Transcription:
Treating Obstructive Sleep Apnea with Inspire

Melanie Cole (Host): Have you been told that you snore, and would you like to stop snoring and get better night's sleep? Because I'm sure your partner would probably like that. Welcome to, It's Your Health Radio with Henry Mayo Newhall Hospital.

I'm Melanie Cole. Joining me today is Dr. David Saadat. He's an Ear, Nose, and Throat Physician, Board Certified in Sleep Medicine and a Facial Plastic Surgeon on the medical staff at Henry Mayo Newhall Hospital, and he's here to tell us about treating obstructive sleep apnea. Dr. Saadat, it's a pleasure to have you join us.

I'm thinking, as I said in my intro, we all know someone that snores. I'd like you to start by telling us about the burden of sleep apnea and sleep disorders in general, the scope of what we're really discussing here today.

David Saadat, MD (Guest): Hello Melanie and everyone else listening. Thank you for the introduction and as you said, I think a lot of people snore. And it's both men and women, young kids and old adults and middle age. It's a disease that affects everybody. And unfortunately, snoring sometimes is a sign of a bigger disease called obstructive sleep apnea or central sleep apnea or mixed sleep apnea, but sleep apnea in general. And oftentimes, as we all know, it is not diagnosed and affects the person tremendously. It's one of those slow, as we call slow killers in medicine. Meaning that slowly affects your heart, slowly affects your brain, affects almost every single organ in your body because when you have sleep apnea, you don't get enough oxygen getting to all these organs that are working 24/7; being brain, heart, kidney, lungs, everything, and little by little by little, they get affected. And unfortunately causes tremendous diseases that can be detrimental, can be lethal, and therefore if untreated, it's not good for the person.

Host: Well, it's true, and we're learning more and more about the association between obesity and diabetes and heart disease and sleep disorders, and so when we're not getting that good quality sleep, which we're not if we have apnea, then as you say, Dr. Saadat, all of those things kind of can spiral.

Who notices these sleep disorders because it's not always the person who is suffering from them. And I'd like you to speak about the common symptoms that we might notice if we're somebody who doesn't even know that maybe we have sleep apnea.

Guest: That's one of the best questions you ask, and I think that everybody should ask. It's very difficult sometimes to notice that you have it. Obviously, the most common person that would bring it to your attention would be your bed partner. And you know, we see them come to the office with a bruise on their back or something because they got elbowed or kicked by the partner. So that's probably the easiest sign. Thank God that doesn't happen that often. But, you know, the bed partner usually notices snoring or actually stopping of the breathing in the middle of the night. Then the other symptoms that are very, very important are if you wake up in the morning and you're tired, if you have to take naps during the day. Let's say at two, three o'clock in the afternoon, you are tired, you just can't keep your eyes open. These are the kind of people that fall asleep during driving, especially if they had a shorter night's sleep and they're tired and they easily fall asleep. As you know, one of the most common causes of accidents, car accidents, are sleeping behind the wheel. And one of the most common causes of that, is sleep apnea. In kids, sometimes it's much harder to diagnose because kids, instead of being tired, they actually act out and they have lack of attention and they don't do well at school. And unfortunately, a lot of them get misdiagnosed with attention deficit disorder.

And in reality, they have sleep apnea. A lot of the burden is on us, the physicians, especially the primary care doctors and cardiologists, because these are the patients that go in with high blood pressure and arrhythmias, specifically atrial fibrillation. And if you really look into it, the cause, the underlying cause of these diseases are chronic sleep apnea.

So the symptoms are sometimes really vague, but sometimes very, very common. I think we just have to increase the awareness and if you have abnormalities in your life, specifically the ones that I mentioned or something similar to it, can't hurt to actually look into the sleep pattern, sleep problems, snoring, and it's a simple solution. It's a tiny little sleep study that we do. We now do it at home. Very, very simple. It's a device that's connected to the app on your phone. It's 2023. Everything is easy and you just basically test yourself and it, it tells you if you have sleep apnea or not.

Host: Well, that's really cool because we've all heard about the stories of the sleep studies where it's a little bit hard to get a night's sleep and you're being watched and you're hooked up and I mean, you still do those, right? You still do a formal sleep study.

Guest: Occasionally, but typically, at least as a screening, we like to do the home sleep study because they're in their own bed, they're with their partner, it's their own pillow and their comfort, and it's really easy. It's just all Bluetooth connected to an app so they don't have wires and stuff attached to them, like a real sleep study.

