{"id":28367,"date":"2019-12-27T10:00:36","date_gmt":"2019-12-27T17:00:36","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=28367"},"modified":"2023-07-03T12:42:02","modified_gmt":"2023-07-03T18:42:02","slug":"inspire-device-for-sleep-apnea-helps-former-cpap-users","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/inspire-device-for-sleep-apnea-helps-former-cpap-users\/","title":{"rendered":"Inspire device for sleep apnea an answer for patient who couldn\u2019t stand CPAP"},"content":{"rendered":"
<\/div>

Jim Nixon, 79, has a sharp mind, a quick sense of humor, and a speedy meter as he converses in an accent shaped in Lubbock, Texas. All these things relate to the coordinated actions of two electrodes, though only indirectly.<\/p>\n

\"couple
Dee McClure and Jim Nixon. Nixon\u2019s device for sleep apnea has them both sleeping better. Photo by Todd Neff for UCHealth.<\/figcaption><\/figure>\n

The electrodes are part of an implanted medical device called Inspire<\/a>, and it only works when he sleeps. Without it, he wasn\u2019t sleeping much. Nixon still managed to run his chain of four Nu-Way dry cleaning shops in his longtime home of Greeley, but he found himself fighting to stay awake in the afternoon and falling asleep at stoplights when he drove from branch to branch. It didn\u2019t take long for Dee McClure to diagnose him with obstructive sleep apnea<\/a> \u2013 an airflow blockage that wakes the body up many times a night.<\/p>\n

McClure is a mental health therapist, and while Nixon jokes that \u201cshe counsels me,\u201d she has no formal training in sleep-related diagnoses. But she is Nixon\u2019s wife, and she was living through house-shaking snoring and observed as Nixon stopped breathing for 20 or 30 seconds or longer as he slept, over and over \u2013 not to mention the night terrors that would rip them both into wide-eyed consciousness two or three times a week.<\/p>\n

In 2012, Nixon went to see Dr. Kelli Janata<\/a>, a pulmonologist and sleep-medicine specialist who now directs the UCHealth Longs Peak Hospital Sleep Lab<\/a>. He was referred to her not because of sleep apnea, but rather what would be diagnosed as moderate COPD<\/a>. Nixon mentioned the possibility of sleep apnea; Janata had him do an overnight sleep study.<\/p>\n

Extreme sleep apnea<\/strong><\/h3>\n

The study ended long before daybreak. As Nixon described it, \u201cThe numbers were so high I was going to break the machine.\u201d Even if the diagnostic equipment in the sleep lab was holding up just fine, his case was extreme. Stop breathing from five to 15 times an hour and it\u2019s called mild sleep apnea; 16 to 30 times an hour is classified as moderate; more than 30 times an hour, severe. Nixon had stopped breathing an average of 113.8 times an hour by the time they finally woke him up at 1 a.m. and said he may as well go home. Nixon now officially counted among the 15 million to 22 million Americans with confirmed sleep apnea (he had been, until that night, among the 24 million others suspected to have undiagnosed sleep apnea).<\/p>\n

\"diagram
Sleep apnea\u2019s complex anatomy. Getty Images.<\/figcaption><\/figure>\n

The list of sleep apnea\u2019s health and quality-of-life impacts is long and seems to be growing: headaches, memory loss, attention deficits, moodiness, depression, impotence, fatigue, immune-system weakness, heart problems, heightened Alzheimer\u2019s risk, the list goes on. Janata\u2019s collection of alarming facts includes a nearly doubled risk of crashing one\u2019s car because of fatigue sleep apnea leaves behind.<\/p>\n

A recent National Geographic<\/em> feature<\/a> on sleep science touched upon the restorative and mind-sharpening powers, the magic of the dream state, and all the other mysterious benefits sleep imparts. It then concluded, \u201cMaybe, then, we\u2019ve been asking the wrong question about sleep, ever since Aristotle. The real wonder isn\u2019t why we sleep. It\u2019s why, with such an incredible alternative available, do we bother to stay awake?\u201d<\/p>\n

Janata prescribed a CPAP (continuous positive airway pressure) machine, which was and remains the first-line treatment for moderate to severe sleep apnea \u2013 and one that\u2019s 100% effective if the patient can wear it comfortably. That\u2019s been a big \u201cif,\u201d though: Depending on the study, somewhere between 30% and 60% of patients have had comfort issues with CPAP machines.<\/p>\n

For the better part of five years, Nixon gave the CPAP machine his best effort \u2013 he really did. But the mask didn\u2019t fit quite right and it leaked and the machine dried out his throat. He had a hard time sleeping with it on, and the machine itself made a whooshing sound with each of Nixon\u2019s breaths. That, in addition to the snoring that continued, kept McClure awake, too.<\/p>\n

Roll the DISE<\/strong><\/h3>\n

In 2017, Janata mentioned the Inspire implantable device for sleep apnea as a possibility for Nixon. It had been approved by the U.S. Food and Drug Administration as a second-line therapy for those who couldn\u2019t tolerate or weren\u2019t helped by CPAP machines. She referred him Dr. Katherine Green<\/a>, an ear, nose and throat surgeon and sleep medicine expert at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>.<\/p>\n

