Understanding Sleep Apnea: From Diagnosis and CPAP to Inspire® Therapy

A full night's sleep should leave you feeling refreshed. But for people with sleep apnea, eight hours of "sleep" may include dozens—or even hundreds—of breathing interruptions. These episodes can prevent the body from getting the restorative rest it needs, even when the person does not remember waking up. 

Loud snoring, morning headaches and daytime exhaustion are often dismissed as minor annoyances. However, they may be signs of a potentially serious sleep disorder that deserves medical attention. 

"Sleep apnea can affect much more than the quality of a person's sleep," said Lorraine M. Williams-Rahming, MD, MPH, FACS, an otolaryngologist at Archbold ENT & Allergy in Thomasville. "Recognizing the symptoms, completing the appropriate testing and finding a treatment the patient can use consistently are all important steps toward better sleep and better overall health." 

Archbold now offers another treatment option for certain patients with obstructive sleep apnea who have struggled with continuous positive airway pressure, or CPAP. Dr. Williams-Rahming recently completed Archbold ENT & Allergy's first Inspire® implant procedure, bringing this mask-free treatment option to qualifying patients in South Georgia. 

What Is Sleep Apnea?

Sleep apnea is a disorder that causes breathing to stop or become restricted during sleep repeatedly. Each interruption may last only several seconds, but the cycle can occur many times throughout the night. 

The three primary types of sleep apnea are: 

  • Obstructive sleep apnea: The most common type, obstructive sleep apnea occurs when the muscles and tissues in the throat relax and block the upper airway. 
  • Central sleep apnea: This type occurs when the brain does not consistently send the proper signals to the muscles responsible for breathing. 
  • Complex sleep apnea: Also called treatment-emergency central sleep apnea, this condition involves characteristics of both obstructive and central sleep apnea. 

Inspire therapy is specifically designed to treat certain patients with moderate with several obstructive sleep apnea, commonly called OSA. 

"OSA is the most common type of sleep apnea. It occurs when the tongue relaxes back into your airway during sleep, blocking your airway," explained Dr. Williams-Rahming. "When your airway is blocked, your body triggers you to wake up and gasp for air."

These brief awakenings may happen so quickly that a person does not remember them to next morning. Nevertheless, they can disrupt the natural sleep cycle and reduce the amount of restorative sleep the body receives. 

Common Signs and Symptoms of Obstructive Sleep Apnea

A bed partner may be the first person to notice possible sleep apnea symptoms. Loud snoring, gasping, choking, or pauses in breathing during sleep can all indicate that the airway is becoming obstructed. 

Other possible symptoms include: 

  • Waking with a dry mouth or sore throat
  • Morning headaches
  • Difficulty staying asleep
  • Daytime sleepiness or fatigue
  • Trouble concentrating 
  • Irritability or mood changes
  • Falling asleep while reading, watching television, or sitting quietly
  • Feeling tired despite spending enough time in bed

Snoring alone does not necessarily mean someone has sleep apnea, and not everyone with sleep apnea snores. A medical evaluation is needed to identify the cause of the symptoms. 

"People sometimes become accustomed to feeling tired and begin to think that it is normal for them," said Dr. Williams-Rahming. "If you regularly wake up unrefreshed, struggle to stay awake during the day or have been told that you stop breathing while asleep, it is important to discuss those concerns with a healthcare provider."

Step 1: Discuss Your Sleep Apnea Symptoms With a Provider

The path toward treatment typically begins with a conversation about your symptoms, sleep patterns, and medical history. Your primary care provider may ask whether you snore, wake up gasping, experience morning headaches or have difficulty remaining alert during the day.

Information from a spouse or family member may also be helpful because they may have observed nighttime symptoms that you do not remember. 

Your provider may refer you to an ENT, also known as an otolaryngologist, for a closer evaluation of the physical factors that may be affecting your breathing during sleep. This specialist can examine the anatomy of your nose, throat, tonsils, tongue, and jaw to identify areas where the airway may be narrowing or becoming blocked. 

