If you’ve been diagnosed with obstructive sleep apnea (OSA), chances are your doctor recommended a CPAP machine as your first option of treatment. CPAP is short for continuous positive airway pressure and has been the standard treatment for years. But what if you can’t tolerate the mask, the noise, or the nightly hassle?
You’re not alone. Many patients stop using CPAP because of discomfort, noise, or difficulty falling asleep. A 2024 case series in Open Journal of Radiology noted that long-term adherence is often limited by mask intolerance and lifestyle disruption.
A significant number of people stop using their CPAP machine after just one year. In fact, one study found that compliance drops to less than 50% over time, with many patients citing discomfort or inconvenience as major factors for discontinuance of use. For people who struggle with CPAP, a newer treatment called Inspire may offer another option.
Inspire is a newer option for patients who can’t tolerate CPAP. It’s a small implant that helps you breathe normally during sleep without a mask or machine.
So, how does Inspire compare to CPAP and which might be right for you? Let’s break it down.
What is OSA?
Obstructive sleep apnea (OSA) is a common sleep disorder that affects millions of people worldwide. It happens when the muscles in the throat relax during sleep, causing repeated pauses in breathing. These interruptions can reduce sleep quality and can cause several health problems.
According to the American Academy of Sleep Medicine, 30 million Americans suffer from OSA. Untreated OSA can lead to: high blood pressure, diabetes, increased risk of stroke, cardiovascular complications, depression, and increased chance of auto accidents due to fatigue.
According to the American Academy of Sleep Medicine, 30 million Americans suffer from OSA. Untreated OSA can lead to: high blood pressure, diabetes, increased risk of stroke, cardiovascular complications, depression, and increased chance of auto accidents due to fatigue.
What is CPAP?
The most common treatment for OSA is continuous positive airway pressure, or CPAP. This therapy uses a machine that delivers steady air pressure through a mask to keep the airway open. CPAP works well when used consistently, but many people find it hard to tolerate.
CPAP therapy delivers a constant flow of air through a mask to keep your airway open during sleep. When it’s used consistently, CPAP is highly effective in treating OSA and reducing health risks, according to the American Academy of Sleep Medicine.
CPAP therapy delivers a constant flow of air through a mask to keep your airway open during sleep. When it’s used consistently, CPAP is highly effective in treating OSA and reducing health risks, according to the American Academy of Sleep Medicine.
Image credit: Cleveland Clinic. Diagram of CPAP machine parts. Retrieved from https://my.clevelandclinic.org/-/scassets/images/org/health/articles/22043-cpap-machine
What is Inspire?
Inspire is an FDA-approved implantable device that treats obstructive sleep apnea by stimulating the hypoglossal nerve, which controls tongue movement. When you sleep, the device sends mild pulses that keep your airway open.
The device was approved by the FDA in 2014 for people with moderate to severe OSA who can’t tolerate CPAP. Inspire is placed during a same day outpatient procedure and activated about a month later. According to the manufacturer’s website Inspire.com, patients use a small handheld remote to turn it on before bed and off when they wake up.
The device was approved by the FDA in 2014 for people with moderate to severe OSA who can’t tolerate CPAP. Inspire is placed during a same day outpatient procedure and activated about a month later. According to the manufacturer’s website Inspire.com, patients use a small handheld remote to turn it on before bed and off when they wake up.
Image credit: Altoona Lung Specialists. Hypoglossal nerve stimulation implant diagram. Retrieved from https://www.thelungspecialists.com/resources/sleep-network/hypoglossal-nerve-stimulation-hns-inspire
The device was approved by the FDA in 2014 for people with moderate to severe Obstructive Sleep Apnea (OSA) who can’t tolerate CPAP. The device works by stimulating the hypoglossal nerve, which controls tongue movement. As you sleep, the device sends mild pulses that keep your airway open.
Inspire is placed in the patient during a same day outpatient procedure and activated about a month later after the device is implanted. Patients use a small handheld remote to turn it on before bed and off when they wake up.
Inspire is placed in the patient during a same day outpatient procedure and activated about a month later after the device is implanted. Patients use a small handheld remote to turn it on before bed and off when they wake up.
