Inspired Therapy

[Broken Bob]

Has anyone had, or know anyone that has, the Inspired Therapy implant? I went to a seminar last night that was moderated by one of our areas leading sleep doctors and an ENT, also highly respected. The implant is made by the same company that makes the Pacemaker and uses the same principles. The module is placed under the skin on the right side of the chest. Two leads run under the skin, one goes to and is attached to a nerve controlling a muscle in the throat and the other down toward the lung where it monitors breathing. You turn the implant on/off with a remote controller and is only used during sleep. Apparently certain conditions must apply in order to be a candidate. Your Apnea has to be in the 20-36 range, and you have tried to use Cpap over a period of time but have been unsuccessful for what ever reasons. One drawback that I know of is that with the implant, you cannot have an MRI.
I am going for an interview this Friday and I am wondering what the Apnea world has to say about this.

[Julie]

I would do absolutely everything I possibly could to not have a hindrance to MRI's.

[Broken Bob]

Yea-that is what my wife says.

[49er]

HI BB,

The issue for me would be what are your chances of needing an MRI in the future which of course can be hard to predict and what alternatives are there to having one. That has to be balanced with your need to treat the apnea and the health risks if you don't. What other options are there vs. using the cpap which I am assuming you you have not had success with. Personally, I wouldn't rule the Inspire Procedure out just yet until you fully weigh these issues.

49er

[Broken Bob]

49er-Thanks for your insight. The MRI issue is a problem although I have only had two of them in 72 years. I understand that todays Pacemakers are immune to MRI and there is a probability that this technology will eventually apply to this device. Right now, I would rather get a good nights sleep than worry about the possibility of having an MRI in the future.

[Julie]

It's not about the pacemakers being immune to MRI, but the MRI being magnetic and potentially effectively pulling your implant out. And you only had 2 MRIs so far because they weren't invented when you were younger plus as you get older, the chances of your needing more will increase. What problems did you find insurmountable with Cpap - and are you sure we can't help with those?

[Broken Bob]

Julie---Where do I start? I have been on Bpap since 2011. I have had 3 sleep studies, the most recent this past May because I changed sleep doctors. My original study on 11-1-11 indicated I had an Apnea of 36 and the tech informed me that he almost put a mask on me, but he did not. The doctor put me on Responics system one and a Mirage Quattro full face mask. My machine was set in an auto mode, cpap, epap set at 14, no ipap. My AHI varied from a low of 16.83 to high of 56.85 thru Aug 2012. Aug. 12, 2012, 2nd sleep study. The tech went through every mask she had during the course of the night. I kept blowing them off. She told me that she was recommending to the doctor that I needed oxygen assistance with my machine. On 9-5-2012, the doctor changed me to bi-level, Epap-5.00, Ipap-25.00. From this date until May,2014, my AHI varied from a low of 4.09 to a high of 42.03. In May of 2014, I changed sleep doctors. I had my 3rd sleep study using my mask. He set up the Epap-13.00, Ipap-17.00 and off the record told me to make adjustments as needed. Currently I am running Epap-14.50 and Ipap-17.00. Since going to him, my AHI has dropped to single digits with a high of 8,97 and a low of 1.35. My main problem now is that I continue to have excessive leaks, with the average total leaks 77.59 and 95% total leaks at 101.00. I am getting and replacing the seal every 30 days, makes no difference if I am using pad-a-cheek or not, The leaks and noise have driven my wife away and she is threatening to move in with a neighbor 3 blocks away just to get away from it. Sorry for the length. Hope you got the picture.

[Broken Bob]

Julie

Forgot to mention that I had deviated septum and turbinate reduction surgery June 23, 2013--sure helped my breathing but did not fix the leaks.

BB

[cnaumann]

Sounds slightly better than a tracheostomy.

[Julie]

So sorry for all your trouble! Have you tried other masks - given them a fair amount of time once properly fitted (while lying down) in your size, etc? I know it sounds obvious, but people (especially if they got started long ago) may not realize what a variety of masks are out there now. I also know it's a huge hassle to have to deal with, but once you find one that works reasonably well you can relax. You're obviously not getting good therapy so it makes the runaround harder, but you could be cheating yourself by not taking the last step to get the right mask. Unless you have tried hard with no luck...?

[Drowsy Dancer]

The implant sounds horrendous (although I am not at all unsympathetic to your struggles with xPAP).

What happens, though, if one's untreated AHI increases over time, as it is wont to do? You're already on the high end of what they recommend this before.

I wouldn't want to be a lab rat for this one, personally...

[49er]

The implant sounds horrendous (although I am not at all unsympathetic to your struggles with xPAP).

What happens, though, if one's untreated AHI increases over time, as it is wont to do? You're already on the high end of what they recommend this before.

I wouldn't want to be a lab rat for this one, personally...

DD,

The issue is one can't get pap therapy to work no matter what they have tried and dental devices are unsuccessful, the only remaining option is surgery and trying to pick the one that is most appropriate for your situation.

When I erroneously thought I had severe apnea, this procedure was on my list to investigate if I found that having a septoplasty (will make plans to see an ENT about this) did not help with pap therapy tolerance. But my sleep study last week showed mild apnea plus a moderate RERA index for 3.7 hours of sleep so for now, I am out of the running which is good or bad depending on your point of view.

This procedure seemed alot less invasive than the sleep apnea surgeries altering the anatomy although of course, I didn't admittedly investigate all the relevant issues. But if you're doing well on cpap, it is understandable you wouldn't want to be a lab rat. Unfortunately, some people don't have any choice but to be one.

49er

[Pugsy]

Have you ever tried a different full face mask?
Why are you using a full face mask? Is it out of a physical need to mouth breathe because you can't breathe through your nose?

You know even if you used a nasal mask and did some mouth breathing, there's a good chance that any mouth breathing leaking might be less of an issue than you are having with current mask. I know it's a weird idea...but if you can normally breathe through your nose most of the time...maybe it wouldn't be the end of the world if you used a nasal mask (much easier to keep sealed) even with a little mouth breathing going on.

If you have never tried a different full face mask...try one or two or three or whatever. Not everyone does so great with the Quattro.

Would you consider at least trying a nasal pillow mask (I might have one for free) to see if it remotely would work?
At this point with the leaks you are having....it would be difficult to be worse even if you did some mouth breathing and maybe your overall sleep quality would improve.

[grayghost4]

i believe this is what you are referring to :


http://healthinfo.uclahealth.org/YourFa ... t/6,683611

[Broken Bob]

Pugsy

I started out with full face because I was a mouth breather. In trying to become a nose breather, I tried a full face that went under my chin and was suppose to keep my mouth closed--didn't work. I have used chin straps and even went so far as to duct tape my mouth. I finally had deviated septum and turbinate reduction surgery, which really helped me, and I have now become a nose breather. When I changed sleep doctors this past May, I tried a nasal pillow against my Respiratory Therapist's advice. She thought my pressures were to high for a nasal pillow. After several nights I had to agree with her and I traded it in for a Mirage Quattro. Since getting the Quattro again I have been back to my equipment provider and discussed my leakage problems but they had nothing to offer me. They did tell me that I can get a new mask in 6 months.

BB