What happens when surgical innovation meets sleepless nights? In this episode of Sleep Is My Waking Passion, Dr. Alison Kole sits down with Dr. Ruchir Patel, one of the nation’s most experienced sleep physicians specializing in hypoglossal nerve stimulation, to unpack the fascinating evolution of sleep apnea treatment. If you’ve ever wondered what those Inspire commercials are really about—or what’s next on the horizon with Genio—this is the conversation you can’t sleep on.

From tongue “pacemakers” to device wars and the ethics of "the perfect patient," Alison and Ruchir go deep into how these technologies are reshaping sleep medicine. They debate payer-driven policies, the art of clinical fine-tuning, and why the future of sleep may look more like cardiology—with combination therapy and precision care.

Key teaching takeaways include:

• The evolution of hypoglossal nerve stimulation and what makes Inspire 5 game-changing
• Genio’s bilateral approach vs. Inspire’s unilateral stimulation—and why that matters
• Updated AHI and BMI inclusion criteria and what they mean for real-world patients
• Why adherence and programming skill determine success more than the device itself
• The role of drug-induced sleep endoscopy (DICE) and the coming paradigm shift in patient selection
• How weight loss drugs like GLP-1s (and even potential oral muscle-tone pills) could merge with device therapy
• Why “perfection” in patient candidacy may actually slow progress—and how sleep physicians can meet patients where they are

This episode challenges assumptions, sparks debate, and redefines what success looks like in treating sleep apnea.

Good Clip Moments:

1. “It’s exciting for what I call the neglected patients—the ones who gave up on CPAP because they thought there were no other options.”
2. “Can a therapy really be the gold standard if half the patients stop using it?”
3. “Managing Inspire isn’t just science—it’s an art.”
4. “Do we always have to have the perfect patient? Who is the perfect patient?”
5. “If we can improve by 50%, that’s better than doing nothing at all.”
6. Alison’s reflection: “Perfection needs to be thrown out the window—in our personal lives too.”
7. “We’re entering a cardiology-like era for sleep—combination therapies, individualized care, and maybe even an oral pill to tone your airway.”

This is not just a conversation about devices—it’s a glimpse into the next frontier of sleep medicine.