Comparison: Inspire vs. CPAP
Who Qualifies for Inspire?
A clinical review in Sleep Medicine Clinics points out that Inspire isn’t for everyone. The best candidates are those who respond well during airway testing and don’t have a lot of central sleep apnea. Inspire is intended for adults who:
- Have moderate to severe OSA
- Are unable to tolerate or benefit from CPAP
- Have a body mass index (BMI) under 40
- Do not have significant central sleep apnea
Who Should Not Use Inspire?
Inspire therapy isn’t right for everyone. There are a few reasons why someone may not be a good candidate for the implant:
- Patients with central or mixed sleep apnea that accounts for more than 25% of total apnea events
- Those with anatomical features, such as complete collapse of the soft palate, that may prevent the device from functioning effectively
- Individuals with a medical condition or surgical history that affects the neurological control of the upper airway
- Patients who are unable to use the handheld remote and do not have assistance available to operate it each night
- Individuals who are currently pregnant or planning to become pregnant
- Patients with another implanted device that may interfere with Inspire; a healthcare provider can help assess device compatibility
If you’re considering Inspire, your doctor will perform a full evaluation to see if it’s the right fit for your body and your sleep needs. Candidates typically undergo a sleep study and an airway evaluation to confirm eligibility. Based on Inspire’s device guidelines, the evaluation is performed during a drug-induced sleep endoscopy procedure, to determine if the airway is suitable for Inspire.
Procedure & Safety
The device is implanted under the skin of the chest and neck during an outpatient procedure, usually taking about two hours. Most patients recover within a week or two. Most side effects are minor and include temporary soreness near the incision site or slight tongue movement during use. After healing, the device is activated and adjusted for comfort and effectiveness.
A 2014 study, published in the New England Journal of Medicine found that patients using Inspire had significant improvements in their apnea-hypopnea index (AHI) and oxygen levels.
More than 90% said they would choose the treatment again.
Newer studies also highlight Inspire's stability over time. In 2024, Open Journal of Radiology published a study that found no device migration or hardware failure in long-term users, even after MRI imaging. Inspire has a strong safety record. Trials and other follow-up studies, including the 2024 case review, have shown long-term safety and patient satisfaction.
Risks and Side Effects
Like any surgical procedure or medical device, Inspire comes with some potential risks. Most side effects are mild and temporary, such as soreness, swelling, or minor tongue discomfort after the procedure. The manufacturer advises some patients may notice mild tongue movement, irritation from stimulation, or temporary changes in speech or swallowing.
Less common but possible risks include:
Less common but possible risks include:
- Nerve or blood vessel injury during surgery
- Infection at the implant site
- Tongue weakness or soreness
- Difficulty swallowing or speaking
- Discomfort from stimulation
- Allergic reaction to implanted materials
- Rare complications like pneumothorax (collapsed lung) or muscle damage
Your doctor will go over the full list of risks before the procedure and help determine if the benefits outweigh the potential downsides based on your health history.
Patient Experience
Many Inspire users who switched to Inspire say they finally were able to have restful sleep without the hassle of a CPAP mask or machine. A 2022 study, published in Life also found significant improvements in quality of life and reduced daytime sleepiness in Inspire users.
The manufacturer website, InspireSleep.com, includes stories from people who say the device helped them feel more rested, energetic, and in control of their health.
The manufacturer website, InspireSleep.com, includes stories from people who say the device helped them feel more rested, energetic, and in control of their health.
In a testimonial with Head and Neck Surgical Associates (HNSA), “Denise H.” shares her journey with obstructive sleep apnea and how Inspire therapy transformed her life. After struggling with CPAP therapy due to discomfort and inconvenience, she sought an alternative solution.
