How Does Inspire Treat Sleep Apnea?

Inspire is a sleep apnea treatment. The device sends a signal to the nerve that controls your tongue and upper airway to tighten them while you sleep. Inspire improves airflow and reduces obstructive sleep apnea.

The Inspire device is placed during a minor surgical procedure, but you can usually go home the same day. Once it's in place, all you have to do is click the Inspire remote to turn on the device when you're ready for bed.

This article will go over how Inspire treats sleep apnea. You will learn how to find out if Inspire could be a treatment option for you and what to expect if you have the device placed.

How Well Does Inspire Work?

Inspire is an effective treatment for moderate-to-severe obstructive sleep apnea. Researchers have looked at a measure called the apnea-hypopnea index (AHI) to see how well Inspire works.

For example, one study looked at 31 people using Inspire. After 12 months, the average reduction in AHI for the patients was 29.3 to 9.0 events per hour. The leftover AHI still means a person has mild sleep apnea, but that number may improve as the therapy continues.

Some of the symptoms of sleep apnea, like excessive daytime sleepiness, also tend to get better when people get the Inspire device. One study showed that patient scores on the Epworth sleepiness scale got better with treatment (on average, they went up to 11 from 6).

Inspire might be helpful while you're using it, but sleep apnea usually returns once the device is turned off.

Who Can Get Inspire for Sleep Apnea?

Inspire is approved for use by people:

• With moderate to severe obstructive sleep apnea and an apnea-hypopnea index (AHI) of greater than 15
• Who have tried continuous positive air pressure (CPAP) therapy but it did not help or they did not want to continue using it
• With a body mass index (BMI) of less than 32 (except for people with morbid obesity)

Who Cannot Get Inspire?

Some people cannot use Inspire therapy for sleep apnea due to contraindications, which are medical conditions or circumstances that would make the device unsafe or unhelpful.

The contraindications for Inspire include:

• The obstruction contributing to sleep apnea is inside the nose (e.g., from allergies or a deviated nasal septum)
• Certain skeletal anatomy (e.g., small or recessed lower jaw)
• Enlarged tonsils (e.g., having tonsil surgery might be a more effective option)
• Certain neuromuscular conditions that affect the ability to swallow or that cause slurred speech
• Frequent need to have magnetic resonance imaging (MRI) for other medical conditions
• Under age 18

Questions to Ask Your Surgeon About Inspire

Inspire probably will not be the first sleep apnea treatment that your provider suggests. The first choice treatment for obstructive sleep apnea is usually CPAP. As long as your CPAP mask fits and the device settings are correct, you may find that this treatment is enough to control your sleep apnea.

Weight loss, bilevel therapy, an oral appliance, or positional therapy are other sleep apnea treatments that you might try before Inspire.

If you've tried a lot of treatments for sleep apnea and none have worked, here are some questions you should ask your sleep specialist about Inspire:

• Am I a good candidate for this surgery?
• If you couldn't do this surgery, what would you recommend as a treatment for me?
• How often have you done this procedure?
• What is your success rate in resolving sleep apnea (AHI greater than 5)?
• How many of your patients have complications from this procedure?
• How will I know if the therapy works well for me?
• Will I have testing after the device is placed to determine the settings and my response to therapy?
• Who will I follow up with once the surgery is complete?

You may have other questions about Inspire for sleep apnea treatment that are specific to your life and needs. Make sure that you bring them up to your provider and that they address your concerns.

Pre-Placement Tests for Inspire

After you talk to a surgeon about Inspire, they will want you to have a procedure called a drug-induced sleep endoscopy to get a better look inside your throat.

During the procedure, you will be given medications to make you unconscious and relax your muscles.

In a very safe and controlled setting, your provider will check to see if your airway collapses from all sides. If it does, surgery for Inspire might not work. If you "pass" the test, your surgeon might decide to go ahead with getting Inspire put in for you.

Placement Surgery for Inspire

Inspire is put in during a same-day, outpatient procedure. That means you don't have to be admitted to the hospital and can go home when the surgery is done as long as there are no problems.

Here's what happens during the surgery to place Inspire:

• First, the stimulation wire is put in leading to the hypoglossal nerve and wrapped around one of its branches.
• Next, a second sensing wire is put along the rib cage to detect breathing. This makes sure that the tongue muscle and airway can be stimulated as breaths are drawn in.
• Then, the stimulator itself is placed within the right upper chest wall and connected to the sensors.

From start to finish, the Inspire placement procedure takes about two hours. When it's over, you can go home.

You probably won't need any pain medication after the Inspire placement. You will be able to eat your normal diet and do most of your regular activities.

However, your surgeon will probably tell you to take it easy for a couple of weeks and not do any strenuous activity for at least two or three weeks after you get the Inspire device put in.

Possible Complications of Inspire

There are few potential complications of having Inspire placed. For example, about 25% of patients felt modest pain and about one-third felt tongue discomfort or abrasion. However, both of these side effects did not last long and got better without any more problems.

About 1% of patients got skin irritation or cellulitis (a skin infection) from the Inspire placement surgery, and another 1% had to have another surgery to correct the placement of the device.

Side Effects and Risks

Most people don't have any side effects or long-term problems from the Inspire device. One of the more common experiences that patients report is the uncomfortable feeling on their tongue when the device turns on during sleep, but they usually do not need to make any changes to address it.

There have been other side effects and risks reported with the Inspire device.

If you've gone through your surgery recovery and still have these symptoms, tell your surgeon:

• Allergic reaction or rejection of the device's materials
• Bleeding
• Coughing
• Damage to the nerve
• Difficulty swallowing or talking
• Dry mouth
• Headaches
• Infection
• Insomnia
• Pain at implant site that does not get better
• Scarring or fibrosis around the implant
• Trouble moving the tongue
• Tongue soreness or weakness

Inspire Surgery Follow-Up

After the Inspire surgery, you will go back to see your surgeon for a check-up in about seven to 10 days. Keeping this appointment is important because the device does not officially get turned on until about a month after it's placed.

You will also need to schedule an in-center sleep study after two months to see how the device is working and whether any adjustments are needed.

How to Use Inspire at Home

Once placed and turned on, Inspire can be activated before you go to sleep, but there is usually a delay of 30 minutes before the stimulation begins.

If you wake up at night, the device can be paused. It can also be set to turn off after eight hours.

How Much Does Inspire Cost?

The company that makes Inspire states that the treatment is covered by "most major insurance providers." Your out-of-pocket costs for the device will depend on your insurance plan.

Can Inspire Be Removed?

Even though most people who get Inspire don't have problems and find it helps their symptoms, you might need or want to have it removed. You will need to tell your surgeon that you want to have it taken out, as it requires another surgery.

Summary

Inspire is a sleep apnea treatment option for some people who have not had luck with more common treatments like CPAP. However, some people can't get Inspire—for example, it's not approved for people under the age of 18. There are also some situations where the device probably won't help with symptoms.

If your provider thinks you might benefit from Inspire, the device can be put in surgically and turned on before you go to sleep. If you have insurance, some of the costs for Inspire might be covered.