Dr. Raphael Nwojo, an Odessa ear, nose and throat physician, has performed what he believes is the first Inspire implant for sleep apnea in the Odessa-Midland area.
According to the Mayo Clinic website, sleep apnea is “a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.”
Inspire began selling the device around 2014. There are videos online about how it works and an app that answers questions.
Nwojo said he saw the implant once or twice when it was being tested during his training in Miami.
“One of my teachers back then was part of the crew that was doing the initial trial of it. … Over the years, it’s matured. It’s well known around the country. We have never done it here,” he added.
“What the implant really is, to summarize it, is a pacemaker for your tongue. Let me break it down. So in patients with sleep apnea what tends to happen is the moment you have fall asleep, you lose all your muscle tone. The body has a little bit of tone muscle, has it while you’re awake. So the tongue is a big muscle. Once you lose tone, in some people, that whole tongue just falls back; falls into the throat. If you have a bulky back on the tongue, it could obstruct the back to your throat so your airway is completely cut off,” Nwojo said.
Compounding that, some people might have an obstruction in their nose as well.
“It’s like a double whammy. Breathe through your nose, the tongue falls back, closes your airway. So you have periods of sleep where you’re struggling to get a (breath). You’re snoring. That snoring is just air turbulence trying to go through that small space and you have poor oxygenation of your blood … so the brain will wake you up,” Nwojo said.
Maybe your partner or spouse will reposition you, but once you fall into deep sleep, the whole cycle repeats, so you’re not getting any rest.
“These patients with sleep apnea, they’re sleepy during the day. They’re tired even though they slept 10 hours,” he said.
Normally, they treat this with a CPAP machine. CPAP stands for Continuous Positive Airway Pressure. The Mayo Clinic website says a CPAP machine “uses a hose connected to a mask or nosepiece to deliver constant and steady air pressure to help you breathe while you sleep.”
Some people don’t mind the CPAP machine.
“But there’s a handful of people that just can’t stand that on their face. This is where this implant becomes an option. In order to qualify to get this implant, you have to have tried a CPAP and failed the CPAP. Then you have to meet a certain criteria for BMI. You have to be less than 35 BMI,” Nwojo said.
You also have to have undergone a recent sleep study in the last two years that shows you have sleep apnea.
“Once you’ve jumped through all those hoops, you will see an ENT, or somebody like me. I examine your nose, make sure the obstruction is not in the nose. That can be surgically corrected. If it’s mostly the tongue, then there’s a study we do called a drug-induced sleep endoscopy,” Nwojo said.
You are taken to the operating room as if you’re getting ready for surgery.
“During that procedure, you are chemically put to sleep. So we’ll put Propofol or some medicine is titrated just enough for you to fall asleep naturally, without tubes … Once you fall asleep, I’ll come with a camera through your nose. We’re looking at the back of your nose. … You’re trying to make sure that soft palate has almost like a valve-like closure each time you breathe. We call it an AP movement, or anterior posterior movement. Each time we take a breath, and some people who we would deem not candidates for the implant, instead of this space here going back and forth like that in an AP fashion, anterior posterior fashion, theirs close like a concentrically,” Nwojo said.
He added that you can’t tell that unless you do the study.
“If you’re closing concentrically, I put an implant (in). What the implant does is to stiffen the tongue and move it forward. Each time you take a breath, there’s a sensor in the chest that can sense that your lungs are trying to expand. There’s a wire underneath the skin that I attach to the nerve that controls your tongue. Each time you try to take a breath, the sensor can tell. There’s also a generator next to the sensor that will send a signal to the nerve that controls the tongue to move forward,” he added.
The battery lasts for about 10 years.
The device has to be calibrated by a sleep doctor, but after that, you put a device that looks like a computer mouse on your chest near the generator. Push a button and put the mouse aside and there’s a 30-minute delay that allows you to fall asleep.
“Once you’re asleep, it kicks in. You can manipulate that 30 minutes; 45 minutes; an hour before the generator kicks in. Hopefully, you were falling asleep lightly and it kicks in. Each time you try to breathe, it will stiffen the tongue a little bit and move it out of the way so you can breathe so the tongue is not closing the airway. It’s really neat,” Nwojo said.
He added that sleep apnea is very common in this area.
“There’s a lot of people walking around with sleep apnea and don’t realize it. Once you start talking to them, it’s obvious; falling asleep inappropriately; morning headaches after you’ve slept the whole night. But you wake up still tired and with a headache … falling asleep just driving from here back home,” Nwojo said.
The first patient he performed the procedure on lives in Midland. It took about three hours, but he expects it to be shorter once he’s done more of them. He has about 15 to 20 patients waiting for the procedure.
“I saw him a week later. He was doing well. No pain or soreness. He will see the sleep doctor to turn on the implant in about four weeks,” Nwojo said.
He added that about 95 percent of the patients who get the implant are happy with it.
“The data is out there. It just hasn’t been done here,” Nwojo said.
He added that the next closest center is in Lubbock and then Dallas and Houston.
“It’s been around; it’s just nobody was doing it here, so I know there’s a need for it,” he said.
