♪ ♪ ♪ ♪ DOES YOUR PARTNER SOUND LIKE A NORFOLK SOUTHERN ENGINE?

IF SO, WE NEED TO GET THEM SLEEPING ON THE RIGHT TRACK.

STAY WITH US AS WE TALK WITH OTOLARYNGOLOGY Dr. KEVIN POTTS ABOUT TREATING OBSTRUCTIVE SLEEP APNEA NEXT ON "KENTUCKY HEALTH."

BETWEEN 2 TO% OF AMERICANS SUFFER FROM ONE TYPE OF SLEEP APNEA OR ANOTHER.

THIS MAY SEEM LIKE A LARGE NUMBER, MOST LIKELY THIS IS AN UNDERCOUNT.

OFTEN OUR FRIENDS, PARTNERS AND FAMILY MEMBERS WHO SUFFER FROM SLEEP APNEA ARE MADE THE BUTT OF OUR JOKES OR RECEIVE INCESSANT TEASING ABOUT THEIR SNORING AND BREATHING PATTERNS.

HOWEVER, THIS MASKS A REAL PROBLEM AND THAT IS THAT SLEEP APNEA IS ASSOCIATED WITH SEVERAL PROBLEMS, INCLUDING STROKES, HIGH BLOOD PRESSURE, DIABETES, CONGESTIVE HEART FAILURE AND IMPOTENCE.

SO MEN, MAYBE WE SHOULD FORGET ABOUT THAT STUFF FRANK THE BIG HURT THOMAS IS SELLING AND INSTEAD FIND A WAY TO GET A GOOD NIGHT'S SLEEP.

LAST YEAR A PULMONOLOGIST Dr. WARREN SHAKEN GAVE US A GOOD DISCUSSION ON SLEEP APNEA.

I ENCOURAGE TO YOU WATCH THAT SEGMENT.

TODAY I WALK TO SPEND OUR TIME TALKING TO Dr. KEVIN POTTS ABOUT THE NEWER TREATMENT OPTIONS FOR SLEEP APNEA.

HE IS A GRADUATE OF THE UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE COMPLETED A RESIDENCE IN ON THE OWE LARGE GOGGLE FOLLOWED BY MBA SCHOOL OF BUSINESS.

HE IS CURRENTLY AN ASSOCIATE PROFESSOR IN THE DEPARTMENT OF OTOLARYNGOTOMY.

THANK YOU FOR BEING WITH US TODAY.

>> WHO IS THE TYPICAL PATIENT.

>> WE SEE AN EQUAL NUMBER OF MEN AND WOMEN AND, YOU KNOW, IT'S INTERESTING HOW THEY'RE NOT ALWAYS OVERWEIGHT.

IN FACT, IT'S PROBABLY 50-50.

WE WILL SEE PATIENTS THAT ARE NORMAL SIZE IN WEIGHT, ATHLETIC, THEY EXERCISE, BUT THEIR AIR WAYS ARE NOT BEHAVING AT NIGHT AND COLLAPSING AND THEY'RE HAVING OBSTRUCTIVE SLEEP APNEA.

>> IS THE FACT THAT THEY HAVE SLEEP APNEA CAUSED BY SOMETHING ELSE OR IS IT JUST THE PRIMARY PROBLEM IN AND AMONGST ITSELF?

IN OTHER WORDS, THERE IS A STRUCTURAL ABNORMALITY GOING ON.

>> CERTAIN MEDICATIONS CAN PRECIPITATE OR WORSEN SLEEP APNEA BUT USUALLY IT'S NEUROMUSCULAR TONE THAT IS DIMINISHED DURING PARTICULAR TIMES AT NIGHT WHEN THEY'RE SLEEPING AND THE SOFT TISSUES IN THE THROAT COLLAPSE AND OBSTRUCT THE AIR WAY.

>> SO WHEN WE TALK ABOUT SLEEP APNEA, WHAT ARE THE DIFFERENT TYPES OF SLEEP APNEA.

>> THE TWO MAIN TYPES ARE OBSTRUCTIVE SLEEP APNEA, THE MOST COMMON AND CENTRAL SLEEP APNEA.

>> WHEN YOU TALK ABOUT OBSTRUCTIVE SLEEP APNEA, EXACTLY WHAT IS HAPPENING?

>> SO DURING THE DEEP STAGES OF SLEEP, THE TONGUE, THE SOFT PALLET, THE VOICE BOX OR LARYNX BECOME VERY RELAXES.

