Sound Sleep Makes All the Difference

Caffeine used to rule Dan Swiech’s days because obstructive sleep apnea ruled his nights.

Now he drinks decaf, is more alert with increased energy and a sunnier disposition, and his wife also is getting her sleep – thanks to the Inspire^® sleep apnea system available through Lehigh Valley Health Network (LVHN).

Swiech’s road to relief was anything but short. The 54-year-old pharmaceutical company maintenance worker from Drums, Luzerne County, says he first sought help in the late 90s outside of LVHN. He says a sleep study then showed early-stage obstructive sleep apnea, but noted there was no follow-up by that medical team.

The intervening years were an oft times ear-piercing snore fest, leaving Swiech perpetually tired during the day, sometimes waking with a headache and not in the best of moods. “I was living my life one cup of coffee to the next,” Swiech says. He was always staying busy, but when he’d stop for five minutes, he’d quickly fall asleep. “Most of my life, I just accepted that I was always tired. I didn’t know any different. I didn’t know I wasn’t getting good sleep.”

Swiech says his wife, Wendy, pushed him to do more to address his sleep apnea, which resulted in snoring, but also with him stopping breathing and waking up suddenly, nearly gagging. “She [Wendy] tried a lot of things to get to sleep herself, including earplugs, headphones and white noise,” Swiech says.

Swiech made an appointment with otolaryngologist and head and neck surgeon Darren Hohn, DO, who sees patients at LVPG Ear, Nose and Throat–Health & Wellness Center, in Hazle Township. Following that appointment, he was referred to the Sleep Disorders Center at Lehigh Valley Hospital–Hazleton and Shahzad Khan, MD, for a sleep study. He got the official news from Dr. Hohn. He had severe obstructive sleep apnea.

In simple terms, it meant his tongue was falling back and blocking his airway when he slept. The study showed it was occurring about 33 times each hour, putting him in the severe obstructive sleep apnea category.

The lack of oxygen caused by obstructive sleep apnea can lead to an increased risk for stroke, heart failure, pulmonary hypertension and dementia. Swiech says he has a family history of heart problems, so it was a bonus to help reduce those risk factors.

He tried continuous positive air pressure (CPAP) therapy in which forced air kept his airway open. No matter how hard he tried, he says he couldn’t get the mask to seal correctly around his nose and mouth. He tried a less intrusive nasal pillow, but that also didn’t provide the improvement he needed, he says.

Dr. Hohn says about half of people who try CPAP therapy don’t tolerate it well, and stop using it.

In a follow-up appointment, Dr. Hohn suggested considering Inspire, provided Swiech met the criteria for the therapy, which had just become available through LVHN. It is the only Food and Drug Administration-approved implant for obstructive sleep apnea.

There are other reasons besides the tongue blocking an airway that can contribute to sleep apnea but would not qualify someone for Inspire. They include enlarged tonsils blocking the throat, a deviated septum (the cartilage that divides your nose into two chambers) and enlarged turbinate bones (long thin bones on the inside of the nose) blocking the nose.

Dr. Hohn says sometimes the solution might be for the patient to lose weight. In some cases, a patient may have qualifying obstructive sleep apnea, but still need to lose weight to reach a qualifying BMI for the Inspire procedure.

Inspire surgery usually takes less than 90 minutes, and patients go home the same day. Most insurance companies cover at least part of the therapy.

Inspire isn’t for everyone. Depending on insurance, you can’t have a body mass index over 35 or 40. You need to have obstructive sleep apnea and not another reason for your sleep problem, such as insomnia, central sleep apnea or another disorder. And you need to be someone who can’t tolerate CPAP therapy. Swiech appeared to meet the criteria, and during an in-hospital sedation it was confirmed his tongue was indeed falling back and blocking his breathing when he slept.

The Inspire device works to stimulate the hypoglossal nerve, which controls the tongue. The Inspire system includes a generator about the size of a half-dollar, a breathing sensor and a lead attached to the hypoglossal nerve. By stimulating the hypglossal nerve, the tongue stays forward and keeps the airway open during sleep. Inspire’s battery lasts about 11 years and is replaced during a quick outpatient procedure.

Swiech decided to move forward with Inspire surgery in late September 2023. “I really didn’t see a lot of negativity in my research,” he says. A month later, he met with Dr. Khan, who worked to set the device for Swiech’s specific needs. Over the following weeks and months, the Inspire unit was fine-tuned even further.

“You can build it up to what is optimal for you,” Dr. Hohn says. “Patients can do this themselves. Patients don’t feel it, but it moves the tongue forward.”

Swiech went from having 33 episodes an hour to six and is considered cured. “Wendy says I don’t stop breathing at all during the night,” he says. “That was the goal. I still snore a little bit, but it’s nowhere near what it was.”

Inspire is operated with a handheld remote control, and patients can set the time until it starts to operate, which is typically the time it takes them to fall asleep. “You tailor it, and you really don’t know it’s working,” Swiech says.

Dr. Hohn says each patient who receives the Inspire can decide if they want to download the Inspire app to their phone. If they agree, Inspire can track progress and provide important usage data. “The software is incredible,” Dr. Hohn says.

Dr. Hohn says Inspire has already advanced its technology since it was approved a decade ago and says even more improvements are likely.

“It really changed my quality of life. There is no question about it,” Swiech says. “It’s the type of thing you don’t think you need because you don’t know any different.”