Because ENTs specialize in conditions involving the ear, nose, throat, head and neck, they play an important role in identifying possible airway obstructions and helping patients understand their treatment options. Archbold ENT & Allergy evaluates and treats sleep apnea along with a wide range of upper-airway conditions. 

Step 2: Complete a Sleep Study

Symptoms can raise suspicion of sleep apnea, but a sleep study is generally needed to confirm the diagnosis and measure its severity. 

Depending on the patient's health, symptoms and provider recommendations, testing may involve an overnight study in a sleep center or a home sleep apnea test. The study records information such as breathing patterns, oxygen levels, heart rate, and the number of breathing interruptions that occur during sleep. 

One important measurement is the apnea-hypopnea index, or AHI. This number represents the average number of complete or partial breathing interruptions a person experiences per hour of sleep. The results help providers determine whether sleep apnea is mild, moderate, or severe. 

"A sleep study gives us objective information about what is happening while the patient sleeps," said Dr. Williams-Rahming. "That information allows the care team to understand the type and severity of the sleep apnea and recommend treatment based on the individual patient's needs." 

Step 3: Review Your Sleep Apnea Treatment Options

Sleep apnea treatment is not one-size-fits-all. The appropriate approach depends on the type and severity of the condition, the patient's anatomy, overall health, and ability to use a particular therapy consistently. 

Healthy Lifestyle Changes

For some patients, lifestyle changes may reduce symptoms or support another form of treatment. Recommendations may include: 

  • Reaching and maintaining a healthy weight
  • Exercising regularly
  • Avoiding alcohol or sedating medications near bedtime unless directed by a provider
  • Quitting smoking
  • Sleeping on the side rather than the back
  • Treating nasal congestion or allergies

Lifestyle changes can be beneficial, but patients should not discontinue prescribed sleep apnea treatment without speaking with their provider. 

CPAP and Other Positive Airway Pressure Therapy

Continuous positive airway pressure, better known as CPAP, is a common and effective treatment for obstructive sleep apnea. A CPAP machine delivers a steady flow of air through a mask to prevent the airway from collapsing during sleep. 

Other positive airway pressure devices APAP, which automatically adjusts pressure, and BiPAP, which provides different pressure levels during inhalation and exhalation. 

CPAP works well for many people, but it must be used consistently. Some patients have difficulty tolerating the mask, air pressure, hose, dryness, or noise. Before moving to another treatment, the care team may recommend trying a different mask, adjusting settings, adding humidification or addressing nasal obstruction. 

"CPAP remains an effective and appropriate treatment for many patients," said Dr. Williams-Rahming. "When someone is struggling with it, the first step is often to determine whether adjustments can make the therapy more comfortable. If the patient still cannot receive the necessary benefit, we can then evaluate whether another treatment may be appropriate." 

Oral Appliance Therapy

A custom oral appliance may be an option for certain patients, particularly those with mild to moderate obstructive sleep apnea. Worn during sleep, the device repositions the lower jaw or tongue to help keep the airway open. 

Patients should receive an appliance designed and fitted specifically for sleep apnea and continue follow-up care to determine whether it is effectively controlling their condition. 

Surgery for Obstructive Sleep Apnea

When enlarged tonsils, nasal blockage, excess throat tissue, or another structural issue contributes to sleep apnea, surgery may be considered. The specific procedure depends on the location and cause of the airway obstruction. 

An ENT specialist can examine the upper airway and help determine whether surgery or another treatment may improve airflow during sleep. 

Step 4: Consider Inspire Therapy When CPAP Is Not Working

For qualifying patients with moderate to severe obstructive sleep apnea who cannot tolerate or benefit from CPAP, Inspire therapy may provide another option. 

Inspire is an FDA-approved upper airway stimulation system that works inside the body. Rather than using a mask and hose to push air into the airway, the implant delivers gentle stimulation to the nerve that controls tongue movement. This stimulation helps move the tongue forward, keeping the airway open while the patient sleeps. 

