Snoring and Sleep Apnea Procedures
Snoring is a very common problem. Virtually all of us either snore, sleep with someone who snores or knows someone who snores. Every family has a snorer who is often the object of many good-natured jokes. Yet, for many, snoring is a serious problem. It is not only embarrassing but often keeps everyone in the house from getting a good night’s sleep. Daytime problems such as fatigue, headache, and poor concentration can be attributed to poor sleep.
A thorough history and physical exam will usually indicate whether or not there is part of the more serious medical problem. The exam allows us to determine the cause of snoring. We can tell what role nasal congestion, allergies, and sinusitis play in snoring. The questions that need to be answered at this visit include: Do you have a nasal obstruction? Are your tonsils and adenoids causing the blockage? Are your enlarged uvula and floppy soft palate the main issue?
We recommend that nasal obstruction, sinusitis, tonsil disease, and allergies issues are ruled out before analysis and treatment of snoring and sleep apnea.
What is OSA
Obstructive Sleep Apnea (OSA) is a common disorder that affects approximately 22 million people in the US. OSA is a result of airway soft tissue collapse during sleep and the corresponding block of oxygen flow to the brain. At night, the brain senses a lack of oxygen due to the airway obstruction and wakes the body up just long enough to take a breath. This awakening is so brief that many do not even remember the sleep disruption. This pattern will repeat throughout the night resulting in low quality, intermittent sleep. The consequences of untreated OSA are many, including compromised heart and brain health that can lead to stroke and heart attack, motor vehicle and workplace accidents, worsening mood and memory, and even sudden death.
What Patients Are Saying
I have been dealing with extremely weird problems with my right ear for about two and a half months. After being ignored at my regular physicians office, I decided to see Dr. Schwartz ( Swartz) and I am so happy I did. The hearing test was thorough and I received the results immediately after which gave me relief. The assistant was so nice and made me feel like she was truly listening to me. I loved how she relayed everything to the doctor before he came in. Because of this, He gave me answers and set up a game plan immediately. I have never felt so taken care of! I truly felt important and heard. Thank you everyone in the office for being so amazing!
I recently had to find a new ENT after my employer changed my insurance. I have a complicated health history so it can be daunting to find a new provider that you trust. I was very pleased with Dr. Picerno – she was kind, patient and very thorough! I’m so happy to have found her! I also met with Amelia, an audiologist, and she was also awesome!
The gold standard treatment for Obstructive Sleep Apnea is Continuous Positive Airway Pressure (CPAP). CPAP pushes pressurized air into the airway via a hose and a mask, forcing the obstruction to open and works well for many patients. However, studies have shown that approximately 50% of people who are prescribed CPAP stop using it, or never even start. For those patients, there are many different treatment options available. Some patients find success with oral appliances or anatomy altering surgeries. For others, there’s Inspire hypoglossal nerve stimulation.
Inspire is a small pacemaker-like device that includes two small wires placed under the skin of the neck and chest and is implanted during a short, outpatient procedure. Patients typically return home the same day and can resume non-strenuous activities within a few days of the procedure. Most patients will manage healing discomfort with over-the-counter pain medication.
Inspire patients turn the device on every evening at bedtime and the device will open the airway with every single breath. Inspire treats the root cause of OSA by working inside the body with the body’s natural breathing process. Mild stimulation is delivered to key airway muscles, allowing the airway to open during sleep and prevent airway obstructions.
The Inspire sleep remote is programmed with a preset range allowing patients to slowly increase their level of stimulation over the following months. Approximately three months after initial device activation, the settings are optimized during an in-lab sleep study.
Inspire therapy was FDA-approved in 2014 and, as of December 2020, is used by over 10,000 people worldwide. Over 325 leading medical centers have been trained to offer Inspire as part of their sleep apnea treatment options.
Inspire is for people who:
- Have been diagnosed with moderate to severe Obstructive Sleep Apnea, specifically an Apnea-Hypopnea Index (i.e. the number of times they stop breathing each hour) between 15 and 65
- Are unable to use or get consistent benefit from CPAP
- Are not significantly overweight
- Are over age 18
The safety and efficacy of Inspire was measured during the STAR clinical trial. One-year STAR trial results were published in January 9th, 2014 edition of the New England Journal of Medicine, showing patients using Inspire therapy had significant reductions in sleep apnea events and significant improvements in quality of life measures. These significant reductions and improvements were sustained over a 5-year follow-up period.
As of August 2019, there have been over 90 peer-reviewed publications on Inspire therapy. These publications show that patients using Inspire therapy in real world, clinical practice settings experience significant reductions in sleep apnea events and significant improvements in quality of life measures, consistent with those seen in the STAR clinical trial.
Notable outcomes of Inspire include:
- 90% of bed partners reported no snoring or soft snoring1
- 79% reduction in sleep apnea events1
- 94% of people are satisfied with Inspire2
- 96% of Inspire patients say Inspire is better than CPAP & would recommend Inspire to others2
1: Woodson et al., OTO-HNS 2018.
2: Heiser et al., ERJ 2019.
Keith Swartz, M.D.
Dr. Keith Swartz is dual-board-certified in otolaryngology and sleep medicine, and he received his medical degree from the Uniformed Services University of the Health Sciences. He was the Chief Resident of the Department of Otolaryngology/Head and Neck Surgery at the United States Air Force Academy and founded the first comprehensive home sleep testing protocol in the United States Air Force. When not helping patients at the Associates of Otolaryngology, he loves to ski, fly fish, and spend time with his wife and three kids.