Answers to Your Questions About Inspire Upper Airway Stimulation Therapy

In this guest post, Dr. Eric Kezirian answers your questions about upper airway stimulation therapy with the Inspire device. 

Positive airway pressure therapy (whether CPAP, BPAP, APAP, or another form) is the first-line treatment for obstructive sleep apnea (see the image of an obstructed airway to the right). 

However, some patients cannot tolerate or sleep comfortably while wearing it.  If you are having trouble with positive airway pressure therapy or if it is not helping you, you may want to consider alternative treatment options, including surgery.

Inspire Upper Airway Stimulation is an exciting new treatment that was approved by the United States Food and Drug Administration in 2014 for patients with obstructive sleep apnea who do not tolerate or do not benefit from positive airway pressure therapy.  I was the first surgeon in the Western United States to offer Inspire Upper Airway Stimulation and have many years of experience with this approach to treating sleep apnea. 

The Upper Airway Stimulation system works somewhat like a pacemaker for the tongue.  There is a main unit (called a pulse generator) that sends a signal to the nerve controlling tongue movement (hypoglossal nerve) through a stimulation lead as well as a sensing lead that allows the system to send that signal only when the patient is breathing in and not through the entire night. 

Upper Airway Stimulation is different from other treatments for sleep apnea in many ways, including the fact that it combines surgery and non-surgical treatment.  Here are answers to some of the questions I receive about it.

How do I know if I’m a candidate for this therapy? Can my doctor order it or do I need to see a specialist?

Surgery for sleep apnea is not one-size-fits-all.  Different people have different causes of their sleep apnea, and this is true when it comes to surgery.  Specialists in sleep surgery are familiar with the wide range of procedures that I describe at sleep-doctor.com.  Evaluation techniques like drug-induced sleep endoscopy allow a sleep surgeon to understand what procedures may work best for an individual patient, and drug-induced sleep endoscopy is actually required before receiving Upper Airway Stimulation because it shows whether someone has a good chance to benefit from this therapy. 

Do I have to use CPAP for three months before I’m eligible?

There is no defined period of time for using CPAP before you consider alternative treatments.  Some patients are completely unable to tolerate CPAP in spite of our best efforts, while some patients take some time to become fully comfortable with it.  The key is making the right decision about whether you can or cannot tolerate and sleep comfortably with CPAP, whether it takes 3 days, 3 months, or 3 years.

What is the surgery like? Is it implanted near my heart? Will the device be visible beneath my skin?

All components of the system are placed inside the body during a surgical procedure that typically lasts 2 ½ hours. The surgery is performed under general anesthesia, and patients typically resume a normal diet on the night after surgery. The system is generally placed on the right side, opposite from the heart.  By far the most visible portion of the system is the main unit that is placed on top of the pectoral muscle, the main muscle of the chest.  This is covered by the skin and by the layer of fat that we all have underneath the skin that camouflages the device a little bit.  The result is that there is definitely a bulge that can be seen, but the device is not right underneath the skin, allowing others to see every edge of the device clearly.

How does the system know I’m having sleep apnea? Does it change the signal based on the severity of my sleep apnea?

Somewhat like with CPAP, every patient has a sleep study where we determine the best settings that treat a patient’s sleep apnea.  Then a patient goes home with their remote control to turn the device on at night and then turn it off in the morning, with the ability to change the strength of the stimulation signal they are receiving.  When the system is turned on using the remote control, the system moves the tongue forward on every breath.  The system does not wait until someone is having sleep apnea to send signals, as it wants to prevent them from happening in the first place.  The remote control can be used to adjust the signal before it is turned on, but the system does not adjust the signal itself while someone is sleeping.

Here’s the remote:
Inspire Remote

Here’s the device:  
Inspire Generator

Can the device shock me or misfire? Will I get hurt?

Because the device is placed entirely inside the body, there is no electric shock feeling and no injury from the stimulation.  The system provides gentle electrical stimulation to the nerve that controls tongue movement, moving the tongue forward without waking up a patient.

Is the system secure? Can someone hack the control to turn it on or off?

The system works with radiofrequency communication that requires a controller placed directly over it.  This is similar to many medical devices.  It would be extremely complicated to hack medical devices, and to my knowledge it has never occurred—for this device or other similar devices.

Can I use it while I’m flying on an airplane?

Yes.  You would just want to bring your remote control with you on the airplane.

How long does the device last and do I need to get it replaced? How about the batteries?

The device has a battery, like a pacemaker for the heart.  The battery lasts 8-10 years.  Replacement involves an outpatient procedure to remove and then replace the main unit.

What if I don’t like the device? How do I have it removed?

Removal of the device is possible and has been done.  It does require another surgical procedure.

What are the differences in the types of devices available now?

There is another device in clinical trials that is not yet widely available in the United States.  We do not know how well it works.  It has some different features, including the fact that it delivers constant stimulation through the entire night instead of just when a person is breathing in.

Will my insurance cover this? What should I expect to have to pay? Do you expect changes in coverage in the near future?

Insurance often covers this, but like any new procedure or device, at first there is a process for obtaining insurance coverage.  The key is to have a thorough evaluation to make sure someone is the right kind of patient that would benefit from Upper Airway Stimulation and then to send information for preauthorization to the insurance company.

To learn more about the Inpsire Upper Airway Stimulation device, please visit the website www.inspiresleep.com. You can reach out to Dr. Kezirian directly with any questions at www.sleep-doctor.com.

