Inspire Implant : My Journey

[Malloc]

Hello everyone!

I'm a longtime lurker who feels compelled to share my own sleep apnea journey.

First: the boring background.  I was first diagnosed with moderate OSA (AHI is the low 20's) back in 2013 at the ripe old age of 25.  Had a BMI hovering around 32 at the time, but I was still pretty bitter about the diagnosis so early in life.  I would come to find out later it ran in the family and everyone who my family suspects had it died in their fifties so early detection was more blessing than curse.  To no one's great surprise, they threw a CPAP in my lap and said, "have fun" which led to years of very marginal results.  Fast forward to 2017 where I had managed to cut my BMI down 5 points and was getting tired of CPAP maintenance with unsatisfactory results.  Went back for my first real sleep evaluation since 2013 and decided to try an oral appliance instead.  It's been again noticeably yet marginally effective (last study showed residual AHI of around 7), but I find the convenience worth putting up with it instead of CPAP.  That takes my situation to the end of last year.

Now to the part everyone is so curious about: Inspire.  I first heard of it some years ago back when it was a huge battle to get coverage and so dismissed the idea.  That was until I heard my own carrier would actually start covering it in mid 2019 which re-peaked my interest.  After attending a workshop put on by my local sleep center doctors and seeing their real world data on patients, many of whom they could titrate down to 1 or 0 AHI, I knew I wanted to pursue this as an option.  Does it sound too good to be true? Maybe, but the idea of an implanted device never bothered me and some amount of desperation to find effective relief was mounting.  After another round of consultations I went ahead with a combination DISE/septoplasty that showed strong candidacy for the Inspire implant much to my relief.  Now the waiting began... or so I thought.  

When I saw the ENT office calling only ~two weeks after insurance submission I was certain it would be my first denial and a, "don't worry we'll keep trying!".  I nearly fell out of my chair when they actually said, "you've been approved".  Not to get anyone's hopes up, but yes the state of approvals for Inspire in 2020 seems to be getting more reasonable.  I swallowed hard and scheduled the procedure for 2/20/2020.  In the blink of two hours it was done without any complications.  Without any really major surgeries to compare this to I can say recovery has been not too terrible.  I only needed Tylenol for pain though it took a full 48 hours for that to make the pain truly ignore-able.  Now of course this is not a surgery forum so I won't spend any more words on the implantation, but if anyone has specific questions feel free.

All that brings me to now where I'll be sharing the rest of the experience live (hah, as "live" as forums get) for anyone curious.

Next stop: Inspire activation and first few nights impression starting end of March!

[Sleeprider]

Looking forward to the continuing story here. This should be a help to others that are interested in this procedure as an alternative to PAP therapies. Malloc, if you also used positive pressure before going to Inspire, it would be good if you included information on that as well.

[Malloc]

Last CPAP I used was the Respironics System One and an Amara full face mask I believe. Went back and forth between auto mode and like 10-11 pressure if I recall correctly, but always had trouble initiating sleep with the feeling of something on my face irrespective of pressure.

[vroomvroom]

Great post. Thanks for sharing! I hope you continue

[Big Guy]

Yes......interested in how you do.

[Malloc]

Thanks everyone.

On day 10 of recovery now and I can make the following observation: I would definitely not want to return to work at this point if my job entailed any sort of physical component. The overall pain level isn't high, but I didn't realize how much the scar tissue tightness would limit range of motion for the head and implant side arm.

Speaking of implant side, one aspect of this procedure I had to manually research was the possibility of getting it done on my non-dominant side (left) to facilitate some of my hobbies. Short answer: here in 2020, my surgeon strongly recommended against doing it left side for elective reasons so I ended up just doing it on the normal right side. Long answer (disclaimer - this is just my experience and situation, none of it should be taken as absolute or medical advice): I reached out to Inspire and they gave me the standard, "we do it on the right in case you need a pacemaker later" answer, but were open to the possibility if I consulted a cardiologist. After getting in touch with a cardiologist specializing in electrophysiology, he wasn't concerned about other implants on either side though admittedly had not ever seen a real life case of it yet. Circling back to my own surgeon, he did some more digging and believes since Inspire is technically only FDA approved on the right side that my insurance would have an opportunity to dispute the approval if done on the left side for non medically necessary reasons. I went with an abundance of caution so as to eliminate the chance of catching that $120k billed to me.

[RMSko]

Malloc - Thanks for your posts. I've been consulting with my doctor about Inspire so I'm interested to see how you progress. My AHI is similar to yours (although for me sleeping on my back results in severe apnea while sleeping on my side results in no apnea). I actually have gone the opposite way of you. I've been using a dental device for almost a decade, but a few months ago switched to the DreamStation Auto-PAP. I'm only using a nasal mask and so it actually has been very easy for me to adjust to. My AHI is still around 5 though (unless I drink - then it shoots up to nearly 10), but I doubt the dental device produced better results. That's actually one of the things I like better about the PAP - that I can actually see my results every day. Anyway, I have really great insurance so I'm pretty sure it would be covered so I'm looking forward to seeing how you progress.

[Sleep2Snore]

I would be interested to see how it goes for you as the only ones we hear of is the ones that it failed for.
As you can imagine it is the ones that it failed for that shout the loudest.
So please let us know how it does for you.  Warts and all.

[OcalaSleeper]

I have just recently had a discussion with my wife and was investigating doctors in my area that work with Inspire. I started CPAP in 2002 and moved to Bi-Pap 2017. I can tolerate Bi-Pap successfully but would love to replace it with Inspire. Please keep going with your Inspire usage, the good parts and the drawbacks. Thank you so much for sharing.

[jaswilliams]

I treat apap like glasses I use it whilst i sleep when I get up it’s removed and I am normalish the inspire is not for me but really interested in your progress and thoughts