{"id":17994,"date":"2018-08-15T09:04:46","date_gmt":"2018-08-15T15:04:46","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=17994"},"modified":"2024-12-24T09:26:38","modified_gmt":"2024-12-24T16:26:38","slug":"trouble-sleeping-finding-the-right-solution","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/trouble-sleeping-finding-the-right-solution\/","title":{"rendered":"Trouble sleeping: Finding the right solution"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><figure id=\"attachment_17996\" aria-describedby=\"caption-attachment-17996\" style=\"width: 266px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-17996 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084803\/kids.webp\" alt=\"James Morales and his kids.\" width=\"266\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084803\/kids.webp 888w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084803\/kids-266x300.webp 266w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084803\/kids-768x865.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084803\/kids-133x150.webp 133w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084803\/kids-200x225.webp 200w\" sizes=\"auto, (max-width: 266px) 100vw, 266px\" \/><figcaption id=\"caption-attachment-17996\" class=\"wp-caption-text\">James Morales and his kids. Photo courtesy of James Morales.<\/figcaption><\/figure>\n<p>Not getting enough sleep on a consistent basis wears on the body and mind. Just ask any new parent or someone with <a href=\"https:\/\/www.uchealth.org\/diseases-conditions\/sleep-apnea\/\">sleep apnea<\/a>.<\/p>\n<p>Just ask James Morales.<\/p>\n<p>\u201cI would wake up and feel exhausted,\u201d said Morales, 41. \u201cI didn\u2019t want to do anything. I\u2019d come downstairs and sit. At work, I had trouble focusing and concentrating. Lots of people were relying on me and asking me questions, but I just couldn\u2019t think.\u201d<\/p>\n<p>When Morales was in his early-30s, his wife, Farhana, started noticing that her husband wasn\u2019t sleeping well.<\/p>\n<p>\u201cHe had always snored, which was difficult for me, but you get used to it,\u201d she said. \u201cBut I\u2019d wake up, and he\u2019d have these weird episodes where he\u2019d be breathing and snoring, and then there would be nothing \u2014 that\u2019s what scared me. That\u2019s when we knew it was serious.\u201d<\/p>\n<p>After talking to his physician, Morales was referred to the sleep clinic near his home in Aurora for a sleep study<strong>.<\/strong><\/p>\n<p>Sleep studies are done in a sleep lab, which looks like a small bedroom but with monitoring equipment. A person arrives a few hours before their normal bedtime and is monitored throughout the night. For those who turn out to have sleep apnea, the study yields an Apnea-Hypopnea Index score, which is the number of times per hour a person stops breathing for at least 10 seconds and shows a decrease in blood-oxygen levels. Someone with severe sleep apnea has a level greater than 30.<\/p>\n<div class=\"su-callout-box col-xs-6 col-sm-6 right\" style=\"background-color:#dce4e7; color:#2e3b44;\">\n<p><strong>Alternatives to CPAP seminar<\/strong><\/p>\n<p>For those who are unable to use CPAP, a\u00a0seminar led by Dr. Katherine Green, medical director of the UCHealth University of Colorado Hospital Sleep Center, will cover treatment options\u00a0like Inspire therapy and sleep surgery.<\/p>\n<p>February 27, 2019<br \/>\n5:30 &#8211; 6:30 pm<br \/>\nUniversity of Colorado Hospital<br \/>\nBruce Schroffel Conference Center<br \/>\nRSVP here: <a href=\"https:\/\/www.uchealth.org\/events\/\">https:\/\/www.uchealth.org\/events\/<\/a><\/p>\n<\/div>\n<p>\u201cAround then I was about 35,\u201d Morales said.<\/p>\n<p>That was more than a decade ago. Fast forward to 2016, and Morales\u2019 number had jumped to more than 70. But then fast forward to the present, where Morales hovers around an 8.<\/p>\n<p>What\u2019s changed? Let\u2019s start again at the beginning.<\/p>\n<h3><strong>Remedies for trouble sleeping<\/strong><\/h3>\n<p>After his first sleep study, Morales began using what most people with sleep apnea are prescribed: a CPAP, or continuous positive airway pressure machine. The machine supplies constant and steady air pressure through a hose and mask, and is effective in treating sleep apnea more than 90 percent of the time. That\u2019s if the person can tolerate it.