Alternatives to CPAP
Inspire Hypoglossal Nerve Stimulation: Who Qualifies
Inspire is an implanted device that stimulates the hypoglossal nerve during sleep to move the tongue forward and keep the airway open. It is indicated for adults with moderate to severe obstructive sleep apnea (AHI 15 to 100) who cannot use or get consistent benefit from CPAP, and certain teens with Down syndrome, with contraindications including a high share of central apneas and complete concentric collapse at the soft palate.
How it works
Inspire is surgically implanted. A small generator sits under the skin of the upper chest with a lead to the hypoglossal nerve, which controls tongue movement, and a breathing sensor. You turn it on at bedtime with a remote, and it stimulates the nerve in time with your breathing so the tongue does not fall back and block the airway.
It treats obstructive sleep apnea only. It does not treat central sleep apnea.
Who it is for
According to Inspire's labeling, it is indicated for adults 22 and older (and ages 18 to 21 under additional criteria) with moderate to severe obstructive sleep apnea, AHI 15 to 100, who are unable to use CPAP or do not get consistent benefit from it. PAP failure is defined as an inability to eliminate OSA (AHI greater than 15 despite PAP use).
For pediatric patients with Down syndrome, it is indicated for ages 13 to 18 with severe OSA (AHI 10 to 50) who cannot effectively use PAP and are not effectively treated by adenotonsillectomy. In an approval dated June 8, 2023, the FDA raised the upper AHI limit from 65 to 100 and the upper recommended BMI from 32 to 40.
Who it is not for
Contraindications in Inspire's labeling include central plus mixed apneas making up more than 25% of the total AHI, complete concentric collapse of the soft palate, conditions that have compromised neurological control of the upper airway, inability to operate the remote without help, pregnancy or plans to become pregnant, and implanted devices that may interact with the system.
Inspire says safety and effectiveness for BMI over 40 are unknown. MRI compatibility depends on model: the 3024 cannot undergo MRI, while the 3028 and 3150 can under certain conditions.
The evaluation process
Candidates usually need a recent sleep study, documentation of CPAP failure or intolerance, and an airway evaluation by an ENT surgeon, which commonly includes an exam of the airway during sedated sleep to look for complete concentric collapse.
Insurance criteria are often stricter than the FDA label, particularly on BMI and documented CPAP trials. Ask your insurer for its written policy.
Questions to ask a surgeon
How many of these procedures have you done? What are the risks for me? What happens if it does not lower my AHI enough? Which model would I receive and what does it mean for future MRIs? How is the device adjusted after implant?
Ask your sleep clinician whether a different mask, settings review or other therapy should be tried first.
Frequently asked questions
Who qualifies for Inspire?
Per its labeling: adults with moderate to severe obstructive sleep apnea (AHI 15 to 100) who cannot use or do not benefit consistently from CPAP, without contraindications such as more than 25% central or mixed apneas or complete concentric collapse at the soft palate. Teens 13 to 18 with Down syndrome and severe OSA have a separate indication.
Is there a BMI limit for Inspire?
The labeling says safety and effectiveness for BMI over 40 are unknown. Many insurers set their own, often lower, BMI cutoffs.
Can I have an MRI with Inspire?
It depends on the model. Inspire says Model 3024 cannot undergo MRI, while Models 3028 and 3150 can under certain conditions.
Does Inspire replace CPAP?
For people who qualify, it is used instead of CPAP. Your sleep clinician will check how well it works with a follow-up study.
Sources
Last reviewed October 11, 2026. How we research · Report an error