Inspire Sleep Apnea Treatment at University Hospitals
Though often overlooked, sleep is a huge part of our lives. Healthy sleep is essential for wellbeing. Conditions that prevent us from achieving restful sleep can have profound effects on our cardiovascular health, daytime functioning, and interpersonal relationships.
At the University Hospitals Sleep Surgery Center, we are able to provide a comprehensive sleep evaluation. We specialize in the medical and surgical treatments of snoring and obstructive sleep apnea (OSA). We work closely with our colleagues in Sleep Medicine, Dentistry/Orthodontics, Oral Surgery, Psychology, and Weight Management to formulate an individualized treatment plan for each patient.
To request an appointment with a sleep surgery specialist, call 216-844-6000.
Obstructive Sleep Apnea Evaluation
- What is Obstructive sleep apnea (OSA)?
Common symptoms of OSA can include snoring, unrefreshing sleep, and daytime sleepiness. Things like morning headaches, clenching/grinding of the teeth, frequent nighttime urination, mood irritability, and memory problems may also be signs of OSA.
- What are the symptoms of OSA?
OSA is a condition that occurs when the upper airway partially or fully closes during sleep, leading to pauses or limitations of airflow to the lungs. This can lead to intermittent dips in oxygen levels, variability in the pulse rate, and arousals from sleep. Along with impairing daytime functioning and restful sleep, OSA is associated with several medical problems. These problems include high blood pressure, diabetes, heart problems, and stroke.
- How is OSA diagnosed?
The diagnosis of OSA involves a comprehensive sleep history as well as a sleep study. Sleep studies can be performed in a sleep lab or in the home setting. For patients who do not have other serious health problems and have classic OSA symptoms, home sleep testing can be a convenient way to establish a diagnosis. Home sleep testing involves wearing a small apparatus to measure breathing flow, breathing effort, and oxygen level while you sleep in your own bed. For more complicated cases, in-lab sleep testing is the gold standard that provides the most sleep information. This involves measures of breathing, sleep movements, and the brain waves of sleep.
Obstructive Sleep Apnea Treatment
If a sleep study shows evidence of OSA, your disease may be classified as mild, moderate, or severe. For mild sleep apnea, treatment is directed at symptoms. For moderate to severe sleep apnea, the goals of therapy are to treat sleep-related symptoms and also to lower some of the medical risks listed above.
Treatment of sleep apnea does not have to be black and white. Various combinations of medical, surgical, and dental therapies as well as lifestyle modifications are often employed for the best possible result. For example, surgery or other therapy to open the nose may help improve CPAP usage and response.
It is also important to remember that OSA is only one of over 50 sleep disorders! Disorders like insomnia and restless legs are even more common than OSA and may lead to significant sleep problems and daytime symptoms. These problems often occur with OSA and should also be addressed for overall symptom improvement.
Medical Treatment Options for OSA
There are several medical treatment options for OSA; the best choice depends on OSA severity, other clinical factors, and patient preference.
- CPAP or BiPAP
Continuous positive airway pressure (CPAP) remains the standard first-line OSA therapy, especially for moderate to severe disease. CPAP involves the delivery of positive air pressure through a tube and mask that sits over the nose and/or mouth; this serves to hold the throat open during sleep. CPAP can be highly effective with nightly use. There are many options for machine modes, pressure settings, and masks for each individual patient.
- Oral Appliance Therapy
Oral appliance therapy (OAT) involves a mouth guard-like apparatus that sits on the upper and lower teeth. These are often made by dentists with special training in sleep problems. OAT holds the lower jaw forward, preventing throat collapse during sleep.
- Weight Loss & Lifestyle Interventions
For many patients, weight plays a role in OSA severity. Even a small change in weight- up or down- can have a significant effect on the amount of throat collapse during sleep. In fact, weight loss surgery may be one of the best “sleep surgeries” available! When the weight is in a normal range, the menu of OSA treatment options expands.
A majority of OSA is positional; most patients have more breathing pauses while sleeping flat on their back rather than on their side, stomach, or in a reclined position. Special beds or devices that discourage sleeping flat on the back can occasionally be used to improve OSA.
Other lifestyle interventions, such as avoiding alcohol or other sedating medications, quitting smoking, and even throat exercises, may decrease throat collapse during sleep.
Surgical Treatment Options for OSA
When patients have trouble with other treatments, surgeries of the nose, throat, or jaw may be favorable alternatives. Surgeries can be used alone or with other treatments to achieve the best possible outcome. In general, OSA surgery has the most success when the weight is in a normal range.
- Drug-induced sleep endoscopy (DISE)
During DISE, a flexible camera is used to look at the nose and throat during sleep-like conditions. DISE itself does not treat OSA, but it is able to offer more information on the location and pattern of upper airway collapse during sleep. DISE can be used to troubleshoot medical therapy and help determine best surgical options. DISE also helps to determine who is and is not an anatomic candidate for INSPIRE, discussed below.
- Soft Tissue Surgery
Soft tissue surgery for OSA involves removing or rearranging structures inside the throat (i.e. tonsils, roof of the mouth, uvula, back of the tongue, or parts of the voice box). This can create more space for airflow and also stiffen parts of the throat, making them less apt to collapse. Nasal surgery does not usually improve throat collapse, but it can help as an adjunct to other medical or surgery therapies.
- Bony Surgery
Bony surgery such as maxillomandibular advancement (MMA) serves to expand or advance the jaw bones, creating significantly more space in the throat.
- Inspire Upper Airway Stimulation (UAS) Surgery
Inspire UAS therapy involves a fully implantable device that stimulates the airway to open with each breath during sleep. Unlike soft tissue or bony surgery, there is no manipulation of the throat itself. UAS is typically performed on an outpatient basis and requires less recovery than traditional sleep surgery. The therapy settings are titratable and adjustable, similar to a CPAP. Candidates for Inspire UAS:
- Are 22 years of age or older
- Have OSA with number of breathing pauses (apnea-hypopnea index, AHI) between 15 and 65 per hour
- Are unable to use or get consistent benefit from CPAP
- Are not significantly overweight (body mass index, BMI <32-35)>32-35)>
- Have appropriate patterns of throat collapse on DISE
Watch how Inspire Sleep Apnea Innovation can help treat your Obstructive Sleep Apnea