Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to sleep apnea.
Inspire is a company that sells a medical device for treating sleep apnea. The company suggests that their device is a more convenient alternative to continuous positive airway pressure (CPAP) machines, and that 91% of patients are satisfied with Inspire.
But is Inspire clinically proven to work, or are these just marketing claims? How does the device actually work in the body? Does Inspire cause side effects? And how does it compare to CPAP for sleep apnea relief based on medical studies?
In this article we'll answer all of these questions and more as we analyze clinical trials on Inspire to determine if the device is proven to treat sleep apnea or if it's a waste of money.
We'll document potential side effects of the device, compare its effectiveness with CPAP, and feature Inspire customer reviews. We'll also share information about the cost of the procedure for those with health insurance and those without.
Is Inspire Proven to Work?
Inspire has funded several clinical trials published in legitimate medical journals which tested the efficacy of their device.
A 2018 clinical trial tracked the results of the Inspire device in 126 patients over five years. The researchers found that the device caused improvements in sleep apnea metrics such as snoring and daytime sleepiness, and quality of life improved from 15% to 67% for Inspire patients.
This study was poorly designed in our opinion, because it wasn't placebo-controlled or even compared to other sleep apnea treatments like CPAP. It does suggest that the Inspire device is better than nothing, but the more clinically-relevant question is whether the Inspire device is superior or to CPAP, which is less invasive.
A clinical trial published in the European Respiratory Journal reported similar results to the previous trial. Patients using the Inspire device reported fewer sleep apnea events, lower daytime sleepiness scores, and improved quality of life.
The article’s footnotes detail that many of the study authors received grants, fees and paid travel expenses, among other forms of compensation, for their work on this trial. This adds bias and makes the data quality questionable in our opinion.
A clinical trial published in The Laryngoscope journal measured the effects of the Inspire device after 12 months of implantation, and the study authors concluded that "[Inspire] is a safe and effective treatment option for patients with [moderate-to-severe obstructive sleep apnea]."
Based on the available research, we consider Inspire likely to be effective for the treatment of sleep apnea.
But how does the device actually work? We'll review in the next section.
How Does Inspire Work?
The innovation of the Inspire device involves a technology called hypoglossal nerve stimulation therapy. An implanted medical device sends electrical signals that prevent the tongue from blocking the airway during sleep, which is a common cause of sleep apnea.
Because individuals aren’t consciously in control of their tongue during sleep, there is no way to naturally replicate this type of device.
Implementation of the device requires an outpatient surgery (meaning patients can leave after surgery and recover at home) where a doctor cuts small incisions into the patient's skin to insert the device.
One incision goes below the collarbone to implant the device. Another goes under the chin where the electrical stimulation is targeted. Inspire notes that some patients require an additional incision on their rib cage.
A YouTube video from the "University Hospitals" channel provides animations showing how Inspire treats sleep apnea:
Questionable Health Claims on Inspire Website
Inspire's homepage proclaims that “94% of Inspire patients say Inspire is better than CPAP & would recommend Inspire to others,” as shown in the screenshot above.
Their citation for this claim is a medical review on patients who used Inspire after a documented intolerance to CPAP.
We find this claim to be highly questionable and arguably unscientific, given that their citation is from a self-selected group of people who already had negative experiences with CPAP devices.
Inspire’s claim makes it seem as though both CPAP and Inspire were trialed by a group of neutral patients who hadn’t used either device, and the vast majority of them preferred the Inspire, which simply isn’t the case.
As shown below, Inspire also describes their device as "the only FDA approved obstructive sleep apnea treatment that works inside your body to treat the root cause of sleep apnea:"
However, a quick Google search revealed a brand called eXciteOSA that sells a sleep apnea device that requires no surgery and also works inside the body (by training the tongue).
Real People Try Inspire
A YouTube channel called "CPAP Reviews" interviewed an Inspire patient in an unsponsored video with over 10,000 views:
A TikTok creator named Alexander Gideon shared his experience using Inspire:
@alexandergideon75 Inspire Device Implant part 1. #inspiredevice #sleepapnea #veterans #vets #inspire #health ♬ original sound - Alexander Gideon
Inspire vs. CPAP
Because the CPAP is the most commonly-prescribed sleep apnea device, many consumers are curious about how the effectiveness of Inspire compares to the effectiveness of CPAP.
There don't appear to be any clinical trials directly comparing the two devices, but like Inspire, there are trials on the effectiveness of the CPAP.
A medical review published in the Journal of Sleep Research suggests that CPAP devices are more effective for severe sleep apnea than for mild-to-moderate sleep apnea.
There are also compliance issues. Because it can be frustrating to use a large face mask at night during sleep, many patients who are prescribed a CPAP don’t use it regularly.
A 2016 medical review on CPAP adherence found that over 1 in 3 patients don’t use the device regularly.
Because the causes of sleep apnea are so individualized, we strongly recommend that patients speak with their doctor to determine which device is best for them.
Inspire may be a better option for those suffering from mild sleep apnea than CPAP, but we can't say so definitively until a comparative study is done. We consider CPAP a better option for severe sleep apnea based on the current state of the research, and how many more clinical trials have been completed on CPAP devices than on Inspire.
Does Inspire Cause Side Effects?
The medical review published in the European Respiratory Journal cited previously reported on side effects caused by Inspire. Only 2% of Inspire patients experienced an adverse event during the implementation procedure.
After the operation and during normal use, 23% of patients experienced adverse events, with the most common being “stimulation-related discomfort.” None of the side effects were severe or life-threatening.
We consider this side effect profile to be similar to that experienced by CPAP patients. Around 30% of CPAP patients have been documented in a medical review to experience minor side effects such as a blocked nose, discomforting mask pressure and skin irritation.
There is no mention of side effects on Inspire's website at the time of updating this article, which we don't consider to be appropriate given that this device causes side effects according to a clinical trial.
We urge Inspire to publish this information on their website, at least in the FAQ section.
How Much Does Inspire Cost?
At the time of updating this article, Inspire fails to publish the cost of cost of treatment on the "Cost and Eligibility" page on their website.
The page claims that most major private insurers and Medicare cover Inspire.
According to CNET, patients with insurance may have to pay up to $1,400 out of pocket, while the total bill (that insurance subsidizes) may be up to $40,000 which is the price that uninsured patients may have to pay.
This would make Inspire more expensive than CPAP, although we wish the brand would publish this information themselves for clarity.
Pros and Cons of Inspire
Here are the pros and cons of Inspire in our opinion:
Pros:
- One-time cost
- Clinically shown to be effective
- May be a better option than CPAP for mild sleep apnea
- No severe side effects documented in clinical studies
- May be more comfortable than CPAP at night
Cons
- Requires surgery
- Questionable health claims on brand website
- Around 1 in 4 patients experiences side effects
- May be less effective than CPAP for severe sleep apnea
- Not tested directly against CPAP
- Study design/bias issues in clinical trials
