Inspire for Sleep Apnea: How Does It Work?

Most people who are diagnosed with obstructive sleep apnea are prescribed CPAP therapy. CPAP uses a mask and a machine that keeps airway pressure steady during sleep, preventing the airway from collapsing. For many people, it works well. But a significant number of patients cannot tolerate the mask, the noise, or the sensation of pressurized air. For those patients, an implanted device called Inspire may be an option.

Inspire works through a technology called hypoglossal nerve stimulation. The word hypoglossal means under the tongue. The hypoglossal nerve controls the muscles that move the tongue. In obstructive sleep apnea, these muscles relax during sleep and allow the tongue to fall backward, blocking the airway. Inspire stimulates this nerve with gentle electrical pulses that keep the tongue and surrounding muscles engaged, clearing the airway with each breath.

The device has three main parts, all implanted under the skin during a single outpatient surgery that takes about two to three hours under general anesthesia. A small breathing sensor is placed between the ribs to detect when you inhale. A pulse generator, roughly the size of a large coin, is implanted below the collarbone. A cuff electrode is placed around a branch of the hypoglossal nerve beneath the jaw. These components connect through thin wires under the skin.

When you go to sleep, you turn the device on using a small handheld remote. The pulses begin automatically after a delay of about twenty minutes, giving you time to fall asleep. As you breathe, the sensor picks up each breath and triggers a synchronized pulse. The pulse causes the tongue to move slightly forward, opening the airway just enough to allow normal breathing without waking you up.

The surgery requires small incisions under the chin and below the collarbone. Both heal to scars of about one to two inches. After surgery, you will rest for a few days at home. Most patients can return to light activity within a week and resume normal exercise after about two weeks. The device is not activated at the time of surgery. You return to the clinic about a month later to have it turned on and adjusted by your doctor.

Not everyone with sleep apnea is a candidate for Inspire. To qualify, you must have moderate to severe obstructive sleep apnea, with an apnea-hypopnea index score between 15 and 65. You must have already tried CPAP and found it unhelpful or intolerable. You must have a body mass index of 35 or less. You must be healthy enough to undergo a two-hour surgery. You also need a drug-induced sleep endoscopy before proceeding. This is a short test performed under light sedation to examine how your airway collapses during sleep and confirm that the device would be effective for your anatomy.

Once activated, most patients experience a meaningful reduction in sleep apnea episodes. Follow-up sleep studies are done to assess how well the device is working. Your doctor may adjust the settings once or twice a year to maintain results.

The device battery is designed to last approximately eleven years. When it runs out, a simple outpatient procedure replaces it. Most people do not feel the pulses during sleep, though some report mild awareness of the stimulation when they first start using it. Temporary side effects can include a sore tongue, dry mouth, or minor difficulty swallowing. These usually resolve with device adjustments.

If you ever need an MRI, consult your implanting doctor first. Newer models of the device have MRI-compatible options under specific conditions.

Inspire is FDA-approved and covered by Medicare and most commercial insurance plans for patients who meet the clinical criteria. The procedure must be performed by a board-certified head and neck surgeon with specific training in the device.