WHEN THAT HAPPENS AND YOU ARE BREATHING OVER AND OVER DURING SLEEP, THIS NEGATIVE PRESSURE PULLS THOSE SOFT TISSUES BACKWARDS, SIDE WAYS, WHATEVER THE COLLAPSE PATTERN MIGHT BE AND THESE TISSUES COLLAPSE THE THE AIRWAY AND YOU STOP BREATHING OR SLOW DOWN YOUR RESPIRATION SIGNIFICANTLY AND THAT'S OBSTRUCTION.

>> SO WHAT CAUSES IT TO RELAX?

THE PATIENT DOES SOMETHING WHEN THEY ARE ASLEEP?

>> DECREASED NEUROMUSCULAR TONE.

SO AND THIS IS, YOU KNOW, SPECIFIC IN THE CERTAIN STAGES OF SLEEP WHEN WE JUST GET VERY, VERY RELAXED AND OUR BODIES AND ALL OF OUR MUSCULAR TONE JUST RELAXES AND THAT'S WHEN IT HAPPENS.

>> WHAT IS THEN THE CENTRAL SLEEP APNEA?

>> CENTRAL SLEEP APNEA IS COMPLETELY DIFFERENT AND IT'S JUST A DYSFUNCTION WITH THE NEURAL CENTERS IN THE BRAIN NOT GIVING APPROPRIATE SIGNALS.

YOU DON'T REALLY TELL YOURSELF TO BREATHE, RIGHT?

I MEAN YOUR BRAIN, THERE IS A RUDIMENTARY SYSTEM IN THE NERVOUS CENTRAL SYSTEM THAT IS AUTOMATICALLY DRIVING RES SEPARATION, INSPIRATION OR EXPIRATION.

YOU CAN STOP IT, INCREASE IT, DEEPEN IT IF YOU WANT TO, BUT TYPICALLY WE ARE NOT PAYING ATTENTION TO OUR RESPIRATORY CYCLE.

SAME THING AT NIGHT, WE OBVIOUSLY ARE NOT PAYING ATTENTION TO IT BECAUSE WE ARE ASLEEP.

SO DURING THAT TIME OUR BRAIN TAKES OVER AND IS MAINTAINING OUR RESPIRATORY DRIVE, SO WHEN THE BRAIN STARTS MALFUNCTIONING, AND THAT'S OUT OF MY AREA OF EXPERTISE BUT WHEN IT STARTS MALFUNCTIONING, AND WE START LOSING THAT NEURAL INPUT TO THE RESPIRATORY SYSTEM, THEN RESPIRATION CAN STOP.

AND THEN WHAT HAPPENS IS YOU OBSTRUCT.

A FEW SECONDS LATER, THE BRAIN TAKES OVER, IT REALIZES HEY, THERE IS A PROBLEM.

IRNEED TO DO SOMETHING ABOUT IT AND YOU START BREATHING AGAIN BUT THE PROBLEM IS IF THIS IS HAPPENING OVER AND OVER AGAIN, IT CAN, OF COURSE, YOU KNOW, CAUSE HEALTH PROBLEMS.

>> HOW DOES THE PATIENT COME IN TO SEE YOU?

IS IT THE FAMILY MEMBER OR THE PATIENT THEMSELVES THAT SAYS... [LAUGHTER] >> THE SNORING IS A BIG PROBLEM SO BED PARTNERS WILL COMPLAIN AND WILL INSIST THAT PATIENTS, YOU KNOW, COME IN AND HAVE IT LOOKED AT.

BY FAR THE MAJORITY OF PATIENTS ARE SENT BY A SLEEP MEDICINE SPECIALIST THAT HAVE DIAGNOSED THEM, TREATED THEM WITH POSITIVE AIRWAY PRESSURE AND FOR WHATEVER REASON, IT IS NOT WORKING AND THEY WANT TO LOOK AT SOME SURGICAL OPTIONS.

>> TELL ME ABOUT THE SLEEP STUDIES.

WHAT GOES ON WITH THAT?

>> YEAH, SO, YOU KNOW, THERE ARE NEW WAYS TO DO THAT NOW AT HOME WHICH IS A LOT MORE CONVENIENT.

TRADITIONAL WAY TO GET A SLEEP STUDY IS YOU GO DOWN TO THE LAB SET UP LIKE A HOTEL ROOM, THEY'RE TRYING TO MAKE IT IS COMFORTABLE AND INVITING AS THEY CAN SO YOU CAN GO TO SLEEP AND STAY ASLEEP.

