Are We Enetring a new Era in OSA Therapy?

[RobertS975]

Back in March, I wrote that someday we may look back at this era of sleep apnea therapy as obsolete and primitive.

viewtopic.php?f=1&t=96746&p=895959&hili ... er#p895955

The first implanted pacemaker to treat sleep apnea has now been approved by the FDA. I can't be sure, but someday, after this technology evolves and is improved, we may look back at all the talk about masks and pillows and machines as interesting medical history.

http://dailydigestnews.com/2014/05/fda- ... eep-apnea/

[fmj13]

If I knew it would work, I would do it in a heartbeat.

[jencat824]

I would not be so hasty to try this. I don't like the ideas of something implanted into my body. I would probably stay willingly with my machine & mask until LOTS of people have used the new tech first. As long as masks & machines are available, I would resist this new implant & I have my reasons for feeling this way. For someone who just can't make the CPAP therapy work, this might be a good alternative, just not for me.

[chunkyfrog]

This is not likely to move ahead very quickly at all, mostly for economic reasons.
The costs of implant and the surgery would be in excess of several years of pap therapy.
Surgeons who wear boat shoes do so for a reason--a lot of them can afford a boat.

[jnk]

Yes. We are entering a new era--an era in which we embrace the beauty and simplicity of PAP therapy and perfect it instead of wishing to take steps backwards into the era of unnecessary surgeries and approaches that only help about half the people half the time to temporarily halve the severity of their condition. The new era will involve finding ways of making PAP viable for ALL OSA sufferers in the cheapest and most effective and most comfortable way.

I embrace the pursuit of the experimental. Science involves trying things that are pretty silly sometimes. I applaud that. Even implanting electrical wires in the throats of willing guinea pigs. BUT, I am much happier that the people who discovered the modern application of PAP for OSA--which is a fairly recent discovery, all things considered, and a discovery way ahead of its time--had the business sense to find a way to get the benefits out to the masses very quickly so that lives could start getting saved as soon as possible, even before the approach was perfected. Machines continue to get better and better. Masks continue to get better and better. Understanding is improving. All leading to the amazing era to come in PAP.

I believe especially that the new era in OSA therapy will involve making PAP available to any human who wants to try it. We will look back on these days of requiring medical tests and medical supervision for PAP use to be the barbaric days that they are. All nations that truly believe in life, liberty, and the pursuit of happiness will one day understand that none of those things matter without the right to pursue the best sleep possible. Denying citizens that right by means of insurance-dictated criteria is a crime perpetrated on humanity. The new era will stop that nonsense and put PAP machines on the shelves of department stores right next to the vaporizers, and with a similar cost as a result of the increased production and distribution. The new era will recognize that if a human can be trusted to choose whether or not to humidify the air in his bedroom, he can likewise be trusted to decide whether or not to pressurize it, too.

The new era will embrace the fact that PAP is less dangerous than an aspirin and so should be OTC to allow the costs to come down with market pressures.

May that new era come quickly.

Lives are at stake.

[Pacer not masker]

I got a pacemaker to stop my heart slowing down too much, including overnight.

After I got it I tried not using CPAP and found: 1) I no longer had OSA symptoms (untreated AHI was 48, O2 sat 90%, apnoeas lasting 45 seconds) including snoring, thrashing around in bed etc, and 2) CPAP no longer made an difference to how I felt during the day. But I need to toilet once a night now, whereas on CPAP it was nil (I know that can be an OSA symptom).

I am of normal BMI and otherwise healthy.

Using CPAP didn't bother me too much when it was benefiting me so much, but I sure was glad to get rid of it when something else took over.

[chunkyfrog]

Where shall we send the flowers?
You do realize this choice is suicide.

[Pacer not masker]

"You do realize this choice is suicide"

I have had more medical advice than is healthy to receive and am getting more.

Someone who does not snore, does not thrash around in bed and is not tired though the day would not be diagnosed with OSA, and that's me since the pacemaker. It boosts my heartrate multiple times overnight.

