Concierge sleep medicine · UK
Hypoglossal nerve stimulation for OSA, by a joint ENT and sleep team.
An implantable device — Inspire — for moderate to severe obstructive sleep apnoea when CPAP cannot be tolerated. Selection led by polysomnography and drug-induced sleep endoscopy, not by a device rep.
Why patients choose us
- 01
A consultant ENT and sleep physician, together
Not a device rep, not a single clinic. A joint pathway with an ENT surgeon and a sleep physician who both sign off before an implant is offered.
- 02
DISE and CPAP compliance checked first
A drug-induced sleep endoscopy and honest CPAP-tolerance review — because Inspire only works for the right anatomy and the right patient.
- 03
Independent, and free
We are paid by no clinic and no device maker, so the recommendation is impartial and costs you nothing.
Indicative pricing
What Inspire therapy costs privately in the UK.
Indicative ranges across our partner centres. On the NHS, access is through specialist commissioning per NICE IPG598 and usually requires an individual funding request.
In short
A full private Inspire pathway: £30,000–£40,000, activated 4–6 weeks after implant.
| Step | Indicative range | Typical duration | Timeline |
|---|---|---|---|
| Inspire implant — full pathway (private) | £30,000–£40,000 | Multi-visit | Activation at 4–6 weeks |
| Polysomnography (in-lab sleep study) | £900–£1,600 | Overnight | 1–2 weeks |
| Drug-induced sleep endoscopy (DISE) | £1,800–£3,200 | 30–45 min | Same visit |
| Activation and titration study | Included | Overnight | 6 weeks post-implant |
| Annual device follow-up | £400–£700 | 45 min | Same visit |
| Consultation with ENT + sleep physician | £350–£600 | 45 min | Same visit |
Prices vary by centre, by which ENT surgeon implants and which sleep physician runs the titration, and by the level of pre-op work-up needed. We come back with a firm quote and a clear pathway within one working day.
The problem
The right selection, the right team, the right expectations.
Inspire is a wonderful device in the right patient — and the wrong operation in the wrong one. Most of the value we add is the honest conversation before you commit.
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Sure CPAP has really failed?
A better mask, a different pressure profile, humidification or an APAP trial fixes many CPAP problems before an implant is needed.
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Sure the anatomy fits?
A drug-induced sleep endoscopy under propofol is the only way to know whether Inspire will actually work for your airway.
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Sure of the maths on outcomes?
AHI usually falls 60–80% in responders. That is excellent — but not zero. We set expectations honestly, in writing.
The journey
From enquiry to activation — what happens, in order.
One coordinator from first message to your six-month device review, working across ENT and sleep medicine.
Phase 1 · Before your implant
Concierge, off-stage for you
Phase 2 · On the day
Half a day in theatre
Phase 3 · After
Activation and follow-up
- 01
Before
You tell us what is going on
A short, confidential form. Your AHI if you know it, what you have tried with CPAP, BMI and general health.
- 02
Before
We come back with a recommendation
Within one working day: whether Inspire is worth exploring, which centre and consultants fit, and an indicative pathway. If it is not the right step, we say so.
- 03
Before
Sleep study and DISE
A polysomnography and a drug-induced sleep endoscopy under propofol — the two tests that decide eligibility. Complete concentric palatal collapse rules Inspire out.
- 04
On the day
Implant surgery
A three to four hour operation under GA. Two to three small incisions — chest wall for the pulse generator, upper chest for the sensing lead, submandibular for the nerve cuff.
- 05
On the day
Home the same day or after one night
Most patients go home the same evening. Simple painkillers, written aftercare, and a follow-up date in the diary.
- 06
After
Activation at four to six weeks
Once the incisions have healed the device is switched on and titrated with a sleep study. You control it nightly with a small remote.
- 07
After
Ongoing follow-up
Sleep-study reviews at six, twelve and twenty-four months and then annually — with fine-tuning of the stimulation settings over time.
Typical end-to-end: 8–12 weeks from enquiry to implant. Activation: 4–6 weeks after surgery.
When it helps
When Inspire is the right step.
The Inspire selection criteria in plain English, plus the one red flag that means today rather than an elective pathway.