AND THEN IT'S SEVERAL HOURS OF YOU BEING HOOKED UP TO A BUNCH OF WIRES AND MONITORS THAT MONITOR YOUR BRAIN WAVES, YOUR RESPIRATORY RATE, YOU KNOW, HEART RATE, YOU NAME IT AND THEY'RE MONITORING ALL THESE FACTORS AND DETERMINING WHETHER YOU ARE HAVING OBSTRUCTIVE EVENTS, IF THOSE ARE CENTRAL OR WHETHER YOU ARE STOPPING BREATHING AND WHETHER THOSE ARE CENTRAL, APNEAS OR OBSTRUCTIVE APNEAS AND YOU CAN DO THOSE AT HOME NOW, TOO, WHICH HAS A VERY GOOD, YOU KNOW, ACCURACY COMPARED TO THE IN LAB STUDIES.

AND WE ARE SEEING THOSE A LOT MORE.

>> ALL RIGHT.

THE CPA THIS MACHINE.

I WENT THROUGH THAT TESTING AND IF YOU TALK ABOUT ANYTHING BEING ABNORMAL WITH THE WIRES HOOKED UP-- GLAD TO HEAR ABOUT THE HOME VERSION OF.

THIS I WAS TOLD TO USE THIS CPAP MACHINE.

I COULDN'T DO IT.

I'M JUST, I JUST COULDN'T DO IT.

BUT TELL ME WHAT IS THE THEORY BEHIND THE CPAP MACHINE.

>> CONTINUOUS POSITIVE AIR WAY PRESSURE.

WHAT THEY'RE DOING IS MAINTAINING THE AIRWAY AND KEEPING OPEN THOSE AREAS OF OBSTRUCTION THAT WE TALKED ABOUT, THOSE SOFT TISSUES THAT TEND TO RELAX AND OBSTRUCT THE BREATHING.

THEY'RE KEEPING THEM OPEN WITH A CONTINUOUS FORCING OF AIR THROUGH THE NOSE, MOUTH OR BOTH DOWN INTO THE LUNGS.

>> IT'S NOT COMFORTABLE.

>> NO.

>> IT'S NOISY.

>> BUT VERY EFFECTIVE.

>> THAT'S WHAT I UNDERSTAND.

>> AND IT'S NON-INVASIVE.

AND IT'S SAFE AND IT'S NOT SURGERY.

SO IT'S DEFINITELY THE BEST THING FOR THE PATIENT IF THEY CAN TOLERATE IT AND THEY'RE WILLING TO USE IT.

>> I THINK OUR DENTAL COLLEAGUES HAVE COME UP WITH SOME LITTLE DEVICES, AN ORAL THING TO PUT IN.

HOW DOES THAT WORK?

>> DENTAL APPLIANCES, YOU NEED GOOD TEETH, AND YOU CAN'T HAVE PROBLEMS LIKE TMJ BECAUSE THIS CAN EXACERBATE THAT.

AND IT'S LIKE A BITE GUARD THAT YOU WEAR THAT THEY CAN INCREASE THE SETTING AND THE DEGREE IN WHICH IT PROTRUDES THE JAW AND WHAT THEY ARE TRYING TO DO BY KEEPING THE JAW FORWARD WITH THAT DENTAL APPLIANCE IS KEEP THE TONGUE FORWARD BECAUSE THE TONGUE IS ONE OF THE BIG CULPRITS OF THOSE TISSUES WE TALKED ABOUT EARLIER THAT COLLAPSES BACKWARDS AND BLOCKS THE AIRWAY.

THESE APPLIANCES HELP DO SIMILAR WHAT THE INSPIRE DOES WHICH WE'LL TALK ABOUT, BUT THAT'S WHAT THE DENTAL APPLIANCES AIM DO.

>> SINCE YOU BROUGHT IT UP, WHAT IS?

WHAT DOES INSPIRE DID.

>> IT IS THE COMPANY THAT INVENTED IN.

NERVE STIMULATION THERAPY.

THE HYPOGLOSSAL NERVE, THE CRANIAL NERVE THAT SENDS INPUT TO THE TONGUE THAT ALLOWS YOU TO PROTRUDE YOUR TONGUE OUT.

SO IT CONTROLS YOUR TONGUE MUSCLE MOVEMENT WHEN WE ARE EATING, TALKING LIKE YOU AND I ARE NOW.

SO WHAT THEY FIGURED OUT WAS IF YOU GIVE A LOW LEVEL STIMULATION TO THAT NERVE, YOU CAN CONTROL THE TONGUE MUSCLE AND PREVENT IT FROM COLLAPSING BACKWARDS.

IT'S NOT JUST THE TONGUE THAT COLLAPSES AND CAUSES OBSTRUCTION, IT'S THE PAM IT-- PALLET OR LARYNX.

ALL OF THESE STRUCTURES ARE TIED TO THE TONGUE.

