What is Inspire for sleep apnea? What to know about the new treatment

Around 22 million Americans have sleep apnea. Traditional continuous positive airway pressure, or CPAP, machines can be loud, uncomfortable, and have a pesky mask and hose attached to the device. For some, sleeping with a CPAP machine is impossible. Despite seeming like a minor annoyance that might keep your partner up at night, there are several serious side effects of sleep apnea if left untreated, including high blood pressure, strokes and heart issues. 

Now there’s a new alternative to CPAP machines. The Inspire system is the latest in obstructive sleep apnea treatment. By stimulating the tongue and airway muscles, Inspire aims to treat the underlying cause of sleep apnea, not just the symptoms. 

What is Inspire for sleep apnea?

To start, let’s talk about what sleep apnea is. It’s a sleep disorder marked by frequent breathing interruptions that can last between 10 to 30 seconds. It’s also often accompanied by loud snoring. 

There are three main types of sleep apnea:

• Obstructive sleep apnea occurs because the tongue and airway muscles relax and block your airway. 
• Central sleep apnea is a brain-to-muscle signaling issue.
• Complex sleep apnea syndrome is the least common type. You can think of it as a mix of obstructive and central sleep apnea. 

Inspire is only for treating obstructive sleep apnea; it will not treat central sleep apnea. It is approved to treat mixed sleep apnea, as long as central sleep apnea does not account for more than 25% of events. 

The Inspire sleep apnea device is a Food and Drug Administration-approved surgical implant that’s placed under the skin on your chest. Even though that might sound intimidating, it’s an outpatient procedure. Numerous clinical trials have found Inspire to be safe and effective at treating OSA. A recent study found that Inspire resulted in a 79% decrease in sleep apnea events.

How does Inspire work?

The Inspire device delivers what’s called “hypoglossal nerve stimulation therapy” while you sleep. Previously it was connected to two places in your body — the hypoglossal nerve and your ribs. As of March 2021, the need for the second lead to the ribs is no longer necessary. That eliminates an incision and, according to Inspire, reduces the procedure time by 20%. Now it’s connected only to your hypoglossal nerve, which stimulates the tongue and airway muscles that open your airway. The battery of Inspire is placed beneath your collar bone.

Each time you breathe, the Inspire device sends an impulse to the hypoglossal nerve. This combats sleep apnea by keeping your airways open. According to Inspire, the stimulation is subtle and is designed to not wake you up, meaning it shouldn’t be painful or uncomfortable. 

The Inspire isn’t constantly sending impulses to your nerves. Instead, you can remote control it. It’s recommended that you turn it on at night and turn it off when you wake up for your day. 

Benefits of the Inspire device

• The impulses sent to the hypoglossal nerve keep your muscles and tongue from collapsing into the airway, which dramatically reduces breathing interruptions. 
• It can reduce snoring and daytime sleepiness.
• It reduces the chance of developing long-term complications associated with sleep apnea — stroke, liver problems, heart attacks and Type 2 diabetes.
• The battery lasts about 11 years. 

Things to consider

• It’s only approved for people who are 18 years or older. 
• To get the implant, you must have moderate to severe OSA and not benefit from a CPAP machine. 
• It’s not recommended for those who are pregnant or intend to become pregnant. 
• It’s also not recommended for anyone with “compromised neurological control” of the upper airway, according to the FDA.
• There are risks associated with the surgery and the device itself, including tongue abrasion and discomfort (more on that below).

How much does the Inspire implant cost?

“A patient’s financial responsibility varies based on the specifics of their individual insurance plan,” Inspire told CNET. “In general, most patients will only be required to pay the applicable deductibles and copayments that exist for their insurance plan.”

According to Inspire’s website, it’s covered by most insurance providers. The exact out-of-pocket cost will depend on your insurance plan. Remember, it’s an outpatient procedure, so there are some medical bills that will have to be taken into account. 

However, as an example, the pricing page states that a person with traditional Medicare should expect to pay a maximum of $1,400 out of pocket if the procedure is done in hospital. 

You can expect to see a total bill of around $30,000 to $40,000 for both the surgery and device cost, but that’s before your insurance kicks in. I can’t say exactly how much you’ll end up paying — it depends heavily on your insurance plan and deductible. If you’re interested in Inspire, it’s best to speak to your provider to discuss your options.

Should you get the Inspire implant?

For some people, Inspire may be the only real option for relief from OSA. Because of the need for surgery to place the Inspire implant, it likely isn’t most people’s first choice. Not to mention that battery replacements are needed every 11 years. 

Inspire is significantly more expensive than traditional CPAP machines, which usually retail between $250 and $1,000 — some go into the multiple thousands. However, if you’re living with sleep apnea and finding no relief with the usual treatments, the Inspire implant may be right for you. 

What are the risks of Inspire?

According to the FDA’s summary of clinical studies on Inspire, the most common adverse events include:

• Tongue soreness, abrasion or weakness
• Dry mouth
• Stimulation discomfort
• Mechanical pain
• Headache
• Mild infection

Inspire says that most of these adverse events resolve themselves over time, with the use of medication or by adjusting the settings on your Inspire, which the FDA’s report also confirms. As with any surgery, there’s also the risk of pain, swelling or infection after the device is initially implanted. 

More serious risks associated with Inspire, which are also much more rare, include allergic reaction, nerve trauma or damage, or damage to blood vessels around the site of the implant.

The benefits of the Inspire implant are significant — better sleep quality, no more daytime fatigue and a lowered risk for a stroke or heart attack. Per the FDA, the “probable benefits outweigh the probable risks” for approved obstructive sleep apnea patients who aren’t benefitting from traditional CPAP therapy.

If you’re interested in Inspire for treating your obstructive sleep apnea, I recommend that you speak to your doctor to assess your needs and if it’s a good fit for you. 

Correction, Jan. 27: A previous version of this story contained outdated information about the battery life of Inspire, the types of sleep apnea for which it’s approved, and the placement of the system in the body.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.