A Review of the Inspire Hypoglossal Nerve Implant

This is a review of the Inspire hypoglossal nerve stimulator implant used to treat obstructive sleep apnoea. This technology is especially useful for people who have sleep apnoea (OSA), but are unable to tolerate a CPAP device or a mandibular advancement device.
Mr Vik Veer - ENT consultant with a specialist interest in sleep surgery provides a full review of the device, how it works, what the evidence is that it works, and who should consider it.

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** Disclaimer - The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. **

[tomsinclair]

The Inspire devices are now being advertised constantly in the US. I had the surgery after a DISE determined I was a “candidate.” In my opinion, unless you are one of the 6% with a solely tongue based obstructive sleep apnea, I would try most everything else first. If CPAP is not working work with your doctor regarding masks, pressures, BIPAP, Auto PAP. Strike out then go mandibular advancement device and see how that goes. If all fails in the end and you can get insurance to cover it then maybe try Inspire.

I had my surgery at The Ohio State University. They were big on Inspire before most. The general anesthesia surgical placement was no big deal to me. I don’t mind getting knocked out and worked on.

After that the surgeon is done with you until 10 years later for battery replacement. From installation forward it goes to a sleep doctor trained in activating and titrating the device. The device is activated about 30 days post surgery. It was an odd but not intolerable sensation when the doctor first had the device pulse in office.

However, contrary to the surgeon’s office which was gung-ho on Inspire, my sleep doctor told me straight up that about 30% of her patients could not tolerate the device at a therapeutic level. Nice to have known that pre-surgery.

As the video explains you adjust the level of stimulation. Protocol is to try upping one level per week and dial back if you are awakened by it.

Well, something I did not know or adequately consider... I don’t do great on my bi-pap but way better than nothing. Now with the Inspire I was looking at weeks of basically nothing as I built up to therapeutic level.

I awakened the first night to go to the bathroom and when Inspire detects you are awake it goes into a mode that does 4 quick pulses and a 1 second pause. Very disconcerting to me. So you gotta have that remote handy to pause it. I think default for pause is for it to resume in 15 minutes. That can be changed, as can the duration before it kicks in when you go to bed initially and turn it on. Both adjustments however can only be done in office. For me that is a flight to another state. These things are still not THAT common. Under 30k worldwide.

The second night was really a disaster for my spirit. I was awakened by the device. This time by, and I can’t believe I am saying this, the noise. I am a light sleeper and use Bose Sleepbuds. I awoke and heard a rhythmic buzzing noise. When I lifted my head from the pillow it went away. Head back down and I heard it again.

Called Inspire the next day and was told that “Yes” some people who sleep on their right side (me) have reported hearing the device pulsing when their head makes a good “seal” with the pillow. I liken it to how you cannot hear yourself breath but when you stick your fingers in your ears a you can quite clearly. Inspire’s solution to my lifetime sleeping position was to sleep on my other side.

At that point sleep deprived, frustrated and a bit hopeless I quit after 3 days. Sometime when the world can take the wrath of a sleep deprived me for 2-3 months while I adjust I may try again. For now, I am grateful that I get some relief from my bi-pap (that took 2 years to adjust to) and am chalking Inspire up to a great sales pitch by my surgeon delivering only part of the story to get the thing in me and out the door.

One last thing, it has been acknowledged that those suffering from insomnia, particularly sleep onset insomnia, may not be good candidates for the device. That is me too.

[martinkounitzlicsw]

This is a thorough, clear and articulate video which is a strong contribution to patient education for those suffering from obstructive sleep apnea.

[maxfrederickson]

I just learned of this device. I underwent a sleep study in Feb of 2019 and was given a CPAP machine. As a rather active sleeper, I move around a lot at night. Sometimes as often as five or six times a night I'd wake up with what felt like hurricane force winds blowing in my face and would have to reseat the mask for a tight seal. I finally just took the machine back and told them to keep it. It seemed to cause more problems than it solved. Now I think I've learned to sleep on my side rather than my back and seem to have fewer episodes of apnea. An episode of apnea woke me up recently, but those episodes seem to be rarer now.

