As many as six in 10 people prescribed a continuous positive airway pressure (CPAP) machine for sleep apnea can’t stick with it. However, there may be a way to treat sleep apnea without a mask at all.
The treatment is called hypoglossal nerve stimulation. Instead of pushing air through a mask to hold your airway open, it works from the inside: a small device sends a mild electrical pulse to the nerve that controls your tongue, timed to each breath, gently nudging the tongue forward so it can’t fall back and block your airway while you sleep.
“Hypoglossal nerve stimulation is often described as a pacemaker for the airway,” Dr. Muhammad Usama, a sleep physician, told The Epoch Times. “The patient turns the device on before going to sleep and switches it off in the morning.”
The Benefits of Hypoglossal Nerve Stimulation
Unlike continuous positive airway pressure (CPAP), which uses air pressure to hold the airway open, hypoglossal nerve stimulation works by activating the muscles that control the tongue and involves implanting a small device under the skin of the chest or behind the chin.
Although it may sound like a new treatment, it’s been available for more than a decade. The Food and Drug Administration first approved an upper-airway stimulation system in 2014 for people with moderate-to-severe obstructive sleep apnea who couldn’t tolerate or didn’t respond adequately to CPAP.
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The benefits of hypoglossal nerve stimulation extend beyond simply keeping the airway open during sleep. The treatment has been shown to improve sleep-disordered breathing, sleep quality, and daytime functioning—and those gains hold up over time.
Overall, breathing disruptions fell by almost 18 events per hour after three years. The benefits extended into the daytime, too. The proportion of participants with normal levels of daytime sleepiness increased from 40 percent at the start of the study to more than 70 percent after three years.
Ideal Candidates
The best candidate for hypoglossal nerve stimulation, Usama said, is “someone with moderate to severe obstructive sleep apnea who has tried CPAP seriously but cannot use it consistently or does not receive enough benefit from it.”
However, eligibility isn’t as simple as checking a number from a sleep study. Doctors also weigh body weight, the shape of the airway, whether the apnea is obstructive or a different type, and exactly where the throat collapses during sleep.
To find that last detail, surgeons use a specific test: drug-induced sleep endoscopy, in which the patient is briefly sedated so the surgeon can watch how the airway behaves during simulated sleep. “Certain patterns of collapse respond well to stimulation, while others do not,” Usama noted.
Before any of that, though, it’s worth ruling out a simpler fix.
“In some cases you can avoid an implant if you fix your nasal blockage,” Dr. Vik Veer, an ear, nose, and throat (ENT) surgeon and head of sleep surgery at the Royal National ENT Hospital in the UK, told The Epoch Times. A blocked nose often forces mouth breathing; sleeping on your back then lets your jaw, and your tongue with it, slide backward, blocking the airway. He added, “The nose and the tongue are not connected by anatomy, but they’re weirdly connected by the flow of air through our system.”
What Does the Surgery Look Like
The implant procedure takes a little over two hours. Most patients go home the same day or the next morning.
If hypoglossal nerve stimulation is appropriate and an examination during sleep shows certain patterns of airway blockage, and the person meets device-specific eligibility criteria, the device is implanted. About a month later, it is switched on, and the person is given a remote control. Over the next three months, they gradually increase the stimulation level as tolerated.
Early side effects can include soreness or swelling around the incision and temporary tongue weakness. Once the device is activated, some people notice tingling in the tongue from where it rubs against the teeth or dry mouth; these effects are usually manageable and often improve with time or a settings adjustment. Less common risks include infection or the implanted wire shifting, which can require additional surgery.
Getting the implant is not the end of the treatment. “It is an implanted treatment that must be activated, adjusted, and followed over time,” Usama said.
The first improvement is often noticed by the person sharing the bedroom. Snoring may become quieter, breathing pauses may decrease, and sleep may appear less restless. Patients will later notice fewer awakenings and better morning alertness, Usama said.
It’s Not a Standalone Fix
An implant can be an important part of treatment, but it is not necessarily the whole answer. Dr. David McIntosh, an ENT specialist and associate professor at James Cook University, emphasized the importance of looking beyond the implant itself.
“The role of hypoglossal nerve stimulation is evolving, but the foundations still remain: being able to breathe through your nose without resistance delivers marked health benefits on top of the better breathing side of things,” he told The Epoch Times. A sleep study may tell you that you have sleep apnea, but it will not necessarily tell you why, McIntosh said. Each patient has their own pattern of contributing problems.
Sleep apnea wakes you up multiple times every hour, and we now know that the body interprets that physiological stress by setting off hormones that make you eat carbohydrates and hold on to fat. This sets up a vicious cycle.
There’s a newer wrinkle, too: patients on rapid weight-loss drugs like Mounjaro can lose muscle from inside the throat along with body fat. If they later stop the medication and regain weight, the fat returns but the throat muscles may not, leaving some patients with worse sleep apnea than before they started. “I am increasingly seeing people return with sleep apnea twice as bad, and when I watch them sleep, I see that the areas where fat accumulates are much worse than before they went on the drug,” Veer said.
Nasal breathing, tongue and throat muscle function can all play a role in sleep apnea, which is why there is no single solution that works for everyone.
“The most effective treatment for snoring and obstructive sleep apnea should be personalized and customized to the individual patient’s anatomy, physiology, lifestyle and preferences,” Dr. Ryan Chin Taw Cheong, a consultant ENT and subspecialist sleep surgeon who specializes in hypoglossal nerve implants and sleep apnea, told The Epoch Times.
Hypoglossal nerve stimulation can be genuinely effective for the right patient, but success depends heavily on being the right fit, Usama said. That means a real evaluation, not just a bad experience with CPAP, before considering surgery.
For some patients, the best approach may combine stimulation with weight management, positional therapy, nasal treatment, an oral appliance or, occasionally, CPAP use alongside it.
