Concierge sleep surgery · London
Inspire hypoglossal nerve stimulator London.
A fully implantable, patient controlled hypoglossal nerve stimulator from Inspire Medical Systems. A genuine alternative to CPAP for the right patient with moderate to severe obstructive sleep apnoea, activated by a bedside remote each night.
What Inspire is
An implantable hypoglossal nerve stimulator.
A pacemaker sized device that advances the tongue base during sleep, activated by a handheld remote.
Inspire is a fully implanted upper airway stimulation system made by Inspire Medical Systems. A pulse generator sits in the upper right chest, a stimulation cuff wraps around the branch of the hypoglossal nerve that protrudes the tongue, and a sensing lead reads the respiratory effort of the intercostal muscles.
Each night you press a button on a small remote. The device waits for you to fall asleep, then delivers a gentle pulse in time with each breath that pushes the tongue forwards, opens the airway and prevents obstructive events. There is no mask, no hose and no external pressure. You control the on time, the pause button and the intensity ramp.
Who it is for
The clinical criteria in the UK.
Inspire is highly selective. Meeting every criterion matters for a good outcome.
-
BMI under 32 to 35
Lower BMI is a strong predictor of surgical response. Most UK centres work to a ceiling of 32, some accept up to 35.
-
AHI 15 to 65
Confirmed moderate to severe obstructive sleep apnoea on a diagnostic sleep study.
-
Failed or intolerant of CPAP
At least three months of a genuine CPAP trial with documented poor tolerance, air leak, claustrophobia or persistent low usage.
-
Favourable DISE anatomy
Drug induced sleep endoscopy shows no complete concentric collapse at the soft palate.
-
Age over 22
Licensed for adults. Some paediatric use exists in Down syndrome under research pathways.
-
Motivated and informed
Willing to use the handheld remote each night and attend titration and follow up.
Not suitable
When Inspire is the wrong choice.
Clear exclusion criteria. Meeting any of these means a different pathway is safer or more effective.
-
BMI above the threshold
A BMI over 32 to 35 predicts a poor response and disqualifies most patients. Weight loss first is often the right step.
-
Complete concentric palatal collapse
Seen on DISE, this pattern of collapse does not respond to tongue base advancement.
-
Central or mixed apnoea
Inspire treats obstructive events. Central and mixed sleep apnoea need a different pathway, often ASV or bilevel.
-
Severe cardiac or pulmonary disease
Uncontrolled heart failure or advanced lung disease may make the implant unsafe or ineffective.
Pre-op workup
Three steps before theatre.
A structured workup confirms candidacy and reduces the risk of a poor response.
- 01
Diagnostic sleep study
Home or in-lab polysomnography to confirm AHI and rule out central or mixed apnoea.
- 02
ENT and DISE
Drug induced sleep endoscopy under sedation to map the pattern of upper airway collapse and exclude complete concentric palatal collapse.
- 03
Cardiac workup
ECG and, where indicated, echocardiogram. The device is not compatible with certain pacemakers and defibrillators.
Implant procedure
Two to three hours in theatre, one night in hospital.
A planned day-case general anaesthetic through three small incisions.
- 01
Day-case general anaesthetic
Around two to three hours in theatre in a CQC registered London unit.
- 02
Three small incisions
Upper right chest for the pulse generator, right neck for the stimulation lead onto the hypoglossal nerve, and right lateral chest for the sensing lead between the intercostal muscles.
- 03
Intraoperative testing
The surgeon confirms tongue protrusion on stimulation before closure.
- 04
One night in hospital
Overnight stay for observation, wound check and simple analgesia. Home the next morning.
Activation and titration
Switched on at four to six weeks.
Healing first, then a careful ramp to therapeutic settings.
The device is switched on four to six weeks after implantation, once the wounds have healed. You receive your bedside remote, and the ENT or sleep clinician sets a starting voltage that produces a visible tongue protrusion without discomfort. You go home and use the device nightly for a few weeks to acclimatise.
A titration sleep study follows, usually as an in-lab overnight test. The clinician steps the voltage up while watching your breathing and confirms the setting that abolishes obstructive events without waking you. Annual follow up then checks device data, refines settings and swaps the remote battery.
