Loud snoring, grunts and gasping generally is a sign of sleep apnea, a serious disorder that causes frequent, short pauses in respiratory throughout the night. It can leave people sleepy and depressed, and put them in danger for hypertension, heart disease and other health problems.
If this seems like you or a bed partner, the recent spate of ads for mask-free treatments for the disorder may get your attention. Medically often called a hypoglossal nerve stimulator, a pacemaker-like device moves the tongue during sleep. This helps to reopen the collapsed airway – the foremost reason for obstructive sleep apnea. But how does it compare to other treatments, and who is likely to be a great candidate?
Second-line therapy for sleep apnea
“Sleep apnea causes the muscles in the back of the throat to relax, causing pauses in breathing that wake you up repeatedly,” he says. PAP, the gold standard therapy for sleep apnea, prevents airway collapse by utilizing a small bedside machine attached to tubing that blows air through a face mask.
It can improve a measurement called the apnea-hypoxia index (AHI) by about 90%, reducing it to lower than 5 in most individuals. AHI is a rating that assesses the severity of sleep apnea. An AHI between 5 and 14 is taken into account mild. Between 15 and 29 is moderate; 30 and above is severe.
Targeting the tongue muscles is less effective.
Inspire only targets the muscles of the tongue as an alternative of the complete airway, so it's not as effective as PAP. In fact, the corporate's stated treatment goal is to lower an individual's AHI by only 50% (or lower than 20), although some people can do higher.
Because PAP is so effective, sleep experts encourage people to try different strategies and stick to it. But research suggests that 1 / 4 to a 3rd of individuals have difficulty using PAP (see Here And Here). When that is the case, Inspire could also be another, says Dr Buddhiraj.
Who Can Consider Hypoglossal Nerve Stimulation?
In addition to trying PAP without success, it is best to also:
- Moderate to severe sleep apnea (AHI rating 15 to 65)
- There is one Body mass index (BMI) is 32 or less (although some centers allow BMI values ​​higher than 35), which implies the device shouldn’t be suitable for people in certain weight ranges.
If you meet these criteria, it’s possible you’ll ask your doctor for a referral to a sleep specialist or an ear, nose, and throat surgeon. The next step is a sleep endoscopy. While you're sedated, a physician passes a small tube with a lightweight and a tiny video camera on one end through one nostril to look at your upper airway. Dr. Budhiraja notes that as much as 1 / 4 of individuals have a pattern of airway collapse that can’t be treated with Inspire. And, as noted, others have too high an AHI rating to try.
A surgery that requires general anesthesia.
The device is implanted during a brief, same-day procedure performed under general anesthesia. A generator is placed just under the collarbone, a respiration sensor on the chest edge through the ribs, and a stimulating electrode across the hypoglossal nerve under the tongue.
As with all surgery, potential risks include bleeding and infection. Some people experience tongue weakness, which causes mild slurred speech and minor difficulty swallowing. But it often resolves inside just a few days, or for most individuals, just a few weeks.
The device should be activated within the sleep laboratory one month after surgery. The respiratory sensor monitors your respiratory and, when vital, tells the generator to send a small electrical pulse to the electrodes to cause the tongue muscles to contract. Stimulation pushes your tongue forward so you possibly can breathe normally.
How does it feel?
“Some people describe a mild tingling sensation, but most say the sensation is difficult to describe,” says Dr. Budhi Raja.
At home, you utilize a small handheld remote control to show the device on at night and off within the morning. The distant is about to steadily increase the stimulation level a couple of times per week until you reach the very best level. You then return to the sleep lab for a study to find out your optimal range. The distant is then programmed to that extent.
Some people begin to note a difference in the standard of their sleep even at the bottom levels of stimulation. Annual testing is really useful thereafter, and a replaceable battery lasts roughly 11 years. Medicare and most major insurance coverage cover Inspire.
Once it's done, hypoglossal nerve stimulation is decidedly easier: no maintenance, cleansing, or buying equipment as needed with a PAP machine. “But since Inspire is less effective, it is not considered a substitute for PAP,” says Dr Buddhiraj.