Treating obstructive sleep apnea (OSA) has traditionally centered around air pressure machines or oral devices. But in recent years, another solution has emerged—one that works from within the body itself. Hypoglossal nerve stimulation (HGNS) is an implantable therapy that activates your tongue muscles to keep the airway from collapsing at night.
Unlike masks or mouthpieces, this approach targets the root cause of the obstruction: muscle tone loss in the upper airway. In this article, we’ll explore how HGNS devices function, who qualifies for them, and what you can expect from the procedure and results.
What Is the Hypoglossal Nerve?
The hypoglossal nerve (cranial nerve XII) controls movements of the tongue, playing a central role in swallowing, speaking, and, critically, maintaining an open airway during sleep. In OSA, the tongue can relax and fall backward, blocking airflow.
HGNS devices stimulate this nerve in a controlled way each night, nudging the tongue forward with each breath. This prevents airway obstruction without the need for forced air, such as that provided by a CPAP machine.
How Hypoglossal Nerve Stimulation Works
HGNS is delivered through a small implant placed under the skin, typically just below the collarbone. It includes:
- A stimulator that sends electrical pulses to the hypoglossal nerve
- A breathing sensor that monitors your respiratory cycle
- A lead wire connecting the sensor and stimulator
When you inhale, the device detects the breath and sends a signal to the nerve. The result? Your tongue gently moves forward, opening the airway right when you need it.
Clinical data from the Inspire Therapy system—the first FDA-approved HGNS device—shows consistent reductions in apnea-hypopnea index (AHI) and oxygen desaturation events in patients who meet the proper criteria.
Who Is a Candidate for HGNS Devices?
This treatment isn’t for everyone, but for certain individuals, it offers a mask-free alternative that directly addresses airway collapse. Ideal candidates:
- Have moderate to severe OSA (AHI between 15–65)
- Are CPAP-intolerant or unable to achieve benefit from positive airway pressure therapy
- Have a body mass index (BMI) under 32–35, depending on the program
- Show no complete concentric collapse at the soft palate (determined by a drug-induced sleep endoscopy)
A full eligibility check typically includes a home or in-lab sleep study, a physical exam, and airway assessment procedures.
The Procedure: What to Expect
The implant is placed during an outpatient surgery under general anesthesia. Recovery is generally quick, and patients return home the same day.
- Week 1–2: Mild discomfort as incisions heal
- Week 3–4: Device is activated and customized
- Ongoing: Adjustments to stimulation levels are made during follow-ups
The user controls the device via a handheld remote, turning it on before sleep and off upon waking. Over time, the body adapts to the stimulation, and users often report improved daytime alertness and fewer nocturnal awakenings.
Benefits of Hypoglossal Nerve Devices
No mask, hose, or pressure
Improved comfort and compliance
Targeted therapy—acts only when you inhale
Silent operation—no machine sounds
Clinically proven AHI reduction in long-term studies
One long-term follow-up study published in The New England Journal of Medicine found sustained improvement in both sleep quality and oxygen saturation over five years of HGNS use.
Limitations and Risks
While the benefits are compelling, HGNS does carry risks:
- Surgical complications, including infection or lead displacement
- Tongue discomfort or tingling
- Not recommended for central sleep apnea or severe obesity
- Battery life: Replacement is needed every ~10 years
Patients with certain heart or neurological conditions, or who require MRI scans, may also face limitations. However, newer systems are increasingly compatible with MRI.
Comparing HGNS to Other Sleep Apnea Treatments
| Feature | HGNS | CPAP | Oral Devices |
| Mask-Free | ✅ | ❌ | ✅ |
| Surgery Required | ✅ | ❌ | ❌ |
| Customizable | ✅ | ✅ | ✅ |
| Portability | ✅ | ❌ | ✅ |
| Best For | CPAP-intolerant with moderate-severe OSA | Most OSA cases | Mild-moderate OSA |
While CPAP remains the most common treatment, many users struggle with long-term adherence. HGNS provides a viable second-line option for those who cannot adjust to pressurized airflow.
Cost and Insurance Considerations
The total cost for HGNS implantation can range from $30,000–$40,000 USD. However, many insurance plans—especially in the U.S. and Canada—now cover Inspire and similar systems if specific criteria are met. A pre-authorization process and physician referral are often required.
Financing options or medical device assistance programs may also be available through certain hospitals or manufacturers.
Success Stories and Real-World Use
Thousands of patients now use hypoglossal nerve devices to improve sleep. Many report:
- Immediate reduction in apnea events
- Improved energy and mood
- Greater relationship satisfaction due to quieter nights
Some patients use sleep tracking apps or undergo repeat home sleep studies to monitor progress—especially in the first year post-implant.
For users who previously had to give up travel or activities due to their reliance on CPAP machines, HGNS has offered renewed freedom and confidence.
Bottom Line: Is HGNS Right for You?
If you’ve tried CPAP and oral devices without success, and you meet the medical criteria, hypoglossal nerve stimulation may be worth discussing with your sleep physician. It doesn’t treat every form of apnea, but for the right individual, it can significantly reduce apnea burden and improve sleep quality.
With the growing popularity of maskless, adaptive treatments, HGNS represents a new chapter in how we address the causes of airway collapse during sleep—not just the symptoms.
