Inspire for sleep apnea: a careful decision, then a clear plan.

What the implant does

Obstructive sleep apnea occurs when the upper airway repeatedly narrows or closes during sleep. Inspire uses hypoglossal nerve stimulation: gentle electrical signals to the nerve controlling tongue movement, helping keep the airway open as you breathe. A small implanted system is operated with a handheld remote at bedtime.

CPAP uses air pressure through a mask. Inspire works inside the body, so there is no mask or hose during sleep. That convenience comes with a surgical implant and follow-up responsibilities; it is not a substitute for getting the diagnosis and treatment choice right.

Who may be a candidate?

We look for obstructive sleep apnea that remains inadequately treated because positive airway pressure has not been effective or cannot be tolerated. A sleep study, treatment history and airway assessment must support the decision.

• Sleep-study findings: the FDA adult indication includes ages 22 and older with an apnea-hypopnea index (AHI) of 15–100. AHI counts breathing interruptions per hour. Separate criteria apply to younger patients.
• The type of apnea: Inspire treats obstruction. Central and mixed events must not account for more than 25% of the total AHI.
• Airway pattern: complete concentric collapse at the soft palate—a circular closing pattern—rules out this treatment.
• Overall fit: weight, other health conditions, prior treatment and the ability to operate the remote all matter.

FDA labeling and insurance coverage are different tests. Medicare policies commonly require age 22 or older, BMI below 35, an AHI of 15–65, and a qualifying sleep study within 24 months. We check the policy that actually applies to you before planning surgery.

Start with the workup you already have.

Bring your recent baseline sleep study and be ready to describe your experience with CPAP: what you tried, what helped, and what made it difficult to continue. Your sleep team or insurer may also need supporting treatment records.

If your evaluation is already complete, Dr. Fewins can focus on the surgical discussion. If important pieces are missing, he helps you return to pulmonary or the sleep lab to complete them. It is better to settle those questions before an operation than discover afterward that a different approach was needed.

What is DISE?

Drug-induced sleep endoscopy is an airway examination during medication-induced sleep. A small camera lets the physician see where—and in what pattern—the airway closes. That information helps determine whether stimulation is likely to address the obstruction.

In our usual referral pathway, the pulmonologist has already arranged or completed DISE. Dr. Fewins reviews the findings and can perform the examination when needed; repeating an adequate study is not automatically part of the visit.

What happens during surgery?

Dr. Fewins places the Inspire system through two incisions, in the upper neck and chest. The operation uses general anesthesia with a breathing tube. His surgical portion usually takes about an hour; time in the operating room is typically around an hour and a half, with preparation and recovery adding to the overall visit.

The device sits beneath the skin, with stimulation delivered to the hypoglossal nerve. Most patients go home the same day after the recovery team confirms that they are ready. Arrange a ride home and follow the anesthesia team’s instructions.

Healing first. Activation next.

Expect some soreness around the incisions. In Dr. Fewins’s experience, discomfort is usually mild, but give yourself a few easy days rather than trying to push through a full schedule immediately. Light, nonexertional activity is generally possible after discharge. Many patients can return to work in about a week, depending on the job and how healing progresses.

Your discharge instructions explain incision care, pain control and restrictions on lifting, strenuous exercise and driving. Contact the surgical team for increasing pain, redness, drainage or other concerns; difficulty breathing needs immediate medical attention.

The implant is not turned on immediately. Once healing is satisfactory, your pulmonary or sleep team usually activates it at about one month. They teach you to use the remote, adjust therapy settings and arrange testing to assess treatment. That follow-through is essential to getting a useful result.

What can you reasonably expect?

Dr. Fewins finds Inspire highly effective in well-selected patients. Treatment can reduce obstructive breathing events, and patients may notice better sleep, less daytime sleepiness or less snoring. No operation cures every case of sleep apnea, and feeling better does not replace follow-up testing.

The tradeoffs include surgery, a permanent implanted system and the possibility of discomfort from stimulation. Risks include bleeding, infection, tongue soreness or weakness, and a need to adjust or revise treatment. Your surgical discussion covers the risks relevant to your health and the proposed device.

CPAP remains an effective nonsurgical option for many people. Oral appliances, positional therapy and weight management may also have a role. Your pulmonary or sleep-medicine team guides those options; Dr. Fewins concentrates on the surgical pathway when that is the appropriate next step.

Insurance approval and your cost

We aim to recommend implantation for patients who meet both the clinical criteria and their insurer’s requirements. Approval commonly depends on documentation of the sleep study, unsuccessful or intolerable CPAP treatment and an acceptable airway evaluation. Prior authorization may be required.

Coverage is not a promise of zero out-of-pocket cost. Ask for an estimate that includes surgeon, anesthesia and facility charges, and check your deductible and network benefits. Our team can help identify what is needed before scheduling. More about insurance and payment options.