Dr. Eric Kezirian MD

If you are interested in learning more about sleep studies and CPAP therapy for sleep apnea click here:

Request sleep study

Request CPAP appt.

Other posts you may find interesting:

Comments

  1. Bob Edwards Reply

    Is it possible to disable the initial pulse when the device is first turned on before going to bed? I find it very uncomfortable

    • Jim Thompson Reply

      The remote can be programmed to delay for however many minutes you want before the device activates. Mine is set for 15 minutes by which time I’m asleep.

  2. Eric J Kezirian, MD, MPH Reply

    I do not think it is, but you should definitely check with Inspire Medical Systems or the team that manages your care. It is there to make sure someone knows the device has been turned on, and most people love it.

  3. Joyce Vince Reply

    I dislike the feeling when it is turned on, I was told it is milder than what happens when you are asleep. Unfortunately, I feel the zaps in the middle of the night, I pause the remote, finally turning it off.

    • Donald Fussell Reply

      Mine is doing the same thing. It works but sometimes it works while I’m awake. I get a couple of hours then I turn it off. I guess it’s too strong. I’m on the lowest setting.

  4. Leslie Reply

    Joyce,

    I had the same issue and reducing the level of stimulation was the ticket. Thus far, I’m very happy now. Have you done a sleep study since your device was implanted? It’s a marathon, not a sprint and does take time.

  5. Eric J Kezirian, MD, MPH Reply

    Slow and steady definitely wins the race, and anyone who finds themselves waking up due to the stimulation should turn it down for at least a few days before turning it back up gradually. The key with Upper Airway Stimulation is to use it at a level that is comfortable. The large majority of patients have found it very comfortable, often waking up much less than before they started the therapy because they are now having treatment of their obstructive sleep apnea. That being said, patients with difficulty falling asleep and/or staying asleep during the night (types of insomnia) can have an especially difficult time getting used to Upper Airway Stimulation.

    • Donald Fussell Reply

      It’s it unusual for it to shock the toung while your awake. I’m on the lowest setting. During the night it shocks my toung like it does when I first turn it on but a lesser amount. Sometimes it’s uncomfortable and I turn it off.

    • Corrine Reply

      Doctor have you heard of anyone having nerve injury from the procedure? I had mine inserted in March 2021 and now have Thoracic nerve injury with neuroma and the right pectoral nerve that’s right under the generator pain and sensitive to light touch. US used to find thoracic injury but when second found no image was ordered. They just keep telling me that nerves take a long time to heal. Very frustrating. I feel no one cares about it.

  6. Olivier Van Glabeke Reply

    Hi everyone,
    It’s very hard to find comments about people who had a Upper Airway Stimulation surgery! As I am about to have the surgery in January, I’m very curious to hear comments of people who have been treated with it. Please help and share your experience. Thank you!
    Kind regards
    Olivier Van Glabeke
    Belgium

  7. Stewart Reply

    I shoot in skeet tournaments would I will be able to shoot once the device is implanted?

  8. Eric Kezirian, MD, MPH Reply

    For patients who fire guns with a barrel placed against the chest, we would want to implant the device on the opposite side. The device can be placed on either side of the upper chest, so it would not limit your ability to continue skeet shooting.

  9. Dina Reply

    My husband had the Inspire device implanted two years ago, and it no longer works for him as a viable means to control his sleep apnea. He went in for a wet endoscopy a couple of weeks ago, so they could take a look at his throat while he was sleeping and the Dt’s are now telling him to go back on the CPAP again. He will likely go back into surgery to have the Inspire device removed in a few months. So not worth the surgery or expense for him to have this device implanted.

    • Luther Scott Reply

      Why does the device no longer work for your husband? Did your husband undergo the sleep endoscopy prior to having the device implanted?

    • Eric James Kezirian Reply

      There are reasons that people do not respond to Inspire therapy, whether right away or over time. Typically, the next step is not just to remove it. I have written previously about a common approach to understanding why someone has not responded and how to resolve issues, if possible. You can see my blog post at https://sleep-doctor.com/blog/inspire-upper-airway-stimulation-not-working-for-your-sleep-apnea/.

  10. Nicole Reply

    Please call me my name is Nicole Peller my phone number is 6146250079

  11. Chester Fisher Reply

    Does Inspire have any beneficial effect on Central Sleep Apnea besides its effect on obstructive sleep apnea?

    • Eric James Kezirian Reply

      There is no benefit for central sleep apnea. In fact, having substantial central sleep apnea can interfere with Inspire therapy’s ability to treat obstructive sleep apnea.

  12. Geoffrey Halberstadt Reply

    Can you have an MRI after inspire is placed

    • Eric James Kezirian Reply

      You cannot have an MRI of the chest, abdomen, or pelvis. However, you can undergo 1.5 Tesla MRIs of the head and neck as well as the arms or legs. Different MRI machines have different magnet strengths, and 1.5 Tesla machines are commonly used, although 3 Tesla machines and other magnet strengths are also seen commonly. For further questions, you will want to discuss this with an Inspire team.

