Thinking of Inspire Surgery for Sleep Apnea?

By Jordan Stern, MD

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About the author: Jordan Stern, MD, Founder and CEO of BlueSleep, is a Head and Neck surgeon, a subspecialty of Ear, Nose and Throat (ENT or Otolaryngology), who has treated over 10,000 sleep apnea patients and published multiple studies on the diagnosis and treatment of Sleep Apnea. He is also the author of The New York Times bestselling book, Dropping Acid, about reducing acid reflux through a better diet.

Inspire is a Pacemaker for Your Tongue

Inspire Medical Technologies has garnered lots of attention as the only FDA-approved obstructive sleep apnea (OSA) treatment that works inside your body, sort of like a pacemaker for your tongue, instead of your heart. The medical term is hypoglossal nerve stimulation (HGNS).

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The company’s catchy tagline line, “No mask. No hose. Just sleep.” appeals to those who mainly fear or fail CPAP, the predominant treatment method for sleep apnea. Yet, the downside is that patients require out-patient surgery to implant the device; a 30-day recovery period for activation; and a titration period. Plus, insurers usually won’t cover the hefty price tag until a non-invasive treatment like CPAP or an oral appliance have been tried first.

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The company’s website suggests Inspire is a plug & play solution, but the device requires a surgical procedure, and several titrations, up to 10 settings of electrical current, to get the device working properly. The tongue, like any muscle, needs to work up to greater strengths, so you have to start with low electrical impulses to move the tongue forward; keep an open airway; and gain a snore-free night.

Inspire Pros

• No CPAP required
• Patient satisfaction is high
• DOT-approved

Inspire Cons

• Requires surgery to chest and neck; light scarring
• Patients must usually first try a non-invasive treatment like CPAP or an oral appliance before insurance pays.
• Some patients complain of tongue abrasion, mouth dryness, and discomfort stemming from the nerve stimulator.

Clinically Proven and High Patient Satisfaction

Inspire Therapy is a proven sleep apnea solution and has the medical research to support its safety and efficacy. And, patients really like it. Studies have shown that Inspire has high patient satisfaction (over 90%) and low adverse events, especially for those who don’t have a very high body mass index (BMI). The company reports that 94% of former CPAP users say Inspire is better and would recommend it to others. Being “better” than CPAP is not a high bar, since roughly 50% of CPAP patients are non compliant, meaning they don’t use their CPAP more than four hours a night for 30 consecutive days within the first three months. And, on the bright side, patients love not having to lug around a CPAP machine when traveling. 

Surgery and Recovery

Any surgery that requires general anesthesia is considered major surgery, especially one that may last for several hours. Ear, Nose, and Throat (ENT) surgeons with special training to perform Inspire surgery are well-qualified to handle this delicate procedure. The doctor makes a two-inch incision at the top of the right pectoral muscle (the chest muscle), two inches below the clavicle (the collar bone). A wire runs between the fatty tissue and the muscle. The other incision, roughly an inch, is under the chin below the tongue. The doctor performs delicate surgery on the nerve of the tongue, the same nerve that allows you to stick out your tongue. The entire device basically controls the movement of your tongue to prevent it from blocking your airway and causing Sleep Apnea. Patients should expect about 2.5 weeks of swelling, redness, and very light scarring. After 30 days of rest and relaxation, patients begin the titration process.

Calibrating the Device

Once you’re all healed, your doctor can begin calibrating the device, starting at a low setting and building up a tolerance to avoid pain and discomfort. Patients can self-adjust the device every 3-5 nights until reaching level 10, the highest setting, if necessary. Before going to sleep, you simply use a hand-held remote to activate the device which is pre-programmed to start working after you fall asleep, based on your personal sleep pattern. After three months, your doctor will recommend a sleep test to evaluate the effectiveness of the device. A check-up is recommended 1-2 times a year. The battery life of the implanted device is roughly 11 years, and requires another out-patient surgery to replace the battery.

Are you a Candidate for Inspire?

To qualify for Inspire Therapy, you should try non-invasive therapies first. Why? Inspire treatment is expensive and requires invasive surgery. Health insurance companies foot the bill, so they make you try less-expensive methods first. To start treatment, you need to schedule a medical appointment with a company like BlueSleep to evaluate your current sleep problem and order a Home Sleep Test (HST). This simple test is required for insurance to pay for a CPAP or an oral appliance, so step one is to get tested for sleep apnea. If you have moderate to severe Sleep Apnea (AHI 15-65), you may be a good candidate for Inspire. Skip the in-clinic lab test unless you have a really serious sleep condition. The home sleep tests are effective, super convenient, and affordable.

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If the HST results show that you have mild or moderate OSA then an oral appliance may be the best option for you. Custom-made oral appliances are covered in-network at BlueSleep (for most payers and plans); are non-invasive and effective. They move your jaw forward, thereby moving your tongue forward to keep your airway open while asleep. Patients who get oral appliances find them easy to use and much less invasive than CPAP. Higher compliance equals better clinical results. The oral appliance is the non-invasive version of Inspire, so patients who respond well to oral appliance therapy are often excellent candidates for Inspire - in case they can no longer use the oral appliance.

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If you have very severe sleep apnea and a high BMI, you should consider trying a CPAP first. CPAP is also clinically effective, but 50% of patients are non-compliant due to various reasons: tubes; sound of the machine; problems with forced air pressure settings; claustrophobia; etc. Essentially, if you want Inspire, you should try a non-invasive treatment first.

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Inspire publishes all its contraindications for Inspire Therapy, such as patients who are pregnant or have Central + mixed apneas >25% of the total apnea-hypopnea index (AHI).

The Road to Inspire

• Make an appointment with a Sleep Specialist.
• Take a Home Sleep Test to measure Sleep Apnea.
• Get an oral appliance or CPAP to reduce snoring and prevent Sleep Apnea.
• Take another Home Sleep Test three months after treatment.
• If you fail the non-invasive treatment, you may be a candidate for Inspire.
• Get a referral to an ENT surgeon with special training for Inspire.
• Call your insurance company for pre-approval for Inspire Therapy.

Inspire at a Glance

Inspire is an excellent clinical solution for treating moderate and severe sleep apnea, especially for patients with a low BMI. Patients may want to try a custom-made oral appliance prior to Inspire since oral appliances are a non-invasive version of Inspire, both working to advance the tongue. Many health plans require first trying a non-invasive treatment like CPAP or an oral appliance before paying for Inspire treatment. Check with your insurance company to see if you’re covered. Medicare currently covers Inspire surgery, and Inspire Therapy is on the Federal Supply Schedule, making it available for veterans at select VA and military hospitals across The United States.