Breathing for Better Sleep
Tired of snoring? Frustrated by CPAP? Watching your child struggle with sleep, focus, or behavior? Breathing for Better Sleep is hosted by airway-focused sleep expert Dr. Fred Eck, unpacks the real root cause of sleep problems - and how to solve them naturally, without the mask or surgery.
Breathing for Better Sleep
Understanding the Inspire Sleep Implant: Who Qualifies and What to Expect
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Sleep apnea affects millions, and with new treatments being advertised everywhere, many are hearing about the Inspire implant, a surgical device designed to keep airways open during sleep as an alternative to CPAP. But how does Inspire really work, who qualifies, and where does it fit among the growing list of options for sleep apnea? In this episode of "Breathing for Better Sleep," sleep expert Dr. Fred Eck breaks down the science behind the Inspire implant, what the procedure and recovery entail, its benefits and limitations, and why understanding your airway anatomy and underlying causes is crucial to finding the right sleep apnea treatment. Whether you’re considering Inspire or just want to understand all your options, this episode will help you make informed decisions for better sleep and a healthier life.
00:00 Tongue pacemaker for sleep apnea
04:29 Inspire surgery qualification process
09:27 Discussing patient treatment options
11:21 Assessing effectiveness of sleep therapies
15:27 Addressing patient's chief concerns
17:33 Managing sleep disorders with multifaceted therapy
23:55 Getting informed on Inspire options
25:01 Getting multiple treatment opinions
Podcast Website - https://breathingforbettersleep.com/
Dr. Fred Eck - Website - https://sleeptreatmentdirect.com/dr-fred-eck/
Podcast Media Partner: TopHealth - https://www.tophealth.care/
“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”
Basically, what it is, it's a pacemaker for your tongue, like pacemaker for your heart. But let's say that I have three kinks, four kinks in the hose, and I get rid of one kink. I still have a problem, right? And the inspire is it gets rid of one kink. Why? How is that success? If I stop breathing 60 times an hour, I'm a severe sleep apnea patient. If I reduce that to 30, so you know what I am? I'm still a severe sleep apnea patient. How is that success?
SPEAKER_00If you've seen advertisements about sleep apnea treatment lately, you've probably heard about something called Inspire Implant. It's often described as a small device that helps keep the airway open during sleep. And for some patients, it can be an alternative to a SEPA. But many people still have questions. Who qualifies for it? How does it actually work? And where does it fit among the many different treatments available for sleep apnea? Today we're breaking down what the Inspire implant is, who it may help, and what patients should understand before considering it. Let's get into it. Let's start with the basics. What exactly is Inspire your sleep implant and how does it work to treat sleep apnea?
SPEAKER_01Basically, what it is, it's a pacemaker for your tongue, like a pacemaker for your heart loot. It installs under your chest muscle and it sends a lead up to the base of your tongue. So it travels up under your skin to the base of your tongue. And you get a little remote device that you turn it on through your skin when you go to sleep. And when you turn it on, your tongue gets pushed forward. It stimulates your tongue to come forward. And by making your tongue come forward, it gets it out of the airway. That's the concept behind it. If I get my tongue out of the airway, it improves my sleep apnea, right? And snoring. It is the same thing we do with a mandibular advancement device. So when we make some of our dental appliances that we make are designed to move your jaw forward. So when you're wearing the apparatus, it moves your jaw forward. So it's the non-surgical way to get your tongue to come forward. The Inspire is the surgical way to get your tongue to come forward without having to wear a dental device.
SPEAKER_00Unlike seat pup, which pushes air through the airway, inspire works through nerve stimulation. Can you explain what that means in simple terms?
SPEAKER_01You're stimulating the tongue to come forward. Trying to, we always use this kink in the hose analogy, right? Unkink the hose so that you can get water flow. Right? The inspire is in trying to unkink the hose. It's trying to get your tongue to come forward and get rid of the kink in the airway. But keep in mind, so the CPAP does the opposite, right? The CPAP doesn't get rid of any kinks. The CPAP just forces air through the kinks in the airway, right? But let's say that I have three kinks, four kinks in the hose, and I get rid of one kink, I still have a problem, right? So this is the limitation in the inspire is it gets rid of one kink. But if you got three other kinks, can it help us? Yes. Can it fix us? No.
SPEAKER_00So in this case, in the inspire, the kink would be the tongue in this particular case.
SPEAKER_01Correct. But let's say our kink is our nasal passage. Let's say our kink is we have a narrow upper jaw or a deficient maxilla or palate, causing us to have no room for our tongue, right? That does not get fixed with the mandibular advancement of coins or with the inspire.
