Inspire Medical’s Upper Airway Stimulation technology is a powerful (no pun intended) addition to the array of options for individuals suffering from obstructive sleep apnea.  As a surgeon who implants this therapy, I see patients (whether my own or those coming for a second opinion) where Upper Airway Stimulation is not working well.  While there are no magical solutions, it is clear that a careful, thorough approach can often lead to major improvements.  Here are some of the steps to take when patients have persistent obstructive sleep apnea after being treated with Upper Airway Stimulation:

1. Do Not Give Up

Treatment with Upper Airway Stimulation is a process.  The process takes a few months, starting with the preoperative evaluation and including the implant surgery, activation and adjustment of the system.  It can be frustrating to go through this processand not have a perfect result.  The important thing is not to give up.  Improving results requires everyone to keep moving forward, figuring out why the therapy is not working and coming up with a plan to address the issues.

2.  Troubleshooting

There are a number of reasons why Upper Airway Stimulation may not be working well enough.  The first step is to collect data from the patient, bed partner, device itself, and the sleep studies done with the system activated.  Identify the source of the problem and develop a plan to address it or learn more.  When I have encountered unusual issues, I have reached out to the Inspire team.  I have been so impressed with their dedication and insight that has helped to resolve issues or overcome obstacles that patients are facing.

3.  Awake or Sedated Titration

Often everything is functioning properly and the patient is tolerating therapy without not having resolution of their sleep apnea.  In these cases, a change in the electrical settings of the device can be helpful.  Upper Airway Stimulation includes a stimulation lead that has 3 electrical contacts placed on a portion of the nerve that controls tongue movement (hypoglossal nerve).  The system typically delivers the electrical stimulation in a certain manner, using the three electrical contacts with a specific combination of positive and negative settings on the contacts to produce an electrical field for nerve stimulation.  Some patients benefit from an adjustment in these settings to modify the electrical field of stimulation if this can move the tongue forward in a more favorable way.  The goal is to open the space for breathing not only in the Tongue Region but also in the Palate Region; sometimes a change in the electrical configuration is all that is needed.  This exploration of changes is often first done while a patient is awake in the office but can be done under sedation using the technique of drug-induced sleep endoscopy.

4.  Consider Additional Treatments, Including Surgery

Treating obstructive sleep apnea often requires a combination of therapies.  While the majority of patients have excellent results with Upper Airway Stimulation alone, in many cases another treatment can be added.  The other treatment can be something as simple as positional therapy (avoiding sleeping on the back), or it can be another surgery.

The surgeries that can be combined with Upper Airway Stimulation range from a revision of the Inspire system (generally to move the stimulation lead) to adding surgery for the Nasal Region or Palate Region.  I have written previously about work presented at the 2018 International Surgical Sleep Society meeting in Munich about good results for soft palate surgery performed in patients treated with Inspire who had incomplete resolution of their sleep apnea.  Currently, I have a couple of patients who are considering soft palate surgery and another who would benefit from repositioning of the stimulation lead cuff.

The Bottom Line

The bottom line is that whenever something does not work as well as we would like…find out why and develop a plan to address it.

9 Responses to “Inspire Upper Airway Stimulation Not Working for Your Sleep Apnea?”

  1. Terri Bly

    If it’s primarily the tongue that falls back who does have a deviated right nasal blockage as well; would you recommend first trying less invasive step by trying the Dental appliance? Can you also go over the procedure of what the inspire process is? I’m primarily concerned with the connection of Thank you. The other palate procedures were explained very well.

    • Dr. Kezirian

      You should see someone who deals often with obstructive sleep apnea. You should have a formal examination and discussion of your options.


    please help me , i need to sleep and cannot , i have tried several sleep machines and need help. please , please help can you contact me about the tongue stimulation implant. daniel faust 989-304-6400

    • Dr. Kezirian

      To schedule an appointment with me, please call our Patient Access Center at 323-442-5790. We can discuss the array of treatment options, including possible surgery.

  3. Greenbaum Robert

    Your thoughts on Inspire for position induced apnea (almost 100% when on my back).
    My AHI is in the 7-8 range.

    • Dr. Kezirian

      I assume that you are not able to use positional therapy (avoiding sleeping on your back) through the entire night. If your AHI is in the 7-8 range, you likely would not qualify for insurance coverage for Inspire. However, there are many other options, whether CPAP, surgery (there are many other procedures), or oral appliances.

      • Dr. Kezirian

        Of note, you may very well be covered for these other treatments even though your AHI is not dramatically high.


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