So of course if screening tests, those home sleep studies show that they have real sleep apnea and we need to further look into it, then that's when we take him into a lab and do it. But at least as a screening, it's good to do the simple test to say yes or no, this is my problem or not my problem. Because that's one of the biggest problems in the, in the world, not diagnosing sleep apnea or underdiagnosing it.

Host: So then tell us about first line treatments. If someone is determined to have obstructive sleep apnea, the first line treatments, tell us conservative measures you'd try before we get into the kind of the main crux of our topic today. But we've all heard about CPAP, and so I'd like you to tell us a little bit about that and what's going on in the world of CPAP and why adherence and compliance to that CPAP is so difficult for some people.

Guest: So in our world, we typically follow what the FDA guidelines are, and the FDA guidelines are three treatments for obstructive sleep apnea. One is CPAP, as you mentioned. The other one is, um, mandibular devices that actually pull forward your lower jaw. And the third one is surgery. CPAP is a device everybody knows that goes on your face, your nose, your mouth, and forces the air to go to your lungs.

It's very, very, very successful. I kind of want to say it's almost a hundred percent successful. The hard part with it is that you have to wear this device every night. It has to be on your face. Sometimes it leaks. It makes a lot of noise. Socially doesn't look good if you're, especially if you're single and you have a girlfriend or boyfriend or a bed partner that you're not comfortable with.

So there's a lot of issues with it that oftentimes people say, you know, forget it. I'm not wearing it. So, yes, successful, but because they're not wearing it, it's not successful. And it's the same thing with the mandibular device. It's very uncomfortable to be in the mouth. It really doesn't work for more moderate to severe apnea. It's much better for mild apnea. So it not completely treats everything. And believe it or not, we had a lot of problems with surgery in the past because we didn't really understand the mechanism of sleep apnea, what is the underlying cause and physiology, pathophysiology of sleep apnea, we didn't really understand it.

So we used to go there and cut out the pallet, cut out the uvula, cut out the tonsils, shrink down the base of tongue, pull down the throat and those kind of things to improve it. And we realized that a lot of those surgeries were not successful. So the latest and the greatest in the industry is, called hypoglossal nerve stimulator.

A hypoglossal nerve is a nerve that goes to the tongue and when it's stimulated, the branches that we pick, when we stimulate certain branches a little bit brings the tongue forward and because it brings the tongue forward, it opens up the airway and therefore the airway does not collapse during sleep apnea.

That's why it's called obstructive sleep apnea. So it just relieves the obstruction and oftentimes it's the tongue that falls back in the throat and causes plugging of the throat. And by doing that, by implanting this device in the body, then every night that the patient goes to sleep, we turn it on. It's a very simple thing. It's just a on off button. And when it does that, it just, during sleep it brings the tongue forward and therefore they can breathe. And believe it or not, oftentimes the apnea is cured, meaning that they have no more apnea.

Host: Wow, so exciting in your field, Dr. Saadat. There's so many alternatives now, you're just getting many more tools in your toolbox to help with this real epidemic of sleep disorders. Now, I'd like you to tell us where in that line of succession of CPAP adherence or compliance issues, refractory to any of these other things that you would discuss, what we're talking about here today, Inspire. Tell us what it is, how it works.

Guest: So Inspire is the first of a line of hypoglossal nerve stimulators that were approved and it's the only FDA approved one that we have. So therefore we're doing that right now solely, that's the only treatment. But those of us who've been dealing with obstructive sleep apnea, especially on a surgical side, we have been disappointed for years and years and years and years. We now found a solution, surgical solution that's very, very successful. More than 80%. We did a little thing on our own patients. We have about 52 or three patients that we've done, and they're more than 90% success rate with it, which is almost impossible to achieve in medicine. So we are extremely excited to have started Inspire therapy in the past, we started in 2018, so it's about four or five years now that we're doing it. And we have a lot of patients that are very, very happy. And unfortunately we realize that a lot of the patients that do well with CPAP are not adherent to it. So it's gotten to a point that almost everybody that has moderate to severe sleep apnea and they meet the criteria.

There's certain level of criteria that we have to have to be able to do this procedure, but almost everyone is a good candidate as long as they meet the criteria. Of course, if somebody has a CPAP machine and they love it and they say, oh my God, it's the best thing that has ever happened to us, great, fine, continue your CPAP.

But the ones that are CPAP intolerant, they're not doing well, they can't adhere to it, this is probably the second best alternative that we have.

