If Inspire doesn’t work, doctors typically recommend returning to other treatment options like CPAP, oral appliances, or additional surgery. The device is usually left in place to avoid nerve damage during removal. Finding out why it’s not working—whether due to improper settings, airway anatomy, or other sleep disorders—is key. 

To improve results, try adjustments, follow-up sleep studies, or combination therapies. Exhaust all troubleshooting steps first. Inspire therapy takes time to work. Many patients need months of fine-tuning before seeing full benefits.

What Can People Do if They’re Not a Good Candidate?

Doctors recommend Inspire therapy only for those with moderate to severe obstructive sleep apnea (OSA). Candidates must also show they can’t tolerate CPAP.

Consider Bi-Level PAP If CPAP Feels Uncomfortable

CPAP remains the most effective treatment for obstructive sleep apnea (OSA), reducing apnea episodes by over 70%. However, some struggle with CPAP due to pressure discomfort. Newer models offer auto-adjusting airflow, quieter operation, and improved comfort settings. 

If CPAP still feels challenging, Bi-Level PAP therapy may be a better option. It delivers different pressures for inhalation and exhalation, making breathing feel more natural. Many who find CPAP intolerable adjust well to Bi-Level PAP. Different masks, humidifiers, and pressure settings improve comfort. These options make therapy easier.

Consider an Oral Appliance

For mild to moderate OSA, a custom-fitted oral device may help. Mandibular advancement devices (MADs) move the jaw forward to keep the airway open. Tongue-retaining devices (TRDs) prevent the tongue from blocking airflow. Research shows oral appliances can reduce apnea severity by 50% in certain cases.

Look Into Surgery

Surgery may help in some cases. Uvulopalatopharyngoplasty (UPPP) removes extra tissue from the throat. Maxillomandibular advancement (MMA) moves the jaw forward and can cut apnea episodes by 83% for some patients. Genioglossus advancement (GA) repositions the tongue muscle to prevent airway collapse. A sleep specialist can determine if surgery is a good option.

Managing Weight to Reduce Sleep Apnea Severity

Excess weight is a major risk factor for obstructive sleep apnea (OSA). Losing 10-15% of body weight can reduce apnea severity by up to 50%. Now, the FDA-approved medication Zepbound offers a new option for adults with obesity and moderate to severe OSA. 

Used alongside a reduced-calorie diet and exercise, Zepbound works by regulating appetite, leading to weight loss and improved breathing during sleep. Clinical trials showed significant reductions in apnea events after 52 weeks of treatment. For those struggling with weight management, Zepbound could be a game-changer in improving sleep and overall health. Consult a healthcare provider.

Try Positional Therapy

Sleeping on the back can make apnea worse for some people. Special pillows, positional belts, and vibration alarms help encourage side sleeping. Training the body to stay in a better position can keep the airway open.

Combine Treatments for Better Results

For some, a mix of treatments works best. Oral appliances, weight loss, CPAP at lower pressures, or surgery can be combined for better airway support. A sleep specialist can help determine the right approach based on individual needs.

What Should Someone Do if They Get the Implant but It Still Doesn’t Work for Them?

Inspire therapy doesn’t guarantee immediate success. Adjustments and troubleshooting are often needed to improve effectiveness. Here’s what to do if Inspire isn’t providing the expected results.

1. Give It Time

  • The adaptation process can take months. The body needs time to adjust to the nerve stimulation.
  • Regular follow-ups help ensure progress and identify any issues.

2. Optimize Device Settings

  • The Inspire system uses three electrical contacts on the hypoglossal nerve to stimulate tongue movement.
  • Programming adjustments may be necessary to modify the electrical field and improve tongue positioning.
  • Some patients undergo an awake endoscopy to analyze how stimulation affects the airway.

3. Sleep Study with Inspire Activated

  • A follow-up sleep study can determine if adjustments are needed.
  • Doctors assess AHI levels, oxygen saturation, and arousal patterns to refine treatment.

4. Address Residual Airway Obstructions

  • Inspire works best when tongue collapse is the primary issue.
  • Additional treatments may be necessary if nasal congestion, enlarged tonsils, or soft palate obstruction contribute to apnea.
  • Some patients undergo soft palate surgery to improve Inspire’s effectiveness.

5. Consider Combination Therapy

  • Inspire + CPAP or an oral appliance can provide better results for some patients.
  • Lifestyle changes, including weight loss, positional therapy, and avoiding alcohol/sedatives, can enhance success.