"Inspire treats obstructive sleep apnea differently from CPAP," said Dr. Williams-Rahming. "It monitors the patient's breathing and provides gentle stimulation that helps keep the airway open. For an appropriately selected patient who has been unable to use CPAP successfully, it can offer a mask-free approach to treatment."

How Does the Inspire Sleep Apnea Implant Work? 

The Inspire system includes an implant placed under the skin during an outpatient surgical procedure. The system detects the patient's natural breathing pattern and delivers mild stimulation during sleep to help prevent the tongue from blocking the airway. 

The patient controls the therapy with a handheld remote. Before going to sleep, the patient turns the system on. A short delay allows time to fall asleep before stimulation begins. The patient turns the system off after waking in the morning. 

Inspire describes its current procedure as involving two small incisions. After implantation and healing, the patient works with the care team to activate the system, adjust its settings, and evaluate how effectively it is treating the sleep apnea. 

"Inspire is not simply implanted and forgotten," said Dr. Williams-Rahming. "Follow-up is a very important part of the process. We work with the patient to activate and fine-tune the therapy so it is both comfortable and effective." 

Who May Qualify for Inspire Therapy?

Inspire is not intended for everyone with sleep apnea. A comprehensive evaluation is required to determine whether the therapy is appropriate. 

Basic qualifications generally include: 

  • Being 18 or older
  • Having a diagnosis of moderate to severe obstructive sleep apnea
  • Being unable to tolerate or receive adequate benefit from CPAP

Current FDA indications include certain patients with an AHI between 15 and 100. The FDA also notes that Inspire has been evaluated in patients with a body mass index up to 40. Individual insurance plans may apply additional coverage requirements, and candidacy cannot be determined by AHI or BMI alone. 

The evaluation process may include reviewing the patient's most recent sleep study, confirming prior attempts at CPAP use, and examining the airway. Patients may also need a procedure called drug-induced sleep endoscopy. During this evaluation, the physician observes how the airway collapses while the patient is sedated. Certain patterns of airway collapse may make Inspire less effective. 

"Inspire is a specialized treatment, so careful patient selection matters," said Dr. Williams-Rahming. "We look at the sleep study, the patient's experience with CPAP, overall health and airway anatomy before deciding whether this therapy is a good fit." 

What to Expect After Inspire Implant Surgery

Patients receive specific recovery instructions based on their procedure and health needs. 

After surgery, the incision and surrounding tissue are given time to heal before the Inspire device is activated. Once activated, stimulation begins at a low level and is gradually adjusted based on the patient's comfort and treatment response. 

Follow-up testing may be recommended to evaluate breathing, oxygen levels, and sleep apnea events while using the device. Adjustments can then be made to optimize therapy. 

As with an implanted medical device or surgical procedure, Inspire has potential risks, limitations and contraindications. A consultation with an Inspire-trained physician is necessary to review those considerations and make an informed decision. 

Why Treating Sleep Apnea Matters

Untreated obstructive sleep apnea can interfere with energy, memory, mood, work performance and quality of life. Excessive sleepiness can also make driving and other daily activities dangerous. 

Effective treatment can help patients breathe more consistently during sleep and receive more restorative rest. The best treatment is one that is medically appropriate and that the patient can use consistently. 

"You should not assume that poor sleep and constant exhaustion are simply things you have to live with," said Dr. Williams-Rahming. "There are several ways to treat obstructive sleep apnea, and Inspire gives us another option for qualifying patients who have not been successful with CPAP."

Find Sleep Apnea Treatment in South Georgia

Archbold ENT & Allergy offers evaluation and treatment for patients with sleep apnea and other conditions affecting the ear, nose, throat, and upper airway. With the addition of Inspire therapy, qualifying patients can now access the implantable sleep apnea treatment closer to home in South Georgia. 

To learn more about Inspire therapy or schedule an evaluation with Dr. Lorraine M. Williams-Rahming at Archbold ENT & Allergy, call 229.228.2400.