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CPAP Alternatives Program

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Overview

UR Medicine is home to Central and Western New York’s only comprehensive CPAP Alternatives Program. This means that if you are not able to benefit from CPAP or BiPAP treatment for sleep apnea, we will offer you a comprehensive evaluation of your sleep apnea and offer personalized, scientifically proven treatment. Dr. Sveta Karelsky, Associate Professor of Otolaryngology, directs the UR Medicine CPAP Alternatives Program in partnership with the UR Medicine Comprehensive Sleep Center. She is a nationally recognized expert in sleep apnea surgery and will meet with you to design the best treatment plan together.

Obstructive Sleep Apnea

Sleep apnea is a common disorder that can contribute to serious health problems such as high blood pressure, diabetes, heart problems and stroke, in addition to fatigue and poor quality of life. Many people with obstructive sleep apnea cannot tolerate using a CPAP mask or do not benefit from it and need a different type of treatment.

Many types of surgeries and devices are available to people with sleep apnea, including:

Throat surgery to remove obstruction
Inspire® device hypoglossal nerve stimulation
Dental devices

However, not all these options are appropriate for all patients. That’s why we aim to guide each patient through finding the best, evidence based treatment for them.

Dr. Karelsky says:

"Because sleep apnea is such a common problem, patients see a lot of information regarding various things that promise to treat their sleep apnea, often without a lot of guidance as to how effective the treatments are or where to start. It is very important to have a team of experts evaluating each patient and guiding them through the most appropriate options for them."

What to Expect from the CPAP Alternatives Program

We know how important quality sleep is to living your best life, and we value your time. When you are referred to the UR Medicine CPAP Alternatives Program, our office staff and Nurse Navigator will start with gathering required information to make the most of your appointment. We have dedicated appointments and staff for sleep patients. Our expert team, consisting of doctors, advanced practice providers (PAs and NPs), nurses, and office staff, aims to help you get the most out of your care with us.

At your consultation appointment, we will discuss your concerns and evaluate your sleep study. Shortly after the consultation, we typically perform a drug-induced sleep endoscopy (DISE) procedure under sedation to examine the throat during sleep and help determine exactly what is causing the problem. We will then develop a personalized treatment plan that takes into account your goals and preferences.

Inspire® Therapy

Inspire® Upper Airway Stimulation (UAS) is the only FDA-approved implantable treatment for people with Obstructive Sleep Apnea. UR Medicine is the only center in New York State accredited as a Center of Excellence for treatment with Inspire®.

Inspire Sleep Therapy might be right for you if:

You have moderate to severe obstructive sleep apnea
You are unable to benefit from CPAP or BiPAP
You are not significantly obese
You are over the age of 18

Inspire® is a small implant that works inside your body with your natural breathing process. While you sleep, the device delivers mild stimulation to key airway muscles, allowing the airway to remain open. The system is controlled by a small handheld sleep remote. Simply turn it on before bed and off in the morning when you wake up.

UR Medicine has developed a highly successful Inspire treatment team led by Dr. Sveta Karelsky (Otolaryngology) and Dr. Carolina Marcus (Sleep Medicine). These experts provide complete evaluation and treatment, from initial consultation to surgical implantation of the device and ongoing care.

Throat Surgery (Pharyngoplasty)

We may recommend surgery on the inside of the throat based on your personalized evaluation and the DISE procedure. This surgery aims to remove any extra tissue in your throat and redirect the muscles of the throat to help keep it open. The most commonly performed procedure is the Expansion Sphincter Pharyngoplasy, or ESP. Dr. Karelsky will discuss ESP with you in detail if it is recommended for you.

Other Surgery and Treatment

Other surgery such as removal of the tonsils or nose surgery may be recommended based on your personalized evaluation. Additional recommendations such as weight loss, sleeping on your side or dental appliances may also be made to help you achieve your sleep goals.

Research and Clinical Trials

As one of the leading sleep surgery programs in the US, we are involved in scientific studies to continue to advance sleep apnea care. These include clinical trials and other studies in which our patients may be offered participation. All research participation is completely voluntary and supervised by the University of Rochester Research Subjects Review Board.

Frequently Asked Questions About CPAP Alternatives for Sleep Apnea

DISE is the procedure that we use to find out what personalized treatment is best for you. After being diagnosed with sleep apnea through a regular sleep study, Dr. Karelsky conducts a sleep endoscopy procedure. This consists of coming into the hospital, receiving some sedation through an IV, and having your airway (throat) observed with a camera while you are sleeping, snoring and while your throat is actually obstructing like it does to cause your sleep apnea. The procedure itself takes only a few minutes. You will need to have a driver and rest for the remainder of the day after DISE because it will make you groggy.

At our center, the success rate is 75-80%, which means that most patients achieve significant improvement in their sleep apnea with treatment. It is important to be treated by a highly experienced team like ours to achieve the best possible outcome with Inspire therapy.

The device is covered by health insurance plans for patients meeting the criteria.

Implantation of the device is done under general anesthesia and takes about 1 - 1.5 hours. Patients go home on the day of surgery. The device is placed through two incisions: one in the right upper neck and one in the right upper chest. Each incision is about 2.5 inches long. The stitches used dissolve on their own.

Patients report mild to moderate pain, often around the neck and chest. The pain is usually controlled with acetaminophen (Tylenol) and ibuprofen (Advil) and resolves in several days. We suggest reducing your activity level for one week after surgery. This includes avoiding things that raise your heart rate, lifting anything over 5 lbs, and any other activity that makes your surgical area sore.

Yes. The neck scar and surrounding swelling often appear bumpy. This will gradually go away.

The Inspire device feels like an involuntary muscle contraction at the back of the tongue and under the chin. There is no sharp pain, "zapping," or burning. After getting used to the treatment, most people are not woken up by the Inspire device.

Yes. You will receive device ID cards that must be taken with you to all airport and other security checks and shown to the security staff.

3-4 weeks after surgery to place the device, you meet with our Sleep Medicine partners and have the device turned on, receive your remote control and instructions for starting to use the device and get used to it. You will then have a sleep study to make sure the device is working for you and that the settings are optimized.

After any surgery for your sleep apnea, we work closely with your Sleep Medicine team to obtain follow up care and sleep studies to make sure treatment has been effective, or to offer additional treatment.

What Sets Us Apart?

As the only comprehensive sleep care center in Central and Western New York, we are here to guide you in the right direction and make the process of seeking treatment for a sleep disorder easier and more successful. We offer convenient and expert care, ranging from conservative treatments to the latest available technology and advanced surgical care.

Our patients have access to a network of specialists in multiple disciplines. Our experts perform hundreds of procedures and surgeries every year, so your care is always in the hands of well-practiced experts. Many of our physicians are involved in research to find new treatments for ENT-related conditions. All our doctors are board-certified by the American Board of Otolaryngology.