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Moderate–severe OSA (AHI 15–100)
A documented apnoea–hypopnoea index in the Inspire range on a full sleep study.
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CPAP intolerance, honestly documented
You have genuinely tried CPAP — mask, pressure and humidification adjusted — and cannot use it consistently.
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BMI under 32 (up to 35 in some centres)
Inspire outcomes drop above a BMI of 32–35, so eligibility usually stops around this threshold.
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No complete concentric palatal collapse
DISE must show that the soft palate does not collapse concentrically — a specific pattern that predicts poor Inspire response.
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Daytime sleepiness affecting life
An Epworth Sleepiness Scale that is high, road safety concerns, or a job where sleepiness is dangerous.
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Mandibular device tried and failed
A properly fitted mandibular advancement device has not controlled your OSA — or you cannot tolerate one.
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Cardiovascular risk from untreated OSA
Poorly controlled blood pressure, atrial fibrillation or cardiovascular disease being driven by uncontrolled apnoea.
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Red flag: sleepiness at the wheel
If you are falling asleep while driving, this is urgent — inform the DVLA and see your GP or a sleep physician the same week, before any elective pathway.
Treatment options
An implant is not the only option.
What each option on the table actually involves — and which fits which patient. CPAP is still first-line.
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CPAP (first-line)
Still the gold standard for moderate–severe OSA. Explored properly before Inspire is ever discussed — see our CPAP page.
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Mandibular advancement device (MAD)
A dentist-fitted splint that holds the lower jaw forward at night. Useful in mild–moderate OSA and in some CPAP-intolerant patients.
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Positional therapy
For patients whose OSA is largely supine. Devices and pillows that stop you sleeping on your back.
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Weight loss and lifestyle
For higher-BMI patients, meaningful weight loss can reduce or resolve OSA — sometimes alongside another treatment.
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Hypoglossal nerve stimulation (Inspire)
The implant discussed on this page — for the right AHI, the right BMI, and the right DISE findings.
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Uvulopalatopharyngoplasty (UPPP)
Traditional soft-palate surgery. Less commonly used now, but occasionally right for a specific collapse pattern.
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Maxillomandibular advancement (MMA)
A skeletal jaw operation with the highest surgical success rates for severe OSA — larger surgery, longer recovery.
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Consultation only
An honest joint review with ENT and a sleep physician — no obligation, and no push toward a specific device.
Our vetted UK network
A small panel of Inspire-trained centres, we picked them.
Consultant ENT surgeons trained on Inspire, working with sleep physicians who run the studies. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every centre in our network.
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Consultant ENT surgeons trained and proctored on Inspire implantation
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Sleep physicians running polysomnography and titration in the same pathway
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DISE performed under propofol by ENT with a sleep-medicine interest
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Centres commissioned per NICE IPG598 with governance in place
Safety and outcomes
What to expect — honestly.
Inspire is a well-studied implant. Five-year STAR trial data shows a sustained response in about 90% of well-selected patients. The risks below are real but generally manageable.
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Selection is the whole game
Inspire only works when AHI, BMI and DISE findings all fit. A yes from a device rep is not the same as a yes from a joint ENT and sleep team.
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Tongue weakness or soreness (5–10%)
A minority of patients notice transient tongue weakness or discomfort after implant — usually settling over weeks to a few months.
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Incision infection is uncommon
Small chest and neck incisions heal within about two weeks. Significant infection is rare and treated promptly.
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Device-related discomfort
Some patients feel the pulse generator under the skin, especially when lying on that side — usually settles as tissues adapt.
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Lead migration or fracture
Uncommon but possible, and may need a revision procedure. Long-term device data shows this is not frequent.
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MRI compatibility
Newer Inspire generators are 1.5T and 3T conditional under specific scanning protocols. You will carry a patient ID card to share with any radiology department.
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Tongue abrasion from stimulation
A rare irritation of the tongue from the stimulation cycle — resolved by adjusting the settings at follow-up.
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Inability to tolerate stimulation
A small number of patients cannot get used to the nightly stimulation. Settings changes and gradual acclimatisation usually solve this.