  13. Jeffrey A Fortezzo Reply

    I am thinking about having the operation for Inspire. Can you give me some data on what results your patients have had? I would like to know how often a problem has occurred during surgery? How many patients have had problems using the device? Also wondering how effective Inspire is after 6 months, one year, two years of use etc. Thanks, Jeff

  14. Jessica Weigle Reply

    My dad just got inspire in March 2020, he was set to go have it turned on a month later when all this COVID stuff occurred and docs offices were closed. In the meantime he had to have a pacemaker put in on May 4. When he went to get the inspire turned on May 8, they wouldn’t do it without a cardiologist present bc they don’t know how it will act with the pacemaker….I’m searching for someone who has both a pacemaker and an inspire to ask if there are any issues…

    • Rosa Reply

      Did you ever get any info regarding pacemaker? My Mom has a pacemaker and hasn’t been able to adapt to the CPAP. thanks

  15. Jerry Ceppos Reply

    I would think twice—no, make that three times—before implanting the Inspire device. I wish I had. Immediately after one was implanted in me last summer, most of my body shut down. I was in critical condition with acute pulmonary edema and many other serious problems. I was on a respirator for about a week and in the ICU for three weeks. After-effects continued for at least five months. I missed work for the entire second half of 2019. Beware.

  16. Nicole Peller Reply

    Could someone explain to me how I was able to get the inspire while I had pneumonia still inside me ?Also I have had so many problems .i decided to find a professional sleep doctor to help me does not know anything about me.After doing his sleep study he says YOU DONT HAVE SLEEP APNE AT ALL so my question is am I the only person that this is happened to you or somebody else got the Inspire put in and then found out they don’t have sleep apnea? Thankyou

    • Eric Kezirian MD MPH Reply

      You should not have had the Inspire device placed if you do not have obstructive sleep apnea. There is the possibility of what is called night-to-night variation in sleep study results, but it should not be so substantial that you would go from having moderate to severe obstructive sleep apnea to having no sleep apnea at all. However, anything is possible. If you had weight loss or a difference in your body position during sleep, that could definitely affect your obstructive sleep apnea.

  17. Nicole Peller Reply

    Has anybody had the Inspire put inside their body and then one year later find out they never had sleep apnea?

  18. Christopher T. Jenkins Reply

    I have sleep apnea and use a ResMed AirCurve 10. It often blows so strong it comes out my mouth. I use air pillows because I cannot tolerate a mask. I already have an implanted spinal stimulator in my back for spinal stenosis and neuropathy pain. When it was implanted I had some very painful problems that eventually went away. Can a person have both kinds of stimulators implanted? I assume no more M.R.I. can ever be done after implantation. I can’t have one anyway. Can both types of stimulators be implanted in the same person?

    • Eric Kezirian, MD, MPH Reply

      You can likely have both kinds of stimulators implanted, but you should speak with the Inspire team when you obtain an evaluation. MRIs are OK with the Inspire device for certain common types of MRI machines (called 1.5T or 1.5 Tesla) and many areas of the body (head, neck, arms, and legs but not chest, abdomen, or pelvis).

    • Wendy Zeller Reply

      I have a nerve stimulator and the inspire device. Unfortunately the inspire device I have has stopped all MRI’s. No doctor will allow an mri due to liability The nerve stimulator can be put on mri mode and they would then allow one if I didn’t have the inspire devise

  19. DAVID LABORDE Reply

    How significant are the pulses to the tongue nerve? I’m concerned about getting to sleep during the stimulation.

    • Eric Kezirian, MD, MPH Reply

      They are noticeable while you are awake because your tongue moves. They should not wake you up from sleep. The system is set up to come on after you are asleep because you tell the system how long to wait until it starts working, choosing the time based on how long it typically takes you to fall asleep and then adding 10 minutes

  20. Robert Vines Reply

    After 18 months with Inspire…

    This is what I read about Inspire before I had my own: “The Inspire therapy works inside your body with your natural breathing process to treat obstructive sleep apnea. It continuously monitors your breathing patterns while you sleep. Based on your unique breathing patterns, the system delivers mild stimulation to key airway muscles which keeps the airway open while you sleep.”

    From that description, I assumed there would be stimulation when my breathing paused causing an apnea event. The way mine actually works is that there is an initial pause in stimulation to allow you to fall asleep then the initial start-up can be a real jolt. My mouth is propped open by my tongue thrusting forward followed by a constant thumping of my tongue against the roof of my mouth. Only one side of my tongue is fully stimulated which causes the tongue to thrust out and to the side. Each stimulation is instant causing the tongue to jerk very fast. It also causes my tongue to buzz somewhat like it was AC current or chopped DC.

    My tongue thrusts out for 3 seconds and then repeats after a one-second pause causing the constant thumping noise against the roof of my mouth. However, after 30 minutes to one hour, the tongue movement seems to settle down to a less aggressive and less jarring thumping. This may be simply a tiring of my tongue muscles rather than a change in the stimulation. The stimulation cycle of three seconds on and one second off eventually changes but never seems to have any coordination with my breathing. Sometimes it becomes quite rapid, and sometimes it lengthens enough to allow a complete breath.

    I also noticed that it will not work at all if my electric blanket is turned on. And, I noticed that sometimes my electric shaver will turn on the stimulation. Experiencing this, makes me want to carry the remote with me everywhere in case the system turns on. I have also found the Patient Manual on the internet (which I now wish I had seen before having the surgery) which states that stimulation can initiate if you are near a CB Radio, electric welder, other electrical devices, dental drills, or near our induction stovetop. This is not so bad for me because I have an excuse not to help my wife in the kitchen, but bad news for not being able to use the handheld 2way CB radios that I use hiking or the welder in my shop. I will also need to remember to take control with me when I go to the dentist.

    Before having the Inspire device I used a mouthpiece that holds my lower jaw forward as well as a BIPAP unit set at a fairly low pressure. I have to use a low pressure because raising the pressure results in severe gas pains for me as air flows into my stomach. The plus with using the BIPAP even at low pressure, however, is that I have online access to the daily report of the previous night’s sleep. I average 17.5 apnea events per hour using these two together.

