Inspire® Implant vs CPAP for Sleep Apnea

Who qualifies, why it doesn’t work for everyone, how effective it is — and what it costs in South Africa

If you’ve been diagnosed with obstructive sleep apnea (OSA) and struggle with CPAP, you may have heard about the Inspire® implant — often called the “sleep apnea pacemaker.”

It sounds exciting. No mask. No hose. No airflow.

But is it right for everyone?

Let’s walk through this in simple, patient-friendly terms — and compare it honestly to CPAP therapy.

What Is the Inspire® Implant?

The Inspire Upper Airway Stimulation system is a small device surgically placed under the skin of your chest.

It works by:

• Monitoring your breathing while you sleep

• Gently stimulating the nerve that moves your tongue

• Moving the tongue slightly forward during inhalation

• Preventing the airway from collapsing

You switch it on at night with a small handheld remote.

👉 It does not shock you.👉 It delivers mild, timed stimulation linked to your breathing.

Does Inspire Interrupt Your Sleep?

This is one of the most common concerns.

Untreated sleep apnea repeatedly wakes your brain because the airway collapses. Inspire is designed to prevent the collapse before your brain has to “rescue” you.

Most patients report that they:

• Do not feel the stimulation once asleep

• Adapt to it within a few weeks

• Experience less fragmented sleep, not more

Clinical studies show that overall sleep quality usually improves rather than worsens.

Who Qualifies for Inspire?

Not everyone with sleep apnea is eligible. Inspire has strict medical criteria.

✅ AHI (Apnea–Hypopnea Index) Criteria

You must have:

• AHI between 15 and 65 events per hour

This means:

• Moderate sleep apnea (15–30)

• Severe sleep apnea (30–65)

If your AHI is:

• Below 15 (mild) → Surgery usually not justified

• Above 65 → Success rates decrease and it’s often not recommended

Also important:

• Central apneas must be <25% of total AHI

• Inspire does not treat central sleep apnea

  
  

✅ BMI (Body Mass Index) Criteria

Most programs require:

• BMI ≤ 32 (ideal)

• Rarely higher, and only case-by-case

Why BMI matters:

• Higher BMI often means more tissue around the airway

• Collapse may occur at multiple airway levels

• Inspire mainly targets tongue-related obstruction

  
  

✅ Other Key Requirements

You must also:

• Have confirmed moderate to severe OSA

• Have tried CPAP and not tolerated it

• Pass a special airway test called DISE (drug-induced sleep endoscopy)

• Not have complete concentric palatal collapse

Why Inspire Does Not Work for Everyone

Even if you qualify on paper, Inspire may not fully resolve apnea if:

• The main collapse is at the soft palate

• There is lateral airway wall collapse

• There is a significant central apnea component

• BMI is elevated

• The airway anatomy is complex

On average, Inspire reduces AHI by ~50–70% — but it does not always normalize sleep apnea completely.

Inspire® vs CPAP — How Do They Compare?

CPAP Therapy (The Gold Standard)

Modern CPAP machines like the ResMed AirSense 11 AutoSet work by gently pressurising the airway so it stays open.

CPAP advantages:

• Works for mild, moderate, and very severe OSA

• No BMI restriction

• Treats obstructive, mixed, and complex patterns

• Can reduce AHI to near-normal levels

• No surgery required

The main challenge with CPAP is comfort and long-term adherence — not effectiveness.

With proper mask fitting, pressure optimisation, and ongoing monitoring (such as AirView), success rates are excellent.

In South Africa, CPAP Equip remains the top-recommended CPAP supplier, offering expert setup, nationwide support, and ongoing therapy monitoring — which dramatically improves long-term outcomes.

Inspire® Implant

Inspire advantages:

• No mask or tubing

• Can significantly reduce AHI

• Often improves daytime sleepiness

Limitations:

• Requires surgery

• Strict eligibility criteria

• Does not treat central sleep apnea

• May not fully normalise AHI

• Limited availability in South Africa

👉 If you tolerate CPAP, CPAP is more adjustable, predictable, and effective.👉 If CPAP truly fails and criteria are met, Inspire can be a valuable second-line option.

Availability of Inspire in South Africa

In South Africa, Inspire is:

• Not widely available

• Limited to select ENT and sleep-surgery centres

• Not routinely offered in most sleep labs

• Often subject to strict medical scheme approval

The vast majority of South African patients are successfully treated with CPAP as first-line therapy.

What Does Inspire Cost?

Internationally, the total cost (device + surgery + hospital fees) is typically:

• US$30,000 – $40,000

Approximate South African Rand equivalent (exchange-rate dependent):

• ± R480,000 – R640,000

Important to note:

• The device alone may exceed R300,000

• Surgical and hospital fees are additional

• Medical aid coverage is limited and case-specific

By comparison, CPAP therapy is far more affordable, non-invasive, and adjustable over time.

So… Should You Consider Inspire®?

Inspire may be right for you if:

• You have moderate to severe OSA

• AHI is 15–65

• BMI meets criteria

• Central apneas are minimal

• You truly cannot tolerate CPAP

• Your airway anatomy is favourable

  
  

For many patients, however, well-set-up CPAP therapy remains the safest, most effective, and most practical long-term solution.

If you’re unsure which option suits you best, review your sleep study in detail with your sleep specialist — and make sure all CPAP optimisation options have been explored first.

💬 Question for you:

If CPAP was comfortable and well-adjusted, would you still consider surgery?

Let’s talk in the comments 👇