No mask, no hose, no noise. Just sleep.

UCHealth first in area to offer alternative treatment for sleep apnea
Dec. 16, 2015

UCHealth is the first health care system  in Colorado and neighboring states to offer an alternative treatment option to people struggling to sleep.

Sleep apnea — a condition in which a person involuntary pauses or stops breathing when asleep — affects about 18 million Americans, according to the National Sleep Foundation.

Here you can see what happens when a person suffers from Obstructive Sleep Apnea, the most common type of sleep apnea. OSA occurs when the throat muscles intermittently relax and block the airway during sleep.

“When you don’t sleep well and you’re not rested, the effect on your awake time is pretty profound,” said Dr. Mark Petrun, whose specialties include sleep medicine. “It affects your concentration, alertness, and ability to get things done.”

Besides wreaking havoc on a person’s daily life, sleep apnea has serious and life-shortening consequences, such as high blood pressure, heart disease and stroke, he added.

The most common treatment for sleep apnea — and until recently, the only option with a fairly high success rate — is the use of continuous positive airway pressure, or CPAP, while a person sleeps.

The CPAP machine supplies constant and steady air pressure through a hose and mask. Although the device is effective in treating sleep apnea more than 90 percent of the time, the number of people actually wearing the device longer than four hours per night drops to about 60 percent, said Cindy Crosby, manager of UCHealth’s Poudre Valley Hospital Sleep Disorder Center.

“Patients with apnea have to wear CPAP every night for the rest of their lives and they’re asking us, ‘What else can I do?’ Oral appliances are effective in treating mild to moderate apnea but this [Inspire therapy] is the first alternative to CPAP that treats moderate to severe apnea and makes sense to people long term,” she said.

Inspire therapy, recently approved by the FDA, provides a person relief without a mask or oral appliance, said Dr. Matthew Robertson, an otolaryngologist with Alpine Ear, Nose & Throat. In a 90-minute outpatient procedure, a small battery is implanted in the chest of the patient. From that device, a wire that senses the patient’s natural breathing patterns is directed to a nerve in the tongue and another to the rib cage area . During inspiration, an electrical stimulus is delivered to the tongue which gives it tone and prevents it from falling backwards and obstructing the airway. The device is controlled by a small hand-held sleep remote that can turn on the device at night and off in the morning when the person is awake.

“This is an exciting cutting-edge treatment option for CPAP-intolerant, sleep apnea patients,” Robertson said. “If [the patient] meets criteria, it will be a life-changing experience.”

Potential patients go through a well-developed screening process, which includes a sleep study and drug-induced sleep endoscopy, or DISE, before it’s determined if Inspire is right for them.

Inspire therapy
Inspire therapy helps open the airway by stimulating a nerve in the tongue using a device that is turned on at night.

Potential Inspire therapy patients also must have these qualifications:

Suffer from moderate to severe obstructive sleep apnea (apnea-hypopnea index of 20-65)

Obstructive sleep apnea (OSA) is the most common type of sleep apnea and occurs because throat muscles intermittently relax and block the airway during sleep. The most common symptoms include snoring, gasping, or choking during sleep, frequent nighttime awakenings, morning headaches, daytime sleepiness, irritability, and difficulty with focus or concentration.

In OSA patients, oxygen levels in the blood decrease because of this blockage. The brain senses this problem and arouses the body from sleep just long enough to open the airway. This cycle of obstructing and waking disrupts sleep. People with moderate OSA have 15-30 of these apnea events per hour throughout the night. (The apnea-hypopnea index is the number of recorded apneas or hypopneas per hour of sleep). Inspire therapy studies report clients having a 68 percent reduction in such episodes.

“Inspire keeps the tissue from blocking the airway by delivering a mild stimulation to those muscles,” Petrun said. “This gently moves the tongue and other soft tissues out of the way.”

Unable to use or get consistent benefit from CPAP

Some patients can’t tolerate CPAP for various reasons, such as claustrophobia or skin irritation from the mask, and though none of these problems cause serious harm to the patient, they often result in noncompliance with treatment.

“In order for them to benefit from CPAP, they have to wear it,” Crosby said. “And even patients who do comply have reported that they don’t necessarily feel more rested.”

Not significantly overweight

Potential candidates must have a total body mass index of less than 32. The technology forces the tongue upward to allow for a clear airway. However, additional fatty tissue in the neck can affect results, Crosby said, adding that as technology advances that requirement could change.

Over the age of 22

Inspire therapy has only been tested on people older than 22, with the exception of children with Down syndrome. The company hopes to make it available in the future to a younger population, including those with Down syndrome who suffer from sleep apnea.

A doctor also will evaluate the overall health of a potential candidate, as well as perform a physical examination of the airway to determine if Inspire therapy is the best alternative. Patients undergoing DISE receive a mild dose of anesthesia to induce sleep to the point at which obstruction-causing apnea can be evaluated.

“It’s critical to ensure that the throat is closing in a way that will respond to the therapy. DISE gives us a visual map of the back of the throat,” Crosby said.

UCHealth will preauthorize all qualification procedures up to this point with a patient’s insurance company. If the patient is still a potential candidate for Inspire — 90 percent continue to be after DISE — Inspire then steps in to help the patient get preauthorization for the Inspire therapy treatment. The treatment is also available at UCHealth Metro Denver through Katherine Green, MD.

For contact information on Inspire at UCHealth, visit the Inspire website.

About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.