Hypoglossal nerve stimulation
Can’t get comfortable with CPAP? Hypoglossal nerve stimulation (HGNS) is an FDA-approved alternative for adults with moderate to severe sleep apnea. A small implant gently moves your tongue forward during sleep to keep your airway open, with no mask or hose.
Learn more about hypoglossal nerve stimulation
Benefits
An alternative when CPAP doesn’t work
The device applies gentle stimulation to the nerve that controls your tongue during sleep. This keeps your airway open so you can breathe normally and sleep without a mask, hose or machine.
An FDA-approved option backed by clinical evidence
Inspire® has been FDA-approved since 2014. In the clinical trial that led to approval, patients’ median apnea-hypopnea index (the number of breathing interruptions per hour) fell from about 29 to about 9 after 12 months. The device is placed under the skin of the neck and chest, and most people go home the same day. After you heal, your device is turned on and fine-tuned for you.
How it works
An Inspire hypoglossal nerve stimulation device senses your breathing and sends a gentle pulse to the nerve that controls your tongue while you sleep. The pulse moves your tongue forward, which keeps your airway open so you can breathe normally. You use a handheld remote to turn the device on at bedtime and off in the morning.
The process
Treatment starts with a few steps to make sure HGNS is a good fit for you:
Sleep medicine consultation. A sleep specialist reviews your sleep study and your CPAP history. You may need a new sleep study.
Surgical consultation. A head and neck surgeon reviews whether HGNS is a fit and explains the procedure.
Drug-induced sleep endoscopy (DISE). A short test under sedation shows how your airway collapses during sleep.
Implant procedure. Your surgeon places the device under the skin of your neck and chest.
Activation and fine-tuning. About a month later, your device is turned on, and your sleep team adjusts the settings at follow-up visits.
Physician services are provided by Atlantic Medical Group.
How to qualify
Our team will determine whether HGNS is right for you. You may be a candidate if you:
Have moderate to severe obstructive sleep apnea confirmed by a sleep study
Are 18 or older
Have tried CPAP and can’t tolerate it or don’t get consistent benefit
Have a body mass index (BMI) within the range your care team and insurer allow
Have airway anatomy that is a good match for HGNS, which we check with DISE
Your insurance plan may require approval before surgery.
Unsure if sleep apnea is the problem?
Learn more about obstructive sleep apnea, its symptoms and how it’s diagnosed.
Tom Thomas, MD
Inspire sleep apnea surgery
Dr. Tom Thomas discusses comprehensive sleep apnea treatments at Morristown Medical Center, including Inspire technology.
Federico Cerrone, MD
Who qualifies for Inspire
A sleep specialist explains the Inspire program for obstructive sleep apnea and how it offers an alternative to CPAP therapy at Atlantic Health.
Frequently asked questions about HGNS
You may be a candidate for HGNS if you:
- Have moderate to severe obstructive sleep apnea confirmed by a sleep study
- Are 18 or older
- Have tried CPAP and can’t tolerate it or don’t get enough benefit from it
- Have a body mass index (BMI) within the range your care team and insurer allow
- Have airway anatomy that is a good match for HGNS, as shown by drug-induced sleep endoscopy (DISE)
HGNS isn’t right for everyone. For example, it may not be recommended if most of your breathing pauses are central apneas (when the brain doesn’t signal the breathing muscles) or if your airway collapses in a complete circle at the soft palate during DISE. A sleep medicine specialist and a surgeon will review your sleep study, health history and test results to decide if HGNS is right for you.
CPAP is still the first treatment for most people with obstructive sleep apnea. It works well when you can use it consistently. HGNS is an option if you’ve given CPAP a fair try and can’t tolerate it or it doesn’t control your sleep apnea.
The two work differently. CPAP uses air pressure delivered through a mask to hold your airway open. HGNS uses gentle nerve stimulation to move your tongue forward, so there is no mask, hose or machine. Results vary from person to person. Your sleep specialist can help you compare them based on your sleep study, your anatomy and your preferences.
Start by talking with your sleep specialist. Sometimes a different mask, a pressure adjustment or a humidifier solves the problem. If CPAP still doesn’t work for you, other options include:
- A custom oral appliance that holds your jaw or tongue forward
- Positional therapy, if your sleep apnea is worse when you sleep on your back
- Weight management, including medical weight loss
- Surgery on the airway
- HGNS, for people who meet the criteria
The best choice depends on the type and severity of your sleep apnea, your anatomy and your overall health.
Many insurance plans, including Medicare and commercial plans, cover HGNS for people who meet their criteria. Some Medicaid plans may also cover it. Plans commonly look for a sleep apnea diagnosis from a sleep study, documented difficulty with CPAP, DISE results, and a BMI below a plan-specific limit. Most plans require approval before surgery. Coverage varies, so check with your insurer and ask your care team to help confirm what your plan requires. Read more about navigating the cost of medical care.
To get started, call 973-629-7575 or use our contact form to schedule a sleep medicine consultation. Bring your CPAP history and any sleep study results.
- Meet with a sleep specialist to review your sleep study and CPAP experience.
- Meet with a surgeon and have DISE to check whether HGNS is a good fit.
- Have surgery, and then have your device activated and fine-tuned about a month later.
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