How I explain Inspire to my patients
Inspire is like a pacemaker for your breathing. It’s placed through two small incisions — one in your neck and one in your chest, both on the right side. Through the neck incision, we place a small stimulation cuff around the nerve that controls your tongue. We then tunnel a wire down to the chest, where it connects to the battery that powers the device.
The battery lasts about eleven years and never needs to be recharged. The surgery takes roughly an hour, and it’s outpatient — you go home the same day.
About a month later, once you’re fully healed, we activate the device in the office. You’re given a small remote and taught how to use it. At bedtime, you press a button to turn the device on. It pulses once to let you know it’s working, then delays about thirty minutes so you can fall asleep.
Once the therapy kicks in, Inspire senses your breathing with every breath and gently pulses your tongue forward to keep your airway open. In the trial that led to FDA approval, the typical patient’s apnea events dropped by about two-thirds — from roughly 29 an hour down to 9. That is a median, not a promise: some people do better, about a third don’t reach the trial’s definition of success, and a small number get no real benefit. I would rather you hear that from me now than find it out at your follow-up sleep study. You’ll come in about twice a year to have the device checked, and we’ll do a home sleep study three to four months after surgery to confirm everything is working well.
Watch: Inspire explained in ten minutes
If you would rather listen than read: a ten-minute overview of Inspire, in my own words.
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What’s actually being implanted?
The current generation of Inspire (Inspire V) has just two components, all hidden beneath the skin.
Why this generation matters — and what we do and don’t know
Every earlier Inspire had a third piece: a thin wire threaded between two ribs to sense your breathing. That wire is the reason a collapsed lung was ever on the risk list at all. In the FDA’s device-report database, the reported pneumothoraces, both cases of a wire migrating into the chest cavity, and the single case of lung penetration were all attributed to it. It was also behind four of the nine serious device problems that required another operation over five years in the pivotal trial.
Inspire V does not have that wire. The breathing sensor is built into the generator itself, so nothing is placed between the ribs.
Two things follow, and I want to be precise about both.
What has not changed is the part that does the work. The stimulation lead and the way the device moves your tongue are the same as the previous generation. This is not a new therapy — it is the same therapy with the breathing sensor moved inside the generator. In the data Inspire submitted to the FDA, that internal sensing performed as well as or better than the previous generation, and taking the wire out from between the ribs makes the operation safer. Nothing in my own practice, or in what I hear from other implanting surgeons, suggests otherwise.
What that means for the numbers on this page. The success and complication rates here come from the years of published experience with this therapy. They describe the same stimulation, the same nerve and the same operation, so they carry over — and where the wire was the cause, as with pneumothorax, Inspire V removes the cause rather than restating the risk.
And one thing that has not changed at all: Inspire V still needs a chest incision and a pocket for the generator. Infection, bleeding, the device shifting, tongue weakness and eventual battery replacement all carry over unchanged.
What does recovery look like?
Most patients are surprised by how manageable the recovery is. The device stays off during the entire healing period — there's no rush.
Surgery day
~1 hour, outpatient.
Go home same day.
Days 1–3
Most soreness.
OTC pain meds enough.
Weeks 1–2
Feeling significantly better; light activity.
Weeks 2–4
Resume normal activity.
Device stays OFF.
1 month
Device turned on.
Remote training.
Sleep study at 3–4 months confirms therapy is working
Am I a candidate?
Candidacy depends on your sleep study results, airway anatomy, and what your insurance requires. Use the criteria below as a starting point — then check the coverage guide to see how they apply to you.
Insurance criteria vary by plan — deductibles, BMI cutoffs, and CPAP-trial requirements can all change what you qualify for.
See if you might qualify →What the data shows
Inspire is one of the most studied surgical treatments for obstructive sleep apnea. The landmark STAR trial was published in the New England Journal of Medicine in 2014, with the same 126 patients followed out to five years.
AHI reduction
Apnea events per hour of sleep
Soft or no snoring
Bed-partner report at 5 years
Sleepiness score
Normalized daytime alertness (ESS)
Years followed
Longest follow-up of the trial that led to FDA approval
Apnea events per hour (AHI)
Bed partner snoring report
Bed-partner questionnaires from the patients still in follow-up at five years — not all 126 who were implanted.
Which five-year number to trust. At five years, 75% of patients still met the success definition — but that is 75% of the 71 people who volunteered for a fifth-year sleep study, out of the original 126. Counting everyone, including 5 who died and 3 who had the device removed, the responder rate was 63%. The volunteers were a better-than-average group to begin with: their 12-month response rate was 74% against 52% among those who did not volunteer. I quote 63%.
Why success rates for this device range from 46% to 91%
They are mostly the same therapy measured different ways. A titration sleep study hunts for the single best setting and scores your apnea during that window — in one study patients were only asleep at that ideal setting for about 50 minutes. A full-night study at one fixed setting scores what you actually get all night. In 61 patients measured both ways at the same center, the success rate was 80% on the titration study and 46% on the full-night home study. Same patients. Same devices.
Whenever anyone quotes you an Inspire success rate, ask which sleep study it came from. I judge results on the full-night study, and that is the number I will quote you. The full explanation, with my own results →
Source: STAR trial, New England Journal of Medicine 2014, with 5-year follow-up in Otolaryngology–Head and Neck Surgery 2018.
How Inspire compares to traditional sleep surgery
Inspire doesn’t change your anatomy — it works with your anatomy. Unlike traditional tissue-removing surgeries, the therapy is adjustable and reversible.
Cuts and restructures tissue
- Approach
- Removes / rearranges tissue
- Success Rate
- 44% at 3+ yrs
- Reversible?
- No — permanent changes
- Adjustable?
- No
- Side Effects
- Permanent swallowing, voice, and taste changes
- Readmission
- Higher complication rate
Works with your anatomy
- Approach
- Stimulates existing nerve
- Success Rate
- 66% at 1 yr
- Reversible?
- Yes — can be removed
- Adjustable?
- Yes — settings tuned over time
- Side Effects
- Temporary soreness, much lower complication rate
- Readmission
- Significantly lower
How to read those two numbers. Inspire’s 66% is the STAR trial’s 12-month responder rate under one specific definition — apnea events cut by at least half and brought under 20 an hour (83 of 126 patients). The UPPP figure beside it pools nine long-term studies whose average follow-up ran from about three to seven years; under the identical half-and-under-20 definition it is 46.5%. The two are also measured at different distances from surgery. Compared at the same early timepoint the two operations are much closer — UPPP’s short-term figure is 67%. The gap opens later, because palate surgery decays: across the studies with more than one follow-up, average apnea events climbed back from 13.8 to 22.6 an hour between the early and late measurements. I quote the long-term number because that is the one you will live with.
Neither figure is the whole story of how success gets measured. The Inspire success rate — what it actually measures →
Living with Inspire
Once you’re up and running, the nightly routine is simple. Press a button at bedtime. Turn it off in the morning. That’s it.
Hear from a patient
A Facebook Live conversation recorded by VCU Health in 2018: one of my Inspire patients on what living with the implant is actually like.
27 minutes. The player loads when you press play.
This page is for educational purposes only and does not constitute medical advice. Individual results may vary. Clinical data referenced from the Inspire STAR Trial (Strollo et al., N Engl J Med, 2014) and the ADHERE post-approval registry. Inspire is an FDA-approved device 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.