleep on their side rather than their back and raise the head of the bed to reduce symptoms.
For moderate to severe sleep apnea, continuous positive airway pressure (CPAP) remains the standard treatment to keep the airways open at night. Oral appliances similar to mouth guards are also available to help reposition the jaw and keep the airways open during sleep.
Some patients, however, receive little benefit from CPAP and other non-invasive treatment approaches. In those cases, they may be candidates for a new surgical procedure to treat sleep apnea.
Known as Inspire therapy, the procedure involves surgically implanting a neurotransmitter (generator), a breathing sensor lead and stimulation lead via small incisions in the neck and chest. The transmitter and leads sense breathing patterns and deliver mild stimulation to maintain an open airway and promote regular breathing.
Put another way, the transmitter and leads function like a pacemaker, but for sleep apnea instead of cardiac issues.
The procedure is typically performed on an outpatient basis under general anesthesia. For some patients, an overnight stay may be required. During a follow-up visit, the system is activated and personalized to the patient, who then controls the system with a handheld remote, turning it on before bed and off after waking.
Appropriate candidates for the procedure are:
- Diagnosed with moderate to severe obstructive sleep apnea
- Unable to use a CPAP or derive a consistent benefit from it
- Age 23 and older
- Not significantly overweight (BMI of 32 or less)
The FDA approved the procedure in 2014. Clinical trials, which began at 22 hospitals in the United States and Europe in 2010, determined the procedure is safe and effective. Further, research showed that Inspire results in a 79 percent decrease in patients’ sleep apnea and hypopnea events during sleep. Inspire reduced daytime sleepiness, improved daytime functioning and resulted in soft or no snoring for most patients.
Inspire therapy is part of the comprehensive care for sleep disorders, including obstructive sleep apnea, through PMC and its Sleep Center, which is fully accredited by the American Academy of Sleep Medicine, a professional organization dedicated to assuring quality care for patients with sleep disorders, advancement of research, and public and professional education.
To learn more about Inspire therapy for sleep apnea, call 888-742-7496 or 609-436-5740 or visit princetonhcs.org/sleepcenter.
Robert Mignone, D.O. is a board certified otolaryngologist and medical director of the Sleep Surgical Program at PMC.