<\/p>\n<figure id=\"attachment_17995\" aria-describedby=\"caption-attachment-17995\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-17995\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084759\/Bike.webp\" alt=\"James Morales and his daughter, Layla, in front of their home in Aurora.\" width=\"300\" height=\"225\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084759\/Bike.webp 960w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084759\/Bike-300x225.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084759\/Bike-768x576.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084759\/Bike-150x113.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084759\/Bike-200x150.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-17995\" class=\"wp-caption-text\">James Morales and his daughter, Layla, in front of their home in Aurora. Photo courtesy of James Morales.<\/figcaption><\/figure>\n<p>Morales fell into that 10 percent who can\u2019t.<\/p>\n<p>\u201cJames slept worse with CPAP and was relying on sleeping pills to tolerate the machine,\u201d said his sleep specialist, Physician Assistant <a href=\"https:\/\/www.uchealth.org\/provider\/anne-r-voorhes-lassiter-pa-c\/\">Anne Lassiter<\/a> with <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-pulmonology-loveland\/\">UCHealth Pulmonology in northern Colorado<\/a>. \u201cThe majority of patients will eventually adapt to CPAP if they are monitored closely and given support beyond simply prescribing equipment. That wasn&#8217;t the case for James.\u201d<\/p>\n<p>Instead of turning a corner with CPAP, Morales had instead hit a wall.<\/p>\n<p>\u201cSo for two to three years I didn\u2019t do anything,\u201d he said. \u201cI just tried to sleep the best I could.\u201d<\/p>\n<p>The concern in Farhana\u2019s voice was evident.<\/p>\n<p>\u201cHe was in the Army Reserves for quite a few years during this time, working as a mechanic,\u201d she said. \u201cI worried about his focus; I worried about him injuring himself.\u201d<\/p>\n<h3><strong>A new option<\/strong><\/h3>\n<p>Then in 2014, Morales read about the FDA\u2019s approval of a device called Inspire, which is implanted into the chest much like a pacemaker but uses electrical stimulation to keep the tongue from obstructing the airway during sleep.<\/p>\n<p>He brought it up to his wife, and she encouraged him to make sure they\u2019d exhausted their options before turning to surgery.<\/p>\n<p>\u201cIt is major surgery, and I was very scared,\u201d she said. \u201cI\u2019m all about yoga and relaxations. I wanted to make sure we\u2019d tried everything.\u201d<\/p>\n<p>So, Morales went back to CPAP. For almost a year, he went back and forth to the medical supply store, trying different masks and machines, frustrated. And during the process, he learned he had a deviated septum, but even correcting that did not allow him to tolerate CPAP.<\/p>\n<p>Next was Provent Therapy, a prescription treatment that is applied to the nostrils, using the power of one\u2019s own breathing to hold the airway open, according to its website. Morales said he showed some success with this treatment, but the small, adhesive, disposable devices would always end up stuck to his pillow instead of his nose.<\/p>\n<figure id=\"attachment_18000\" aria-describedby=\"caption-attachment-18000\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18000\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb.webp\" alt=\"James Morales with his family at the top of the York Minster\u0092s Central Tower in England. \" width=\"300\" height=\"225\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb-300x225.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb-1024x768.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb-768x576.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb-150x113.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084815\/york-minster-climb-200x150.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-18000\" class=\"wp-caption-text\">James Morales with his family at the top of the York Minster\u0092s Central Tower in England. Morales said he would have never had the energy to climb the 275 steps to the top if it weren\u0092t for Inspire. Photo courtesy of James Morales.<\/figcaption><\/figure>\n<p>\u201cThere were a few things that would work for a bit, but everything was temporary,\u201d Farhana said. \u201cThen we were back to square one, listening to him struggle again.