SPEAKER_00Oh, so what part of the airway is Inspire actually targeting during sleep?
SPEAKER_01It's essentially the area behind the tongue.
SPEAKER_00So not every sleep apnea patient is candidate for Inspire. What criteria do doctors use to determine whether someone qualifies?
SPEAKER_01There's several qualifications and the process, so we've talked about in the past the importance of 3D imaging that we do in our offices in order to evaluate airways and what the cause, where the kinks are, et cetera, right? Well, I can kind of predict, based on these things, the probability of an Inspire working for you. But to officially get qualified to do the Inspire surgery, so if I have a patient and I say, okay, I think this is going to work for you, maybe, there is a process to go through. You have to fall within a certain BMI, okay? So your weight has to be within a certain range. Your sleep test has to be within a certain range. And then a lot of people are unaware of this. You actually have to go in for an appointment and be sedated. And what they do is they sedate you and they put a scope down and look down your throat and they stimulate a constriction in your airway so they can see how your throat essentially closes while you're sleeping. And if it closes in one way, you're a candidate. And if it closes in a different way, you're not. So you have to go through that procedure to determine whether or not ultimately you're a candidate. So that is part of the process going through that appointment.
SPEAKER_00So the sedation is just part of the testing.
SPEAKER_01You have to be sedated so they can stick this thing down your throat and evaluate how your throat constricts. Because it has to do it in a certain way in order to qualify. Because if it constricts in a different way, it doesn't work for you.
SPEAKER_00Okay. And why is airway anatomy such an important factor when deciding if the implant will work?
SPEAKER_01Well, back to what we just said, that that anatomy and how your throat closes will determine whether there's any chance at all of it working or not. Secondly, is when we look at the anatomy, it goes back to where the kinks are, right? So if your big problem in your airway is you have a completely deficient and narrow upper jaw, resulting in a deficient nasal airway, and that is your root cause, then Spire does nothing for that. So you have to determine all of these things to decide whether or not it can work for you.
SPEAKER_00I guess a common denominator would be the root cause, right? And I think this is what distinguishes you from other doctors, from other providers, that you actually look at the root cost of sleep apnea. And that changes between patients. That's why not one treatment fits all. It's not as one size fits all.
SPEAKER_01Right. Most patients have more than one treatment option. There's almost always more than one treatment option that will work for each person. But not every option will work for every patient. I mean, when you look at the success rate of Inspire, like how many people will successfully work for, I would argue that it's in the neighborhood of the CPAP. It's probably 30, 35%. I think in their studies, it was 48 or 52% or something like that. But let's define in these studies how they defined success. They define success by reducing your AHI, the amount of hypotney and apnea events that you have per hour. They reduced that by 50%, and they considered that success. Why? How is that success? If I stop breathing 60 times an hour, I'm a severe sleep apnea patient. If I reduce that to 30, do you know what I am? I'm still a severe sleep apnea patient. How is that success? But that is how they defined success. And if I reduced somebody's AHI by 50%, there's not a pulmonologist in my town that would call that success. But yet when they go get this Inspire sleep implant in place and it reduces our AHI by 50%, they consider it success. I don't understand it.
SPEAKER_00And for patients who can't tolerate CPU, how often does Inspire become part of the conversation?
SPEAKER_01For us, when we do consults, the Inspire and a CPAP are both discussed with every single patient we see. Because I believe they should be informed of all their options. And I talk about them. I talk about the chances of success. I talk about the restrictions and the uh possibilities in their case of what might limit it from working. But I talk about all of these options with every single patient we see. And whether it's going to be work or not is dependent upon their anatomy, their 3D imaging. And ultimately, based on that testing that's done by the ENT or surgeon, whoever's going to do it, they ultimately have to have that evaluation to even determine if they're a candidate.
SPEAKER_00What should patients understand about the procedure and recovery before deciding on it?
SPEAKER_01When they go for their consultation and that evaluation to see if they're a candidate, they review all those possible side effects and the post-ops and what to expect and all that with them. But understand it is a surgical procedure. So there is a post-op to it. There is a scar. So a lot of females don't like it because they end up with scars because it is surgical. So there is one of the big things that people don't think about is now you have this metal device in your chest. So you have a limitation on getting MRIs done for the rest of your life. So you have a limitation in diagnostics for other stuff.
SPEAKER_00Is inspire implant meant to be long-term treatment or meant to be there forever? Or how does it work?
