Inspire is implanted during an outpatient surgery that typically takes about two to three hours under general anesthesia. The procedure involves three small incisions to place three components: a breathing sensor between the ribs, a pulse generator in the upper chest, and a stimulation cuff around a specific nerve in the neck that controls tongue movement. The device stays off for about a month after surgery while your body heals, then gets activated and fine-tuned over the following weeks.
Who Qualifies for the Implant
Before the surgical procedure itself, candidates go through a screening process. The FDA has approved Inspire for adults 22 and older with moderate to severe obstructive sleep apnea, defined as an apnea-hypopnea index (AHI) between 15 and 100. Your BMI needs to be 40 or below. These thresholds were expanded in recent years from earlier, narrower limits.
One critical screening step is a procedure called drug-induced sleep endoscopy, or DISE. While you’re sedated, a doctor passes a small camera through your nose to watch how your airway collapses during sleep. Front-to-back collapse patterns at various levels of the airway are compatible with Inspire. However, complete concentric collapse, where the airway closes in a circular pattern like a drawstring, is a contraindication. Research has consistently shown that this collapse pattern predicts poor outcomes with the device.
The Three Incisions and Components
The surgery uses three separate incision sites, each serving a distinct purpose.
The first incision is made under the chin, on one side of the neck. Through this opening, the surgeon identifies the hypoglossal nerve, which controls tongue movement. This is the most delicate part of the procedure. The surgeon needs to isolate the specific nerve branches that push the tongue forward (protrusion) while avoiding branches that pull the tongue backward (retraction). A small blood vessel that runs along the nerve typically sits right at the point where these functional branches divide, giving the surgeon a reliable anatomical landmark. A stimulation cuff is then wrapped around the correct branches and secured with sutures.
The second incision is in the upper chest, below the collarbone. This is where the pulse generator, roughly the size of a hockey puck, gets implanted beneath the skin. Think of it as the brain of the system. It contains the battery and the electronics that control when and how strongly the nerve gets stimulated.
The third incision is along the side of the chest, between two ribs. Here, the surgeon places a breathing sensor that detects the natural rhythm of your breathing. This sensor tells the pulse generator when you’re inhaling so the device can time its stimulation to match each breath.
Thin wires (leads) run beneath the skin to connect all three components. The tunneling of these leads between incision sites is done subcutaneously, meaning just under the skin, without additional cuts.
How the Device Works Once Placed
During sleep, the breathing sensor picks up the slight pressure change each time you inhale. It sends that signal to the pulse generator, which then delivers a mild electrical pulse through the stimulation cuff to the hypoglossal nerve. This causes the tongue muscles to stiffen and move slightly forward, opening the airway just enough to prevent the collapse that causes apnea events.
The precision of which nerve branches get the cuff matters enormously. The branches that protrude the tongue (the genioglossus and the intrinsic tongue muscles that stiffen it) need to be included. The branches that retract the tongue, like those controlling the hyoglossus and styloglossus muscles, must be excluded. Stimulating the wrong branches would actually make the obstruction worse.
Recovery After Surgery
Most people go home the same day. Soreness at the incision sites is normal, particularly in the neck and chest. For the first week, you should avoid strenuous activity and heavy lifting. For the first month, your doctor will ask you not to raise the arm on the implant side above shoulder level. This protects the leads from shifting before scar tissue anchors them in place.
The device stays completely off during this initial healing period. The FDA’s implant manual recommends keeping therapy deactivated for the first month to allow the stimulation lead to settle and become encapsulated by tissue.
Activation and Calibration
About four weeks after surgery, you’ll return to your doctor’s office for activation. The device gets turned on and set to initial stimulation levels using an external programmer. You’ll also receive a small handheld remote that lets you turn the device on at bedtime and off in the morning, and adjust the stimulation intensity within a preset range.
Fine-tuning takes additional time. Between four and eight weeks after activation, you’ll need at least one overnight sleep study where technicians adjust stimulation settings while monitoring your breathing. The goal is finding the lowest effective stimulation level that keeps your airway open without causing discomfort. Some people need more than one titration study to dial in the right settings. From implant to fully optimized therapy, expect a timeline of roughly two to three months.
Potential Complications
Like any implanted device, Inspire carries surgical risks. A review of the FDA’s adverse event database found that among reported complications, infection was the most common (about 34% of reported events), followed by temporary nerve weakness affecting tongue movement (about 15%), and blood or fluid collection at the surgical site (about 12%). These are percentages of reported adverse events, not of all patients who receive the implant, so they reflect the types of problems that occur rather than overall complication rates.
When complications did require a second surgery, the most common procedures were complete removal of the device (about 46% of reoperations) and repositioning or revising a lead (about 37%). Temporary tongue weakness usually resolves on its own as the nerve heals, but persistent issues can occasionally require intervention.
Battery Life and Replacement
The pulse generator runs on a non-rechargeable battery. Inspire’s manufacturer has cited an expected battery life of approximately 11 years, though actual longevity depends on your nightly usage hours and stimulation settings. When the battery eventually depletes, only the pulse generator needs to be replaced through a relatively minor procedure at the chest incision site. The breathing sensor and nerve cuff typically remain in place, which makes the replacement surgery shorter and simpler than the original implant.