6. Evaluate for Device Revision or Additional Surgery

  • In extremely rare cases, repositioning the stimulation lead can optimize function.
  • Additional airway surgery may be recommended to complement Inspire if there are airway collapse patterns noted during the drug-induced sleep endoscopy that may impact overall success of Inspire therapy.

7. Understand When Removal May Be Necessary

  • Inspire removal is very rare but may be considered if severe discomfort, persistent ineffectiveness, or complications arise.
  • Doctors may leave the device implanted to avoid nerve damage, even if patients switch to another treatment.

If Inspire isn’t working, don’t give up. Consulting a board-certified sleep specialist is the best way to reassess treatment options and find a solution that works.

Is There Any Way to Prevent Inspire Therapy From Failing?

Inspire therapy is most effective when patients are carefully selected and the device is adjusted correctly. Regular follow-ups help fine-tune settings and improve results. Other treatments, like weight management or positional therapy, can improve Inspire’s work. 

1. Patient Selection Matters

    • Moderate to severe OSA (AHI 15-100) – Inspire is FDA-approved for this range.
    • CPAP intolerance must be documented – Inspire is only recommended for those unable to use CPAP.
    • BMI should be 40 or lower – Higher BMI can reduce effectiveness.
    • No severe anatomical obstructions – The device is ineffective if soft palate collapse or nasal obstruction is the primary issue.
    • No significant central sleep apnea (CSA) – Inspire works on obstructive apnea, not neurological breathing issues.
  • No chronic insomnia – individuals with a history of chronic insomnia do not respond well to Inspire therapy and have a high rate of “treatment failure”.

Patients meeting these criteria have a higher likelihood of success. Those outside these parameters may not respond well.

2. Optimize Device Settings

  • Inspire therapy requires customized stimulation settings to work effectively.
  • Titration sessions help fine-tune the device based on individual anatomy.
  • Some patients need awake or sedated adjustments to ensure the tongue moves properly.
  • A follow-up sleep study with Inspire activated can reveal whether adjustments are needed.

3. Staying on Track with Follow-Ups

  • Inspire therapy takes time to work. Many people need weeks or months of adjustments before seeing full results.
  • Regular check-ups with a sleep doctor help fine-tune the device. Adjustments may be needed to improve effectiveness.
  • Keeping track of symptoms, sleep quality, and apnea levels can help doctors make the right changes.

4. Complementary Treatments Can Improve Success

  • Weight loss: Losing 10-15% of body weight can enhance Inspire’s effectiveness.
  • Positional therapy: If apnea worsens when sleeping on the back, positional devices may help.
  • Surgery: Soft palate or nasal procedures may be needed alongside Inspire to maximize airway patency.

When Should Someone Consider Removing Inspire®?

Most doctors keep the device in place to avoid nerve damage even if it’s not working. Removal is rare but may be needed in some cases. A sleep specialist can determine if it’s the right decision.

Some patients still struggle with sleep apnea even after multiple adjustments and follow-ups. Doctors may consider removal if the device isn’t helping. Airway blockages that Inspire can’t fix might make it ineffective. Severe side effects, though rare, can also be a concern. Nerve irritation, muscle pain, or strong stimulation may cause discomfort. Some people have trouble swallowing or speaking if the settings aren’t right.

Post-surgical infections or device failure can sometimes make removal necessary. Doctors may suggest surgical correction if an Inspire device shifts or stops working. In severe cases, complete removal might be the best option. Some patients prefer to switch to CPAP, oral appliances, or other treatments. 

Doctors try every possible fix before considering removal. If Inspire isn’t helping, a sleep specialist should explore other treatments first. Finding the best option requires a careful evaluation of what’s working and what’s not.

The Insomnia and Sleep Institute of Arizona: Your Trusted Experts in Sleep Medicine

The Insomnia and Sleep Institute of Arizona provides expert care for sleep apnea, including Inspire therapy. Dr. Patel and our specialists focus on finding the most effective treatment for each patient. Every plan aims to improve the quality of sleep (deeper and restorative) and overall health.

Why Choose Our Team?

  • Highly experienced sleep specialists with deep knowledge of Inspire therapy
  • Advanced diagnostics to determine the most effective treatment approach
  • Thorough airway evaluations to see if Inspire therapy is a good match
  • Multiple treatment options, including CPAP, oral appliances, and surgical referrals

Our team is here to help. Schedule a consultation today. Better sleep leads to better health.

Visit our specialists in Scottsdale, Gilbert, and Phoenix.

 

Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.