Obstructive sleep apnea (OSA) is a disorder in which breathing frequently stops during sleep. It happens because your upper airway involuntarily becomes too narrow when you’re sleeping.

The gold standard treatment for OSA is continuous positive airway pressure (CPAP). It involves using a machine with a mask that’s worn over your mouth or nose. The mask is connected to a machine that delivers a continuous flow of pressurized air. The air forces open your airway, helping you breathe during sleep.

Over the years, CPAP machines have become less bulky and easier to sleep with. Still, many people find it uncomfortable or inconvenient to use. Some may also experience claustrophobia while wearing the mask.

An alternative to a CPAP machine is a sleep apnea implant. This involves a device that opens your upper airway by changing the placement of your tongue.

Read on to learn how sleep apnea implants work, along with the risks and costs of getting one.

A sleep apnea implant is a device that helps you breathe during sleep. It’s also called a hypoglossal nerve stimulator or upper airway stimulation device.

The device is implanted in your upper right chest beneath your skin. It has four main parts:

  • Generator. The generator is implanted under your collar bone. It has batteries and produces electrical signals.
  • Breathing sensor. The breathing sensor is implanted in the side of your chest near your ribs. It’s connected to the generator.
  • Stimulation electrode cuff. This component is placed around the hypoglossal nerve. It’s also connected to the generator.
  • Remote control. This is an external handheld component. You can use it to control the strength of stimulation.

When you breathe, the breathing sensor sends electrical signals to the generator. This triggers the generator to send signals to the stimulation electrode, which stimulates the hypoglossal nerve. This contracts your tongue muscles, moving your tongue slightly forward.

As a result, the airway becomes less narrow, which lets air flow through.

The remote control can be used to:

  • turn the device on and off
  • pause the stimulation
  • increase or decrease the level of stimulation
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Illustration by Maya Chastain

According to a 2015 scientific review, upper airway stimulation has been used to manage OSA for several decades. Research on the therapy has increased within the last decade.

The first long-term clinical trial was published in 2014. In the 2014 study, 126 people with OSA received an implanted upper airway stimulation device. The researchers examined the safety and effectiveness of the device over 12 months.

According to the trial results, the device significantly reduced the severity of OSA. This was determined using overnight sleep studies, self-reported sleepiness, and scales that measure the severity of sleep apnea.

A 2020 study involving 51 people with OSA also found that hypoglossal nerve stimulation improves OSA.

Additionally, a 2021 review notes that the therapy is effective for people who have severe OSA and can’t use CPAP machines. The review analyzed 31 studies in total.

Implanted sleep apnea devices and CPAP machines work in different ways.

An implanted device stimulates the hypoglossal nerve, which is connected to your tongue. It directly moves your tongue muscles, thus opening your airways.

In contrast, a CPAP machine uses a constant stream of pressurized air to open up your airways. It doesn’t directly stimulate your nerves or tongue muscles.

When used regularly, CPAP machines are highly effective. However, the adherence rate of CPAP machines is low; between 30 to 60 percent. The adherence rate refers to the nightly use of the CPAP machine.

The low adherence rate of CPAP machines can reduce its effectiveness.

Implanted devices are also effective. But compared to CPAP machines, it has a higher adherence rate. For example, in the long-term 2014 study, it had an 86 percent adherence rate.

The higher adherence rate of implanted devices may make them an effective option.

Implant surgery is an outpatient procedure, meaning it’s done in a hospital or clinic. It takes 90 to 180 minutes to complete.

Generally, the procedure involves the following steps:

  1. You’re given general anesthesia, so you won’t feel anything during the surgery.
  2. Once you’re asleep, your surgeon makes an incision in your right upper neck and locates the hypoglossal nerve.
  3. Your surgeon places the stimulator cuff around the nerve. They test the cuff using an external nerve stimulator.
  4. Your surgeon makes another incision in your chest on the same side as the first incision. They implant the generator device in your chest.
  5. Your surgeon makes a third incision near your ribs. Here, they implant the breathing sensor.
  6. Your surgeon connects all three parts with wires. They perform an electrical test to make sure the device triggers the correct tongue movements.
  7. Your surgeon closes the incisions using stitches.

Typically, you can go home the same day or the next morning.

The surgery, like all procedures, is associated with some risks:

Having the device in your chest could pose several risks:

  • blood vessel damage near the implant
  • nerve damage or injury
  • allergic reaction to the device materials
  • irritation
  • swelling
  • discomfort caused by nerve stimulation
  • changes in stimulation caused by loose device connections
  • tongue weakness
  • difficulty moving your tongue

Another possible drawback is the remote. If you misplace the remote, or if your children find it, it could be difficult to use the device properly. For some people, keeping track of the remote may be stressful.

According to a 2020 review article, the procedure costs about $30,000. Your health insurance provider may cover some or all of the costs.

With regular use, the battery of the device will last about 11 years. The implantation of the new battery will be an additional cost.

Depending on your health status or employment, you may qualify for financial aid through special programs. Ask your doctor or insurance provider if your state or health care facility offers these programs.

You can also ask your doctor if they accept payment plans. Although this won’t reduce the total cost, it might be easier to pay for the procedure over time.

A sleep apnea implant is not for everyone.

You’re a good candidate if you have moderate to severe OSA and you:

  • are unable or unwilling to use a CPAP machine
  • are older than 18 years old
  • do not have a blocked upper airway
  • have tried other OSA treatments without success
  • are unable to get your tonsils removed

You should avoid getting the surgery if you:

  • only have central sleep apnea
  • are pregnant
  • have an upper airway blockage
  • have a neurological condition that affects your upper airway
  • are unable to operate the remote
  • have an implanted device that might interact with the sleep apnea device
  • frequently get MRI scans

Hypoglossal nerve stimulation is used to manage moderate to severe obstructive sleep apnea. It involves a device that stimulates your hypoglossal nerve, which moves your tongue forward. This improves your breathing during sleep.

Compared to CPAP machines, an implanted sleep apnea device is more comfortable and convenient to use. However, it’s more expensive. Some people may also worry about losing the external remote.

Your doctor can determine if you’re a good candidate for the device. Generally, it’s used for people without an upper airway blockage and who are unable to use a CPAP machine.