<\/p>\n<p>\u201cI saw his energy levels go downhill. He was having trouble remembering things. His mood changed. He was working off of very little sleep,\u201d she continued. \u201cBeing a person who loves sleep, I can\u2019t imagine going even a few nights without it, and he\u2019d been going through this for years.\u201d<\/p>\n<h3><strong>Let\u2019s talk \u2018Inspire\u2019<\/strong><\/h3>\n<p>James decided to talk to his wife about Inspire one more time. They did the research and found that <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-poudre-valley-hospital\/\">UCHealth Poudre Valley Hospital<\/a> was the only location on the Front Range with a trained otolaryngologist and surgeon, <a href=\"https:\/\/www.uchealth.org\/provider\/matthew-l-robertson-md-otolaryngology\/\">Dr. Matthew Robertson<\/a>, doing the procedure.<\/p>\n<p>\u201cHe had a good success rate and track record, and there was nothing else that James could do that didn\u2019t require other major surgeries,\u201d Farhana said. \u201cMy logical mind was like: let\u2019s try it.\u201d<\/p>\n<p>UCHealth University of Colorado Hospital\u2019s <a href=\"https:\/\/www.uchealth.org\/services\/respiratory-lung-care\/comprehensive-lung-breathing-program\/\">Comprehensive Lung and Breathing Program<\/a> in Aurora has since hired <a href=\"https:\/\/www.cumedicine.us\/providers\/otolaryngology-head-and-neck-surgery\/katherine-green\">Dr. Katherine Green<\/a>, an otolaryngologist and fellowship-trained sleep medicine specialist and surgeon, to provide patients at UCH with Inspire therapy.<\/p>\n<p>In early 2016, Morales talked with Cindy Crosby, manager of <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-sleep-disorders-center-at-poudre-valley-hospital\/\">UCHealth Sleep Lab \u2013 Poudre Valley Hospital<\/a>, and the two of them began the process.<\/p>\n<h3><strong>Is Inspire right for you?<\/strong><\/h3>\n<p>Morales went through the initial screening to make sure he met the FDA qualifying criteria, which include a body mass index of less than 32. The team reviewed his sleep study result \u2014 he had to have a new study done since it had been several years since his last one \u2014 and then a procedure was done to determine if the back of the throat was collapsing in a way that Inspire could treat. It was at that time that he was introduced to Lassiter, who followed him through the whole process.<\/p>\n<p>\u201cDr. Robertson, Anne (Lassiter) and Inspire were amazing at this portion of the process,\u201d Morales said. \u201cThey prepared me for the lengthy insurance process but were encouraging that eventually, it would go through.\u201d<\/p>\n<p>It took almost a year to untangle the ropes and restrictions of his insurance, but finally, they approved the procedure in early 2017, and within a month, Morales was scheduled for surgery.<\/p>\n<figure id=\"attachment_17997\" aria-describedby=\"caption-attachment-17997\" style=\"width: 256px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-17997\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084806\/mexico.webp\" alt=\"James Morales swimming in a cave in Mexico.\" width=\"256\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084806\/mexico.webp 636w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084806\/mexico-256x300.webp 256w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084806\/mexico-128x150.webp 128w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15084806\/mexico-200x235.webp 200w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><figcaption id=\"caption-attachment-17997\" class=\"wp-caption-text\">James Morales enjoys a recent trip to Mexico. With sleep apnea not being addressed, traveling was exhausting for Morales. But after his Inspire procedure, he\u0092s got the energy to enjoy his travels with his wife and family again. Photo courtesy of James Morales.<\/figcaption><\/figure>\n<h3><strong>The big day<\/strong><\/h3>\n<p>\u201cI was a little worried about the surgery, but for me, it was more excitement,\u201d he said. \u201cAt this point, I wasn\u2019t getting any sleep. I was losing track of things, having trouble driving \u2014 even driving to the doctors\u2019 appointments was hard. It was exciting knowing we were going to fix these issues.\u201d<\/p>\n<p>In the past several years, Morales had become so tired that he had stopped doing a lot of the things he used to do with his family. Weekend snowboarding trips with the two teenagers who still lived at home had stopped. Projects around the house were not getting done. Thoughts of heart attacks loomed in the back of his mind.