Drs. Minor and Paddack on advances in treating sleep apnea

Sleep apnea is a serious medical condition that causes you to repeatedly stop breathing for brief moments while you sleep. One in five adults have mild obstructive sleep apnea (OSA), and one in 15 adults have moderate-to-severe OSA.

“With more than 20 million Americans experiencing OSA, its prevalence is similar to diabetes and asthma,” said sleep expert Thomas Minor, MD, with Boulder Valley Pulmonology. ‘Sleep apnea is also more common at higher altitudes.”

Fortunately, very effective treatments exist for OSA, as Dr. Minor and his co-presenter, Dr. Angela Paddack, an Ear, Nose and Throat (ENT) specialist with Boulder Medical Center, described during a recent free online lecture hosted by Boulder Community Health (BCH).

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Watch Advances in Treating Sleep Apnea

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What is Obstructive Sleep Apnea, its risks and consequences?

Dr. Minor explained, “OSA occurs when the muscles at the back of the throat, mainly the tongue and soft palate, temporarily relax while we’re sleeping. This results in narrowed or even closed airways, causing us to repeatedly stop breathing for brief moments while we sleep.”

If left untreated, OSA decreases life expectancy and increases risk for serious conditions, including high blood pressure, stroke, heart failure, irregular heartbeat, artery disease, dementia and type 2 diabetes. However, if sleep apnea is treated, we can reduce these health risks.” He then emphasized, “All our organs have their own needs for sleep to enable them to repair and recover from all the work they did during the day.”

Symptoms of sleep apnea

The most common signs and symptoms of OSA include:

• Loud snoring
• Episodes in which you stop breathing during sleep — which would be reported by another person
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Difficulty staying asleep (insomnia)
• Excessive daytime sleepiness (hypersomnia)
• Difficulty paying attention while awake
• Irritability

Dr. Minor said, “Because you’re not sleeping well, you’ll have trouble concentrating, you may fall asleep during the day or while driving and you’re more likely to be irritable, have memory issues, become frustrated and agitated.”

He added, “While everyone who has sleep apnea snores, not everyone who snores has sleep apnea.”

Diagnosis of sleep apnea

Sleep studies may be recommended to monitor your breathing if OSA is suspected. These can be done at home or in a sleep laboratory.

BCH’s Sleep Diagnostics center in Boulder offers comfortable, home-like settings. Each room has a queen-size premium mattress fitted with high-quality linens, private bathroom with shower, flat-screen HD television, gourmet coffee and a personal wardrobe closet. These amenities serve an important clinical purpose: recreating the comforts of home helps patients experience a better, truer sleep quality that gives clinicians more accurate data.

Studies performed in a sleep laboratory also produced a more sophisticated study. “With the lab experience, it’s possible to test out sleep apnea treatments while you’re in the lab."

BCH’s Sleep Diagnostics is the only sleep study lab in Boulder County fully accredited by the American Academy of Sleep Medicine (AASM), the professional medical association dedicated to assuring quality care for patients.

Treatments for OSA

CPAP Therapies

To prevent sleep apnea, your doctor may recommend a device called a continuous positive airway pressure (CPAP) machine. A CPAP machine delivers just enough air pressure to a mask to keep your upper airway passages open, preventing snoring and sleep apnea.

According to Dr. Minor, the advantages are:

• It’s most likely to be effective
• You can be treated within 24 hours
• Your health care provider will quickly know if the CPAP is effective

The disadvantages are:

• It can cause claustrophobia
• It’s not at all sexy

Oral Appliances

Oral appliances are custom mouthpieces. They pull the jaw forward to create a wider airway to allow you to breathe more easily as you sleep. “Oral appliances aren’t as effective for those with severe sleep apnea. They can cause temporomandibular joint dysfunction (TMJ) and take longer to work,” said Dr. Minor. He also noted, “They are better at reducing snoring than at correcting sleep apnea.”

Oxygen Therapy

Your health care provider may prescribe supplemental oxygen for you to use while you sleep. The oxygen is delivered through plastic tubing called a nasal cannula, typically at a rate of several liters per minute.

“Oxygen therapy can be a good patch,” said Dr. Minor “for those who can’t tolerate other therapies.” He added, “However, to know if it’s successful you need to come back to the lab for another sleep study.”

Positional Therapy

Positional therapy involves wearing a special device around your waist or neck that helps keep you sleeping on your side. It gently vibrates when you start to roll over to sleep on your back. This vibration alerts your body to change position.

Dr. Minor explained that positional therapy is designed to keep the sleeper in a position that minimizes their breathing obstruction.

Inspire Upper Airway Stimulation – A minimally invasive surgical option

“We will always look at CPAP or some of the other devices used to alleviate sleep apnea before we jump into surgery,” stated Dr. Paddack. “Though some patients can’t tolerate CPAP, and Inspire is a great therapy that has had very successful outcomes. This is a hypoglossal nerve stimulation or also called Upper Airway Stimulation. The main company that supports this is Inspire Medical Systems.”

BCH’s Foothills Hospital is proud to be the first and most experienced in Boulder County facility to offer Inspire® Upper Airway Stimulation — an innovative mask-free treatment option for patients with moderate-to-severe obstructive sleep apnea (OSA) who can’t tolerate CPAP.

How Inspire works

Inspire is a minimally invasive surgical alternative to CPAP. It uses an implantable device (similar to a pacemaker) to monitor every breath you take and, based on your unique breathing patterns, it delivers mild stimulation to the nerve that controls your tongue position. By stimulating these muscles, the system keeps your airway open during sleep. With a handheld remote, you turn the device on before bed and off when you wake up.

What you can expect with Inspire

If you meet eligibility requirements, your physician will confirm that Inspire therapy is right for you.

"Inspire is a safe outpatient procedure," Dr. Paddack explained. "Two small incisions are made: one under the jawline and another at the upper chest. A sensor is placed in between the ribs, which then sends a signal to the stimulator on the nerve to open the airway while sleeping.”

A week or two after the procedure is performed, patients are back to all their normal activities. “The battery,” said Dr. Paddack, “lasts about 11 years, which at that point the battery pack alone can be replaced through a simple procedure. Patients have loved Inspire and are very happy they did it.”

As a clinically proven therapy, most insurance providers cover the procedure, including Medicare and the Veterans Health Administration.

Statistics and satisfaction

Inspire therapy is very successful. As of October 2020, there had been more than 100 peer-reviewed publications on Inspire therapy. These publications show that patients using Inspire therapy experience significant benefits:

· 79% reduction in sleep apnea events, resulting in a healthier, restful night’s sleep

· 88% reduction in snoring

· 94% of people are satisfied with Inspire

· 96% of patients say Inspire is better than CPAP and would recommend Inspire to others

· Improved daytime functioning from better sleep

“Nationally, we know that people tolerate CPAP 50% of the time. With Inspire, we are seeing a satisfaction rate of 94%," said Dr. Paddack. "There’s no uncomfortable mask, and they can sleep in different positions. The result is people are getting better sleep and management of their OSA."

Make an appointment

Please visit the Boulder Valley Pulmonology website or call 303-415-5399 for more information and to schedule an appointment with Thomas Minor, MD. To schedule an appointment with Angela Paddack, MD, or for more information about Inspire®, please visit the Boulder Medical Center website or call (303) 440-3073.

Click here to view/download slides shown during the lecture on "Advances in Treating Sleep Apnea."

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