IF YOU KEEP THE TONGUE FORWARD, THE STRUCTURES TEND TO STAY FORWARD AS WELL.

>> SO AM I WEARING A DEVICE THAT HANGS ON THE OUTSIDE OF ME OR I HAVE TO PUT IN MY MOUTH?

>> NO, THAT'S THE GREAT THING ABOUT IT.

THIS IS A PULSE GENERATOR.

THIS IS THE IMPLANTED DEVICE PLACED IN A SUBCUTANEUS OR UNDER THE SKIN AND FAT TISSUE POCKET IN THE UPPER CHEST, USUALLY ON THE RIGHT SIDE, AND IT'S COMPLETELY HIDDEN IN A.

IN A THIN PATIENT YOU CAN SEE IT A LITTLE BIT AND IF YOU FEEL AROUND FOR IT, YOU CAN FEEL IT BUT OTHERWISE IT DOESN'T BOTHER YOU.

YOU DON'T KNOW IT'S THERE.

AND THEN THERE IS A COUPLE OF WIRES THAT COME OUT OF THIS GENERATOR, ONE THAT'S TUNNELED UP BEHIND THE SKIN TO THE HYPOGLOSSAL NERVE AND ONE THAT HAS A SENSING PROBE THAT GOES BETWEEN THE RIBS THAT IS GOING TO ACTUALLY DETECT YOUR RES SEPARATION BECAUSE WE WANT THIS-- YOUR RES RESPIRATION BECAUSE WE WANT THIS TO WORK WHEN WE ARE BREATHING IN.

THAT'S WHEN WE OBSTRUCT.

THAT'S THE SYSTEM.

COMPLETELY IMPLANTED AND NOT VISIBLE.

>> SO YOU ARE IT AUTOMATICALLY FIRES WHEN SOMEONE TAKE TAKES IN A DEEP BREATH.

WHAT DOES THE PATIENT FEEL WHEN THEY DO THIS?

>> WE DON'T WANT THEM TO FEEL ANYTHING.

WE DON'T WANT TO STIMULATE THEM AND WAKE THEM UP.

THAT WOULD BE COUNTERPRODUCTIVE, OF COURSE.

SO IT'S THE LOWEST POSSIBLE SETTING IN LEVEL OF NEURAL SOMETIME STIMULATION THAT KEEPS THE COLLAPSE FROM HAPPENING THAT THE SLEEP MEDICINE DOCTOR IS GOING TO SHOOT FOR WHEN THEY'RE TURNING THIS ON AND ACTIVATING IT AND GETTING THE PROPER SETTINGS AND THEY DO THAT USING AN ADDITIONAL SLEEP STUDY TO MAKE SURE THAT, YOU KNOW, THEY'RE PREVENTING ALL OBSTRUCTIONS OR ALMOST ALL OBSTRUCTIONS AT THE LOWEST SETTING POSSIBLE.

THE GREAT THING ABOUT THE HYPOGLOSSAL NERVE, THERE ARE NO PAIN FIBERS AND NO PAIN AT ALL F. YOU HAPPEN TO WAKE AUTOPSY AND THIS THING WORKING OR ACTIVATING, YOU MIGHT FEEL A LITTLE TWINNING IN YOUR TONGUE LIKE A TINY MUSCLE SPASM.

I CAN'T TELL YOU EXACTLY BECAUSE I'VE NEVER HAD ONE I CAN ONLY TELL WHAT YOU PATIENTS HAVE TOLD ME BUT NOT PAINFUL AT ALL.

>> HOW DO YOU PUT IT IN.

>> TWO INCISIONS, FIVE CENTIMETERS IN UPPER CHEST AND UPPER NECK AND THIS IS JUST PLACED IN A POCKET ON TOP OF THE PEC MUSCLE IN THE CHEST AND THEN THE UPPER INCISION ALLOWS US TO FIND THE HYPOGLOSSAL NERVE THAT WE HOOK THE STIMULATION WIRE TO, JUST WRAPS AROUND THE NERVE GENTLY AND THEN WE TUNNEL THAT WIRE DOWN UNDER THE SKIN, WHICH IS NOT VISIBLE AND HOOK IT TO THIS THING HERE.

>> WHEN YOU SAY TUNNEL, I MEAN THERE ARE STRUCTURES THAT ARE BETWEEN THE CHEST AND HERE.

BLOOD VESSELS AND BONES.

>> WE STAY WAY SUPERFICIAL TO THAT SO WE USE A TUNNELING DEVICE THAT IS VERY ATRAUMATIC.

IT MAKES A SMALL TUNNEL UNDER THE SKIN.

>> HOW DO YOU IDENTIFY THE HYPOGLOSSAL NERVE?

