What Inspire is and how it works
Inspire is a small device surgically placed under the skin of your chest and neck that keeps your airway open while you sleep. Instead of using a mask or mouthpiece, Inspire works by sending gentle electrical pulses to the nerve that controls the muscles in your throat. When you turn on the device before bed using a small remote, it stimulates these muscles to stay tense and prevent the airway collapse that causes sleep apnea.
The system has three parts: a small generator implanted under your collarbone, a sensor that detects your breathing, and a stimulation lead that delivers the electrical pulses. The device is about the size of a pacemaker and works only when you are asleep and have turned it on. During the day, it remains inactive.
Inspire is designed for people with obstructive sleep apnea (OSA), the type where your throat muscles relax and block your airway during sleep. It is not used for central sleep apnea, where the brain fails to signal the breathing muscles to work.
Key Takeaways
- Inspire is a surgically implanted device that sends electrical pulses to keep your throat muscles from collapsing during sleep.
- The surgery takes about 30 minutes to an hour and is usually done as an outpatient procedure under general anesthesia.
- You must have moderate to severe obstructive sleep apnea and have tried or not tolerated a CPAP machine to be considered for Inspire.
- Most insurance plans cover Inspire, but you will need prior authorization from your insurance company before surgery.
- After surgery, you return for follow-up visits to have the device turned on and adjusted to work with your breathing patterns.
Who is a candidate for Inspire
Your doctor will consider Inspire if you have moderate to severe obstructive sleep apnea and have either tried CPAP therapy without success or cannot tolerate wearing a mask. CPAP (continuous positive airway pressure) is the most common first-line treatment, so doctors typically recommend it before considering surgery.
You also need to meet certain physical requirements. Your airway must collapse at the soft palate level (the back of the roof of your mouth), not at multiple levels in your throat. Your doctor will use a procedure called drug-induced sleep endoscopy to determine where your airway is collapsing. Additionally, you cannot be severely obese, as this can affect how well the device works. Your doctor will discuss your specific body type and anatomy during your evaluation.
Age matters too. Inspire is approved for people 18 and older, though most candidates are adults. Your doctor will also review your overall health to make sure you are healthy enough for surgery and anesthesia.
The surgical procedure and recovery
The surgery to place Inspire typically takes 30 minutes to one hour and is performed under general anesthesia, meaning you will be asleep during the procedure. Your surgeon makes small incisions under your chin and under your collarbone to place the generator and the stimulation lead. Because the incisions are small and hidden, most people find the scars barely noticeable after healing.
You will usually go home the same day or stay overnight for observation. Most people return to normal activities within one to two weeks, though you should avoid strenuous exercise and heavy lifting for about two weeks. You may feel some soreness or mild discomfort at the incision sites, which is normal and manageable with over-the-counter pain relief.
About two weeks after surgery, you will return to your doctor's office for the device to be turned on for the first time. This is called the activation visit. Your doctor will use a remote control to power on the device and begin testing it while you are awake. You will not feel the stimulation at this point because you are not asleep.
How the device is adjusted after surgery
After activation, you will have several follow-up visits over the first few months. During these visits, your doctor uses the remote to adjust the strength and timing of the electrical pulses. The goal is to find the right settings so the device works effectively with your natural breathing pattern without causing discomfort.
You will also receive a patient remote that you use at home to turn the device on before bed and off when you wake up. Some people need multiple adjustments before finding the right setting. Your doctor may ask you to keep a sleep diary or use a home sleep monitor to track how well the device is working.
Most people notice improvement in their sleep apnea symptoms within the first few weeks, though it can take a few months to reach full benefit. Many report sleeping better, feeling less tired during the day, and experiencing fewer breathing interruptions.
Insurance coverage and cost
Most major insurance plans cover Inspire, including Medicare and Medicaid in many states. However, coverage varies by plan and state. Your doctor's office will typically check your insurance coverage before scheduling surgery and will request prior authorization, which means getting written approval from your insurance company before the procedure.
If you do not have insurance or your plan does not cover Inspire, the out-of-pocket cost varies widely depending on your location and the surgical center. The manufacturer offers financing options for uninsured or underinsured patients, and your doctor's office can provide information about these programs.
You will likely have a copay or coinsurance amount due at the time of surgery, depending on your specific plan. Ask your insurance company and your surgeon's office for a detailed cost estimate before your procedure.
Risks and side effects
Like any surgical procedure, Inspire carries some risks. Infection at the incision sites is possible but uncommon. Temporary soreness, swelling, or bruising at the surgical sites is normal and usually resolves within a few weeks. Some people experience mild discomfort when the device is stimulating, though this typically decreases as they adjust to it.
Rarely, the device may not work as well as expected, or your sleep apnea may not improve significantly. In these cases, your doctor can adjust the settings or, if necessary, remove the device. Device malfunction is uncommon, but like any implanted device, Inspire can occasionally require repair or replacement.
You should avoid MRI scans unless your device is specifically labeled as MRI-safe, as the magnetic field can interfere with the device. Your surgeon will provide you with an identification card listing your device information to carry with you.
Inspire compared to other sleep apnea treatments
CPAP machines remain the most common and first-line treatment for sleep apnea. They are non-invasive, do not require surgery, and work well for many people. However, some people find masks uncomfortable, have trouble sleeping with the noise, or develop skin irritation. For these people, Inspire offers an alternative.
Other options include oral appliances (custom-fitted mouthpieces that move your lower jaw forward), positional therapy devices that keep you from sleeping on your back, and lifestyle changes like weight loss or sleeping position adjustment. Your doctor will discuss which options make sense for your specific situation.
Inspire is more invasive than these alternatives because it requires surgery, but it does not require wearing anything on your face or in your mouth during sleep. For people who have failed CPAP therapy or cannot tolerate it, Inspire can be an effective long-term solution.
Frequently Asked Questions
Can I feel the device working when I am asleep?
Most people do not feel the stimulation once they are asleep, though some report a mild tingling sensation in the throat or tongue. Your doctor can adjust the settings to minimize any sensation. It typically takes a few weeks to adjust to the device.
How long does the battery last?
The battery lasts approximately 7 to 10 years, depending on how often you use the device and the settings your doctor programs. When the battery nears the end of its life, your doctor will schedule a replacement procedure, which is simpler than the original surgery.
Will I need to use Inspire every night?
Yes, for the device to be effective, you should use it every night. Your sleep apnea returns when you do not use the device, so consistent nightly use is important for maintaining the benefits.
Can I travel with Inspire?
Yes, you can travel with Inspire. The device is small and portable. You will carry your patient remote with you. Airport security will not be affected by the device, but inform security personnel if asked about any implanted devices.
What happens if the device stops working?
If you notice the device is not working or your sleep apnea symptoms return, contact your doctor immediately. Your doctor can check the device settings and battery status. If repair or replacement is needed, your surgeon can address this during an office visit or with a minor procedure.