Chris DeNardis said he started dreaming again about three months ago, for the first time since he was eleven.
“I wake up with more energy. I can’t believe people are living the way I used to live, ”said DeNardis, who lives in Wallingford and turned 36 on Sunday, a little over a year after he was implanted with the Inspire device to treat his obstructive disease Cure Sleep Apnea. “Now I’m waking up and ready to go. I usually wake up before the alarm clock, ”he said.
Continuous positive airway pressure (CPAP) is considered the “gold standard” for treating sleep apnea, according to sleep medicine experts. But for those who can’t stand wearing the mask or just don’t want to handle it, the Inspire device may be the best alternative.
It works by sensing when the patient is breathing and stimulating one of the hypoglossal nerves, which pushes the tongue forward and opens the airway.
CPAP didn’t work at DeNardis. “I would wake up and it wouldn’t be on my face anymore,” he said of the mask that is worn over the nose and mouth (some models only cover the nose). “I just don’t think it worked for me at all. It hasn’t changed anything for me. “
DeNardis not only snored, but: “I used to choke on myself all the time. … When I was on a trip to Florida with my mother, I fell asleep and she was scared of the noises I was making. “
CPAP works by forcing air into the airways and preventing the tongue, throat, or roof of the mouth from closing. When they do and a person cannot breathe, he or she keeps waking up.
Dr. Andrey Zinchuk, pulmonologist and director of the Advanced Apnea Management Program at Yale School of Medicine, said sleep apnea can cause “poor sleep duration or poor quality sleep.”
“Both of these things have been linked to impaired neurocognitive function, daytime sleepiness, fatigue, loss of productivity, irritability … higher car accident rates,” Zinchuk said.
Not only that, but as the person continues to try to breathe, “the oxygen levels in the lungs go down and they go down in the heart, kidneys and brain,” he said. “Stress hormones are released, blood pressure rises, heart rate rises.”
Blood pressure will also rise during the day, and high blood pressure can lead to stroke, he said.
Waking up more than five times an hour is considered abnormal, Zinchuk said. It is considered severe sleep apnea more than 30 times, and Zinchuk has seen patients wake up 120 times an hour.
“CPAP is pound for pound the most effective treatment for opening the airways,” he said. “It’s brute force.” It’s also non-invasive.
Although CPAP works best, “it has been studied pretty well that about 40 to 50 percent of patients … don’t tolerate it very well” and stop using the device, said Dr. Bruno Cardoso, specialist in ear, nose and throat surgery at the Yale School of Medicine.
Although the Inspire device is considered low risk, implanting the Inspire device requires two incisions, “one in the neck, just below the jaw line, usually on the right side, and one incision in the right chest wall under the collarbone” between two ribs said Cardoso.
An electrode is attached to the section of the hypoglossal nerve that controls the forward movement of the tongue, he said, and “we put an electrode in the rib space between the rib muscles and connect the electrodes to the generator.”
“The test lead detects breathing and sends the signal to stimulate the hypoglossal nerve,” said Cardoso.
“Recovery is minimal” compared to surgery that removes part of the tongue or palate. These operations are not as effective either, he said.
Dr. Mark D’Agostino, who has worked with Inspire since 2007 – the device was approved by the Food and Drug Administration in 2014 – said of Inspire, “Apart from CPAP, it’s the highest success rate of any.”
D’Agostino is the Head of Otorhinolaryngology at Middlesex Health and has offices in Middletown, Milford and several in the New Haven area.
Not for everyone
There are limitations. The patient’s body mass index must be below 32 according to most insurance companies. When we put on weight, “our tongue gets bigger and the side walls of our throat get bigger and our airways narrow,” said D’Agostino. This makes it harder to move the tongue forward.
Also, the apnea must be caused by the tongue falling back, not the airway collapsing like a wet straw while sucking. To make sure that the patient’s nerve stimulation is successful, “we perform a so-called drug-induced endoscopy,” said D’Agostino.
After surgery, “most patients will be back to normal in a day or two,” he said, although the device was not turned on for a month to allow healing.
The patient switches on the device with a remote control. “The device only works when you fall asleep,” said D’Agostino. “We can set the start time at any time.”
While insurance requires that a patient fail CPAP in order to receive the Inspire device, D’Agostino said, “Failure of CPAP is loosely defined. You can say, ‘I don’t want to wear it anymore.’ “