WakeMed Sleep Medicine Inspire® Program Overview
The Inspire® device is a hypoglossal nerve stimulator which is approved to treat moderate to severe obstructive sleep apnea (OAHI ≥ 15) where there are < 25% central events.
STEP 1
- You will have an Initial Consultation with WakeMed Sleep Medicine. Please note it could take several weeks to schedule your consultation.
- At your appointment, the Sleep Medicine provider will review your sleep history in detail and review and discuss prior attempts at treatment with PAP therapy and/or oral dental appliance therapy.
- They will review indications and contraindications to Inspire® therapy and appropriate expectations for your case.
- A diagnostic in-laboratory sleep study (polysomnography) at the WakeMed Sleep Lab will be ordered. Home sleep studies are not designed to adequately differentiate between central and obstructive sleep apnea. This in-laboratory sleep study will allow us to ensure you are an appropriate candidate for Inspire® therapy and set the initial baseline biometrics required to determine if Inspire® therapy is successful.
STEP 2
- The diagnostic in-laboratory sleep study (polysomnography) will be scheduled at the WakeMed Sleep Lab. WakeMed Sleep Lab staff will verify insurance and benefits.
- Once the sleep study is completed, the raw data will be reviewed and interpreted by a Board-Certified Sleep Medicine physician.
STEP 3
- A follow-up appointment will be needed in the Sleep Medicine clinic to review the results of your sleep study in detail.
- The provider will also review the Letter of Shared Medical Decision-Making form. This form must be signed by the patient and activating sleep medicine provider prior to Inspire® implantation for WakeMed Sleep Medicine to be able to activate and manage your Inspire® device.
STEP 4
- If you meet all the qualifications, a referral can be made to a trained Inspire® ENT surgeon (otolaryngology). The WakeMed ENT division will then call to schedule the initial consultation. The focus of the ENT consultation is to review surgical risks, benefits, and alternatives of the surgery; rather than review details of the sleep study for Inspire® outcomes.
STEP 5
- Your ENT Surgeon will schedule and perform a procedure called a drug-induced sleep endoscopy (DISE). If this procedure demonstrates an “anterior-posterior collapse” and not a “complete concentric collapse”, the Inspire® implantation surgery can be scheduled. Your ENT office will schedule the surgery with you.
STEP 6
- Once the Inspire® Surgery is performed, an appointment will be needed at WakeMed Sleep Medicine, no sooner than 30 days after the surgery for activation.
- At this visit, the provider will inspect and activate the Inspire® device, confirm that the Inspire® smartphone application is synced/linked to your sleep team, and you will be given your Inspire® remote and instructions on how to begin therapy.
STEP 7
- For the next 8-12 weeks, you will be considered in the “initial titration phase”. Over time, Inspire® will begin to become more therapeutic. However, it is important to follow the prescribed titration schedule and not increase settings faster than once per week.
- A follow-up visit with WakeMed Sleep Medicine will need to be made to check in on how therapy is going and to ensure the appropriate milestones have been met.
- When appropriate, an in-laboratory Inspire® titration sleep study will be ordered.
STEP 8
The in-laboratory Inspire® titration sleep study will be scheduled and performed at the WakeMed Sleep Lab.
- During this overnight sleep study, the Inspire® trained sleep technicians will gently adjust your Inspire® settings overnight to fully explore your psychological response to therapy.
- Once the sleep study is completed, the raw data will be reviewed and interpreted by a Board-Certified Sleep Medicine physician with recommendations for therapy settings or next steps.
STEP 9
- A follow-up visit with WakeMed Sleep Medicine will need to be made to adjust and finalize the Inspire® device settings.
STEP 10
- Regular follow-up visits to check-in and adjust the device will be scheduled with WakeMed Sleep Medicine occurring every 6 to 12 months.
- At these visits, the Inspire® device will be inspected and milestones continued to be reviewed. Your sleep medicine provider will discuss your individual case and the standard recommendation to repeat a home sleep study at least every 12 months to verify your sleep apnea remains well treated and at therapeutic goals.