UR Medicine Otolaryngology CPAP Alternative Program

The UR Medicine Department of Otolaryngology-Head & Neck Surgery is the regional leader in providing care for patients with obstructive sleep apnea (OSA) who do not benefit from treatment with CPAP or BiPAP devices. Dr. Sveta Karelsky, Associate Professor of Otolaryngology, directs the UR Medicine CPAP Alternatives Program in partnership with the UR Medicine Comprehensive Sleep Center. Together, we aim to provide individualized, evidence-based care for patients with OSA. 

OSA is a very common disorder and can contribute to serious health problems such as high blood pressure, diabetes and stroke, in addition to fatigue and poor quality of life. Many patients with OSA cannot tolerate using a CPAP mask or do not benefit from it and need a different type of treatment. There are many types of surgeries and devices that are available to people with sleep apnea, but not all of these options are appropriate for all patients. 

“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,” says Dr. Karelsky. This is why we built a comprehensive, personalized CPAP Alternatives Program to guide each patient through finding the best, scientifically proven treatment for them. 

Our team collaborates with a wide range of providers across UR Medicine as part of the Comprehensive Sleep Center. As the only comprehensive sleep care center in Western New York, we aim to make care convenient and guide patients to the correct providers to meet their needs. 

Patient-focused Approach to Sleep Apnea

Our goal is to evaluate each person’s specific problem as completely as possible so that optimal treatment can be offered. At your consultation appointment, we will talk with you about your concerns and evaluate your sleep study. We then typically perform a procedure called a drug induced sleep endoscopy (DISE) to look at the throat during sleep and help determine exactly what is causing the problem. Based on this information, we can offer each patient a personalized approach to their sleep apnea. Options are then discussed with the patient and a treatment decision is made together.

We work very closely with UR Sleep Medicine and other sleep medicine providers in our region because they are an integral part of your sleep apnea care team before, during and after your treatment at the CPAP Alternatives Program.

For patients interested in treatment with the Inspire hypoglossal nerve stimulator device, UR Medicine has developed a highly successful team. Dr. Karelsky (Otolaryngology), Tarek Siala, PA (Otolaryngology), and Dr. Carolina Marcus (Sleep Medicine) provide complete evaluation and treatment, starting from initial consultation to surgical implantation of the device and ongoing care. We are currently the only center in New York State accredited as a Center of Excellence for treatment with the Inspire device.

We know how important quality sleep is to living your best life. We have dedicated appointments for sleep patients and dedicated staff to review each person’s case and help direct them to the most appropriate care. Our expert team consisting of doctors, advance practice providers (PAs and NPs), nurses and office staff aims to help you get the most out of your care with us. This is why we will start by making sure we have all the necessary information prior to your consultation appointment. We also highly recommend reviewing the FAQ section at the end of this page prior to your visit.

Other Conditions We Treat

Snoring: If you have bothersome snoring but a sleep study does not show sleep apnea, we can help. “Patients are told many different things about the cause of their snoring, and there is an ever-increasing number of devices available for treatment,” says Dr. Karelsky.  Our team offers a comprehensive, step-wise approach to snoring ranging from conservative treatment to the latest available technology. 

CPAP Intolerance: We also provide a comprehensive approach to patients who want to use CPAP but are struggling with it because of disorders of the ears, nose or throat. Conditions that may make CPAP use difficult include nasal obstruction, cough and acid reflux among others. Patients have access to subspecialty trained ENT experts in each of these areas for evaluation and treatment.

Frequently Asked Questions

What causes obstructive sleep apnea?

Obstructive sleep apnea means that something in the throat, also called the “airway,” is closing, or “obstructing,” during sleep. This typically happens due to decreased muscle tone of the airway during sleep, due to excess body weight or neck size, and sometimes due to structures such as the tonsils taking up room in the airway.  A combination of these causes is also possible.

What is a DISE procedure?

A drug-induced sleep endoscopy, or DISE, procedure refers to looking at the airway with a camera during sedated sleep to determine what it causing the obstruction. Because the cause of obstruction is not the same for everyone, a DISE procedure is very helpful to determine what particular treatment is likely to help someone with sleep apnea.

What is the Inspire device and how does it work?

The Inspire device is an implantable nerve stimulator device used to treat sleep apnea in some patients. It stimulates a nerve which is located in the upper neck and is responsible for the decreased muscle tone that is often a problem in sleep apnea, increasing the tone of those muscles and opening the airway. The device is turned on at night with a remote control and turned off during the day.

How successful is treatment with the Inspire device?

At our center, the success rate is 80-90%, which means that the majority of patients achieve significant improvement in their sleep apnea with treatment.