I REALIZE THIS IS YOUR BUSINESS BUT... >> YEAH LOTS OF TRAINING AND PRACTICE AND JUST IT IS ALSO IN THE SAME PLACE.

SOME PATIENTS ARE HARDER THAN OTHERS BUT IT IS ALWAYS THERE.

>> HOW DO YOU USE THIS THING?

>> SO AT NIGHT WHEN YOU ARE READY TO GO TO SLEEP AND IT HAS BEEN ACTIVATED, YOU ARE AT YOUR PERFECT SETTING PER THE SLEEP MEDICINE DOCTOR, YOU ARE GOING TO TAKE YOUR REMOTE CONTROL WHICH LOOKS LIKE JUST THIS PLACE IT OVER THE TOP OF IT, HIT THE BUTTON AND YOU ARE ACTIVATED.

NOW WHAT WE DO IS WE SET A LATENCY ON IT, LET'S SAY YOU TYPICALLY FALL ASLEEP IN FIVE MINUTES LIKE MY WIFE.

WE COULD MAYBE DO 15 MINUTES TO WHERE IT'S NOT GOING TO START STIMULATING THE NERVE FOR 15 MINUTES, GIVES YOU A CHANCE TO GET TO SLEEP.

30 MINUTES, 45 MINUTES, AN HOUR, WHATEVER YOU FEEL LIKE YOU NEED AND THAT CAN BE CHANGED EASILY.

IT HAS A LATENCY SETTING BEFORE IT STARTS WORKING.

IF YOU WAKE UP IN THE MIDDLE OF THE NIGHT GO TO RESTROOM, GET A DRINK OF WATER, YOU CAN TURN IT OFF REAL QUICK, DO YOUR THING, COME BACK, TURN IT BACK ON, GO BACK TO SLEEP.

SOME PEOPLE SAY IT DOESN'T BOTHER ME, I JUST LEAVE IT ON, USE THE RESTROOM, COME BACK.

>> SO HOW DOES THIS DIFFER FROM THE CPAP?

WHAT ARE THE BENEFITS AND THEN THE DIFFERENCES?

USING ONE OR THE OTHER?

>> YEAH, THE BENEFIT OF CPAP IS YOU DON'T HAVE TO HAVE SURGERY.

AND IT'S VERY EFFECTIVE IF YOU CAN TOLERATE IT.

IF YOU DON'T TOLERATE IT, THAT'S WHEN YOU HAVE TO LOOK FOR SOMETHING ELSE SUCH AS INSPIRE.

AND THE BENEFIT OF INSPIRE IS YOU DON'T HAVE A MASK OR A NOSE INSERT OR WHATEVER THESE DELIVERY DEVICES MIGHT BE, YOU KNOW, THAT HAVE YOU TO SLEEP IN.

AND THERE IS NO MACHINE HAVE YOU TO TURN ON.

HAVE YOU TO CLEAN.

SAY YOU GO OUT OF TOWN A LOT.

TRAVEL FOR BUSINESS, YOU DON'T HAVE TO LUG THIS THING AROUND IN THE AIRPORTS AND TO YOUR TRAVEL DESTINATION SO THAT'S A BIG ADVANTAGE OF INSPIRE.

YOU DON'T HAVE HIGH PRESSURE AIR BLOWING THROUGH YOUR NOSE AND/OR MOUTH ALL NIGHT LONG WHEN YOU ARE TRYING TO SLEEP.

ONCE AGAIN IF YOU TOLERATE THAT AND YOU ARE OKAY WITH THAT, THAT'S FINE.

USE IT.

BUT IT'S-- THIS COMES INTO PLAY WHEN YOU DON'T REALLY TOLERATE.

>> FOR PATIENTS WHO HAVE HAD BOTH, ARE THE BED PARTNERS PREFERRING THE INSPIRE OPPOSED TO THE CPAP MACHINE?

>> YEAH, I MEAN THEIR MAIN CONCERN IS THE SNORING SO THE TURBULENT AIR FLOW KEEPING THEM UP AT NIGHT.

AND BOTH ARE GOING TO TREAT AND POTENTIALLY ELIMINATE THE SNORING.

SO THE CPAP NOWADAYSES ARE VERY QUIET.

TO MY KNOWLEDGE THEY'RE NOT REALLY BOTHERING THE BED PARTNER AND THIS OF COURSE, MAKES NO NOISE AND ADDRESSES THE SNORING AS WREL.

>> SO WHAT ARE THE INDICATIONS FOR PUTTING IN INSPIRE DEVICE NOW?

>> WELL, ONE OF THE INDICATIONS IS YOU HAVE TRIED AND DO NOT TOLERATE CPAP.