Outcomes
What the published data show.
STAR trial, ADHERE registry and five year real world follow up.
-
Surgical response
~68%
STAR trial and ADHERE registry: AHI drop of over 50% and to below 20 events per hour.
-
AHI reduction
~68%
Mean reduction in apnoea hypopnoea index at 12 months.
-
ADHERE 5-year
durable
Five year real world data show sustained AHI improvement and high patient adherence.
-
Nightly use
~5.7 h
Median device use per night in the ADHERE registry, well above typical CPAP compliance thresholds.
A surgical response is defined as an AHI reduction of over 50% and to below 20 events per hour. Roughly 68% of implanted patients meet this bar in published series. The remainder gain partial benefit or need to consider alternatives.
Cost in London
£30,000 to £45,000 all inclusive.
Indicative self pay pricing across the UK centres offering Inspire.
In short
Inspire implant in London: £30,000 to £45,000, one night in hospital.
The range reflects the device itself, hospital and theatre fees, the ENT and sleep consultant, anaesthetic, one overnight stay, activation, the titration sleep study and first year of follow up. We share firm written quotes once we have confirmed BMI, DISE findings and insurance status.
Where it is performed
Limited UK centres.
Inspire is offered at a small number of UK units. Discuss the current list with the concierge team.
-
Limited UK centres
Inspire is only offered at a small number of specialist UK ENT and sleep units. We share the current list of implanting consultants and hospitals through the concierge team.
-
Insurer covered pathways
A subset of centres accept Bupa, AXA and Vitality with preauthorisation. We handle coding and prior approval on your behalf.
-
Self pay pathways
Full self pay quotes are available. We help you compare fixed price packages between units.
NHS availability
NICE IPG598 and limited NHS access.
NICE has issued interventional procedures guidance but routine commissioning is limited.
NICE reviewed hypoglossal nerve stimulation in IPG598 and concluded it may be used with special arrangements for clinical governance, consent and audit. Routine NHS commissioning is not established, so NHS access is patchy and often restricted to a small number of specialist units under local approval. The private pathway is the main route for most UK patients today.
Related
Related pathways.
-
CPAP titration and fitting
First line for moderate to severe OSA.
Learn more -
Mandibular advancement device
Custom oral appliance for mild to moderate OSA.
Learn more -
Positional therapy for OSA
For supine dependent sleep apnoea.
Learn more -
Sleep study
Diagnostic test to confirm AHI.
Learn more -
Sleep apnoea
Condition guide and pathways.
Learn more -
Bariatric surgery
For higher BMI patients unsuitable for Inspire.
Learn more
Frequently asked
Inspire, honestly answered.
-
Is a DISE always required before Inspire?
Yes. Drug induced sleep endoscopy is mandatory. It confirms the pattern of upper airway collapse and rules out complete concentric palatal collapse, which is the main anatomical exclusion for the implant.
-
Is the Inspire device MRI safe?
The current Inspire IV generation is conditionally MRI compatible for full body 1.5 T and 3 T scans under specific parameters. Always tell the radiographer you have an implant and bring your patient ID card.
-
Is Inspire covered by private medical insurance?
A limited number of UK insurers cover Inspire on a case by case basis, usually with a clear CPAP failure history and DISE evidence. Bupa, AXA and Vitality have all authorised cases. We handle preauthorisation on your behalf.
-
How often does the battery need replacing?
The pulse generator battery typically lasts around 11 years depending on nightly use and stimulation settings. Replacement is a short day-case procedure through the original chest incision.
-
Will I feel the stimulation while I sleep?
Most patients describe a mild tongue movement rather than a shock. A 20 to 30 minute delay lets you fall asleep first, and the device ramps up gradually. Settings are refined at titration to stay comfortable.
-
What happens if Inspire does not work for me?
Around a third of patients do not meet the surgical response threshold. The device can be reprogrammed, or turned off and left in situ, and other options such as MAD, positional therapy or weight loss can be revisited.
Speak to an Inspire implanter
Assess for Inspire in London, with the right team.
We match you to a UK GMC registered ENT surgeon who implants Inspire regularly, at a centre that offers DISE, activation and titration under one roof. Insurer preauthorisation handled.