How do I know if the Inspire device will help me?

The Inspire device is helpful for patients over age 18 with moderate to severe sleep apnea, who are not significantly overweight and have a DISE procedure indicating that the device will be right for them. Our providers will discuss the details of your sleep study and DISE results with you during your appointments with us. 

Is Inspire treatment covered by insurance?

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

What is Inspire surgery like?

Implantation of the Inspire device is done under general anesthesia and takes about 1 - 1.5 hours. Patients go home on the day of surgery.

What are the incisions and scars from Inspire surgery?

The Inspire device is placed through 2 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. There will be a dressing placed on each incision.

What is the recovery like after Inspire surgery?

we recommend 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.

How much pain is there after Inspire surgery?

Patients report from very mild to moderate pain, more often around the neck than chest. This can include pain of the right ear and right side of the head. The pain is usually controlled with acetaminophen (Tylenol) and ibuprofen (Advil). Pain usually improves or resolves in several days.

What do the incisions look like after Inspire surgery?

The incisions will initially appear pink or red, swollen, and “bumpy.” This is normal due to the stitches and healing process, and will go away over several weeks. When completely healed, the incisions usually look live very thin scars.

Is it normal to have neck swelling and lump after Inspire surgery?

Yes. There is often a bumpy appearance of the neck scar and surrounding swelling. This will gradually go away.

What is an activation appointment?

This is an appointment with your Sleep Medicine team where the Inspire device is turned on and you receive your remote control.

What does the device working feel like?

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.

Will it wake me up?

Most people are not woken up by the Inspire device after they get used to the treatment. Your Sleep Medicine team will have a detailed plan for gradually ramping up your treatment strength as you get used to sleeping with Inspire. It is a gentle increase that helps you get used to the sensation.

Can I have MRIs with the Inspire device?

Yes. The Inspire device is compatible with MRI of the whole body as long as it is not a very high strength MRI.

Can I have x rays, mammograms, CT scans and ultrasounds with the Inspire device?

Yes.

What happens with going through airports and security with the Inspire device?

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

Do dental devices treat sleep apnea?

Dental devices, also known as mandibular advancement devices, are intended to fit onto the teeth and move the lower jaw forward in relation to the upper jaw. While this does help with snoring and mild sleep apnea for many patients, it is not typically sufficient to treat moderate or severe sleep apnea.

Does throat surgery treat sleep apnea?

Surgery on the inside of the throat aimed at taking tissue out of the throat has been done for many decades and can be effective for select patients with sleep apnea. The DISE procedure helps to determine if this is a reasonable option for you.

Is the CPAP alternatives program only for surgery?

No. Our approach allows patients to get insight into what is structurally causing their sleep apnea so they can make the best treatment decision for them. This decision may involve returning to using CPAP. Avoiding surgery that is unlikely to work is just as important as finding something that does.

Are all CPAP alternatives the same?

It is very important to understand that the best treatment for obstructive sleep apnea depends on individual anatomy (throat structures) causing the problem. Therefore, a treatment option that works for one person may not work for another. Helping understand what is most likely to treat each individual is at the core of our treatment approach.

Are there any patients who do not benefit from CPAP alternative treatments?

Patients with excess body weight (body mass index >35) as well as a larger neck size are less likely to benefit from CPAP alternative treatment. The weight contributes to sleep apnea and cannot be corrected by throat surgery or the Inspire device. However, treatment options for reaching a healthy weight can positively impact sleep apnea. Treatment options can be discussed, including referral information to fitness science, dietitians, physicians with a specialty in medical management of weight loss, bariatric surgery and more, with help from UR Medicine and your primary care provider. 

Do you offer telemedicine?

Yes. We offer telemedicine consultation and follow up appointments, particularly for patients coming from a distance.  We encourage in-person visits when possible for a more complete evaluation.

Why do I need more than one doctor/provider for my sleep apnea?

Optimal sleep apnea treatment requires a team approach. The Sleep Medicine team typically diagnoses sleep apnea and starts treatment with CPAP. If this is not beneficial, the sleep surgery team at the CPAP Alternatives Center

How can I make the most of my CPAP-alternative evaluation appointment?

As with any medical condition, it is important to have a complete diagnosis prior to treatment. Before you come to see us, we will work with your sleep or other referring team to obtain your sleep study and other records. We may occasionally call you to ask about this information or suggest that you get an updated sleep study from your sleep medicine team. If you have not yet had a sleep study and sleep medicine evaluation we will suggest that you do so prior to having a consultation with us. This is to maximize what you get out of each visit.

We highly encourage patients who are undergoing evaluation for the Inspire device to view the Educational link!