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IN NEED OF ZS
In 2015, Dr. Tapan Padhya (left) became the fi rst surgeon in Florida to perform an Inspire nerve transplant, a device that helps those with moderate to severe obstructive sleep apnea.
—DR. TAPAN PADHYA
Between busy jobs, family responsibilities, and the stress of daily life, it’s no surprise that Americans are suffering from a lack of sleep.
Adults require seven or more hours of sleep each night, according to the federal Centers for Disease Control and Prevention (CDC). But more than one-third of U.S. adults report sleeping less than that on average.
I t ’ s a p r o b l e m o n e c o u l d e a s i l y l o s e s l e e p o v e r . G e t t i n g l e s s t h a n t h e s e v e n - h o u r g u i d e l i n e c a n p o t e n t i a l l y l e a d t o s e r i o u s h e a l t h i s s u e s . I n f a c t , r e d u c e d s l e e p h a s b e e n l i n k e d t o s e v e n o f t h e l e a d i n g c a u s e s o f d e a t h i n t h e U n i t e d S t a t e s , f r o m a c c i d e n t s t o h e a r t d i s e a s e a n d c a n c e r .
At Tampa General Hospital’s Sleep Disorders Center, Dr. Tapan
Padhya, medical director of the TGH Ear, Nose & Throat Institute, is fi nding solutions to the causes of sleep deprivation. Padhya, who also is professor and chair of the Department of Otolaryngology – Head and Neck Surgery at the USF Health Morsani College of Medicine at the University of South Florida, is a pioneer in the use of a cutting-edge device called Inspire to help patients suffering from one of these causes: sleep apnea.
“ T h e r e a r e t w o p a r t s o f s l e e p , ” P a d h y a e x p l a i n e d . “ O n e p a r t i s d u r a t i o n o f s l e e p t h r o u g h t h e n i g h t . T h e a v e r a g e s l e e p c y c l e i s a b o u t 9 0 m i n u t e s , a n d y o u n e e d f o u r t o fi v e o f t h o s e c y c l e s t o g e t a r e s t f u l s l e e p . T h e o t h e r p a r t i s t h e q u a l i t y o f s l e e p . T h i s i s w h e r e c o n d i t i o n s d i s r u p t s l e e p , i n c l u d i n g o b s t r u c t i v e s l e e p a p n e a , i n s o m n i a , a n d n a r c o l e p s y . ”
People suffering from narcolepsy experience heightened daytime drowsiness, bouts of sudden sleep, and diffi culty staying awake for extended periods of time. By Dr. Tapan Padhya
The Inspire device is implanted under the collarbone and activated via remote control. When the patient takes a breath while sleeping, the device delivers an electrical stimulus to gently push the tongue out and create an open airway.
contrast, those with insomnia find it difficult to fall asleep or to get back to sleep if awakened. With obstructive sleep apnea, the muscles that support the tongue and palate temporarily relax, narrowing one’s airway and momentarily restricting breathing.
“ N a r c o l e p s y a n d i n s o m n i a h a v e m o r e o f a p s y c h o l o g i c a l c o m p o n e n t t o t h e m , w h e r e a s o b s t r u c t i v e s l e e p a p n e a i s a s t r u c t u r a l / c o l l a p s e i s s u e , ” P a d h y a s a i d . “ T h e r i s k g o e s u p s i g n i fi c a n t l y f o r m o s t e v e r y o n e o v e r 3 0 y e a r s o f a g e . ”
Obesity also increases the risk of developing the condition, which afflicts some 18 million Americans. In the United States, BMI and obesity increase as people age, contributing to the increased prevalence of sleep apnea.
Padhya knows of what he speaks. As an obstructive sleep apnea sufferer himself, he wears a CPAP (continuous positive airway pressure) machine at night to prevent his airway from collapsing. “I’m very empathetic to the sleep disorder population because I live it every day,” he said. “I connect with them because I know what they’re experiencing, and I know what their sleep partner is saying.”
Sleep disorders aside, the general lack of adequate sleep remains a concern, made worse by people’s habits of using their cellphones or watching TV at bedtime.
“Our days are longer, and we have less time to sleep,” Padhya noted. “And even if we feel like we’re closing our eyes, we’re not getting a quality night’s sleep.”
Patients at the TGH Sleep Disorders Center answer a questionnaire to help determine what kind of problem they may have. They also complete an extensive “sleep-wake” cycle history that delves into habits. Some are asked to keep a sleep diary, noting when they go to bed, get up in the middle of the night, and awaken over a two-week period. One common issue is that people are quick to push back their bedtime.
“The thing that gives us the most problem is going to bed,” Padhya said. “People have to wake up at the same time in their lives, so going to bed early enough is the challenge. It is frequently pushed back due to family care or job commitments. Our fallback is to catch a power nap during the day or catch up on sleep over the weekend. But getting a nap isn’t possible for everyone. And it’s been shown that sleeping in on the weekend does not catch you up.”
The result is America’s sleep shortage.
“Many people’s quality of life is being affected in some way,” Padhya said. “Sleep deprivation goes hand-in-hand with sleep disorders.”
Just Like a Dream
For those who suffer from sleep apnea, the Inspire device can be a game changer
David Borden was running out of options and hope. The 43-year-old Ocala resident had been using a CPAP machine for his obstructive sleep apnea for more than 20 years, and it was making his life worse.
“It was constantly leaking, there was always air blowing, and it was even hard on my partner—she couldn’t get a good night’s sleep,” Borden said.
Further complicating his problem was that Borden has suff ered from another health condition since early childhood, and the CPAP machine seemed to be aggravating that as well.
But then he heard a radio ad about a surgically implanted product for sleep apnea called Inspire. He went online and learned that the procedure was available at Tampa General Hospital, a two-hour drive south on I-75. He made an appointment at TGH’s Sleep Disorders Center and was soon conferring with Dr. Tapan Padhya about a surgery that would ultimately change Borden’s life dramatically.
Little did he know at the time that Padhya was instrumental in the pivotal clinical trial that helped with FDA approval for Inspire in 2014. He became the fi rst in Florida to perform the Inspire nerve implant in 2015, and the fi rst in the federal Veterans Administration system nationally. Today, Padhya has performed more than 250 implant surgeries.
Created by Medtronic, Inspire addresses the root cause of sleep apnea. It is half the size of a cell phone, placed under the collarbone during an outpatient procedure, and activated by remote control. Electric leads beneath the skin deliver a small stimulus to the base of the tongue when a patient takes a breath.
“It will gently push the tongue out to help the airfl ow,” Padhya explained. “You have an open airway. You don’t have that struggle to breathe.”
To qualify for the Inspire treatment, patients must have a body mass index under 32, their sleep apnea must be moderate to severe, and they must previously have tried using a CPAP and believe that it no longer works for them.
A month after Borden’s implantation, the device was turned on and calibrated—and Borden enjoyed a restful night’s sleep for the fi rst time since he could remember. In fact, he was so quiet that his partner wondered momentarily if he was still breathing.
“She thought about holding a mirror under my nose to make sure that I was,” he said with a laugh.
With help from TGH, Borden’s turnaround has been nothing short of inspiring. “I don’t wake up tired anymore, and I fi nally feel rested,” he said. “I can’t say enough about Dr. Padhya—he’s awesome. And the whole thing is like a dream.”
Something he can fi nally enjoy doing again.
David Borden’s severe sleep apnea was impacting not only his health and sleep quality, but the sleep quality of his partner, Diana Sawyer, too. That all changed when he received the Inspire transplant.
