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6 | Health Matters:Providence Queen of the Valley Medical Center Freedom for Sleep Apnea Patients CPAP machines have long been the gold standard treatment for sleep apnea. But what do you do when you are unable to tolerate using one? Get Inspired. I f you have sleep apnea, you have probably tried a CPAP (continuous positive airway pressure) machine, and you either love it or hate it. On the one hand, it might offer the joy of a good night's sleep. On the other hand, there's the challenge of tubes, tangled wires and masks, which can make you wonder how you'll ever sleep again. If you think there must be another option, you're right: Called Inspire, it's a surgical implant that can keep you comfortably breathing through the night CPAP-free. According to the National Council on Aging, there are 39 million adults in the U.S. who suffer from obstructive sleep apnea, defined as having a skipped or shallow breath due to a blockage in the throat more than five times in one hour. The measurement used to determine the severity of sleep apnea is referred to as the apnea-hypopnea index, or AHI for short. The moderate range is 15 to 30 apnea instances per hour, and severe is 30 and up. Those suffering from sleep apnea often snore loudly, gasp for air, experience insomnia and awaken with a dry mouth and irritability (see box for more symptoms). "Untreated sleep apnea can lead to memory loss, fatigue, and risk of stroke and heart attack," according to Lois Montague, MD, co-owner and practicing surgeon with Napa Valley ENT, which performs the Inspire procedure at Providence Queen of the Valley Medical Center. Additional risks include obesity, high blood pressure, asthma, kidney disease, pregnancy complications, Type 2 diabetes, cancers and more. BREATHING EASIER The Inspire procedure is an alternative to CPAP for select sleep apnea patients. It is a tiny implanted device that helps you maintain an open airway all night long with no wires, tubes, hoses, elastic, masks or cords attached. "Inspire is a therapeutic device implanted behind the tongue," explains Dr. Montague. "It senses when the lungs are breathing in and then stimulates the tongue to move out of the way in the throat." Like a CPAP machine, Inspire delivers the stimulation you need for your individual breathing pattern. It's implanted with a surgical procedure requiring general anesthesia and involves making two small incisions. Through an incision in the neck, a nerve-stimulating cuff is placed around the nerve that enables your tongue to move forward. A second small incision in the upper chest allows placement of a small battery and a sensing lead that responds to the patient's breathing, explains Dr. Montague's partner and fellow surgeon Joyce Colton House, MD. When the device senses that a patient has inhaled, it stimulates their tongue to move forward slightly, opening the airway. Before going to sleep each night, patients turn on Inspire with a handheld remote, and they turn it off again each morning. The procedure to insert Inspire, both doctors stress, is straightforward and usually takes around 90 minutes to perform. And like CPAP, the Inspire device has a strong success rate for patients who qualify to use it. Typically, 80% of patients who receive the Inspire implant have both a significant reduction in their AHI and improvement in their sleep apnea symptoms. The total process, from Inspire insertion to activation of the device and follow-up visits, takes about six months on average. IS INSPIRE FOR YOU? While certain requirements for consideration vary among health insurance companies, all insurances require that patients: • are 18 or older • have been diagnosed with moderate to severe sleep apnea (AHI between 15 and 65) in a formal sleep study • have tried and failed with CPAP • have a body mass index (BMI) under 35 • have completed a sleep endoscopy showing that their throat collapses from the front to the back, not from the sides Note: At this time, Partnership/ MediCal is not covering the Inspire procedure. Providence Queen of the Valley Medical Center is currently the only Providence hospital in Northern California where the Inspire procedure is performed. Discuss your situation with your sleep medicine doctor or ENT (ear, nose and throat) specialist to determine the most effective approach to treating your sleep apnea. Drs. Montague and Colton House are happy to schedule an Inspire consultation if you meet the above criteria. They also assist with general diagnosis and management of obstructive sleep apnea. For more information about Inspire, visit inspiresleep.com/en-us. SYMPTOMS OF SLEEP APNEA According to the National Institutes of Health, these are the symptoms to watch for: Your partner might notice: • breathing that starts and stops during sleep • frequent loud snoring • gasping for air during sleep You might notice: • daytime sleepiness • dry mouth • headaches • sexual dysfunction • waking often during the night to urinate

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