WE ALL THINK THAT INDICATION IS GOING TO START TO LOOSEN AS THIS BECOMES MORE AND MORE AS IT ALREADY HAS, ACCEPTED AS A FIRST LINE TREATMENT FOR SLEEP APNEA BUT THE INSURANCE COMPANIES, YOU KNOW, THEY'RE WANTING TO PAY AS LITTLE AS POSSIBLE, OF COURSE, SO THEY'RE WANTED YOU TO TRY C PAP AND HAVE DOCUMENTATION THAT YOU GO NOT TOLERATE IT FOR WHATEVER REASON.

THAT'S THE FIRST INDICATION.

SECOND INDICATION IS YOU NEED TO HAVE MODERATE TO SEVERE SLEEP APNEA BASED ON A NUMBER GENERATED ON YOUR SLEEP STUDY CALLED THE APNEA HIPOTNI AIB DECKS.

IT IS AN AVERAGE OF HOW MANY TIMES YOU STOP BREATHING APNEA OR SLOW DOWN BREATHING.

SO THAT NUMBER NEEDS TO BE BETWEEN 15-100.

IT WAS 15-655 AND THE FDA INCREASED THAT TO 100 WHICH IS ANOTHER SIGN THAT THIS IS BECOMING MORE AND MORE ACCEPTED AND, YOU KNOW, VALUE TREATMENT FOR SLEEP APNEA.

OTHER INDICATIONS THAT ARE IMPORTANT ARE THE BMI.

SO YOU KNOW, THAT'S THE NUMBER THAT IS GENERATED BASED ON YOUR HEIGHT AND WEIGHT AND YOUR B BMI NEEDS TO BE UNDER 40.

>> UNDER 40.

>> AND IT WAS 32.

FIVE YEARS AGO.

THEY RAISED IT TO 35 TWO OR THREE YEARS AGO AND NOW IT'S 40.

THESE ARE ALL GOOD SIGNS THAT PEOPLE ARE SEEING THIS AS A GREAT OPTION.

SO 40 IS PRETTY HIGH.

I MEAN IF YOU ARE OVER 40 BMI, YOU KNOW, THERE MAY BE SOME OTHER THINGS WE NEED TO DO BEFORE TALKING ABOUT SURGERY.

>> I'M KIND OF CURIOUS BECAUSE, AGAIN, THE TYPICAL PATIENT THAT MANY OF US THINK ABOUT, WHO HAS SLEEP APNEA, ESPECIALLY OBSTRUCTIVE SLEEP APNEA WOULD BE THAT PERSON IS OBESE.

SO WHY WOULD A HIGH BMI ELIMINATE THEM FROM HAVING A DEVICE THAT WOULD OPEN UP THEIR AIRWAY?

>> THAT'S A GREAT QUESTION AND THAT'S WHAT THE SURGEONS AND PHYSICIANS ARE ASKING THE INSURANCE COMPANIES.

IT SHOULD BE UP TO US TO DECIDE WHICH PATIENT WOULD BENEFIT FROM INSPIRE.

MAYBE YOU HAVE A BMI OF 43 BUT CARRY YOUR WEIGHT DOWN LOW, NOT UP IN YOUR NECK WHICH IS THEIR POINT.

IF HAVE YOU A BMI OF 43, THEN THERE IS TOO MUCH WEIGHT AND FAT TISSUE IN THE NECK AND THIS ISN'T GOING TO BE AS EFFECTIVE AS IT SHOULD BE FOR US TO, YOU KNOW, HAVE THE EXPENSE OF PAYING FOR THIS IS WHAT KIND OF THE INSURANCE COMPANIES ARE THINKING.

>> AS WITH EVERYTHING, IT'S GOOD, BUT THERE HAS GOT TO BE SOME COMPLICATIONS THAT CAN POTENTIALLY OCCUR.

WHAT ARE SOME OF THE MORE COMMON ONCE THAT YOU ARE SEEING?

>> WELL, IT'S A TRUE SURGERY SO YOU ARE GOING TO SLEEP, GENERAL ANESTHESIA FOR ABOUT AN HOUR AND A HALF.

AND WE ARE IN PLAN IMPLANTING PATIENTS IN THEIR 70s AND 80s.

SO ANESTHESIA IS RISKIER AS YOU GET OLDER.

AND WE MAKE SURE THE ANESTHESIOLOGIST OF COURSE ARE OKAY WITH PUTTING A SPECIFIC PATIENT TO SLEEP.

BUT ANESTHESIA RISK IS OF COURSE ONE OF THEM.

INFECTION, HEMATOMA OR BLOOD CLOT, NERVE INJURIES.