Thanks for the info, Doc. I needed it! And if I feel that apnea becomes a problem again, I know what to ask for now.

[charlesoliver]

Excellent video, full marks. Natural orator who is so easy to listen to and understand.

[jodyhill]

This doctor’s video is fantastic. Extremely informative, easily understood explanations, detailing the good and bad facets of this device. Well done sir, thank you very much. Other YouTube creators should take notice of your videos.

[brendaharrup]

Thanks so much for this informative video. I have been a severe sleep apnea sufferer for more years than I can remember. My first lung dr prescribed a CPAP for me. I used it for two years, but kept getting sick with sinusitis, so I gave up on it. Last year my primary care physician recommended Inspire to me and a ENT specialist who is a leader in this field. I had a comprehensive evaluation and exam, had a sleep endoscopy, and was informed that I was an ideal candidate for the Inspire implant. I had my surgery in mid January and after a few days of post surgery pain I am doing well. I’m now on level 5 of my stimulator strength and am sleeping through the night. I also have mild MDS and eosinophilic asthma, both of which cause fatigue. My Inspire implant has given me more rest and energy to help me deal with these other problems. I’m so thankful for this and for all my care team for this miracle 🙏🏻

[richardraasch]

Best thing I ever did. I feel amazing after going to this vs cpap. Highly recommended.

[taminew]

Thank you for this review - it's great in explaining the device. After using CPAP for close to 8 years with little real benefit, I just had the device installed earlier this month and am looking for great outcomes. I appreciate that it treats the root cause of the apnea, as opposed to just the symptoms.

[McQ]

Just got my results, which I knew. I had tried a CPAP machine a few years ago and being a stomach and side sleeper, I couldn’t sleep. From my doctor: Your study demonstrates severe obstructive sleep apnea, averaging 35.3 events per hour. I think I am going to go for this. Thank you for this video

[geralddorsett]

My goodness, what a great job of explaining sleep aphnea and the Inspire device. You are a great communicator. Thank you!!!

[lauracremente]

You explain this extremely well. I have Inspire and am asked a lot about the stimulation. It is continuous stimulation to allow the airway to be open while you are sleeping but does not detect an apnea event. Rather it prevents it from happening.

[hw]

I just got diagnosed with sleep apnea and i found out i stop breathing 97 times per hour. Yes 97. But this Apap machine doesn't work to well for me. The auto adjustment gets too strong and wakes me up. Great to know that this inspire might be a possible solution for me.

[TigerBlackTigerBlackTigerBlack]

Thank you very much for this video! I'm about to do my second sleep study. I already got diagnosed with severe obstructive sleep apnea but my issue isn't with my tongue but with my lateral wall. I had surgery to try and correct this which was successful enough but after a few years it seems to have failed. I have EDS so it's not unusual. This video was very helpful in letting me know that I don't qualify for this device.

[jonfrisch]

Well done. As a candidate for the device, I would like to learn more about physical activity, regarding Inspire implant. Thank you!

[nanbulla]

Best explanation of the actual surgery, how the Inspire device works and possible complications. Thank you from across the pond!

[konstantinosmerelis]

I got Inspire 6 months ago in Athens, Greece with Dr Koutsourelakis. Very happy with that choice. I could not tolerate CPAP and suffered for at least 10 years.

[alanperlman]

Thank you so much for this extraordinary video providing the impartial, objective evaluation a prospective patient needs in order to make an informed decision on INSPIRE. You have helped me a lot!

[CynicalWilson]

Very good to see that this seems to be available in Europe as well...I really hope that they have it in Germany so my mom could get it :)

[mickyates]

Great video! My insurance just approved the implant. Currently get very little sleep at night. I’m allergic to the mask, so can’t use a CPAP. To me this looks just like my pacemaker! This is something that I’m actually looking forward to getting done. Just hope it works well for me. Hopefully I’ll be able to get this done within the next 2 months here in Wyoming.

[MountainAirOrganicBeds]

Hey Doc I am finally getting my inspire surgery tomorrow. I pray everything goes safely.