Host: So tell us about the procedure itself, Dr. Saadat. And I'd like you to add in there what changes you've seen in patients, once they start using it,

Guest: The procedure is about an hour and a half to two hour surgical procedure. It's done under anesthesia. The device has two parts to it. One part goes on the chest, on the anterior wall of the chest, the front right underneath the collar bone with a small incision, that's where the generator goes.

And then another incision underneath the jawline, that is done to place the electrode around the nerve. Both of them heal so well that majority of our patients, when they come back, you can hardly see the scars. So basically the implant is placed inside the body and then we close it, we wait about a month or so, give it time for everything to heal.

Once it's healed, then we start turning on the implant so the patient gets used to it. And then, shortly after that, we actually do a sleep study where we titrate the amount of stimulation that each individual needs to create a cure of their sleep apnea. So that's how the device works.

It's very simple. The beauty of it is that these patients are coming back and they're saying, you know, we're free of the Darth Vader mask that goes around our face. We don't have to deal with cleaning the hose and the machine, ordering parts and products and, you know, believe it or not, with COVID, everything was backordered.

So we had a lot of patients complaining about not having the parts for their CPAP. There are no parts. They basically have their own internal CPAP for lack of better term, their own internal treatment, that they just have to turn on and off every night. It's a tiny little remote, which is very simply used.

And, these patients can travel. Oftentimes it's hard to travel with CPAP so they can travel without carrying anything with them. Their high blood pressure got better, they have more energy, they can exercise more. They're losing weight. I'm sure if you really looked at them and go back, it has affected their medical diseases that were caused by apnea, such as cardiac problems, atrial fibrillation, high blood pressure.

So the benefits are tremendous. And, you know, I think one of the most important ones, which we don't think about is that and I want to do a real study with this myself; almost all of them say that now the bed partner is back in the room with them because oftentimes these people are such bad snorers that they sleep in different rooms.

So, they're back with their partner, which as you know, that would socially, psychologically help us tremendously.

Host: Well, I think in so many different ways, Dr. Saadat, as you said, I mean people have relationship issues because of that and loud snoring and sleep disorders, so you're right. And what a cool procedure that is. I'd like you to wrap up by giving us your best advice about sleep cause you are a sleep medicine physician and we hear about something called sleep hygiene.

And I would like you to end this informative, exciting podcast by telling us your best advice for really, really good sleep. And when you want people to call you or see a physician about their sleep problems.

Guest: Well, you brought up a really good point. So, sleep apnea is just one of the many disorders of sleep. Of course sleep problems are so many that we won't have time to talk about it here, but one of the most important things that we know affect sleep for anything, for anybody is what you just called sleep hygiene.

Sleep hygiene, means that you basically pay so much attention to your sleep and it's so important for us to sleep really well, that you prepare everything for your sleep, meaning that you try to go to bed on a regular basis, on a regular time. So don't go to bed one night at eight, the next night at two o'clock in the morning. The next night at five. The other thing is when you go to bed, you want to make sure bed is used for sleeping and other things, but just sleeping, not being on your phone, not watching tv, not doing other things. Most of us know that there's a light reflex that we have in our body, so when lights are out, we sleep. When lights are on, we wake up.

So when you go to bed, you turn off the lights and you try to sleep. So these are called sleep hygiene, and there's a list of them. We can look them up on Google. It's all over the place. But the whole point is that if you really adhere to this hygiene, the quality of your sleep gets better. You fall asleep easier. You stay asleep, better. You get your six to eight hours for an adult that we have to get. Obviously kids need more sleep. You get six to eight hours of sleep. So it's more regulated and regular, and therefore the quality of your awake life gets much, much better because the quality of your sleep is better.

So that's sleep hygiene in so many words. And then, going back to sleep apnea treatments, we now offer this at Henry Mayo, obviously, and we have a full program going. We have a great team of people that deal with Inspire hypoglossal nerve stimulator and how to get it all together.

So if any of you out there have sleep apnea, have been diagnosed with obstructive sleep apnea, cannot use CPAP, cannot do anything else, and you're not using the machine and you know that you have diseases and problems; there is solution for this and call our office. We'll be more than happy to meet with you, consult with you, go over all the solutions so you have an alternative to your CPAP machine.

Host: Well, certainly nothing does more for mental health than a good night's sleep. And Dr. Saadat, you've given us so much to think about today and what great information. Thank you so much for joining us. And you can learn more at henrymayo.com/inspire. You can also visit the free health information library at library.henrymayo.com.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.