Sleep Nuggets
When is National Sleep Awareness Week?
Next week! 3/8-3/14
4 things we're checking at every follow-up visit
Tongue motion, sense lead waveform, adherence/ sleepsync, subjective benefit
Recommended amplitude range settings for a patient who is using their Inspire at their TA of 1.0V
0.8-1.2V
Provider, Care Team, Center
What does ESS stand for?
Epworth Sleepiness Scale
In-lab PSG (could give more time to continue stepping up if appropriate)
What is the average level patients step up to in the first few months leading up to their fine tune sleep study?
Level 7-8
List 3 differences between Inspire therapy & Genio therapy
Patient experience, bilateral vs. unilateral stimulation, incisions, existing established care pathway, sensing technology, BMI criteria, adherence monitoring, clinical evidence
What are the 4 stages of sleep?
N1 (lightest), N2 (deeper relaxation, HR & breathing slow), N3 (deep, restorative sleep), REM (dreaming occurs, body temporarily paralyzed, increased apneic events)
3 possible causes of no tongue motion at activation
Healing (most common), cuff dislodgment, hardware problem
Criteria for increasing a patient's amplitude range (4 things)
Top of remote level, great usage, not feeling subjective benefit, sub-optimal tongue motion
List 3 timeline events that are present in the Patient Timeline section of SleepSync
Therapy activation, implant, insurance submission, DISE, ENT consult, sleep consult
What is the most common sleep disorder worldwide?
Insomnia
3 watchouts we're looking for when evaluating the sensor waveform
Physiological rise & fall, no downward deflection at blue line, no high frequency noise, minimal cardiac artifact (should not affect stimulation timing)
Provide 5 examples of patient complaints/ scenarios that you'd consider red flags for potential over-stimulation
Increased over 1V since activation, discomfort with stimulation, stimulation waking them up, increased pausing, decreased usage, now an oral breather, new dry mouth, new tongue abrasion, decreased subjective benefit compared to earlier on with therapy, increased central apneas on titration study, overly robust tongue motion
What is the working length of our new tunneling tool?
36 cm
Describe hypoxic burden in your own words
A metric that quantifies the total impact of oxygen desaturation events during sleep, integrating the frequency, depth & duration of these events to better assess sleep apnea severity & associated health risks
Care pathway recommendations for a patient with tongue abrasion
Reduce amplitude if over-stimulation is suspected, change electrode configuration if one shows better tongue lift, refer to dentist for tongue glide device/ shave teeth down if needed
Name & describe the 3 interactions for over-stimulation (aka how it affects the body)
1) Anatomical- airway closure (overstretched), oral breathing (increased upper airway resistance)
2) Neurological - brain arousal (disrupted sleep), discomfort
3) Physiological - disrupted respiratory loop gain, leads to treatment emergent central sleep apnea
This nerve is superior to the hypoglossal nerve & will give you no NIM signal or tongue motion if cuffed & tested in the OR
Lingual nerve