    I found if I use the Inspire device without the mouthpiece or the BIPAP, I wake in the night with a headache. Using the BIPAP, the mouthpiece, and the Inspire device solves the headache problem but does not change the average number of events per hour. It does add two inconveniences. First, frequently when the Inspire initiates the stimulation I wake up. This is almost always the case if I have it set on one of the highest values. The second is that I have always experienced sinus drainage, especially when I lie down. When this drainage is in my throat, I swallow reflexively. Using the Inspire device, I cannot swallow. A third problem is that the sensor pokes painfully in my ribs if I try to sleep on my right side.

    My summary is that the device has been a disappointment for me. Because I still use the BIPAP on low pressure and can access a daily report on events per hour, I have repeatedly experimented with using Inspire and not using Inspire to see if it helps. My repeated data shows events per hour is the same using the Inspire or not using Inspire. In other words, the Inspire does not help me. I am also surprised to see a device being marketed with such a susceptibility to EMC/EMI interference. UL approval of the device would have revealed these problems. There should be a ramp of the initial stimulation over a period of minutes to prevent the initial jolt of full stimulation that wakes me up. There should also be a ramp of each stimulation to allow a more gentle tongue movement. And, of course, the sensitivity to electronic interference needs proper filtering. And finally, there should be an on/off switch on the control to keep the battery from going bad while you are carrying it with you.

    • Eric Kezirian, MD, MPH Reply

      You definitely have a constellation of real challenges. This is not typical, although there are patients who awaken at higher stimulation levels, including when the system starts working. I would group your problems into those of waking you up (can be difficult to fix unless you can come down on the stimulation intensity), the abrupt nature of tongue movement with stimulation (can be adjustment somewhat by changing the electrical settings), interference from other devices (I have not heard of anyone having this much trouble), and incomplete relief of obstructive sleep apnea. For the last point, I have written about this before on my blog: https://sleep-doctor.com/blog/inspire-upper-airway-stimulation-not-working-for-your-sleep-apnea/. I would absolutely keep working with your center, as there should be room for improvement, at least.

    • Shari T Reply

      Hi Robert…I’m scheduled to get inspire today….after reading ur post I’m feeling affraid. I hope I’m making the right decision. My dad also has sleep apnea and his drs have said some, perhaps most of his dementia symptoms are related to his uncontrolled condition. My dads condition is a possibility for me too. Which also scares me. The device turning on by itself is especially concerning. The pain u mentioned is likely to cause me not to use it as directed… right now I dont know what to do. My email is Sharit2015 (AT) aol.com if u get notice of my reply and u want to reply.

      • Kim Saghy Reply

        Shari, did you get the Inspire Surgery?

    • Corrine Reply

      Agree with a lot of what you said. I had my device inserted in March 2021 and had complications of nerve injuries X 2 and now have daily headaches. The stimulation felt like it was regulated and going well then I had my inpatient sleep eval, they adjusted things and then I turned it on to have a major tongue spasm that first night. Very painful and scared. I’m still not set right. My nerve injuries were from the insertion and are still painful at times. Nerves take a long time to heal they say. No one explained to me prior to surgery all of these risks especially the nerve injuries. I would like to know if anyone has had the nerve injuries like me.

  21. Ele T Reply

    Shari, what did you end up deciding?

    Also, it seems Inspire comes out with a new device model every 3 years. Being right at the milestone for a new one, has anyone heard if they have a new model coming out soon? Debating whether to hold off or not. Thank you

    • Brad Reply

      Yes they have a new device out. Just had it installed. But my spinal cord stimulator interferes with it. So not sure what they are going to do.

      • Brad Reply

        Also they have tried for 2 years to get mine to work and no success.

  22. Craig Van Anne Reply

    Dr. Kezirian — I have undergone a drug-induced sleep endoscopy which shows complete palate obstruction with the tongue 100% in contact with boths sides of the throat. My AHI is 17, intermittent; RDI 34. I am approved for Inspire therapy, but recently have become aware of Radio Frequency Ablation. I am intrigued with RFA being much less intrusive and avoiding the MRI-ban of Inspire. Your thoughts on RFA, please. I live in the SF Bay Area. Thanks!!

    • Eric Kezirian, MD, MPH Reply

      Inspire does allow you to obtain an MRI of your head, neck, arms, and legs, so it is not an MRI ban. As far as radiofrequency, there are more details on my website (https://sleep-doctor.com), and you can contact me there directly if you would really like to discuss this in more detail.

  23. Harry Reply

    I’m Harry from Brooklyn and I just completed level 4 of my Inspire Sleep.
    My 1st panic was acceptance of my Metro plus insurance, which was accepted. I was disappointed that the VA isn’t part of the inspire program as yet. My surgery performed by MD Steven Parks @ Montifeur Hospital in the Bronx went very well. Just a little discomfort at first (no real pain). Just rest and heal for approx 30 days. The consult to activate the remote was very informative. It was strange feeling my tongue being controlled by the Inspire device. I do get up after a few hours of sleep to urinate and drink water, therefore, I pause the remote ((15 minutes), then it automatically resumes. By that time I’m back in bed asleep. I still have a ways to go but I’m very encouraged!!! All I can say is: Get rid of your CPAC NOW machine
    THE STORY CONTINUES

    • Tim D Reply

      The VA covered my Inspire through care in the community.

  24. BECKY HUTCHENS Reply

    ARE MAJOR CARRIERS COVERING THE DEVICE ITSELF? I KNOW THE PROCEDURE CODES ARE COVERED BUT JUST WONDERED ABOUT THE DEVICE.