WE ARE OPERATING ON A NERVE AND THAT NERVE COULD THEY'RE RECEIPT THEIR BE INJURED.

THAT'S PRETTY WELLMENT THE HYPOGLOSSAL NERVE IS A STRONG ROBUST NERVE AND WOULD YOU HAVE TO PRETTY MUCH CUT IT IN TWO TO INJURY IT AND THAT SHOULD NOT HAPPEN BY ANYONE DOING THAT PROCEDURE.

SO TYPICAL SURGICAL RISKS, YOU KNOW, PAIN, SWELLING, THINGS LIKE THAT.

>> WHAT DO YOU DEFINE AS A SUCCESS WHEN YOU PUT THIS DEVICE IN AND WHAT DOES THE PATIENT DEFINE AS A SUCCESS?

>> I THINK A SUCCESS WOULD BE A DRAMATIC REDUCTION IN THEIR OBSTRUCTIVE EVENTS, AND THE PATIENT TOLERATES IT AND USES IT.

SO IF YOU ARE USING IT FIVE, SIX PLUS HOURS A NIGHT, AND IT'S DROPPED YOU FROM AN APNEA INDEX FROM 40 DOWN TO 8, THAT'S A SUCCESS.

NORMAL IS UNDER 5.

IF WE CAN GET YOU UNDER 5 ON THAT AHI NUMBER, THEN THAT'S A CURE, BUT SUCCESS IN MY BOOK IS DRAMATIC REDUCTION THAT IS MINIMIZING THE MANY, MANY HEALTH RISKS THAT UNTREATED SLEEP APNEA POSES.

>> DO YOU SEE A REVERSAL OF SOME OF THE MEDICAL PROBLEMS THAT BROUGHT A PATIENT IN FOR THE SURGICAL TREATMENT?

WHEN THEY HAD THE DEVICE PUT IN?

>> MY LOOSE ANSWER IS YES BUT REMEMBER I'M JUST THAT TECHNICIAN PUTTING THESE THINGS IN AND THEN THEY GO BACK TO THEIR SLEEP DOCTOR, PRIMARY CARE DOCTOR AND THAT'S WHERE THEIR HYPERTENSION, DIABETES, ALL OF THOSE PROBLEMS ARE BEING ADDRESSED BUT IF WE CAN GET PATIENTS SLEEPING BETTER, AND NOT TIRED DURING THE DAY, THEY'RE EXERCISING MORE, MORE ACTIVE, LOSING WEIGHT, SO THERE IS SO MANY DOWNSTREAM EFFECTS TO ELIMINATING SLEEP APNEA THAT ARE POSITIVE.

>> SO HAVING THIS DEVICE IN PLACE THEY THERE HAVE GOT TO BE SOME RESTRICTIONS ON ACTIVITIES OR ANYTHING, OR ARE THERE RESTRICTIONS?

>> ONCE YOU'VE HEALED, I WOULD SAY-- I WOULDN'T WANT YOU LIFTING WEIGHTS OR SWINGING A GOLF CLUB FOR AT LEAST A COUPLE OF WEEKS, PREFERABLY FOUR TO SIX WEEKS.

BUT AFTER THAT POINT, IF EVERYTHING IS GOOD, THERE IS REALLY NO LIMITATIONS.

WE HAVE PATIENTS THAT PLAY GOLF ALL THE TIME AND LIFT WEIGHTS, EXERCISE, RUN, YOU NAME IT.

SO THERE IS REALLY NOT ANY LIMITATIONS.

>> I REMEMBER A LOT OF PATIENTS WE HAD SOME IMPLANTS IN THAT THEY COULDN'T GET AN MRI STUDY DONE.

IS THAT OR SOME OTHER X-RAY STUDIES.

IS THAT SOMETHING, ANY RESTRICTIONS HERE?

>> NO, AND THAT'S A GREAT QUESTION BECAUSE ONCE AGAIN, ABOUT TWO YEARS AGO, ALL THIS CHANGED, IT WAS IN THE CHEST REGION FROM ABOUT THE CHIN DOWN TO THE ABDOMEN.

IT WAS RECOMMENDED NO MRIS.

>> I SEE.

>> AND THAT, OF COURSE, IS PROBLEMATIC FOR PATIENTS THAT HAVE HAD, YOU KNOW, BREAST CANCER OR OTHER PROBLEMS THAT MIGHT NEED MRI IMAGING IN THE FUTURE, SPINE DISEASE.

>> SURE.

>> SO NOW THEY'VE CHANGED IT ALL AND THE MRI IS 100% COMPATIBLE ANYWHERE ON THE BODY.

>> ANYWHERE.

