A hypoglossal nerve stimulator is an implantable device that can help improve your breathing while you sleep. But getting one doesn’t come without risks.
The gold standard treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP).
An alternative to a CPAP machine is a sleep apnea implant, which involves a device that opens the upper airway by changing the placement of the 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 (HNS) 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 collarbone. 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 and 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.
Once the electrode receives those signals, it stimulates the hypoglossal nerve and 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
Upper airway stimulation has long been used to manage OSA, and research on the therapy has increased within the last decade.
The first long-term clinical trial was published in 2014. In the 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.
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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 (nightly use) to CPAP machines is only
Implanted devices are also effective. But compared to CPAP machines, they have a higher adherence rate. For example, in the long-term 2014 study, they 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
Generally, the procedure involves the following steps:
- You’re given general anesthesia, so you won’t feel anything during the surgery.
- Once you’re asleep, your surgeon makes an incision in your right upper neck and locates the hypoglossal nerve.
- Your surgeon places the stimulator cuff around the nerve. They test the cuff using an external nerve stimulator.
- Your surgeon makes another incision in your chest on the same side as the first incision. They implant the generator device in your chest.
- Your surgeon makes a third incision near your ribs. Here, they implant the breathing sensor.
- Your surgeon connects all three parts with wires. They perform an electrical test to make sure the device triggers the correct tongue movements.
- 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:
- swelling at the incision sites
- pain
- excessive bleeding
- infection
- reactions to the anesthesia
Having the device in your chest could also 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
The device’s battery will last about
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 healthcare 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. But you’re a good candidate if you have moderate to severe OSA by Apnea-Hypopnea Index (AHI) standards 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 or plan to become 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
A hypoglossal nerve stimulator is used to manage moderate to severe obstructive sleep apnea. It’s a device that stimulates your hypoglossal nerve, which moves your tongue forward, improving your breathing during sleep.
An implanted sleep apnea device is more comfortable and convenient to use than a CPAP machine. However, it’s more expensive, and 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.