  25. David R Wells Reply

    I’m scheduled to have the device implanted on Sep 29. I have been doing research and now, after the comments here, I am seriously considering cancelling the surgery. I’ve struggled with apnea for many years and it has really taken a toll on me. Tried CPAP multiple times and have had all the surgeries possible to correct the problem, except a tracheotomy. To make things worse, I have other serious health problems, most noticeably chronic Adult On-Set Still’s Disease. Getting to sleep is a chronic problem due to pain and staying asleep is just as bad. I would appreciate any additional comments on experiences that could assist me in deciding whether to go forward next week. Thank you.

  26. Eric Kezirian, MD, MPH Reply

    You should speak with your doctor about this. It can be complicated to become comfortable with Inspire if you have substantial troubles falling asleep, but your individual situation should be discussed with them.

    • David R Wells Reply

      I have a superb physician and we have a great relationship. I trust that he would not suggest if the benefits did not out way the negatives. So all I really have left is this therapy or a perm opening. The comments above have me concerned, but I say you’re right … work with my physician.

  27. Eric Kezirian, MD, MPH Reply

    It can be difficult for some patients to get comfortable enough with Inspire if they have substantial difficulty falling asleep. However, this is really something for you to discuss with your own physicians.

  28. Margaret McCarthy Reply

    I am 75 have recently been diagnosed with normal pressure hydrocephalus and may need to have a shunt put in my brain. My GP and Cardiolist want me to take care of my sleep apnea Problem and have suggested the Inspire. I definitely cannot use any CPAP masks with my clastrophobia problem. Have tried all the masks over years. I am worried about the MRI problems and I can only sleep well enough on my right side. What do you suggest? I live in Scottsdale Arizona.

  29. Frank Cook Reply

    I had the Inspire surgery on September 21. Since then I have had several pain on the right side(same side where the device is installed) of my head, it is exacerbated with the movement of my tongue. The pain is in my right eye, ear, and throat. When I move my tongue as when eating it is severe pain. It seems like when the device leading to my tongue was attached that there was not enough length to allow the tongue to move about freely.
    Has there been anyone else had any similar experience? I need more info before I complain to the surgeon.

    • Julie Hurlbut Reply

      Hi Frank, I had my implanted 10 days ago and have the same pain in my eye,ear and throat upon swallowing. I understand it will get better but I do not understand the eye and ear pain. I am going to assume that will get better with time also but can not, for the life of me see how my eye and ear should hurt at all. Hopefully we will see improvement with that and the device works well when it’s turned on. Good luck.

      • Kim Saghy Reply

        Julie, are you doing better with the Inspire? Would you recommend?

    • Adela Reply

      Hi Frank, I had the same experience and thought I was having a brain hemorrhage. My jaw, my ear, my eye and the right side of my head/ brain felt like I was having an aneurysm. However the pain did get better and is almost nil now. My surgery was on June 29th. So about 5 weeks ago. Right after the surgery I could not eat or drink anything without hurting so bad. But now all is fine. I did mention it to my surgeon and to The Sleep therapist and they said a small percentage of people to experience this.

  30. Frank Cook Reply

    I had the Inspire surgery on September 21. Since then I have had several pain on the right side(same side where the device is installed) of my head, it is exacerbated with the movement of my tongue. The pain is in my right eye, ear, and throat. When I move my tongue as when eating it is severe pain. It seems like when the device leading to my tongue was attached that there was not enough length to allow the tongue to move about freely.
    Has there been anyone else had a similar experience? I need more info before I complain to the surgeon.

  31. James Reply

    Dr. – Shortly after having the Inspire Stimulator implanted & activated, I developed bilateral tinnitus, which had gotten extremely distrissing. The percieved ‘sound’ is louder at night(high pictched screeching, sometime a forest full of crickets) than in the daytime(low hissing).
    Are you aware of any other reports of tinnitus developing directly after activation?

  32. James Reply

    Dr. – Shortly after having the Inspire Stimulator implanted & activated, I developed bilateral tinnitus, which had gotten extremely distressing. The perceived ‘sound’ is louder at night(high pitched screeching, sometime a forest full of crickets) than in the daytime(low hissing).
    Are you aware of any other reports of tinnitus developing directly after activation?

  33. Mike G. Reply

    I am considering the Inspire implant. I’m confused by the sleep study reposrt and the docs haven’t been all that helpful. During my home sleep study my overall AHI was 75, but it also said that I had 289 Obstructive events, 80 central events and 153 mixed events. It also says my obstructive apnea index was 37, my central apnea index 10 and mixed apnea index 19.

    I have been using an Auto Pap for 10 weeks. During that time my AHI has averages about 30 despite numerous pressure adjustments. The Neurologist in the sleep clinic has basically declared the APAP ineffective. Next steps being BiPap or surgery. I have seen two surgeons in the sleep clinic., an ENT and an oral maxillofacial surgeon. The two surgeries discussed have been a Maxillomandibular advancement (very scary) and an inspire implant. the oral surgeon says try Bipap first because the presence of the central apnea will mean continued sleep apnea even after surgery. The ENT says BiPAP will likely be ineffective as well and that its benefit over cpap/apap is one of comfort and not necessarily effectiveness. he is enthusiastic about Inspire and I have scheduled me for the DISE. I sent him an email today asking if I should be concerned about the central apnea. One of the first things that crossed my mind when first told about Inspire was comfort i.e. will it wake me up, keep me up or keep me from falling asleep. After reading the posts above I admit I am concerned, however, I recognize that these posts represent a very small sampling of Inspire patients and also that people who have a negative experience with a product of any type are more likely to write a negative review than someone who is please writing a positive review. I think my bigger concern is whether my central apnea will have a negative effect on the efficacy of the device such that I still have to use some type of PAP device.

