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Postoperative Instructions for Inspire Hypoglossal Nerve Stimulator

Implantation Procedure:

• The procedure to implant Inspire is typically an outpatient procedure lasting about 3 hours. For some special circumstances, your physician may recommend a single night stay in the hospital.
• Pain after the procedure varies but for most patients is not severe. Pain will usually resolve within 7-14 days after the procedure and pain medication will be provided.
• Three incisions will be made: one at the upper neck, one just below the collar bone and a third lower down on the chest under the armpit. All wounds will have Steri strips® placed over them which can be left in place until you are seen for your first postoperative appointment. Additionally, pressure dressings will be placed on the 2 chest incisions and should be left place for 48 hours after the procedure after which they may be removed (leaving the Steri strips® in place). You may shower after the pressure dressings are removed.
• An arm sling will be placed at the time of surgery. This is to provide comfort and limit arm movement. You may remove the sling 24 hours after surgery but may continue to use it if it is more comfortable to do so.
• Swelling at incision sites is expected and will typically improve over the first 2 weeks. Most patients can expect some swelling under the jaw that will give the appearance of a “double chin.” This will improve over 2-4 weeks.
• For the first week after surgery please do not perform any strenuous activity or heavy lifting.
• Your physician also asks that you do not lift the right arm above your shoulder for 1 month after surgery.
• You may resume a normal diet after surgery.
• Please call the office if you have any of the following symptoms: Fever higher than 100.5, excessive swelling at any of the incision sites, bleeding from incisions, slurred speech, difficulty swallowing, or shortness of breath.
• A postoperative appointment should be made for 1 week following the procedure. If one has not been previously scheduled, please call the office to arrange.
• It is important to know that the stimulator device will NOT be active in the immediate postoperative period. Therefore, no sensations of stimulation should be expected.

What to Expect After the Procedure

Week 1:

• At the first postoperative visit, your wound will be evaluated and any remaining sutures removed.
  Please note that the device will still remain inactive.

Week 4:

• At the 1-month visit post-surgery, you will come to the office for activation of the device. You will need no special preparation but please wear a shirt/blouse that can be unbuttoned so that the physician can check all incisions and access the implant.
• Your physician will use a programmer to check the device for proper function and turn it on for you to begin using it. The process of activation is not painful and typically takes less than ½ hour.
• At this visit you will be given a remote control and given instructions on how to use it. A range of therapy will be programmed for you to start at a low level of stimulation and gradually increase it over the next several weeks. Usually, it is advisable to increase the stimulation every 3 days. If you find that the stimulation level is too high, you may decrease the setting to one that is more comfortable and then try to increase again after several days. A manual for details about the remote will be provided.
• Once activated, you should begin using the device every time you go to sleep (including naps).  When you turn the device on, you should expect an initial pulse of tongue motion to let you know that the device is working. The device will then delay any further stimulation for ½ hour; allowing you to fall asleep without feeling any sensations. Your physician can modify this delay period at any time if you require more or less time to fall asleep. There is also a pause feature that allows the device to be temporarily shut off for 15 minutes. This can be used if you need to get up in the middle of the night.

Week 8:

• At roughly 2 months, you will return to the sleep center for a sleep study and additional programming of the device. This will consist of a routine sleep study (without a CPAP mask) where the device will be set to a level to optimize control of your sleep apnea. A limited range of stimulation will be programmed to allow you to adjust your device to your comfort. You should continue to use the device every time you sleep.
• A visit will be set up with your physician shortly after this study to go over the results, to follow up on how you are doing, and make any necessary adjustments.
• Please note that at any time, your physician can reprogram the device for your comfort.

Subsequent visits:

• Your physician will want to see you periodically. In the first year, there will be several visits scheduled to check in on how you are doing with your Inspire treatment. At each visit, the device will be checked to see how often you are using your device and to trouble shoot any problems.
• If you have any technical problems, you may also call Inspire at any time 1-844-OSA-HELP.
• The battery life on the Inspire device is roughly 10 years. When the battery is low, there will be indicators on your remote to let you know to come in to see your physician. The battery change will require a minor procedure, which can be performed under local anesthesia (or sedation). The battery on the remote control is a 9-volt standard battery. Please make sure to use a high quality non-rechargeable battery.
• Because of changes in sleep and changes in weight that may occur over time, adjustments may need to be made periodically. If you experience changes in how the device seems to be functioning for you should call your physician and potentially arrange a follow up appointment.

Timeline Overview:

• Initial evaluation: Office assessment of sleep apnea.
• Drug induced sleep endoscopy: Diagnostic procedure to identify the mechanism and sites of airway collapse. This is a critical component to the evaluation, to determine candidacy for Inspire.
• Implantation: Surgical procedure to place the implant.
• First postop visit (1 week post implantation): First visit in the office after implantation to check incisions and recovery.
• Activation (1 month post implantation): Office visit to turn device on and assess for proper function.
• Sleep study with device adjustment (2 months post implantation): Routine sleep study at which time the device will be adjusted to identify the best settings to control the sleep apnea.
• Routine follow up visits: Visits to monitor status of sleep apnea, sleep quality and assess for device function and use.

For Questions or Emergency Care:
Call the office at 601-984-5160. You may need to speak with the doctor on-call.

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