Amanda Wilde (Host): This is A Podcast Today with Memorial Health System. I'm your host, Amanda Wilde. There is a device that is revolutionizing sleep apnea treatment. We'll get the 411 on the Inspire device with Dr. Drew Phillips, ear, nose, and throat specialist at Memorial Health System. Dr. Phillips, thank you so much for being here.

Drew Phillips, DO: Hey, Amanda. Thanks for having me.

Host: Can you get us started with just a simple explanation of what obstructive sleep apnea is?

Drew Phillips, DO: Yeah. So, obstructive sleep apnea is a little more than just snoring. It's actually pausing, gasping in our sleep where our oxygen keeps going down multiple times a night, sometimes in a severe setting to where it's affecting us from a heart standpoint, a lung standpoint, a memory standpoint, and a blood pressure standpoint.

Host: How common is sleep apnea? I certainly hear that it affects not only the sleeper, but anyone in the vicinity.

Drew Phillips, DO: Much more common than our general public thinks. Almost 80% of people with sleep apnea, and we're talking almost 80 to 84 million people—adults—in America have diagnosed or undiagnosed—and we're going to see more undiagnosed sleep apnea, 80% of those people undiagnosed. So, they're going every night, pausing, gasping, not getting that good dream sleep, that restful sleep, that regenerative sleep that our body craves and needs.

Host: Why do so many people not realize they have it?

Drew Phillips, DO: I think a lot of people don't recognize the signs, or it's something that they've been dealing with for years, and feeling tired during the day, feeling groggy when they're driving and, you know, having to drink four or five cups of coffee, they go, "Oh, that's normal. That's my normal." That's how I've always been, but sometimes it's not normal.

Host: So, should we consider those symptoms? What are some of the most common symptoms people do notice?

Drew Phillips, DO: Yeah. So, the first thing typically our spouse or bed partner will say, "You're snoring, you're waking us up, you're pausing, you're gasping, you're tossing, you're turning." That's usually something that the patient's not seeing necessarily. The things that patients start to see, and we ask these questions when they come in. This is a good one that their general practitioners can ask. And we kind of rate it from a never to all the time and a couple in between of "Are you feeling tired or wanting to fall asleep when you are sitting and resting, when you're watching TV, when you're a passenger in a car, when you're sitting at a bench in public, when you're at a stoplight driving your own car, or just watching TV, these are things that, as we talk about driving, get kind of scary if we're nodding off, falling asleep. Those should be our first signs that we're not getting good sleep.

Host: And who is most at risk for obstructive sleep apnea?

Drew Phillips, DO: So, the target demographic that we see is our overweight individuals. However, it can affect our underweight or normal weight individuals as well from a mild to a severe aspect as well. What we do see with some of our heavier individuals is that we can put them on weight loss medication, get them on a diet, exercise routine. And we can drop that severity of their sleep apnea. But sometimes it's just how we're built. It's how our throat's built and it's how we collapse.

Host: Now, what if you are one of those people who don't know you have it or you know you have it, but your obstructive sleep apnea goes untreated? What happens if it is not treated?

Drew Phillips, DO: It gets kind of scary. So in starting up through how many years we've been dealing with it, it takes a toll on our body. So, we see individuals who are on multiple blood pressure medications. They start having atrial fibrillation. That's where our heart's not even beating correctly, and they get put on medication for that.

We see individuals who have insomnia and they're having trouble falling asleep, because they don't sleep well and they wake up through the night. And we see some of our individuals who are a little bit later in life diagnosed with early dementia where really, when we drill down, they haven't been sleeping well for decades and not getting that good restful sleep. And we do know that that's one causative factor.

Host: So, that saying "You can sleep when you're dead," don't listen to that. You really need your good restful sleep. That is part of living.

Drew Phillips, DO: It's a quality of life thing. It is where we interact better, we feel better, we get sick less. We're on less medications when we're just maximizing our sleep. .

Host: So, sleep apnea affects your heart health, your energy, your mood, maybe your memory as well. Let's talk about diagnosis and treatment plans. How is sleep apnea typically diagnosed?

Drew Phillips, DO: So first, we start with kind of that general questionnaire that I kind of floated out there with "Where are you feeling tired, where are you falling asleep?" If you start to answer more of those questions, and that's one you can kind of ask yourself at home that's when it's time to ask your family medicine doctor or your practitioner, "Hey, I think I need a sleep study." There's two ways to get a sleep study and I do recommend going through our sleep medicine department. we have a fantastic sleep medicine department on Broughton Street here in Marietta, and they also have an office in Belpre and Athens. But I recommend a sleep study.

