Inspire implant helps sleep apnea patients

First Iowa procedure done in February in Iowa City

A demonstration sample of the Inspire unit, which is surgically implanted into the chest of patients with sleep apnea, c
A demonstration sample of the Inspire unit, which is surgically implanted into the chest of patients with sleep apnea, controls tongue movement and keeps airways open. Photographed at ENT Medical Services in Iowa City on Wednesday, May 4, 2016. (Liz Martin/The Gazette)

IOWA CITY — Larry Mahnke surrendered his driver’s license two years ago after sleep apnea made him so drowsy he couldn’t drive safely.

The 63-year-old Manning man was driving home late one night when he was pulled over by a police officer.

“He said, ‘I got a report that you’ve been driving around town drunk’,” Mahnke recalls. “I don’t even drink.”

Several weeks later, the Iowa Department of Transportation sent him a medical questionnaire that included a section on sleep apnea, a common disorder in which breathing during sleep is interrupted dozens of times an hour, causing poor sleep. Mahnke couldn’t get a doctor to sign off on the section, so he was forced to turn in his license.

Mahnke was waking up more than 30 times an hour — considered a severe disorder. He’d been prescribed a continuous positive airway pressure device, a mask that uses mild air pressure to keep airways open, but he wasn’t using it.

“I cannot keep that mask on at night, no matter what,” Mahnke said.

A camcorder Mahnke set up by the bed showed him taking off the mask to itch his nose, then not putting it back on. Or he’d wake up with the device on his forehead or on the floor — unsure how it got there.

Mahnke’s not alone. A study published in 2015 in Otolaryngology–Head and Neck Surgery showed more than half of 616 Cleveland Clinic patients prescribed CPAP devices weren’t using them.


One evening, Mahnke’s brother-in-law, John Campbell, of Denison, called to say he heard a news report about a new sleep apnea procedure approved by the FDA in April 2014.

A Pacemaker-like device called Inspire is surgically implanted in the chest. One sensor attached near the ribs senses breathing and triggers a pulse in a second sensor, connected to the hypoglossal nerve. That pulse controls tongue movement and keeps airways open so the person can stay asleep.

Mahnke became the first person to have the Inspire surgery in Iowa on Feb. 29. Dr. Dwayne Capper performed the procedure at the Iowa City Ambulatory Surgical Center, so far the only Iowa medical facility to offer the surgery.

Each night, Mahnke uses a remote control to start the device. It has a 20-minute to 30-minute standby mode to allow the patient to fall asleep, explained Kent Lee, therapy development manager for Inspire Medical Systems, of Maple Grove, Minn. Mahnke can adjust the stimulation settings.

“It’s been working pretty darn well,” Mahnke said. “I’m sure not as drowsy as I have been.”

During a sleep test May 4 in Iowa City, Mahnke woke up fewer than 15 times per hour — a 50 percent reduction from before the surgery.

Wellmark Blue Cross and Blue Shield originally wouldn’t cover the Inspire device, which costs between $20,000 and $30,000, Mahnke said. Physicians must document a qualified patient has tried cheaper solutions first. Capper and Lee helped Mahnke seek an independent, external medical review, which came out in favor of coverage, Lee said.

The Iowa City center has eight to 10 other patients awaiting insurance approval to have the surgery, Capper said.


The Inspire devices must be replaced every eight to 10 years, when the battery wears out. Patients come in for checkups every six months to a year, when doctors can measure the device’s battery life and how much the patient is using the device.

So far, Mahnke is getting seven to eight hours of sleep a night with Inspire. He’s also working to lose weight and increase exercise, steps shown to reduce sleep apnea.

“I’m hoping I can be well enough to get my driver’s license back,” Mahnke said. “That is my big goal.”

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