    • Erika Reply

      Mike- The Inspire will not be effective for your central sleep apnea at all. BIPAP typically makes central sleep apnea worse. CPAP/APAP and BIPAP will not fix your central and mixed events either. I am shocked that no one has mentioned ASV to you (aka VPAP)!!!! That is the gold standard for complex sleep apnea, which is what you have. However, the use of it depends on your cardiac ejection fraction, which can be obtained via echocardiogram. I would consider this route FIRST before any type of surgery! (I am an registered sleep technologist of 19 years). Good luck!

  34. Tim Reply

    After three failed CPAP attempts over the years, I had Inspire surgery in June 2019. It is pretty common to return to the office with the Inspire rep to adjust the device, which they can do from a computer. I think they eventually want you up around 7,8,9 level. I am at a level 3 right now and have no issues with snoring and am sleeping all night. I’ve tried to go up to a level 4 but when the device turns on after 30 min, it’s pretty powerful and wakes me up. It takes about a minute to settle down to a calmer level. So I just stay at a 3. It definitely works better for apnea than the cpap, for me anyway.

  35. E Mares Reply

    Going on 9 months since surgery. Had 2 adjustments and settled on level 6. Considerable reduction in snoring and more sound sleep. The device takes some time to get used to but I am not dealing with CPAP anymore. Had I had to pay for copays I don’t know if I would elect to have implant. VA picked up the cost.
    This is evasive surgery so be prepared for recover time and pain associated with it.
    If you get pain meds be aware that will cause constipation so drink lots of fluids or you’ll have some issues.

  36. Timothy Keil Reply

    I am a candidate for the Inspire implant and have been doing my research. I am grateful for the honest testimony presented on this page, and especially appreciative of the courage of the woman who so wants people to hear her story that she has posted her phone number here. For any in the position of considering this option for their sleep apnea treatment, I strongly endorse you to contact this woman (assuming her phone number remains posted here) because her testimony is worth hearing. What i have learned from both her testimony and the other testimony presented here is that my sleep doctor was not completely transparent and forthcoming in selling this option to me. But then, that can be expected from a doctor who would actually try to leverage me into submitting myself for this surgery by threatening to withhold the medication I use to treat the consequential narcolepsy. So here is my commentary for all you doctors, surgeons and Inspire technology execs living high on the lucrative kickbacks of pushing this option onto your patients- we are NOT dispensible commodities for your profiteering enterprises. We still make the call when it comes to our bodies, our health, and most importantly, our sovereign propriety. I am happy for those of you who have truly been helped (or lead to believe, perhaps, that you’ve been helped) by the Inspire. I think I have found all the evidence that I require however to make the right and the best decision for myself. And to hell with the fact that my sleep doctor will disagree with me. My body and life are not for sale. Thank God for courageous folks like Nicole who still find a way to put the truth out there for those who need to hear it most in making wise choices in their own best interest.

  37. Leslee King Reply

    My husband was recently setup with an inspire. He said it sends an impulse to the tongue when he is inhaling, but when trying to exhale it sends an impulse to the tongue not allowing him to take a full breathe. Suggestions? He is super dedicated to using this but is having trouble working through it. Help?

  38. Nico Bonestroo Reply

    Hi, I’m Nico from The Netherlands.
    I’ve had a surgery in July 2019. The inspire was implant in my chest. After the surgery my tongue muscles didn’t work. The reason of this problem was the difficult location of my tongue nerves. After 7 weeks the function comes back. After that the therapy could slowly startup. Now I’m very happy with it. Sometimes the doctor must change the settings.
    Before the Inspire a had 59 breath interruptions. Now below 8. I can do all the things like sports, driving and working again without tired feelings.

  39. Rena Reply

    I got one implanted about 5 weeks ago. I am in the severe category and my incidents per hour are at least one time per minute with my oxygen level going down to the low 50s. They just activated the system and I am so sorry I did this. Something isn’t right and it is shocking me up the side of my head to my temple, down my arm making my fingers twitch, down my leg and making my fourth toe twitch. My neck is twitching all day long and is completely swollen. I am having difficulty swallowing and breathing. All of this is without even activating it with the remote. Everything from my sonic toothbrush to my cell phone is activating it. I keep saying something is wrong. My doctors are saying to give it time. I have not fallen asleep for days and I am beyond being sane. I told them to deactivate it but nobody will. Can’t I demand that it be deactivated? I am telling you that there is something wrong and nobody will listen. What do I do. I am literally ready to do something drastic here because this is really bad. Please help me!

  40. Julie Hurlbut Reply

    Rena, don’t do anything drastic, the implant can be removed if it is faulty, I had one put in and it didn’t work at all, they took it out and put in a new one. You may need to do that and if your dr refuses to do it report to the medical board.

  41. kevin Reply

    I had the surgery done January 8th and the wiring for my neck to my chest is tethered do my chest and my neck and every time I try to lift my neck up I can’t it’s like the wiring is like stuck to my skin I guess underneath and they told me to massage and stretch my neck back and forth I’ve been doing all that for 2 and 1/2 Weeks. went to see the doctor the other day and he told me to keep massaging it and stretching my neck well it seems to be getting tighter what can I do to free the tension of the wire between the device and my neck?