It can be at home. And that gets graded and we see things like how many times do you pause and gasp in the middle of the night? Not just snoring. But we also see how low does your oxygen drop every time this happens. And sometimes that can be pretty eye-opening. For other individuals, we get them plugged into our sleep lab clinic. We watch them overnight. We can get a couple more important measures to see how bad your sleep apnea is. And then, we may be able to get you fitted for a non-invasive technique, a CPAP, which a lot of people don't want to hear, but that's part of the process of getting to an Inspire implant. We'll talk about that more here in a couple minutes.

Host: Oh, okay. Why is a CPAP then the first treatment option?

Drew Phillips, DO: It's the gold standard because, look, I'm a surgeon. I love doing surgery. However, I want you to have a non-surgical treatment first, and there's a lot of people—the vast majority of people—diagnosed with sleep apnea from mild to severe do really well with a CPAP at night. It takes a little getting used to, but we can see where we drop those times that you pause and gas from really high down to next to nothing. And it's not a surgery. We're not taking any risk of surgery by doing that. But for the people who can't tolerate it, they get wrapped up in their mask, it doesn't fit right, they have a big beard, they feel claustrophobic, that's when we start talking about surgical procedures.

Host: And that's where Inspire comes in, right?

Drew Phillips, DO: Where Inspire comes in, exactly. And it's a new thing. It's kind of revolutionized the way we thought of sleep medicine. I'll take it back about 40 years ago, which isn't that far away. Our treatment—because it was before we had a CPAP—we were doing a tracheostomy, we were putting a hole in people's neck for really severe sleep apnea to help them breathe. We're not doing that anymore if you fail on a CPAP. Now, we're looking at the Inspire procedure, which it's a nerve stimulator. We'll tell you more about it here in a second.

Host: Well, what is the device? How does it work?

Drew Phillips, DO: Perfect. Yeah. So, it is a surgical procedure where we are finding—I am finding—the nerve under your chin behind your tongue that controls your tongue. It's what protrudes your tongue out and stiffens it up. Your a CPAP. It opens your airway with air every time you breathe. With an Inspire procedure, I am opening your airway every time you breathe by giving you a very gentle, not-hard-enough-to-wake-you-up impulse to stiffen and protrude your tongue out a little bit, to open your airway every time you breathe.

Host: Who is a good candidate for Inspire? You mentioned people who can't tolerate a CPAP. Anyone else?

Drew Phillips, DO: Yeah. So, there is a pretty stringent criteria for people who are candidates for Inspire. This is both for what we got it approved for, what we see good success rate. And I like to have good patient selection. And what the insurance looks at when they say, "Yeah, we're going to approve this person because this will help them."

First thing we're looking at, you have to have moderate to severe obstructive sleep apnea. That is when we get that sleep study, we see that you pause and gasp over 15 times an hour. That's a lot. That's almost every four minutes our oxygen is dropping down.

The second thing we look at is kind of what we alluded to earlier, you can't tolerate your a CPAP. We tried it. You take it off, and you don't even know you've taken it off in the middle of the night. I kind of tell patients it's not doing very much when it's CPAP-ing the floor, or you're laying on it at night. It has to be on your face. So if you can't keep it on, it's not working for you.

The third thing we look at is weight. So when we got it approved about a decade ago, a BMI—that's a fancy criteria where we're taking your height, your weight we're crunching into a number—a BMI of under 40 is what we got it approved for. What we found out is people 35 and below did much better. So, sometimes we have to get you plugged into lose a little bit of weight with our dietary team sometimes with some newer medications to get you under that 35 mark. Those are good candidates.

The last thing we have to do, we have to do a minor surgical evaluation where we put you to sleep for about 10 minutes where you start falling asleep again and collapsing you stop breathing. And we take a look at a camera. About 90% of people have this correct type of collapse, this is kind of front to back collapse. Unfortunately, about 10% of people have this kind of towel ringing out motion when they collapse. There aren't candidates unfortunately. And then, we look for a couple other procedures that I do to help them out. But for the majority of those people, once you meet those criteria, that's when you get sent over to me, and that's when we talk about possibly doing an Inspire procedure.

Host: And what does the procedure and the recovery look like?