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Red flags
Fever, spreading redness at any incision, new severe tongue weakness or sudden device pain are reasons to call the clinic or A&E the same day.
Reading your operation note
Your implant note in four parts. Read the last one first.
The record the ENT surgeon and sleep physician send you keeps to the same shape — so anyone reading it later can follow the reasoning.
A quiet reminder
Surgical and sleep-medicine language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your activation appointment, just ask.
- 01 Header
AHI, BMI and DISE summary
The three numbers and the one endoscopy pattern that decided you were a candidate — recorded so any future clinician can see the reasoning.
- 02 Technique
Implant technique and lead placement
Which incisions were made, where the pulse generator sits, and how the stimulation cuff was placed around the protrusor branch of the hypoglossal nerve.
- 03 Findings
Intra-operative testing
The tongue-protrusion response confirmed on the table, and the sensing lead position confirmed against the breathing cycle.
- 04 Impression
Activation plan and follow-up
Read this first: when to come back for activation, what the titration study will look like, and when the six, twelve and twenty-four month reviews are booked.
Recognised by major UK insurers
Cover for hypoglossal nerve stimulation varies. Some UK insurers fund the implant when documented CPAP failure and Inspire criteria are met; others do not yet. We confirm cover before booking.
Frequently asked
Everything we get asked about Inspire.
Quick answers on eligibility, cost, NHS access, how the operation works, and how well it actually works.
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What is hypoglossal nerve stimulation, in plain English?
An implanted device — Inspire is the licensed brand in the UK — that gently stimulates the nerve to your tongue in time with your breathing, holding the airway open during sleep. It is for people with moderate–severe obstructive sleep apnoea who cannot tolerate CPAP.
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Am I likely to be eligible for Inspire?
Roughly: an AHI between 15 and 100, a genuine failure of CPAP, a BMI under about 32 (sometimes 35), and a DISE that does not show complete concentric palatal collapse. Age, general fitness and cardiovascular status also matter. A joint ENT and sleep review is the only reliable way to say yes or no.
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Can I get Inspire on the NHS?
Sometimes. NICE IPG598 (2018) allows use with special arrangements for governance, and NHS access is through specialist sleep and ENT centres by individual funding requests. It is not routinely commissioned in most areas, though this is evolving.
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How much does hypoglossal nerve stimulation cost privately in the UK?
The full private pathway — device, implant, anaesthetist, theatre, activation and first year of follow-up — is usually £30,000–£40,000. Sleep study and DISE work-up is separate and typically £2,700–£4,800 together.
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How does the operation work?
A three to four hour operation under general anaesthetic. The pulse generator sits in the chest wall like a pacemaker, a sensing lead detects your breathing in an intercostal space, and a small cuff around a branch of the hypoglossal nerve delivers the stimulation. Most people go home the same day or after one night.
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When is the device switched on?
About four to six weeks after surgery, once incisions have healed. You will have a titration sleep study to find the right stimulation settings, and you switch the device on and off each night with a small remote.
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How well does Inspire actually work?
In well-selected patients, AHI typically drops by 60–80%, daytime sleepiness scores improve, and quality of life measurably improves. Five-year STAR trial data shows around 90% of responders are still doing well at five years — selection is what drives these numbers.
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What are the main risks?
Transient tongue weakness or pain in 5–10% (usually resolving), rare incision infection, device-related discomfort, uncommon lead migration or fracture needing revision, and occasional inability to tolerate the stimulation. MRI is possible under specific 1.5T and 3T conditional protocols with newer generators.
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What are the alternatives I should have tried first?
CPAP is still first-line and gold standard — see our CPAP page. Mandibular advancement, positional therapy and weight loss all matter. Traditional soft-palate surgery (UPPP) and maxillomandibular advancement are surgical options in specific situations.
Related
Looking for something else?
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CPAP therapy
First-line treatment for OSA — the option to exhaust before an implant.
Learn more -
Sleep apnoea
Condition overview, diagnosis and full treatment ladder.
Learn more -
All tests and procedures
Every test and procedure we arrange.
Learn more -
Talk to us
Send an enquiry and we come back within one working day.
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