Upper Airway Stimulation: An Implant Option for Sleep Apnea When CPAP Doesn’t Work

For millions of 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 your face, the hose tangles, the air pressure feels like choking, and the noise drives your partner crazy. If you’ve tried CPAP and walked away, you’re not alone. Nearly half of people stop using it within the first year. But there’s another option that doesn’t involve a mask, a hose, or nightly frustration: 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. It’s not a cure, but it keeps your airway open while you sleep without needing a mask. 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.

How does it work? While you sleep, the device senses when you inhale and sends a mild electrical pulse to the hypoglossal nerve. That nerve controls the muscles in your tongue. The pulse moves your tongue slightly forward, preventing it from collapsing backward and blocking your airway. It only activates during breathing - not all night - so there’s no constant stimulation or muscle fatigue.

How It’s Different from CPAP

CPAP works by blowing air through a mask to keep your throat open. It’s effective - but only if you wear it. Studies show 29% to 46% of people abandon CPAP within a year. The reasons? Discomfort, claustrophobia, dry mouth, skin sores, and noise. Many say it ruins their sleep more than the apnea itself.

Upper airway stimulation solves the compliance problem. Once implanted, you don’t need to wear anything on your face. You just flip a small remote control on before bed and off when you wake up. No masks. No hoses. No noise. Patients report higher satisfaction: 86% say it’s better than CPAP, and 80% would recommend it to someone else.

Who Is a Good Candidate?

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

• 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’ve tried and failed CPAP - meaning you used it less than 4 hours a night for at least 30 days
• You don’t have mostly central apneas (those caused by your brain not signaling your body to breathe)
• Your airway isn’t completely collapsed when sedated - confirmed by a special endoscopy test
• You’re at least 22 years old

If you’re overweight, have severe nasal blockages, or have a lot of central apneas, UAS probably won’t help. It’s designed for people with anatomical obstruction - a tongue or soft tissue that falls back during sleep.

The Procedure: What to Expect

The surgery is done as an outpatient procedure under general anesthesia. Three small incisions are made: one in the neck to access the nerve, one lower in the neck to place a sensor near the windpipe, and one below the collarbone to implant the battery-powered pulse generator.

The whole thing takes about 2 to 3 hours. Most people go home the same day. Recovery is quick: you’ll feel sore for a few days, but most return to normal activities within a week. There’s no overnight hospital stay.

Activation doesn’t happen right away. Your doctor waits about a month for healing. Then, during a short office visit, they turn on the device and adjust the stimulation level using a programming wand. You’ll get a remote control to turn it on and off each night.

How Effective Is It?

The data speaks for itself. In the landmark STAR trial, patients saw their apnea events drop from an average of 29 per hour to just 9 - a 68% reduction. Two-thirds of patients achieved at least a 50% improvement, and 80% ended up with an AHI under 20, which is considered mild or better.

Long-term results are just as strong. A five-year follow-up study showed patients maintained those improvements. Daytime sleepiness dropped significantly. People reported feeling more alert, focused, and energetic. Bed partners noticed a huge difference: 85% said snoring stopped or became very quiet.

Complications are rare. Over 99% of patients had no major issues. The most common side effects are temporary tongue weakness (5% of cases) or minor swelling at the incision sites. Infection happens in about 2% of cases - similar to other implant surgeries. The device can be removed if needed, making it reversible, unlike most other sleep apnea surgeries.

Cost and Insurance

The total cost - including surgery, device, and follow-up - ranges from $35,000 to $40,000. That sounds steep, but it’s comparable to the long-term cost of CPAP when you factor in masks, tubing, repairs, and replacement machines every 5 years.

Good news: insurance coverage has expanded dramatically. As of 2023, 95% of Medicare patients and 85% of privately insured patients have coverage for Inspire therapy. Most insurers require proof of CPAP failure before approving the implant. Your doctor’s office will usually handle the pre-authorization process.

Real Stories, Real Results

One patient in Manchester, who asked to remain anonymous, had used CPAP for six years. He wore it inconsistently and still woke up gasping. After getting the Inspire implant, he said: “I don’t remember the last time I woke up because I couldn’t breathe. My wife says I’m quiet now. I feel like I’m 10 years younger.”

Another user on a sleep forum wrote: “I used to dread bedtime. Now I turn on the remote, roll over, and sleep. No mask. No noise. No guilt. I wish I’d done this five years ago.”

Not everyone has a perfect experience. Some report a strange tingling sensation at first - like a mild electric buzz in the tongue. It usually fades after a few weeks. Others forget to turn it on. That’s why the remote is so important. If you skip a night, your apnea returns.

How It Compares to Other Surgeries

Traditional surgeries for sleep apnea - like removing tonsils, shrinking the soft palate, or repositioning the jaw - are more invasive, painful, and unpredictable. Many require long recovery times and don’t guarantee results. UAS avoids cutting or removing tissue. It works by gently moving structures into place, not destroying them.

Unlike jaw surgery, which can change your bite or facial appearance, UAS leaves your anatomy untouched. Unlike tongue reduction, it doesn’t risk permanent numbness or swallowing problems. It’s a targeted, reversible intervention that adapts to your breathing.

What’s Next for This Technology?

The FDA expanded eligibility in 2023 to include patients with higher BMI and more severe apnea. That means more people can now qualify. Researchers are working on smaller devices, longer battery life, and AI-powered systems that automatically adjust stimulation based on your sleep position or alcohol intake.

One study is testing whether machine learning can predict who will respond best to UAS by analyzing airway scans. That could make patient selection even more accurate. As more doctors get trained in the procedure, access is improving. The global market for this therapy is expected to grow over 14% per year through 2028.

Is It Worth It?

If you’ve given up on CPAP and still struggle with daytime fatigue, loud snoring, or high blood pressure linked to sleep apnea, upper airway stimulation offers real hope. It’s not a magic fix - it requires surgery, a habit change, and ongoing care. But for those who qualify, it’s the most effective alternative to CPAP we have today.

The benefits go beyond sleep. Better sleep means lower risk of stroke, heart disease, and diabetes. It improves mood, memory, and relationships. It can even help you stay alert while driving.

It’s not for everyone. But if you’ve tried everything else and still can’t breathe at night, this might be the answer you’ve been waiting for.