Drew Phillips, DO: That's a good question, So, it is a same-day procedure, outpatient. You come in, it's about a 50-minute to about an-hour-and-a-half procedure. You come in, you leave the same-day. Two incisions. There's one incision about an inch and a half under your chin, one on your chest. The one on your chest is where the sensor that senses when you breathe, as well as the battery, which lasts about 10 to 11 years, similar to a pacemaker is. And there's a tiny wire that tunnels up to that upper incision, that's where we find the nerve and put a tiny little cuff around it, that's the stimulator portion. All dissolvable sutures. I put skin glue over top. You can take a shower that same day. And then, we let those sutures heal. And then, a month afterwards, you meet the sleep medicine team again, And we turn the device on. We give you about a month to heal.

Host: Okay. And then, what feedback do you hear most often from patients after treatments?

Drew Phillips, DO: They're doing really well. So, I will say I've been at a couple places, where we've done Inspire implants. This sleep medicine team is all in, in terms of education, following you before, during, and after implantation to make sure you're getting the most out of your implant.

We do kind of monitor, similar to a CPAP, your compliance rate. We're want to see how much are you using it, how high of a stimulation have you moved up to, how well is it working for you? And when we see that you're not using it as much, that's when we're contacting you and saying, "Hey. What's going on? Let's see—" Because the ultimate goal is we want to get your sleep good.

we want you sleeping better. and there's minor adjustments we can make to fine tune that. And then, about four months afterwards, we get another sleep study, and that's the proof in the pudding of how well are we sleeping. Do we need to make minor adjustments? How well are we done?

Host: And what kind of improvements do patients typically notice? And what patterns do you notice as a physician?

Drew Phillips, DO: I will say the biggest compliment that gives me little cold chills sometimes is when people come in usually about three months afterwards, once they've gotten used to it and titrated up a little bit. But the power is, "I'm dreaming again. I haven't dreamed for decades." And sometimes I go, "We can turn it off for you if you want to." And they know it's good dreams. I'm really happy with this. So, that's the first thing that I like to hear when people are now hitting that restful sleep and they're staying in that restful sleep. And they're getting into it multiple times a night. And they're feeling better during the day. They are working better, interacting better. They can stay up a little bit later with their family. It's just an overall quality of life change.

Host: Really a lot. What should someone do if they think they might have sleep apnea and they're just at the beginning of this journey?

Drew Phillips, DO: So when you're at the beginning of the journey, I would say the first stop you really need to make is either your general practitioner, or your family medicine doctor, and talk it over. They can get you a referral over to the sleep medicine clinic. The sleep medicine clinic will take it from there in terms of getting a diagnosis for you. And that's with a sleep study. Like we said, it could be a home sleep study too to see do you have sleep apnea? And if you do, how bad is it? And then, they can start that next phase of treating it first. Like we said, you have to be on a CPAP first to qualify for an Inspire. But if you're one of those people who don't do well with it, that's when you're coming over to me and we're having a conversation.

Host: So, first stop is your primary care physician, and then maybe a specialist. Is a referral needed for a specialist?

Drew Phillips, DO: Typically, for sleep medicine, you can contact them to get plugged in for a sleep study. For me, I do not need a referral. However, to streamline the process, I do recommend getting a sleep study first because I like to know, first, do have obstructive sleep apnea, and two, how bad is it. Are you already a candidate for inspire?

Host: Well, Doctor, any final advice for listeners who are tired of being tired?

Drew Phillips, DO: Tired of being tired. I would say listen to your body or listen to the person who's sleeping with you sometimes. Are you snoring? Are you pausing? Are you gasping? But ask yourself, "Have I been tired almost every day for the last. 10 years, 20 years?" "Am I falling asleep, taking midday naps multiple times a day?" "Am I on multiple blood pressure medications that I wasn't on before?" "Am I feeling groggy and just tired and having mental lapses?" The first thing to start looking at, especially if you're snoring, is, "Am I not sleeping correct?" And we can test that pretty easy, and the rest we can take care of.

Host: Well, Dr. Phillips, thank you. So much for explaining sleep apnea and how the Inspire device is transforming sleep apnea treatment and moving beyond traditional a CPAP. I'm curious to see what further developments we will see ahead in the future.

Drew Phillips, DO: No problem at all. I appreciate you guys having me. This was great.

Host: That was ear, nose and throat specialist Dr. Drew Phillips. Do you think Inspire might be right for you? Connect with Memorial Health Systems Department of Sleep Medicine by calling 740-568-5310 mhsystem.org/sleepmedicine. And that wraps up this episode of A Podcast a Day with Memorial Health System. Be sure to subscribe for more conversations from Memorial Health System.