>> ANYWHERE.

ARE PATIENTS A SOURCE OF REFERRAL?

ONE THAT HAS HAD IT DONE SAYS YOU HAVE TO GET IT DONE?

>> ABSOLUTELY.

AND WE HAVE AMBASSADOR PROGRAMS WITHIN THE INSPIRE COMPANY WHERE PATIENTS ARE GIVEN THEIR TESTIMONIALS AND I SEE A LOT, YOU KNOW, I'VE LIVED IN LOUISVILLE FOR OVER 50 YEARS, SO I HAVE A PRETTY GOOD NETWORK OF FRIENDS AND FAMILY AND SO WE SEE A LOT OF PEOPLE COMING IN THAT HAVE BEEN KIND OF TIPPED BY OTHER PATIENTS.

>> SO THE PROCESS TO GET TO A PERSON LIKE YOU WOULD BE THEY SEE THEIR PRIMARY CARE PHYSICIAN WHO STARTS THE PROCESS.

OR DO THEY CALL YOU DIRECTLY?

>> IT DEPENDS ON THEIR INSURANCE.

SOME INSURANCE COMPANIES REQUIRE A REFERRAL PRIOR TO SEEING A SPECIALIST BUT IF YOU DON'T HAVE THAT, YOU CAN BYPASS PRIMARY CARE, GO STRAIGHT TO SLEEP MEDICINE OR STRAIGHT TO ME.

NOW REMEMBER I NEED A SLEEP STUDY BEFORE I CAN MAKE ANY JUDGE MANIES ON TREATMENT.

-- JUDGMENTS ON TREATMENT AND REMEMBER WITH INSPIRE, YOU WANT TO TRY AND SEE IF CPAP WORKS FOR YOU FIRST.

SO PROBABLY SEEING A GOOD SLEEP SPECIALIST THAT IS FAMILIAR WITH THE INSPIRE PROGRAM AND ACTUALLY MANAGES INSPIRE IN THEIR PRACTICE WOULD BE THE BEST FIRST STEP.

>> IF YOU WOULD BE SO KIND AS TO GIVE ME THREE TAKE HOME POINTS THAT WE SHOULD KNOW ABOUT SLEEP APNEA.

>> WELL, IT'S A REAL DISEASE.

AND IT CAN BE VERY BAD WITH A LOT OF POTENTIAL DOWNSTREAM HEALTH PROBLEMS.

SO THAT'S NUMBER ONE.

YOU KNOW, PEOPLE THINK I'M JUST TIRED DURING THE DAY IS THE WORST THING I HAVE FROM THIS SO I'M JUST NOT GOING TO WORRY ABOUT IT.

I CAN TELL YOU THAT PATIENTS HAVE A LOT OF PROBLEMS IF THEY GO YEARS AND YEARS ONE TREATED SLEEP APNEA.

SO THAT WILL BE NUMBER ONE.

NUMBER 2: THERE IS OPTIONS.

WE HAVE SURGICAL OPTIONS WE HAVE DENTAL APPLIANCE OPTIONS LIKE YOU TALKED ABOUT EARLIER.

NOT JUST THE BREATHING MACHINE.

EVERYONE KIND OF, YOU KNOW, THINKS CPAP WHEN THEY THINK OF SLEEP APNEA BUT THERE ARE OTHER OPTIONS.

AND NUMBER 3 IS HELP IS THERE.

WE ARE WANTING TO HELP PATIENTS.

>> I GOT TO EL YOU, THIS IS ONE OF THE MORE INTERESTING THINGS I'VE HEARD ABOUT AND IF MY WIFE DOESN'T SEND ME, I MAY COME ALONG AND TRY TO FIND OUT MORE ABOUT IT MYSELF.

THANK YOU VERY MUCH FOR BEING WITH US TODAY KEVIN.

I REALLY APPRECIATE YOU.

AND THANK YOU FOR BEING WITH US TODAY.

AS YOU HAVE SEEN, THERE ARE MANY OPTIONS AVAILABLE FOR THE TREATMENT OF SLEP APNEA.

NO MATTER HOW EFFECTIVE A TREATMENT MAY BE.

NONE ARE OF USE IF WE DON'T USE THEM.

I ENCOURAGE YOU TO FIND THAT TREATMENT THAT YOU WILL USE.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH" AND PLEASE FOR THE SAKE OF YOURSELF AND FOR YOUR PARTNER, IF YOU HAVE SLEEP APNEA, GO SEE SOMEBODY AND TALK TO YOUR DOCTOR ABOUT IT AND GET TREATMENT.

SEE YOU NEXT TIME ON "KENTUCKY HEALTH."