[RobertS975]

This pacemaker is inserted just below the skin.... as far as surgery goes, it is not complex. Right now, the FDA has approved it for people who cannot tolerate CPAP or in whom it simply doesn't work for some reason. As more experience is gained with this technology, it may be well be expanded to include others OSA sufferers.

Personally, as a OSA patient and as a physician, I would choose this new option in an instant once it is proven to be effective and once the technology has been proven. It is a minor subcutaneous procedure and it may well be better than sleeping with straps and tubes and air leaks. Trust me, I am grateful for what CPAP has done for me over the past two months of treatment, but maybe, just a maybe at this point, there may be something superior down the road.

[Sludge]

...maybe, just a maybe at this point, there may be something superior down the road.

No doubt, but "IMHO", HGNS won't be it:

viewtopic.php?f=1&t=74721&st=0&sk=t&sd=a&hilit=hgns

At 30G per procedure,it's going to be a tough sell:

http://www.startribune.com/business/257581481.html

Yikes!

They are $50 million in the hole already?

I'd like to see the financial adviser on THAT decision! Better yet, I'd like to see the salesman for Inspire who sold the idea...

And what happens WHEN this company folds (when the pharmaceutical "Magic Bullet" comes along)?

[Sludge]

Further, the Sales Hook for this thing remains:

"HGNS: Hey, It's Better Than Nothing!"

Their "Large Scale" study shows the Arousal Index dropping by half.

Further2, check out Page 11:

http://www.nejm.org/doi/suppl/10.1056/N ... pendix.pdf



I mean, with a stringent qualifying process, a third of them went nowhere?

You think CMS will authorize that?

[Todzo]

I got a pacemaker to stop my heart slowing down too much, including overnight.

After I got it I tried not using CPAP and found: 1) I no longer had OSA symptoms (untreated AHI was 48, O2 sat 90%, apnoeas lasting 45 seconds) including snoring, thrashing around in bed etc, and 2) CPAP no longer made an difference to how I felt during the day. But I need to toilet once a night now, whereas on CPAP it was nil (I know that can be an OSA symptom).

I am of normal BMI and otherwise healthy.

Using CPAP didn't bother me too much when it was benefiting me so much, but I sure was glad to get rid of it when something else took over.

It certianly makes sense that if you find the cause of a problem it results in a cure.

Glad for you.

[49er]

I got a pacemaker to stop my heart slowing down too much, including overnight.

After I got it I tried not using CPAP and found: 1) I no longer had OSA symptoms (untreated AHI was 48, O2 sat 90%, apnoeas lasting 45 seconds) including snoring, thrashing around in bed etc, and 2) CPAP no longer made an difference to how I felt during the day. But I need to toilet once a night now, whereas on CPAP it was nil (I know that can be an OSA symptom).

I am of normal BMI and otherwise healthy.

Using CPAP didn't bother me too much when it was benefiting me so much, but I sure was glad to get rid of it when something else took over.

Did you get a sleep study to confirm this? That is the only way you truly know if your apnea has disappeared for good.

49er

[Todzo]

This pacemaker is inserted just below the skin.... as far as surgery goes, it is not complex. Right now, the FDA has approved it for people who cannot tolerate CPAP or in whom it simply doesn't work for some reason. As more experience is gained with this technology, it may be well be expanded to include others OSA sufferers.

Personally, as a OSA patient and as a physician, I would choose this new option in an instant once it is proven to be effective and once the technology has been proven. It is a minor subcutaneous procedure and it may well be better than sleeping with straps and tubes and air leaks. Trust me, I am grateful for what CPAP has done for me over the past two months of treatment, but maybe, just a maybe at this point, there may be something superior down the road.

Currently CPAP seems to help optimistically somewhat over 50% of those with OSA.

Recent research would indicate that the "pacemaker" might help some 37%[1].

We still need more options.

[1] http://www.atsjournals.org/doi/abs/10.1 ... 2IGGaZ3_FW

[RobertS975]

CPAP has continued to evolve and improve for decades. It would be a big mistake for anyone to assume that this new technology, still in its infancy, will not do the same... evolve and improve.