Sleep Apnea Implant

What is a sleep apnea implant?

A sleep apnea implant is a surgically implanted device that keeps your airway open as you sleep. It helps manage obstructive sleep apnea (OSA) symptoms.

Many people choose this procedure if using a continuous positive airway pressure (CPAP) machine isn’t a successful treatment option.

The only current commercially available, U.S. Food and Drug Administration (FDA)-approved implant is the Inspire® upper airway stimulation device. It’s also known as a hypoglossal nerve stimulation device.

How does the sleep apnea implant work?

The sleep apnea implant activates your hypoglossal nerve. This is the nerve that moves your tongue. If you have obstructive sleep apnea, your tongue may block your upper airway, preventing you from breathing. The sleep apnea device sends an electrical impulse to the nerve. This will move your tongue slightly forward. As a result, your airway stays open as you sleep.

There are four parts to a sleep apnea implant that work together:

• Stimulator device. This is the device that sends electrical impulses to the nerve that regulates your tongue’s movement.
• Stimulation electrode. This is the wire that connects to your nerve. It sends an electrical impulse to tell your tongue to move.
• Pressure sensor electrode. This sensor detects your breathing. It tells the device when to send an electrical impulse to your nerve.
• Remote. The remote turns the device in your body on and off. It can control the strength of impulses.

Who is eligible for a sleep apnea implant?

You may be a candidate for a sleep apnea implant if you:

• Are at least 18 years of age or older
• Have a BMI up to 35 to 40
• Have moderate to severe obstructive sleep apnea
• Aren’t able to use a CPAP machine to treat OSA

A healthcare provider is the best person to talk to if you’re interested in getting a sleep apnea implant. Don’t feel discouraged if you don’t meet one or more of the criteria. There’s a lot for your provider to consider before approving this device as a safe treatment option for you.

How should I prepare for a sleep apnea implant?

Before your provider approves sleep apnea implant surgery, they’ll run a test called a drug-induced sleep endoscopy (DISE) to make sure the device will properly work in your body. You’ll be asleep during the test. Your provider will use an endoscope, which is a device with a small camera on the end of it, to get a closer look at your upper airway, throat and tongue.

Your provider is looking for complete concentric collapse (CCC). This is an upper airway blockage when the sides of your throat and soft palate collapse. CCC may make the device not work.

Your provider will give you specific instructions to follow before the date of your procedure. This may include:

• Don’t eat food the night before the surgery.
• Take certain medications or make adjustments to your medications based on what your provider tells you to do.
• Stop or reduce smoking.

What happens during this procedure?

On the day of your procedure, you’ll receive general anesthesia from an anesthesiologist. This will make you sleep for the entire surgery so you won’t feel any pain.

Once in the operating room, your surgeon will:

1. Make a small cut (incision) in your upper neck, below your jaw and locate your hypoglossal nerve
2. Place a stimulator cuff around the nerve with a stitch to hold it in place, which attaches to a thin wire (stimulation lead electrode)
3. Make a second cut below your collarbone
4. Create a pocket under your skin for the stimulator device and stitch it in place
5. Place a sensor that detects your breathing (pressure sensor electrode) between the muscles in your ribs that attaches to a thin lead wire (this is done through a second incision)
6. Connect the stimulation lead and the pressure sensor lead wires to the device
7. Test the device to make sure it works properly
8. Close all cuts in your skin and cover them with bandages

Sleep apnea implant location

Your surgeon will place the stimulator device under the skin in your chest, below your collarbone. A very thin wire (pressure sensor electrode) that detects your breathing goes under your ribcage. The thin wire that provides an electrical impulse (stimulation lead electrode) connects to a cuff that wraps around your hypoglossal nerve. This is under your jaw.

How long does sleep apnea implant surgery take?

It takes approximately 90 minutes to place the implant in your body.

What happens after this procedure?

Sleep apnea implant surgery is usually an outpatient procedure. This means that you can go home the same day.

You’ll likely feel sore and slightly swollen after the procedure. Your provider will recommend over-the-counter pain relievers to help you manage this. Symptoms should go away within a couple of weeks as you heal.

Your provider won’t immediately turn on your sleep apnea implant after surgery. They’ll make sure the surgical sites heal as expected before starting treatment. This will take about one month.

Activating the sleep apnea implant

You’ll meet with your provider at their office for a follow-up visit after your surgery. During this visit, your provider will examine how well your surgical sites healed and let you know that they’re ready to turn on the device.

The sleep apnea implant works with a remote control — similar to what you’d use to change the channel on your television. Your provider will show you how the remote works. They’ll adjust the settings to stimulate the nerve that moves your tongue. You won’t feel any pain, but you’ll notice your tongue move slightly in your mouth. You can adjust these settings to your own comfort level and under your provider’s guidance.

You’ll use the device every night when you sleep and turn it off in the morning when you wake up.

Your provider will give you instructions on what settings to start using and when you should increase the signal strength. You’ll increase the strength slowly. It usually takes three months to reach the desired signal strength to meet your treatment needs.

When the device is adjusted to an appropriate level, your provider will schedule a sleep study to see how well the device is working. They may recommend changes to the signal strength after the sleep study.

What are the benefits of a sleep apnea implant?

The benefits of a sleep apnea implant include:

• It may reduce symptoms of obstructive sleep apnea.
• You don’t have to use a CPAP machine or wear a mask when you sleep.
• You don’t have to clean or maintain any sleep apnea oral appliances.
• It reduces your risk of health complications caused by OSA.

What are the side effects of a sleep apnea implant?

As with any type of surgery, a sleep apnea implant comes with possible risks, like:

• Bleeding
• Infection
• Pain
• Headache
• Nerve damage (abnormal tongue movements)
• Need for device repositioning surgery

Once the device is on, you may experience some side effects related to the stimulation, such as:

• Discomfort
• Dry mouth
• Tongue cut (abrasion)
• Device malfunction

Your provider may suggest changing the settings on your remote to make the stimulation more comfortable.

What is the recovery time for a sleep apnea implant?

You’ll need to rest after surgery for a few days. But you should be able to get back to your regular activities, as long as they aren’t too strenuous. This is usually within a couple of weeks. Your provider will let you know what activities are safe to do during your recovery.

After one month, your provider will show you how to turn on your sleep apnea device and use it. When adjusted appropriately, you’ll undergo a sleep study. Follow-up exams are very important if you get this device. Your care team wants to make sure it works well and it’s helping relieve symptoms of obstructive sleep apnea.

How long does a sleep apnea implant battery last?

The battery in the implanted device usually lasts around 10 years. A surgeon can replace these batteries by making a small cut (incision) in your skin. They don’t need to remove the entire implant to change the battery. Your provider will monitor battery levels at each follow-up visit.

You may need to change the batteries in your remote more often. You can change these on your own at home.

When should I call my healthcare provider?

Let your provider know if you experience severe pain or swelling at the surgical sites, in addition to a fever, after the procedure.

Talk to your provider if you’re having trouble adjusting to the device once you start using it. It may be uncomfortable, but it shouldn’t be painful. Your provider may have some helpful advice, or they’ll make adjustments to the settings so you can manage this.