Hate CPAP? Here are alternative medical treatments that might be covered by your health insurance.
Nearly 5 years ago surgical implants were approved by the United States of America Food and Drug Administration (FDA) for treatment of obstructive sleep apnea. Implantable therapy is an option for patients who cannot tolerate positive airway pressure therapy: CPAP, BPAP and APAP machines. It is also an option for people who do not benefit from or meet the requirements for an oral appliance, patients who do not like the constant drooling associated with oral appliances and patients with severe sleep apnea who are not eligible for an oral appliance.
Surgically implanted devices for treating OSA work by neurostimulation and are called “implantable neurostimulation devices”. Neurostimulation devices for OSA are similar to cardiac pacemakers except instead of stimulating the heart, the device stimulates muscles in the upper airway. When the device senses a reduction in breathing, a mild stimulation is sent to muscles of the upper airway. The stimulation causes muscle contraction and this opens the airway.
Implantable neurostimulation devices for treatment of obstructive sleep apnea are recommended when the patient has moderate to severe obstructive sleep apnea. The severity of obstructive sleep apnea is defined by the number of apneas and hypopneas occurring per hour of sleep. An apnea occurs when the airway is completely blocked. A hypopnea is a shallow breath that is associated with a reduction in blood oxygen level or an arousal from sleep. Moderate sleep apnea is defined by an AHI of 15-30. Severe obstructive sleep apnea is present when the AHI is greater than 30.
There are currently two types of devices: the Inspire and the THN
The Inspire was the first implantable device on the USA market. The Inspire was introduced to the United States in 2014. The device was updated in 2018.
The Inspire is a small medical device that is fully implantable. It consists of three parts:
1. small generator
2. sensing lead
3. stimulation lead
The Inspire is turned on and off by a small hand held remote control. The sensing lead monitors breathing. The stimulation lead sends a mild pulse to the muscles of the upper airway causing the muscles to contract and create more space for easier breathing.
There is a large and growing body of evidence supporting the medical benefit of implantable devices. January 2018, Aetna, a large health insurance company with offices in the United State of America, became one of the first medical providers to include Inspire therapy as a covered benefit. In 2019, “ Medical experts at Blue Cross of Idaho, a not-for profit mutual insurance company in the USA, found sufficient evidence to determine that Inspire therapy provides meaningful improvement in health outcomes”. 
THN Sleep Therapy is another implantable device used to treat obstructive sleep apnea. The THN system consists of an implanted rechargeable battery operated computer that is capable of generating mild stimulation. The stimulation is carried to the nerve in the tongue. When the tongue is stimulated, the tongue contracts and moves forward. This creates space behind the tongue and opens the airway. The THN is controlled by a small handheld remote that allows the patient to start and stop the device.
Implantable neurostimulators provide additional options for treatment of OSA. The devices are especially useful for patients unable to tolerate CPAP or Oral Appliances (OA). The devices provide freedom to sleep without masks or mouth pieces.
Medical Requirements for Inspire or THN
The Cleveland Clinic limits neurostimulators to patients meeting the following criteria:
AHI of 15-65,
At least 22 years of age
A body to height ratio (BMI) of less than 32.
Inability to tolerate CPAP, BPAP or APAP
 Sleep Review The Journal for Sleep Specialist, January 15, 2019