  42. Wendy Reply

    I’m scheduled to have the Inspire implant surgery on April 1st. I have been very excited about getting this done and finally being rid of the CPap and the lack of sleep that I have while using it.
    Yesterday, my husband began voicing concerns about me having this installed. He is worried about doing permanent damage to the hypoglossal nerve. I have been telling him that it is safe and I will be great afterwards. Now, after reading the comments above, I have to admit, I am also worried.
    I hadn’t been made aware of the difficulty people have getting use to this if they have difficulty falling asleep at night . This has ALWAYS been my issue. Even when I was a child, I would lay awake at night begging for sleep to come.
    I really, really want to have this surgery and get rid of that machine on my nightstand, getting twisted in the hose, and the constant sores in my nasal cavities.
    I’d like to hear from people who have had great success with the Inspire and what their journey was like regarding getting use to the device?

    • Nick Reply

      I started on CPAP, gave it several attempts over about 8 years, to no avail. Tried first an off the internet mouth piece, then one made by my dentist, no luck. Didn’t tolerate any of them very well. I received the implant in Jan 2020. About the time I was supposed to start the testing and adjusting, the pandemic hit, so it did not happen for a few months. Still no in-house sleep study at the lab though. I’ve been up and down the Inspire range settings. Highest I reached would shoot my tongue out of the mouth hard, very disturbing, had to back down a couple of notches. What I found was I slept no differently with or without the Inspire, waking every couple of hours or so. Sometimes the Inspire would come on just as I was nodding off and would awaken me. When I would awake with it active, never able to sleep with it active, it was audible and noisy enough to disturb me if my ear was on the pillow (which it usually is), so would pause it. Even that would sometimes wake me when it kicked on after the pause. Started turning it off, then on, instead for more time. But trying to adjust half awake is a bit of a pain, groping for the device half asleep, drag to my chest, hitting a couple of buttons, and return it. Last appt with the sleep doc, told him I would use it all the time until next follow-up (Apr 1), about 6 weeks later. Same problems ensued as noted above, but held in there. Until one night, I forgot to turn it on, had one of my better nights. Continued NOT using it, and have done better without it, not ideal, but better. I did get one benefit from it though. When I first asked my doctor about the Inspire after seeing on a local news show, he said I would be an ideal candidate but should probably lose about 8 lbs first. Lost the 8 and kept going, ultimately losing 40 lbs. So there is that.

    • Kim Saghy Reply

      Wendy, did you have the surgery? How are you doing? Would you recommend?

  43. Tamra Scott-Hunt Reply

    Can you please tell me the name of the other device in clinical trials that you mentioned above? I’m a very light sleeper, can’t tolerate CPAP, and worry that the stimulation of Inspire therapy may keep me awake. I’d like to read about possible alternatives in the pipeline. Thx.

  44. Kelley Reply

    I am scheduled for the Inspire surgery in mid-May. After reading all the comments, above, I am seriously considering not getting the surgery. I have one major issue with severe migraines (almost daily), and have just purchased the Cefaly system to try to tame them. The Cefaly device (www.cefaly.com) attaches to the forehead (between the eyebrows) and sends pulses to stimulate the trigeminal nerve to help relieve and prevent migraines. At this point, I’m more concerned about migraine relief, which could help me sleep better (when I have level 8-10 migraines every day, I don’t sleep well.) I’ve been on every type of migraine relief and prevention medications over the last 30+ years, with very little relief. I just found the Cefaly, and I’m desperate. However, I also have concern that the Cefaly would interact with the Inspire system. I have searched the internet for information on possible interaction, and I’ve found nothing. Looking for input on possible interaction between the two systems, if anyone can provide information.

  45. Sue Dlugos Reply

    I’m having the implant 5/3. Getting nervous. Does anyone have anything positive to say about it?

    • Kim Saghy Reply

      Hi Sue. Did you go thru with the surgery? I am supposed to have it installed in June. After reading these comments I am very nervous. If you did have it placed I hope you are doing well and I am thinking of you.

  46. Kristin Reply

    I’ve had inspire since 3/4/21 and it was turned on 4/4. I don’t notice any of the pain or things others are saying. I do believe I’m in a low setting though. It’s only my first month using it. I sleep pretty sound though. Once I’m asleep it doesn’t wake me up but if I haven’t fallen asleep yet when it turns on, I pause it bc it is weird feeling when ur awake (like ur throat tightens and pulsates.) But usual by the time the pause is over, I’m asleep. I haven’t noticed any improvement w my daytime tiredness from the sleep apnea yet. I go on May 13th for an adjustment. It’s definitely way better than the CPAP for me. I couldn’t tolerate that at all.

  47. Danette Richards Reply

    Thank you all. I’m scheduled for Friday. As with so many of you I’ve been really excited about it and finally being able to sleep. I’m anxious now and worried but you have given me a number of things to discuss with my doctor before surgery. Thank you.

  48. Troy Reply

    I’m in the pre work up for the inspire and after reading reviews I’m going to revisit my options.
    My oral appliance was working before my 15 COVID pounds, perhaps I will try getting back to the gym before an operation.
    I’m an RN and read surgical articles about complications like pneumothorax or nipping the Carotid and just the people talking nerve problems has slowed me down on the process.
    I appreciate everyone’s input, every case is different, consult with your MD.