SPEAKER_01Yeah, so if it will work for you and it will work for you successfully, then yes, it's designed to be a long-term solution. And again, how do we know if it's working? We talked about this with the CPAC, right? We talked about this with the oil appliances. How do we know if it's working? We do a sleep study at home in our every night environment to see if it's actually working. And if you do a sleep test and it's working for you, and the sleep test is successful, and you feel like it's treating your symptoms and whatever your chief concerns are, then that can be your end solution. But if your sleep test isn't normal or it's not treating the symptoms that you went in for, then you have to start adding alternative or co-therapies.
SPEAKER_00And has the Inspire implant been around for long?
SPEAKER_01It's been around a long time. And when it first came out, it was this new thing, of course, that everybody was jumping on as the next best thing. But now that we're getting years into this and we find that it's not working, it does not work for the majority of people. That's the important thing here. It does not work for the majority of people, which means it is successful on less than 50% of people. It's a$40,000 surgery that works on less than 50% of the population. So you got to know that going into it.
SPEAKER_00And that's covered by insurance, just like the C Fapperton.
SPEAKER_01Some people it is, some people it's not. There's no, there's no, when it comes to insurance coverage, there is no blanket answer. It's based on your policy. What are your co-pays? What are your deductibles? Um, most insurance companies, by the way, are going to require you to do a non-surgical, quote-unquote, more conservative therapy first that fails before they're going to cover a surgery like this. So a CPAP, an oral appliance, etc., that fails for you, then you could potentially get some insurance coverage towards the inspire.
SPEAKER_00And now we've we've spoken about a bit about the numbers that you look into when you're getting a sleep test done or when you when you are to consider a treatment successful. But what kind of results do patients typically experience if the treatment works well?
SPEAKER_01If the treatment works well, it's no different than any other therapy, whether that be CPAP, an oil appliance, epigenetics, nasal surgery. If it works well, and how I define success and whether something works well or not, is did it treat your chief concern? Why did you come in to see me for a consult? Is it your snoring? Is it your daytime tiredness? Is it your insomnia? Why did you come in? Has that been resolved, first and foremost, in order to determine success? Okay. Secondly, does your sleep test look normal now? If those two things are accomplished, that's how I define success. Whatever your treatment you're doing is.
SPEAKER_00Yeah, I guess you can't overlook the symptoms, right? You can't, success is not just a number, it's a person feeling well or unwell.
SPEAKER_01Correct. You can't ignore somebody's symptoms, right? Their chief concern. Why did they come in to see you in the first place? I don't care what the sleep test shows. And I deal with this all the time. I actually have a lecture that I give. What is success? Because your sleep test may look great, but if I have not accomplished your and fixed your chief concerns, why you walked in my building to start with, is that success? And a lot of doctors give somebody an inspired sleep implant, give somebody a CPAP, and then just say, uh, you're good. Right? This is as good as you get. Your test looks great. And then it doesn't matter how they feel. It doesn't matter if they're chief concern. This is it. This is as good as you get. That's nonsense.
SPEAKER_00That's so sad that people have to, I don't know, that we rely on numbers much more than how people feel. Like the marker should be, are you feeling rested? Are you feeling well? If not, who cares what the tests say, what the numbers say? If the person doesn't feel like the problem is being solved for them in terms of their symptoms, then how can you just dismiss that? I think that's super sad.
SPEAKER_01Yeah, you can't dismiss that. And I think that is a big part of the failure in treating sleep, is that we just don't pay enough attention to the symptoms. We're looking at a test, and people are not numbers. People are people.
SPEAKER_00And are there limitations or situations where Inspire may not fully solve someone's sleep apnea?
SPEAKER_01Oh, uh the majority of people. Keep in mind, what is the success rate of Inspire? It's under half the population, right? It's under half the people. So you can't expect it to fix everybody. You do it, you see how much success you have, and then do I need to add other therapies to it? You have to go into this with realistic expectations. Most people with a sleep disorder need a group approach, a multifactorial, multi-doctor approach that normally takes more than one provider. So when I see a patient and we're doing, let's say, epigenetic therapy, we're normally adding one of many different therapies, whether it be a nasal surgery, whether it be myofunctional therapy, whether that be laser treatment, CPAP temporarily, the Inspire. It's a combination group approach. And anybody going in to treat a sleep disorder who thinks this is a magic pill, anything, you just put this implant in and I'm fixed. That's not likely. It's not likely to be the case for anybody. It's not likely that I can just stick an appliance in your mouth and that's it. That's highly unlikely.
SPEAKER_00And you mentioned before that you do co-treatments with CPAP. Is there such a thing as a co-treatment with the ANSIRE?
