Joseph Bergeron doesn’t know how many close calls he’s had.
But, he does remember one.
“I was driving home from my job in Ware one night. I work second shift and it is about a 45-minute ride back home to Chicopee. When I got off my exit from the Mass. Turnpike, I pulled behind a truck with my foot on the brake. The next thing I knew, I hit the truck……my foot was off of the brake,” Bergeron said.
“I continued to tell my wife how I would zone out while driving home and then the next thing I knew there would be a car in front of me. I was afraid it was going to be my demise. ‘Well, you do stop breathing at least 10 times a night,’ my wife told me,” he added.
Bergeron was a patient of Dr. Daniel Plosky at Ear, Nose and Throat Surgeons of Western New England, and told him what was happening. Suspecting his patient was suffering from sleep apnea, he sent him to Baystate Medical Center for a sleep study.
A common condition
Sleep apnea is a common condition that can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. This is known as obstructive sleep apnea. Studies at a sleep center or at home can detect obstructive apneas or hypopnea events - which are times when your breathing stops or partially blocks during sleep - monitor blood oxygen levels during sleep, and in laboratory studies monitor brain activity during sleep.
Dr. Kranti Bhagi, a sleep medicine specialist at Baystate Medical Center, explained to Bergeron that he stopped breathing 32 times per hour with large drops in his oxygen levels due to obstructive sleep apnea and that treatment was needed. She ordered a CPAP machine, the most common treatment for obstructive sleep apnea that uses air pressure to keep the airway open and improve breathing in sleep.
However, despite great improvements in CPAP masks and machines that are now silent and that have led to 85% of patients being able to use CPAP regularly, there are still patients who cannot tolerate the air pressure or full face or nasal masks used with the CPAP machine. The main reason for not using them is that patients often find them cumbersome and uncomfortable.
A newer option than CPAP
“I tried it, didn’t like it, and was totally uncomfortable with the masks,” Bergeron said, who would soon learn about a newer option called Inspire to treat his apnea.
Inspire is the only FDA approved obstructive sleep apnea treatment - deemed safe and effective in multiple clinical studies - that works inside the body to treat the root cause of sleep apnea. It is a small device placed under the skin of the neck and chest during a same-day, outpatient procedure that takes about two hours. When you go to bed for the night, Inspire is turned on by simply clicking the remote you were given. While sleeping, Inspire sends mild stimulation to the motor nerve that controls your tongue, moving it out of the way. The stimulation is very gentle and designed to move the tongue forward without disturbing your sleep.
“After the surgery to implant the device, the patient heals for one month and then Inspire is activated and the amount of stimulation is slowly increased until it controls snoring and the sleep apnea stopping the drops in oxygen and awakenings caused by obstructive sleep apnea. Inspire typically starts stimulating the tongue after a delay so the patient is able to fall asleep without any discomfort,” said Dr. Karin Johnson, medical director, Baystate Health Regional Sleep Program and Baystate Medical Center Sleep Laboratory.
A slight adjustment
“Mr. Bergeron initially felt the tongue movements before falling asleep and felt they were not in sync with his breathing. After a quick adjustment to his stimulation settings in the office, he was able to tolerate Inspire without difficulty and his follow-up sleep study showed much improved sleep and breathing,” she added.
The procedure was introduced at Baystate in December 2019, not long before COVID-19 shut down the country.
“It was something I had been aware of and now was getting more popular and established with success rates that were looking very favorable for patients. Previous surgical interventions for those patients who could not tolerate CPAP were painful and invasive, and their success rate did not compare to the Inspire device,” Dr. Plosky said, who performs the surgery with Dr. Jonathan Y. Lee of Baystate Plastic & Reconstructive Surgery.
A paradigm shift
Dr. Lee first gained insight into Inspire during a fellowship at University for Pittsburgh Medical Center, which was an early adopter of the procedure.
“I was training in cranial facial surgery, part of which is learning how to address apnea through nasal surgery, so the concept of hypo nerve stimulation to increase muscle tone in the oral pharynx was at the time a paradigm shift in addressing the problem. When I arrived at Baystate four years ago, I soon learned that no one was offering the procedure in the area. That is when I began working with Dr. Plosky and Dr. Johnson to develop a program here,” Dr. Lee said.
Candidates for Inspire must be over age 22 and have moderate to severe obstructive sleep apnea, are unable to use or get consistent benefit from CPAP, and must not be significantly obese.
Screening exam required
“When patients like Mr. Bergeron are referred to us they must undergo a screening exam to see if they are candidates for Inspire. The pre-screen exam is done in outpatient operating rooms at Baystate’s Chestnut Surgeryl Center. The patient receives just enough general anesthesia medicines to mimic their normal sleep at home. Once we hear and see what their bed partner experiences each night, we understand the location of their upper airway collapse. Only a small proportion of patients are not appropriate for Inspire,” Dr. Plosky said.
Drs. Lee and Plosky spent two days learning the procedure in New York, and they are the only physicians in western Massachusetts to offer Inspire.
“Dr. Lee and I were already working together to care for head and neck cancer patients. I would first remove the entire cancer and then Dr. Lee would reconstruct the area to provide better function and aesthetics,” Dr. Plosky said.
A delicate surgery
The Inspire surgery requires delicate surgical techniques to identify the nerves that control tongue movement.
“Some parts of the nerve move the tongue forward and some move it backward or to the side. The nerves are separated using surgical loupes and operating microscopes to enhance our vision. The stimulator is wrapped around the correct branches and then connected to a generator which is placed below the collarbone just under the skin. A sensor that monitors when the patient tries to fill their lungs with air controls the timing of tongue movement,” said Dr. Plosky.
“In regards to the incisions, we have modified our technique in line with a new FDA approved approach to place the device with only two incisions - one under the chin and one under the collar bone. The incisions are meticulously closed in layers with dissolvable sutures, so there is no need for suture removal in the office. Although the ultimate appearance of the scar is dependent on each individual's healing ability, most patients heal extremely well,” added Dr. Lee about the surgery.
Most patients take over-the-counter pain medication and resume non-strenuous activities within a few days, and more strenuous activities within a couple of weeks.
The real value of Inspire is that patients who have tried everything else to get their apnea under control now have Inspire as a last resort, noted Dr. Plosky.
“Its success is very high when used in the right patients who were really struggling with CPAP. And with Inspire they now have more freedom that they didn’t have with CPAP. They don’t have all the tubing and apparatus to worry about that comes along with CPAP when traveling,” he said.
Earning high ratings
According to the Inspire website, 90% of bed partners report no snoring or soft snoring; 94% of people are satisfied with Inspire; 96 of patients say it is better than CPAP and would recommend it to others, and there is a 79% reduction in sleep apnea events.
And Bergeron is happy with his results.
“I get up in the morning now feeling rested and head to the golf course by 7 am After playing 18 holes, I return home to have lunch with my wife then go to work second shift. There’s no more snoring, no more stopping breathing, and no more exhaustion,” he said.
Inspire is covered by most major insurance providers, including Medicare.
If you have sleep problems and want to learn more about treatment options, visit the Baystate Regional Sleep Program.