Video credit: Head and Neck Surgical Associates. Inspire Therapy Patient Testimonial featuring Denise H. [Video]. Retrieved from https://www.youtube.com/watch?v=ZceI63lvEuo
Watch the video testimonial here: Inspire Therapy Patient Testimonial
When Inspire Might Be a Better Fit
You might want to talk to your doctor about Inspire if:
You have been diagnosed with moderate to severe OSA
CPAP has not worked for you or is too uncomfortable
You are looking for a mask-free and travel-friendly treatment
You meet the eligibility criteria after a sleep evaluation
Final Thoughts
CPAP is an effective and widely used treatment. If it works for you, then stick with it because it is effective and non-invasive, but it is not the right fit for everyone. If you have trouble using CPAP or have stopped treatment, Inspire may offer an alternative that fits better with your lifestyle.
Talk to your sleep specialist to learn more. You can also visit InspireSleep.com to take a short quiz and see if you may qualify for Inspire therapy.
Talk to your sleep specialist to learn more. You can also visit InspireSleep.com to take a short quiz and see if you may qualify for Inspire therapy.
Learn More
1. American Academy of Sleep Medicine.New report highlights importance of prompt sleep apnea diagnosis and treatment. Retrieved from https://aasm.org/new-national-indicator-report-details-importance-prompt-sleep-apnea-diagnosis-treat2. Karthik, K., Shanmugam, R., & Patel, A. (2024). Obstructive sleep apnea device therapy: A radiological perspective. Open Journal of Radiology. Retrieved from https://www.scirp.org/pdf/ojrad2024144_11780691.pdf
3. Inspire Sleep. (2024).How it works and who qualifies. Retrieved from https://www.inspiresleep.com/en-us
4. Cleveland Clinic. Diagram of CPAP machine parts. Retrieved from https://my.clevelandclinic.org/-/scassets/images/org/health/articles/22043-cpap-machine
5. Altoona Lung Specialists. Hypoglossal nerve stimulation implant diagram. Retrieved from https://www.thelungspecialists.com/resources/sleep-network/hypoglossal-nerve-stimulation-hns-inspire
6. Strollo, P. J., Soose, R. J., Maurer, J. T., et al. (2014). Upper-airway stimulation for obstructive sleep apnea. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1308659
7. Karthik, K., Shanmugam, R., & Patel, A. (2024). Obstructive sleep apnea device therapy: A radiological perspective. Open Journal of Radiology. Retrieved from https://www.scirp.org/pdf/ojrad2024144_11780691.pdf
4. Cleveland Clinic. Diagram of CPAP machine parts. Retrieved from https://my.clevelandclinic.org/-/scassets/images/org/health/articles/22043-cpap-machine
5. Altoona Lung Specialists. Hypoglossal nerve stimulation implant diagram. Retrieved from https://www.thelungspecialists.com/resources/sleep-network/hypoglossal-nerve-stimulation-hns-inspire
6. Strollo, P. J., Soose, R. J., Maurer, J. T., et al. (2014). Upper-airway stimulation for obstructive sleep apnea. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1308659
7. Karthik, K., Shanmugam, R., & Patel, A. (2024). Obstructive sleep apnea device therapy: A radiological perspective. Open Journal of Radiology. Retrieved from https://www.scirp.org/pdf/ojrad2024144_11780691.pdf
8. Baptista, P., Di Frisco, I. M., Urrestarazu, E., Alcalde, J., Alegre, M., Sanchez, I., O’Connor-Reina, C., & Plaza, G.
Quality of life impact of hypoglossal nerve stimulation with Inspire device in patients with obstructive sleep apnea intolerant to continuous positive airway pressure therapy. Life, 2022;12(11):1737. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9694893/
9. Bestourous a, et al. “Adverse Events Associated with the Inspire Implantable Hypoglossal Nerve Stimulator: A Maude Database Review.” American Journal of Otolaryngology, W.B. Saunders, 25 June 2020, www.sciencedirect.com/science/article/abs/pii/S0196070920303100.
10. Inspire Therapy Patient Testimonial. (n.d.). [YouTube video]. Retrieved from https://www.youtube.com/watch?v=ZceI63lvEuoDisclaimer: This blog post was written as a patient education piece to help individuals understand Inspire therapy as an alternative to CPAP for obstructive sleep apnea. It draws on peer-reviewed research and professional guidelines to support informed conversations between patients and providers.
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