A new surgery is helping people breathe easier at night.
Last year, the U.S. Food and Drug Administration approved a new sleep apnea treatment that’s kind of like a nudge from your partner in the middle of the night.
Sleep apnea is an exhausting cycle of obstructed breathing. The airway gets blocked, followed by a choking-startle as the brain wakes the body just enough to get it breathing gain.
“I don’t snore, I just stop breathing,” said Bucks County resident Larry Jalowiec.
His wife, Ann Tucker, first noticed the problem nearly a decade ago. She’d often find herself lying in bed beside her husband waiting for him to start breathing again.
“He makes a funny squeal-y noise like a balloon letting out air,” Tucker said.
When Jalowiec was first diagnosed, the problem was severe: he stopped breathing 47 times an hour.
“It’s tough because when I wake up in the morning I don’t feel rejuvenated. I don’t feel refreshed. I feel tired,” he said.
After four previous surgeries to open up his airways, Jalowiec decided to go under the knife one more time to try upper airway stimulation.
Jalowiec was the fourth person in Philadelphia to get the new implant from Inspire Medical Systems.
“This is the first generation, they are putting a Model T in my chest. In five, 10 years, they’re going to have a Tesla,” Jalowiec said in January as he waited for surgery propped up in bed a Thomas Jefferson University Hospital.
The therapy is a pacemaker attached to two wires. A surgeon tucks the implant behind the collarbone, where one wire monitors breathing. The second wire snakes up under the chin. Throughout the night, that wire gently pokes a nerve in the tongue, pushing it forward, away from the throat.
About 18 million Americans have sleep apnea. Physicians have linked sleep apnea to trouble concentrating and sluggishness during the day. And after years, chronic drops in oxygen can lead to high blood pressure and diabetes.
“Who knows, I’m not a medical doctor, but if you are stopping breathing for long periods of time, that is a brain problem,” Tucker said.
Jalowiec says he’s noticed memory problems that seem premature for a man in his 40s and 50s. He travels for work and has forgotten to pick up his checked baggage, another time he left his laptop on a plane.
Operations and other fixes
There are lots of fixes for sleep apnea. One medical device is a strap for the back of your neck. During the night, it vibrates and jiggles to encourage the wearer to shift sleep positions. A dentist can make a plastic mouthpiece designed to push the lower jaw forward and open the airways. But for people with severe sleep apnea, continuous positive airway pressure (CPAP) is the therapy doctors often recommend.
It’s a nighttime breathing machine with a mask that sends a stream of air into your mouth and nose as you sleep.
It’s bulky and noisy. Some people feel claustrophobic inside the mask. There’s a long tube that connects the mask to the bedside machine. Jalowiec says it flops around and sometimes gets in the way.
“There are times when it just becomes such a pain that I just pull it off and throw it aside and shut the thing off and try to go to sleep on my own,” he said.
CPAP works for the vast majority of people when they use it. But Jefferson sleep specialist and surgeon Maurits Boon says 50 percent to 80 percent of patients stop using the machine.
He put in Jalowiec’s pacemaker: the 54-year-old’s fifth surgery attempt to get a good night’s rest.
After previous operations, there was lots of pain, and only a bit of improvement. First, surgeons shaved bone ridges inside his nose. Another time, they fastened screws in his jawbone. Then, doctors re-shaped the back of his throat.
A ‘brighter’ start to the day
“We really came to this for Larry because he had failed other procedures,” Boon said.
Patients wait about a month to let surgery scars heal while the device settles in the body, then the doctor turns it on and adjusts the voltage.
“It’s hard to describe, it was just this odd sensation I was not in control of my tongue. The back of the tongue kind of scrunches up and moves forward,” Jalowiec said.
He noticed a difference one morning soon after.
“I sat up in bed, feet hit the floor, I felt refreshed. There is just something magic about being rested. That everything seems to be, I don’t know, much brighter,” he said.
Patients use a remote control to turn off the machine during the day. Just before bedtime, they can program it to begin working as they fall off to sleep.
The device maker funded a study of 126 patients who’ve received upper airway stimulation therapy. The trial found a 68 percent reduction in disturbing nighttime chokes and startles.
Boon said those are great results. He was trained by Inspire to implant the pacemaker, but says he has no financial ties to the company.
If you’ve never struggled to sleep well, it might seem extreme to have surgery, but Boon says sleep problems are undertreated and affect every aspect of your health.
“All you have to think about is that time you pulled an all night-er, and the next day how terrible you felt, the people who have sleep apnea feel like that every day, ’cause they never get a good night’s sleep,” he said.
Jalowiec said he expects the therapy to cost as much as a car, between $10,000 and $30,000.
That estimate is about right for the fees paid by the insurance company, but patients don’t pay the full freight, Boon said.
After a bit of a financial back and forth, Jalowiec’s insurance provider signed off on the operation.