Learning About Hypoglossal Nerve Stimulation Implant for Sleep Apnea

Hypoglossal nerve stimulation (HNS) means using an implanted device to stimulate the nerve under your tongue (hypoglossal nerve) while you sleep. HNS can help people with obstructive sleep apnea, the most common type of sleep apnea.

When you have sleep apnea, your airways become blocked when your throat muscles and tongue relax during sleep. This causes you to stop breathing for short periods of time. Sleep apnea leads to poor-quality sleep and can raise your risk of health problems like heart disease, high blood pressure, and type 2 diabetes.

Most of the time, sleep apnea is treated with lifestyle changes and continuous positive airway pressure (CPAP). Lifestyle changes can include losing weight if you need to and sleeping on your side instead of your back. CPAP uses a machine to help keep your airways open. This machine pushes air through a mask that you wear over your mouth or nose or both. But some people have trouble using a CPAP machine, or the machine doesn’t work as well as it should to treat their sleep apnea. In those cases, the doctor might recommend an HNS implant.

An HNS implant has three parts:

• A breathing sensor that is implanted next to your ribs. Every time you breathe, it sends a signal through a thin wire to the pulse generator.
• A pulse generator that is implanted below your collarbone. It sends an electrical impulse to the stimulation electrode.
• A stimulation electrode that connects to the hypoglossal nerve under your tongue. It is placed under the skin below your jaw. When the electrode stimulates the nerve, your tongue moves forward. This opens up your airway and allows you to take a full breath.

You'll use a remote to turn the HNS implant on and off, set a timer, and control the strength of the electrical impulse.

HNS usually doesn’t hurt. You might feel a tingling when the implant turns on. Some people also have a sore tongue, a dry mouth, or trouble swallowing or talking. These side effects usually get better over time.

Before you can get an HNS implant, you have to do a test called a drug-induced sleep endoscopy to see if HNS is the right choice to treat your sleep apnea. To do this test, the doctor will give you medicine to make you sleepy. While you’re asleep, the doctor uses a thin, flexible tube (called an endoscope) with a camera to look into your upper airway.

Before surgery, the doctor will give you medicine to put you to sleep (called general anesthesia). You won't feel any pain.

To put in the HNS implant, the doctor will make three small cuts (incisions) in your skin:

• One by your rib cage to place the breathing sensor
• One under your collarbone to place the pulse generator
• One below your jaw to place the electrode

Then the doctor will put the parts of the implant in place and connect them with thin wires under your skin.

The battery in the pulse generator lasts about 10 years. After that, you’ll need to have a small operation to replace the battery.

Most people go home the same day and can resume their normal activities after a few days.

Your HNS implant won’t be turned on right after surgery to give your skin time to heal where the cuts were made. Your doctor will turn the implant on during an appointment about a month or two after surgery. The doctor will teach you how to use the remote to adjust the settings.

You’ll have regular follow-up visits with your doctor to see how well the implant is working to treat your sleep apnea.

Like any surgery, getting an HNS implant has possible risks. These include:

• Infection, pain, or swelling where the cuts were made.
• Bleeding.
• Nerve damage.
• Weakness or numbness in the tongue, which can affect speaking and swallowing. This usually goes away over time.