Inspire Therapy in Sharjah

What is Inspire therapy?

Inspire therapy is a treatment for obstructive sleep apnoea that uses a small implanted device to stimulate the hypoglossal nerve, the nerve that moves the tongue. In many people with apnoea, the tongue relaxes and drops backwards during sleep and blocks the throat. Inspire works from the inside: with each breath in, it sends a mild pulse to the nerve, the tongue moves forward, and the airway stays open.

The system has two main parts. A small generator, similar in size to a pacemaker, sits under the skin of the upper chest, and a thin lead runs from it to a branch of the hypoglossal nerve under the jaw. The device senses your breathing pattern and times each pulse to the breath.

A fact many people find surprising: Inspire is used only at night. You switch it on with a small handheld remote when you go to bed, and there is a pause setting for waking in the night. In the morning you switch it off, and the tongue works normally through the day. At Dar Al Kamal Hospital, Sharjah, Inspire therapy is provided in-house by the ENT surgeon as part of sleep apnea treatment.

Who needs it

Inspire therapy is designed for adults with moderate to severe obstructive sleep apnoea who have tried CPAP and found it unworkable, for example because of mask discomfort, claustrophobia, air leaks or broken sleep. It sits later in the treatment pathway, after CPAP and simpler measures have been given a fair trial.

Suitability is checked in several steps:

• A recent sleep apnea test that shows the type and severity of apnoea, with most pauses caused by blockage of the airway
• Body weight within the range the device is approved for, since heavier weight around the neck changes how the airway collapses
• An ENT examination of the nose, mouth and throat
• A sleep endoscopy, a short look at the throat with a thin camera while you are in a medicated sleep, to watch how the airway closes

The sleep endoscopy matters because Inspire suits a particular pattern of collapse. When the soft palate closes from front to back, the tongue moving forward pulls the palate with it and opens the airway. When the throat closes in a ring from all sides, other treatments suit better.

Alternatives include returning to CPAP with a different mask or humidifier, a dental device that holds the lower jaw forward, weight reduction, and throat surgery such as UPPP sleep apnoea surgery. The ENT surgeon goes through each option with you, and the decision is yours.

What happens

Inspire is implanted under general anaesthesia, so you are asleep throughout. The surgeon makes a small incision in a skin crease under the jaw to reach the hypoglossal nerve and places the stimulation lead on the branches that push the tongue forward. A second small incision in the upper chest creates a pocket under the skin for the generator, and the lead is passed beneath the skin to connect the two. The wounds are closed with dissolving stitches or skin glue.

The device stays switched off at first while the wounds heal. At a later clinic visit it is switched on, you are shown how to use the remote, and the strength is set low. Over the following weeks you increase it gradually at home within a set range. A follow-up sleep study then fine-tunes the settings while you sleep.

Preparing for it

A pre-operative assessment, blood tests and an anaesthetic review confirm you are ready. Bring your sleep study reports, the sleep endoscopy report and a full list of your medicines; blood thinners and diabetes medicines each need a plan, and you receive clear fasting instructions. Wear a loose top that buttons at the front, which is easier over a chest wound.

Keep using CPAP, if you can, until the device is active. If surgery or activation falls near Ramadan, raise it early, because your sleep pattern changes around suhoor and the settings are best tuned in a typical week.

Afterwards

Some soreness and swelling under the jaw and in the chest are expected for the first days. Keep the dressings clean and dry, and in the Sharjah heat avoid sweating into them. Lift only light items and keep the arm on the implant side below shoulder height early on, as your surgeon advises. Desk work often resumes sooner than manual work, and your surgeon gives you a personal timeline.

Once the device is active, you feel the tongue move gently forward with each breath in, a sensation that becomes familiar with use. Use it every night, including naps and travel. You receive an implant card: carry it through airport security, and show it before any MRI scan so the scan can be checked against the device. The generator battery lasts many years and is replaced through a smaller operation at the chest.

Contact the hospital if a wound becomes red, hot, swollen or starts to leak, if you have a fever, or if the tongue feels weak or swallowing is difficult. **Go to the emergency department straight away if swelling in the neck grows quickly or you have difficulty breathing.**

Cost and insurance

Inspire therapy is a device-based treatment, so insurance pre-approval is essential before surgery. Approval usually needs the sleep study, a documented CPAP trial and the sleep endoscopy report, and some plans exclude implanted sleep devices altogether. Dar Al Kamal Hospital, Sharjah can help you confirm your cover on 06 599 7777.