Green met with Nixon at the UCHealth Sleep Medicine Clinic – Anschutz Medical Campus<\/a>, where Green is medical director. The clinic, unique to the region, combines pulmonary sleep specialists, airway specialists, physician\u2019s assistants, psychiatrists, and neurologists to diagnose and treat all variety of sleep disorders \u2013 insomnia, narcolepsy<\/a>, parasomnia, restless leg syndrome, and, yes, sleep apnea.<\/p>\n

Green emphasizes that sleep apnea can present with many different symptoms. The first step with all patients is to determine the severity of sleep apnea. Diagnosis can involve a home sleep study and, in more complex cases, an in-lab sleep study at the UCHealth Sleep Lab \u2013 Stapleton<\/a> which, as with studies done at the sleep lab at UCHealth Longs Peak Hospital, involves brain-activity-monitoring electroencephalograms; eye-movement detection; and the monitoring of heart rate, airflow, leg movement, and chin-area muscle.<\/p>\n

\"man
Jim Nixon holds his Inspire controller over the implant as he does each night before going to sleep. Inspire is a device for sleep apnea and has Jim sleeping again at night. Photo by Todd Neff for UCHealth.<\/figcaption><\/figure>\n

A sleep study will diagnose the severity of sleep apnea but can\u2019t shed light on precisely what\u2019s causing a given patient\u2019s airway blockage. A bottleneck in the nose can render an otherwise appropriate CPAP solution intolerable. The palate can be the problem, or the tongue, or the epiglottis, or some combination of them. So before settling on a surgical option, Green performs a drug-induced sleep endoscopy, or DISE<\/a>, which shows exactly where the problem is.<\/p>\n

Diagnostic precision is particularly important for patients facing surgery. There are now about a dozen sleep apnea procedures, Green says, and the nature of the blockage can dictate which may be appropriate.<\/p>\n

\u00a0<\/strong>\u201cThere is no perfect procedure,\u201d she said. \u201cAn airway evaluation with DISE can provide a more educated selection of the most successful surgery.\u201d<\/p>\n

Inspire device for sleep apnea<\/strong><\/h3>\n

That said, like Janata, Green is a strong proponent of CPAP machines, which work for most patients and which have improved drastically in recent years. They\u2019re smaller, the nose and\/or mouthpieces fit better, the air pressures are finely adjustable, the humidifiers work better, and they\u2019re all but silent as they operate. But when CPAP fails for reasons of comfort or claustrophobia, there are other options. They range from custom-made oral appliances that pull the jaw forward to complex surgeries to the tongue and throat that can involve long, painful recoveries. For Nixon, Green suggested the Inspire device for sleep apnea.<\/p>\n

It\u2019s implanted like a pacemaker, but on the right side of the chest. It has two wires. One is implanted between the muscles of the rib cage and detects breathing patterns. The other is placed around the nerve that controls the movement of the tongue. Stimulation causes the nerve to push the tongue forward and opens the airway.<\/p>\n

Green implanted the device for Nixon during an outpatient procedure in late November 2017. About a month later, Green activated the device for sleep apnea in clinic and Nixon began using therapy at home nightly. She adjusted the simulation level over the next couple of months until they found settings that effectively eliminated his apneic events at home.<\/p>\n

A remote control that looks like a sleek wireless mouse turns the Inspire device on and off. Nixon turns it on with the push of a button as he holds the remote against his chest. He has it set to start working 30 minutes afterwards, giving him time to drift into sleep first. The Inspire device doesn\u2019t deliver constant simulation. Rather, the tongue nerves get an electrical nudge when the electrode sensing his breathing pattern, and stimulates every time he takes a breath.<\/p>\n

The Inspire device has worked very well, Nixon says. The night terrors have all but disappeared \u2013 two or three in the two years he has had the device for sleep apnea. He feels much, much better-rested, he says, and no longer finds red lights to be a sleep trigger.<\/p>\n

McClure says she\u2019s sleeping much better, too \u2013 which is only fair, given that it was she who started her husband down the road to pleasant dreams via minimally invasive surgery in the first place. Sometimes, the right medical device for sleep apnea can help more than just the patient who gets it.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Jim Nixon, 79, has a sharp mind, a quick sense of humor, and a speedy meter as he converses in an accent shaped in Lubbock, Texas. All these things relate to the coordinated actions of two electrodes, though only indirectly. The electrodes are part of an implanted medical device called Inspire, and it only works […]<\/p>\n","protected":false},"author":23,"featured_media":28369,"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":[8],"tags":[9138,1112,4202],"class_list":["post-28367","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-ear-nose-and-throat-care","tag-ear-nose-throat-care-otolaryngology","tag-sleep-disorders"],"acf":[],"yoast_head":"\nDevice for sleep apena gives former CPAP users relief - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Jim wasn't sleeping at all, so neither was his wife. 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