<\/p>\n<p>On an early morning in July 2017, Morales and Farhana arrived at PVH.<\/p>\n<p>In the 90-minute outpatient procedure, a small battery was implanted in Morales. From that device, a wire that\u00a0senses his natural breathing patterns\u00a0is directed to a nerve in the tongue and another to the rib cage area. When he breathes in, an electrical stimulus is delivered to his tongue that gives it tone and prevents it from falling backward and obstructing his 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 he wakes.<\/p>\n<p>Morales said his recovery took about a month. The first few days he couldn\u2019t use his right arm. Surgeons implant Inspire on the right side in case the patient ever needs a cardiac pacemaker, which goes on the left side. Farhana took good care of Morales while his arm was in a sling, he said. By week two, he was mobile, out of the sling and doing things, but it wasn\u2019t until about week three that he felt fully recovered.<\/p>\n<p>At that time, he returned to the sleep center for the calibration of his device.<\/p>\n<p>\u201cNot unlike when a patient has a sleep study done to allow technologists to target the best CPAP pressure, calibration of the Inspire unit is done to ensure the best level of stimulation is occurring,\u201d Crosby said. \u201cThat allows for maximum treatment of apnea as well as an opportunity to explore settings that can make its use most comfortable.\u201d<\/p>\n<figure id=\"attachment_18003\" aria-describedby=\"caption-attachment-18003\" style=\"width: 183px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18003\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15090424\/wedding-1.webp\" alt=\"James Morales walks his daughter down the aisle\" width=\"183\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15090424\/wedding-1.webp 611w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15090424\/wedding-1-183x300.webp 183w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15090424\/wedding-1-92x150.webp 92w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/08\/15090424\/wedding-1-200x327.webp 200w\" sizes=\"auto, (max-width: 183px) 100vw, 183px\" \/><figcaption id=\"caption-attachment-18003\" class=\"wp-caption-text\">James Morales walks his daughter down the aisle during her Star Wars-theme wedding. Photo courtesy of James Morales.<\/figcaption><\/figure>\n<p>\u201cThis is when I knew I made the right choice,\u201d Morales said. \u201cAnd once they figured out where the device needed to be set at, I didn\u2019t have any issues.\u201d<\/p>\n<h3><strong>To sleep like you<\/strong><\/h3>\n<p>\u201cEverything has changed,\u201d Morales continued. \u201cNow I wake up and feel like I can do something. I\u2019m going back to school, which I was afraid of doing before because I couldn\u2019t focus. I go up snowboarding without worrying about falling asleep on the way home. And I\u2019m headed to Italy, and then Yellowstone the next month.\u201d<\/p>\n<p>And in the year since the procedure, Morales\u2019 daughter completed her first year of high school.<\/p>\n<p>\u201cThere is no way I would have survived my daughter\u2019s first year of high school if I didn\u2019t get this done,\u201d he said. \u201cI was driving her everywhere.\u201d<\/p>\n<p>And James also got to walk his other daughter down the aisle recently. \u201cI could have missed that,\u201d he said.<\/p>\n<p>\u201cInspire not only saved my life, but it has changed my entire life,\u201d he continued. \u201cI feel like an actual person now, and I told my wife, \u2018I finally get to sleep like you do.\u2019\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Not getting enough sleep on a consistent basis wears on the body and mind. Just ask any new parent or someone with sleep apnea. Just ask James Morales. \u201cI would wake up and feel exhausted,\u201d said Morales, 41. \u201cI didn\u2019t want to do anything. I\u2019d come downstairs and sit. At work, I had trouble focusing [&hellip;]<\/p>\n","protected":false},"author":2164,"featured_media":18000,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[2597,3357,4202],"class_list":["post-17994","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-comprehensive-lung-and-breathing-program","tag-lung-and-respiratory-care-pulmonology","tag-sleep-disorders"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - 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