SPEAKER_01Yes. So when somebody gets the Inspire done and they do their sleep test and their numbers are not normalized, we then have to add other therapies. And it might make the other therapies work better, faster.
SPEAKER_00And there could be the possibility where with these co-therapies, then the person with the Inspire uh implant can at some point remove it as well. Get it removed?
SPEAKER_01Well, if it's not working at all, or you're having side effects from it, it can be removed. I see patients several times a year that have had one removed.
SPEAKER_00But that's only if it's not working, right? What I'm saying is if you did cotherapy with the inspire implant, another sort of treatment, can the sleep problem, the sleep apnea get better and then therefore remove the implant?
SPEAKER_01Not usually, because if we're doing cotherapy with the inspire implant, which is common, we do it quite often, but the implant is doing its job. It's doing something. And so the other thing we're adding to it, okay, and the combination therapy is what's giving us a therapeutic result. So, no, it would be a uh you would expect that to be a lifetime thing. You would, you know, you wouldn't go in and remove it for the most part. Most of the time, when you're doing the Inspire, it's for the purpose of doing a co-therapy that's meant to be done together forever and ever.
SPEAKER_00When someone is exploring treatment options, CPAP, oral appliances, airway therapies, uh, surgery, how should they think about where Inspire fits those choices?
SPEAKER_01So when we do consultations with patients, we go through this process that we've talked about ad nauseum, right? Of the 3D images and finding root causes and finding the kinks and the hoes and all of this stuff. So we discuss the Inspire with every single consult and its likelihood of ability to possibly work for you. Um so for me, it's always in the picture. It's always one of the options, just like a CPAP temporarily, it's always part of the picture in our office. I always like to find a permanent solution, a fix, if you will, a treatment, not a management. And so the inspire can fall into that category of a good treatment if it will actually work for somebody. And so for those people that it will work for, it is a great alternative for those people, because they don't have to remember to wear an appliance every night. They don't, I mean, you got to remember to turn it on, by the way. You got to take your little remote and turn it on. If you don't, it's not working, right? So if you if I make you an appliance and you don't put it in when you go to bed, it's not doing anything, right? If you don't turn it on when you go to bed, it's not doing anything. So you have to remember to comply, keeping in mind that when it comes to success, and this is a big decision that patients have to make. Patients have to choose a treatment option that they will comply with. We talked about MDA, mean disease alleviation, right? When we talked about CPAP, how well does it medically work for me? One of the factors in that mean disease alleviation is compliance. The patient has to do their part. Are you going to follow through with your myofunctional therapy? Are you going to remember to turn the remote on every night? Are you going to wear the appliance? Are you going to wear your mask? Patient compliance is key, whatever option they choose. So they need to, in their mind, choose an option that they are likely to comply with. And for some patients, tapping their chest with a remote is an easy thing to comply with.
SPEAKER_00Dr. Eck, we've reached the end of our episode. Is there anything else you would like to leave our listeners with today?
SPEAKER_01I think the main thing is if you're looking at the Inspire, and we get calls every single day in our office, every single day with people inquiring about the Inspire because the company does a lot of marketing. They're on TV everywhere, right? So the word's getting out that it's out there and it's an option. But I think people need to make sure they're doing their research. Go to a provider that's going to speak to you on multiple options. If you go to a provider and the only thing they give you is one option, whether that's a mask, whether that's some kind of surgery, including the inspire, whether it's one oral appliance, if they're giving you only one option, seek a Another opinion. If they're not giving you multiple options, then they're too narrow focused on their solution to try to make you fit into their treatment. In our office, I don't care what option you do. Don't even care if you do it with us. I want you to get treated. I want you to get better. And if you what works best for you is to have something I don't personally do, but my buddy across the street does, or your buddy, your TNT does. It doesn't matter to me. I want to make sure you're treated. Make sure you're seeking out a provider that thinks like that. And they're not trying to make, you know, um a square peg fit into a round hole. They're not trying to make you fit into their only treatment that they provide. Okay, just make sure that you're getting a couple of opinions and make sure you're seeking and looking at different options and make sure you're aware of all the options. And most importantly, are you seeking out an option that you will comply with?
SPEAKER_00Thank you so much, Dr. Eck, for all the valuable information you have left us with today. Sleep apnea treatment isn't one size fits all. Different patients benefit from different approaches depending on their airway structure, health history, and treatment goals. Understanding how options like the Inspire Implant work helps patients make more informed decisions about their sleep and breathing. If you found this conversation helpful, share it with someone exploring treatment for sleep apnea. And to learn more about airway focused sleep care with Dr. Eck, visit sleepreatmentdirect.com. Better breathing, better sleep, better life.