Two FDA-approved hypoglossal nerve stimulators. One goal: helping you sleep and breathe better — without CPAP.
Both Inspire and Genio treat obstructive sleep apnea by gently stimulating the hypoglossal nerve — the nerve that controls your tongue. During sleep, mild electrical impulses keep your airway open so you can breathe naturally, without a mask or machine. Dr. Nord is one of the few surgeons who implants both devices and can help determine which option is the best fit for you.
Breath-synchronized, unilateral stimulation
Inspire is a fully implanted two-part system placed in the chest and neck. A small generator (similar to a pacemaker) delivers stimulation to one side of the hypoglossal nerve in sync with your natural breathing pattern throughout the night. You control the device with a small handheld remote — simply turn it on at bedtime and off when you wake up.
New to Inspire? A surgeon’s guide to the Inspire implant for sleep apnea →
Battery-free implant, bilateral stimulation
Genio uses a small, battery-free stimulator implanted under the chin through a single incision. Each night, you attach a lightweight external activation chip under your chin that powers the implant wirelessly and delivers stimulation to both sides of the hypoglossal nerve using a timed on-and-off pattern. You manage settings through a smartphone app.
Key differences at a glance
| Feature | Inspire | Genio |
|---|---|---|
| FDA Approved | Yes — 2014 | Yes — 2025 |
| How It Stimulates | Unilateral (one side of the nerve) | Bilateral (both sides of the nerve) |
| Implanted Components | 2 parts: pulse generator and stimulation lead | 1 part: small stimulator chip under the chin |
| Incisions | 2 incisions (neck + chest) | 1 incision (under the chin) |
| Implant Battery | Internal battery (~11 years), then outpatient replacement | No implant battery — powered externally each night |
| Daily Use | Turn on with a handheld remote at bedtime | Attach external activation chip + disposable patch nightly; manage via smartphone app |
| Stimulation Pattern | Stimulation is synchronized with your breathing via a built-in sensor, delivering therapy when you inhale | Duty-cycle algorithm delivers stimulation in a timed on-and-off pattern; no internal sensor needed |
| MRI Compatibility | Conditional — Inspire IV & V allow full-body MRI at 1.5T and 3T (Feb 2026 labeling) under scan conditions; the oldest model (3024) is not MRI compatible | Full-body MRI conditional at both 1.5T and 3T |
| Eligible BMI | Up to 40 in FDA labeling (insurers commonly cap at 32–40; Medicare requires under 35) | Up to 32 — FDA labeling states safety and effectiveness above BMI 32 are not established |
| AHI Range | 15–100 | 15–65 |
| DISE Required? | Yes — must rule out complete concentric collapse (CCC) | Yes in the U.S. — used to confirm you don’t have complete concentric collapse (CCC); in Europe, Genio is also approved for CCC |
| Typical Procedure Time | ~40–80 min | ~45–90 min |
| Clinical Evidence | 10+ years of data; STAR trial, ADHERE registry (5,000+ patients); 350+ peer-reviewed publications | DREAM study (115 patients); FDA premarket approval (PMA) August 2025; growing evidence base |
| Insurance Coverage | Widely covered by most major insurers and Medicare | Coverage growing; check with your insurer |
Both devices require a prior trial of CPAP therapy. What does it mean to fail CPAP? Your surgeon will evaluate which option — or whether either option — is right for you based on your anatomy and medical history.
Sleep study, DISE procedure to evaluate airway anatomy, insurance authorization.
Outpatient surgery under general anesthesia. Two small incisions: one below the jaw and one on the chest for the pulse generator. Typically 40–80 minutes.
Most patients go home the same day. Soreness and swelling for 1–2 weeks. Avoid strenuous activity for ~3 weeks. Pain is typically mild and managed with over-the-counter medication.
Device is activated approximately 1 month after surgery. Settings are fine-tuned over subsequent visits and an in-lab titration sleep study.
Sleep study, consultation, and insurance authorization. DISE may or may not be required depending on your surgeon's evaluation.
Outpatient surgery under general anesthesia. A single small incision under the chin. The battery-free stimulator is secured near the hypoglossal nerve. No chest incision, no leads, no tunneling. Typically 45–90 minutes.
Most patients go home the same day. Swelling under the chin for 1–2 weeks. Avoid strenuous activity for ~2 weeks. The single incision is discreetly hidden in the chin fold.
Device is activated approximately 2 months after surgery. Stimulation settings are adjusted at follow-up visits, and patients can fine-tune comfort levels at home through the smartphone app.
Every patient's anatomy and needs are different. Dr. Nord will work with you to determine whether Inspire, Genio, or another approach is the best path to better sleep.
Meet Dr. NordThis page is for educational purposes only and does not constitute medical advice. Individual results may vary. Clinical data referenced from published peer-reviewed studies including the Inspire STAR Trial, ADHERE Registry, and Nyxoah DREAM Study. Both Inspire and Genio are FDA-approved devices for the treatment of moderate to severe obstructive sleep apnea in patients who meet specific eligibility criteria. Always consult with your physician to determine the best treatment option for your individual needs.
Both devices are FDA-approved for adults with moderate-to-severe obstructive sleep apnea who cannot tolerate CPAP. Inspire therapy was validated in the STAR trial, published in the New England Journal of Medicine in 2014, with benefit sustained at five years of follow-up. Genio was validated in the BETTER SLEEP trial, published in the European Respiratory Journal in 2020. Eligibility — including apnea-hypopnea index range and body mass index limits — is defined by each device's FDA-approved indications.
At 12 months, participants saw a 68% reduction in apnea-hypopnea index and a 70% reduction in oxygen desaturation events, with improvements in daytime sleepiness and quality of life.
Strollo PJ Jr, Soose RJ, Maurer JT, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139–149. Read the study on NEJM →Bilateral hypoglossal nerve stimulation produced a median 47% reduction in apnea-hypopnea index at six months, with improvements in oxygenation and sleep-related quality of life.
Eastwood PR, Barnes M, MacKay SG, et al. Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea. Eur Respir J. 2020;55(1):1901320. Read the study in ERJ →Improvements in AHI, oxygenation, and daytime sleepiness were maintained at five years, with durable patient satisfaction and quality-of-life gains in the STAR cohort.
Woodson BT, Strohl KP, Soose RJ, et al. Upper airway stimulation for obstructive sleep apnea: 5-year outcomes. Otolaryngol Head Neck Surg. 2018;159(1):194–202. Read the abstract on PubMed →Each device's AHI range, BMI limits, and anatomic requirements are defined in its FDA approval. These are the authoritative criteria U.S. surgeons use to determine who is a candidate.
Citations are provided for educational reference. This page summarizes published evidence and is not a substitute for a clinical evaluation — candidacy decisions should be made with a qualified sleep surgeon.
