New surgery for sleep apnea now available in Chattanooga

Staff Photo by Matt Hamilton / Physicians assistant Dennis Prok, left, uses a tablet to control the device implanted in the chest of Ooltewah resident James Southwick on March 21 at Advanced Center for Sleep Disorders.

James Southwick was 26 years old the first time he recalls someone suggesting he had sleep apnea — a common and potentially life-threatening condition where a person's breathing is interrupted on and off during sleep.

"I had just gotten out of the Marine Corps, and that's when my girlfriend indirectly told me that it freaked her out that I stopped breathing," he said with a chuckle. "I was like, 'Well, feel free to hit me if you think I'm dead or whatever.'"

Though the problem persisted, Southwick said he didn't think much about it until years later when, despite being otherwise healthy, he constantly felt tired and his blood pressure skyrocketed. He underwent a sleep study, was officially diagnosed and started using a machine that pumps air through a face mask when he slept.

CPAP machines, which stands for continuous positive airway pressure, are the gold standard for treating most cases of sleep apnea. Patients wear a mask over their nose and mouth while a bedside machine pumps air through the mask, encouraging a person's airways to stay open so they can breathe normally.

Chattanooga sleep specialist Dr. Anuj Chandra said that while CPAPs are life-changing for those who can use them, only about 30-40% of people with sleep apnea are able to adjust to the machines. Untreated sleep apnea can lead to a host of serious health issues, including stroke, cognitive decline, heart attacks, heart failure, irregular heart rhythm, high blood pressure, Type 2 diabetes and sudden cardiac death.

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While there are a handful of other alternatives for treating sleep apnea, Chandra said none of them are great, which is why several years ago he began offering his patients who fail CPAP a newer medical device called Inspire.

The device is surgically implanted, similar to a pacemaker, and works by gently stimulating the muscles in the airway to keep it open. People get to go home the same day as the outpatient surgery and typically have little to no pain, Chandra said.

After the device is implanted, patients wait a month to heal before going back to the doctor to tune it. Patients activate the device themselves before bed via remote control.

Until recently, Chandra had to send Inspire patients to Nashville to have the surgery because no local hospitals offered it. But CHI Memorial in Chattanooga was recently approved to perform the surgery, meaning local patients who want the device no longer need to travel long distances to get it.

Head and neck surgeon Dr. Alexander Sokohl said in a phone interview that he's excited to finally be able to offer the implantation in Chattanooga.

"Every single day in my clinic, I have at least one if not two people searching to become an Inspire candidate. There's a lot of interest and a lot of candidates," Sokohl said.

To qualify for Inspire, patients must have genuinely tried and failed using CPAP for at least six months, Chandra said.

"You don't want to do surgery unless we absolutely have to," he said.

When he first started using his CPAP machine, Southwick's fatigue and blood pressure improved. He successfully used it for years before he started to notice its effects wearing off.

He also missed going camping and on days-long hikes, because with CPAP you have to consider a power source, where to get distilled water and how to lug his machine around.

After a while, the CPAP therapy became less effective. He started feeling more tired during the day and decided to explore other options.

Recently, Southwick became a candidate for Inspire. He's the second Chattanooga patient to get the surgery locally and went back for his first tune up in March.

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"(CPAP) really curbs what you can do and where you can go," he said. "Now, I'm looking forward to easier travel."

He's in the general tuning phase now — his doctors want to see him have less than 20 episodes, or instances when he stops breathing while sleeping, in an hour. Eventually, a fine tune should try to get it lower than five, which Southwick said will be a "game-changer."

Southwick hasn't noticed a big difference yet, but he's still in the early stages.

"I would definitely recommend for anyone who has sleep apnea to, at very least, get on a CPAP," he said. "It's better than nothing, but I think that not being attached to a tube and being able to go camping or enjoy activities like that — you can't really do that with a CPAP."

Nobody wants to be tethered to CPAP, Southwick said.

"I have friends, for example, that refuse to use their CPAP, and apparently, that could shave decades off your life depending on how bad your apnea is," he said.

Janet Spangler, another Chattanoogan who uses the Inspire device, said she was never able to successfully use CPAP because she would rip her mask off in her sleep every night.

"Nothing worked," Spangler said, adding that she just gave up until a friend of hers died from complications due to sleep apnea. "That kind of scared me."

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She started scouring the internet in search of other options and also found Inspire. The surgery was easy and painless, she said.

Now Spangler has used the device for a year and said she can't imagine life without it.

"I wish more people knew about it," she said. "If somebody has sleep apnea and they don't have the information or don't know about it, they're missing out on so much life."

Contact Elizabeth Fite at or 423-757-6673.