Upper Airway Stimulation: An Implant Option for Sleep Apnea When CPAP Fails

For many people with sleep apnea, the CPAP machine is a nightmare - not because it doesn’t work, but because it’s unbearable to wear night after night. The mask digs into the face, the hose tangles, the air pressure feels like choking, and the noise drives partners crazy. If you’ve tried CPAP and given up, you’re not alone. Nearly half of people abandon it within the first year. But there’s another option that doesn’t require a mask, hose, or daily setup: upper airway stimulation.

What Is Upper Airway Stimulation?

Upper airway stimulation (UAS) is a surgically implanted device that treats obstructive sleep apnea by gently stimulating the nerve that controls your tongue. When you breathe in during sleep, the device sends a small pulse to move your tongue forward, keeping your airway open. It’s like having a tiny, smart muscle helper inside your neck that wakes up every time you sleep.

The most common system is called Inspire, developed by Inspire Medical Systems. It was approved by the FDA in 2014 and has since helped over 200,000 people worldwide. Unlike CPAP, which pushes air into your airway from the outside, UAS works from the inside - fixing the root cause of obstruction without any external equipment.

How Does the Inspire System Work?

The Inspire device has three tiny parts implanted during a single outpatient surgery:

• A small generator (about the size of a pacemaker) placed under the skin near your collarbone
• A sensing lead that detects your breathing pattern
• A stimulation lead that connects to the hypoglossal nerve, which moves your tongue

At night, you turn the device on with a small remote - just like turning on a TV. It waits for you to start inhaling, then delivers a mild electrical pulse to your tongue. This keeps your airway open without waking you up. In the morning, you turn it off. No masks. No hoses. No noise.

The device only activates during inhalation, so it doesn’t cause muscle fatigue. It’s also adjustable. Your doctor can fine-tune the strength of the stimulation during follow-up visits, just like adjusting CPAP pressure.

Who Is a Good Candidate?

This isn’t for everyone. You need to meet specific criteria:

• You’ve tried CPAP and couldn’t stick with it
• You have moderate to severe obstructive sleep apnea (AHI between 15 and 100 events per hour)
• Your BMI is under 35 (some centers accept up to 40)
• You don’t have complete blockage of your soft palate
• You’re at least 22 years old
• Your sleep study was done within the last two years

A key step before surgery is a sleep endoscopy - a procedure where doctors watch your airway collapse while you’re asleep under light sedation. This helps them confirm that your tongue is the main problem. If your airway collapse is mostly from your soft palate or throat walls, UAS may not help.

How Effective Is It?

The data is strong. In the STAR clinical trial, patients saw their apnea events drop from an average of 29 per hour to just 9 - a 68% reduction. Two-thirds of users had their AHI cut in half or more, and most stayed below the dangerous threshold of 20 events per hour.

Long-term results are just as good. Five years after implant, patients still show 70%+ reduction in apnea events. Daytime sleepiness improves, energy levels rise, and blood pressure often drops. One study found 85% of bed partners reported no snoring or only soft snoring after four years.

Compared to CPAP, adherence is dramatically better. While CPAP users average less than 4 hours a night, Inspire users typically use it over 7 hours - because they actually want to wear it.

What’s the Surgery Like?

The procedure takes 2 to 3 hours and is done under general anesthesia. You’ll have three small incisions:

• One under your chin to access the nerve
• One near your collarbone to place the generator
• One lower on your neck for the breathing sensor

Most people go home the same day. Recovery is quick - most return to light activities in 5 to 7 days. Pain is usually mild and controlled with over-the-counter meds. You won’t feel the device when you’re awake. It only activates when you’re sleeping.

What Are the Risks?

Complications are rare. Over 99% of patients have no major issues. The most common side effects are temporary:

• Minor tongue weakness (5% of patients, usually fades in weeks)
• Small infections at the incision sites (about 2%)
• Discomfort from the stimulation at first - takes 2 to 3 weeks to adjust

Unlike surgeries that remove tissue (like UPPP), UAS is reversible. If you decide to remove it later, the device can be taken out with minimal damage to your anatomy.

How Does It Compare to Other Treatments?

Comparison of Sleep Apnea Treatments

Treatment	Effectiveness	Adherence	Invasiveness	Adjustable?	Reversible?
CPAP	High (if used)	Low (29-46% abandon)	Non-invasive	Yes	Yes
Oral Appliances	Moderate (mild to moderate OSA)	Moderate	Non-invasive	Yes	Yes
UPPP Surgery	Moderate to low	High (permanent)	High	No	No
Upper Airway Stimulation	High	Very High	Moderate (implant)	Yes	Yes

UAS sits between oral appliances and major surgery in the treatment ladder. It’s more effective than mouthpieces for moderate to severe cases, and far less destructive than cutting or removing tissue.

Cost and Insurance

The total cost - including surgery, device, and follow-ups - averages $35,000 to $40,000. That sounds steep, but it’s comparable to 10 years of CPAP equipment, masks, repairs, and clinic visits. More importantly, insurance covers it for most people.

In 2026, 95% of Medicare patients and 85% of commercial insurers cover Inspire therapy. You’ll still need to meet pre-approval steps: failed CPAP trial, sleep study, and endoscopy. Your doctor’s office usually handles the insurance paperwork.

Real-Life Experiences

One man in Melbourne, 58, had severe sleep apnea for 15 years. He tried 7 different CPAP masks. None worked. After Inspire surgery, he says, “I sleep through the night for the first time since I was 30. My wife doesn’t need earplugs anymore. I don’t feel like a zombie during the day.”

Another user on a patient forum wrote: “I forgot to turn it on once. I woke up gasping. That’s when I realized - I didn’t just get better sleep. I got my life back.”

Some admit it’s not perfect. “I still have to remember to turn it on,” says one user. “But that’s easier than wrestling with a mask every night.”

What’s Next for This Therapy?

The FDA expanded eligibility in 2023 to include patients with BMI up to 40 and AHI up to 100 - meaning more people qualify now. Researchers are testing AI tools to predict who will respond best based on airway scans. Newer versions of the device are being developed with smaller batteries and longer life.

As awareness grows and more doctors become trained in implantation, access is improving. The global market for UAS is expected to grow nearly 15% each year through 2028.

Is It Right for You?

If you’ve given up on CPAP and still feel exhausted, snore loudly, or have high blood pressure linked to sleep apnea, UAS might be your best shot at real relief. It’s not a cure, but it’s a long-term solution that works with your body - not against it.

Talk to a sleep specialist who’s experienced with UAS. Ask for a sleep endoscopy. Ask about insurance. Ask what your chances are of success. This isn’t a quick fix - it’s a life-changing step for the right person.

For many, it’s the first time in years they’ve woken up feeling like themselves.