  49. Sally Lujan Reply

    I have had OSA for many years and I have tried unsuccessfully to use CPAP and BIPAP and different masks. I have claustrophobia and also the mask leaves deep strap marks on my face which last like 5 hours. Water sprays in my face and air seeps out around the mask making squeaking noises which wakes up me and my husband. I had made up my mind to get the Inspire system implanted because I know I am damaging my health being untreated. I scheduled an appt. today and now after reading all these negative comments I am thinking about canceling my appt. I am really scared now and feeling hopeless. My dad had sleep Apnea and was never treated and died with Alzheimer’s and dementia at 70 years old. I don’t know how to proceed.

  50. Rachael Kaempf Reply

    My boyfriend had the inspire therapy for migrains and it worked for that. He still, however, snores very very bad and he’s not a large man. What else can be done for the snoring? We cannot sleep in the same room or on the same level of the home.

  51. Eric J. Kezirian, MD, MPH Reply

    There are many things that can be done for snoring, including for snoring that continues with Inspire therapy. The best thing to do would be for him to see a sleep surgeon and discuss options. I would actually start with his Inspire team to make sure that the Inspire therapy is optimized, but beyond that there are many options.

  52. Fitness Blogs Reply

    Great job. Please keep it up guys.

  53. Lily Reply

    I really liked your article post. Really Great.

  54. Robin Reply

    I just had Inspire implanted on July 13, followed by the month of recovery before they activated the device 2 weeks ago. So far I’m not sleeping any better and have problems when I wake up in the middle of the night. I pause it several times because 15 minutes isn’t enough to fall back to sleep and it wakes me back up as I’m starting to drift off. I was really hopeful about it, but if it doesn’t make much of a difference, I’m going to ask about having it removed. I didn’t realize I couldn’t have MRIs of my lower back with the implant. My doctor said I couldn’t have an MRI of my chest, but later I found out that it’s really your whole torso. I have degenerative disc disease and spinal stenosis. I know from past experience, MRIs are the only thing that show what’s going on for my neurosurgeon (already have had 4 discs rupture in my neck and one in my lumbar, plus 2 more degenerated discs). I’m pretty upset this wasn’t explained to me, because I wouldn’t have done it. I’m still hoping that Inspire will make me feel more rested, but that hope is fading. I hope that Medicare will cover having it removed if it comes to that.

    • Eric Kezirian Reply

      Medicare should cover the removal, but you should check with your Inspire team.

      • Diane Carpenter Reply

        I need to have my device removed. The dr. Emani said he would not take it out. May I have the name of a surgeon who will. I live in Tucson and am moving to Washington state the middle of November. So if I could have the information for both places? I am near the end of my rope.

        • Eric Kezirian, MD, MPH Reply

          Inspire surgeons can be found through the company website or your current Inspire representative covering the center.

  55. Al Reply

    The surgery to implant the device caused a big problem for me: I now have a lisp in my speech. Have you seen this happen before? Does it get better?

    I am nervous about having the device activated, because I wonder if it will worsen my lisp.

    • Eric Kezirian Reply

      If the lisp is from weakness of the nerve controlling tongue movement, you may want to wait. You should discuss this with your Inspire team.

  56. Anida Westbrook Reply

    I had the surgery to implant the device on Sept. 13, 2021. It has been five days now. I am having a big problem with my tongue. It does not move correctly when I need to swallow. My device had to be installed on my left side due to previous radiation treatment on my right side while being treated for breast cancer a few years ago. The problems with my tongue not moving correctly to swallow seems to only effect the left side of my tongue. My tongue also doesn’t move correctly when trying to chew food. It doesn’t move the food around my mouth. This is something you never notice your tongue doing before the inspirer. It has also effected how I talk. I can only talk in a way people can understand me for a couple of minutes before my tongue muscles are so tired and weak that I have to stop. I had had very little pain until today, day five, today I woke up with bad pain in the back of my throat on the left side and some pain in my jaw line. I was expecting this type of pain after surgery. But it is strange to have five days having very little pain first and the pain starting almost a week later. I did call the surgeon’s office yesterday to report the problems. They told me it was normal. I have my first followup on Monday which is only two days away. I am interested if anyone else has had any of these symptoms and if it is temporary how long before my tongue starts acting normal again. If there is anyone from the inspire company reading this I would like to here from you as well. I am trying to stay positive.

    • Eric Kezirian, MD, MPH Reply

      You should continue working with your surgeon and your own Inspire representative. It is not so straightforward to understand what might be occurring, but it can be something that could clear up or something that needs attention sooner rather than later.

  57. Stuart Hill Reply

    I had my Inspire implanted on July 16th, and got my remote on August 16th. After the first few nights of adjustment, I found it was controlling the apnea just fine, but my snoring went up to 11, so it was back to the guest room. Then last Thursday night I woke up a couple of times with my heart racing. My wife said she heard the usual sounds of apnea again. It was like the device wasn’t working. I’d turn it off and on and felt nothing at all. The same thing happened the next two nights. I changed batteries, thinking that might be the problem. But that didn’t help either. I’m not sure what’s going on, why it stops during the night.

  58. Eric Kezirian, MD, MPH Reply

    Usually, when the device is turned on, it is set at a very low level. Then the patient gradually increases the settings within the range set by the Inspire center. The idea is that you get used to the stimulation by starting slowly. You should keep your Inspire team notified by your progress and continue increasing. Sometimes other adjustments need to be made even before the in-laboratory sleep study that is done to examine closely how well the system is working to control your sleep apnea (with adjustment of settings).

  59. Dewey Reply

    Good post. I learn something totally new and challenging on sites I stumbleupon everyday. It will always be helpful to read articles from other authors and practice something from their sites.

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