The Inspire obstructive sleep apnea device is a relatively new treatment option that has received a lot of attention in recent years due to its unique approach to treating the condition. This therapy uses a small device that is surgically implanted in the patient’s body and works by stimulating the nerve that controls the tongue to prevent the airway from collapsing during sleep.
In this blog post, we’ll cover the advantages & disadvantages, indications & contraindications, ideal candidates, and the treatment pathway of the Inspire upper airway stimulation (UAS) device, as well as some information from a clinical study regarding its efficacy.
We will also share information about Bongo Rx, the new CPAP alternative treatment for mild to moderate obstructive sleep apnea. Bongo Rx is a non-invasive Expiratory Positive Airway Pressure (EPAP) device that is effective, comfortable, easy to use, convenient, and discreet. Bongo Rx is an alternative to CPAP that requires no machine, hose, electricity, or batteries.
Inspire is an Upper Airway Stimulation (UAS) device that is surgically implanted to stimulate the hypoglossal nerve during sleep. The stimulation is controlled by an external, handheld remote that the patient uses nightly to turn on the Inspire device before sleep. Inspire is classified by the FDA as a Class III device, which includes devices with the greatest risk.
Advantages of Inspire Sleep Apnea Treatment
- No CPAP Machine, No Hose, and No Mask: Unlike continuous positive airway pressure (CPAP), Inspire sleep apnea treatment doesn’t require the patient to wear a mask or have a flow generator CPAP machine delivering air to their body.
- Simple to Use: Once the device is implanted, the patient simply uses a handheld remote to turn on and off the Inspire before and after sleep.
- Customizable: Inspire sleep apnea therapy is customizable, allowing the patient (or doctor) to adjust the level of stimulation they receive based on their needs.
- Effective: Clinical studies have shown that the Inspire sleep apnea device is effective for moderate to severe sleep apnea patients, with patients reporting improvements in their sleep apnea symptoms and quality of life after undergoing the therapy. In a clinical study published in the New England Journal of Medicine, for example, the study patients reported a 68% reduction in their apnea-hypopnea index (AHI) after undergoing the surgery and using the therapy for 12 months.
Disadvantages of Inspire Sleep Apnea Treatment
- Cost: Inspire sleep apnea treatment is a relatively new treatment option, and as such, it can be quite costly. This can be a barrier for many patients who are unable to afford the treatment. Some insurance companies may offer coverage for Inspire for those who meet specific criteria, but patients typically can expect to pay any unmet deductible along with any copay or coinsurance fee for the surgery.
- Complex procedure: Inspire sleep apnea treatment is a complex procedure that requires surgery and implantation of the device by a trained specialist. This can be a disadvantage for patients who are not comfortable with undergoing a surgical procedure.
- Risk of complications: As with any invasive device or surgical procedure, there is a risk of complications associated with implanting and using Inspire sleep apnea therapy. This can include infection, nerve damage, or pain. To remove the implanted device or to replace its batteries, additional surgery is needed.
- The procedure may also leave small scars. According to the company, “the visibility of the scars associated with the surgery to implant the Inspire will depend on your skin tone and individual healing process. There are two or three incisions made to place the device. Each patient will have one incision under the chin and one below the collarbone. Some patients will also have one on the side of the rib cage.”
- Some patients are not candidates for the procedure.
- It can be a lengthy process to qualify for and get the surgery.
Indications for the Inspire Sleep Apnea Device
Inspire is indicated for use to treat a subset of patients with moderate to severe obstructive sleep apnea (OSA) that meet all of the following requirements:
- Have moderate to severe sleep apnea that is limited to between 15 and 65 AHI (Apnea-Hypopnea index).
- Do not have central and mixed apneas that make up 25% or more of their Apnea-Hypopnea index (AHI )
- Have been confirmed to fail, or cannot tolerate, Positive Airway Pressure (PAP) treatments, such as CPAP or EPAP.
- Do not have a Body Mass Index (BMI) of greater than 32.
- Do not have a complete concentric collapse at the soft palate level as determined by an internal airway examination procedure.
Contraindications for Inspire Sleep Apnea Device
- Pregnancy: Inspire sleep apnea treatment is contraindicated for patients who are or who plan to become pregnant as the safety of the therapy during pregnancy has not been established.
- Implanted devices: Patients with certain implanted devices, such as pacemakers or defibrillators, may not be eligible for Inspire sleep apnea therapy due to potential interactions with the device.
- MRI: Patients who require an MRI other than what is described in the Inspire labeling.
- Anatomic issues: Any anatomical finding that would compromise the performance of upper airway stimulation.
Ideal Candidate for Inspire Sleep Apnea Therapy
The ideal candidate for Inspire sleep apnea therapy is a patient diagnosed with moderate to severe sleep apnea (limited to 15 to 65 AHI) who has been confirmed to have failed or not tolerated other PAP treatments, such as CPAP or EPAP. This patient should be in overall good health and have no contraindications for the therapy, such as pregnancy, implanted devices, or anatomical issues. They should also be willing to undergo the surgical procedure required for implantation of the device.
It is important to note that every patient is unique, and the best way to determine if Inspire sleep apnea therapy is right for you is to consult with a sleep specialist and undergo a thorough evaluation of your sleep apnea symptoms and medical history.
The general steps for getting started with Inspire are:
- An initial meeting with a specialized doctor is required to see if a patient is a potential candidate for Inspire.
- To further determine if the Inspire is right for you, you must have a first procedure where you are put to sleep so a doctor can insert a camera into your airway to review whether or not you have a complete concentric collapse at the soft palate level.
- In a different procedure, the Inspire device is surgically implanted under general anesthesia into the chest area, as well as in the neck area under the skin.
- Under the direction of their doctor, patients can typically resume non-strenuous activities in a few days and more strenuous activity in a couple of weeks.
- Finally, about thirty days after the surgery, the patient meets again with their doctor to turn on their Inspire and fine tune its stimulation impulses.
How much does the Inspire sleep apnea implant cost?
The device is covered by most insurance providers. The exact out-of-pocket cost will depend on the individual’s insurance plan. Also, the Inspire implantation procedure is mostly performed as an outpatient surgery, so there are medical bills that will have to be taken into account.
According to a cnet.com article on Inspire, an individual can expect to see a total bill of around $30,000 to $40,000 for the surgery plus the cost of the Inspire sleep apnea device, before insurance.
Before Considering Surgery, Learn About The Non-invasive CPAP Alternative – Bongo Rx EPAP Therapy
If you have mild to moderate sleep apnea, learn about EPAP therapy with Bongo Rx — non-invasive and effective sleep apnea treatment without the CPAP machine.
- Bongo Rx is an FDA-cleared prescription device for the treatment of moderate or mild sleep apnea
- Non-surgical / Non-invasive
- Conveniently available to you whenever and wherever you want to sleep
- Clinically tested
- Easy to use, small and discreet
- Requires no machine, hoses, electricity, or batteries
- Designed, molded, and assembled in the USA
- Affordable
In conclusion, the Inspire sleep apnea device is a promising new treatment option for a narrow qualifying group of patients with sleep apnea. While it has many advantages, including its customizable stimulation, and effectiveness, it also has some disadvantages, including its cost, complex procedure, and risk of complications. Inspire is also only appropriate for a small sub-set of sleep apnea patients.
Patients should carefully consider the advantages and disadvantages of this therapy and consult with their healthcare provider to determine if it is the right choice for them.
Patients with mild to moderate sleep apnea may also want to try Bongo Rx, a non-invasive, low-cost solution.
(Inspire is a registered trademark of Inspire Medical Systems, Inc.)