What question did this study set out to answer?

Evaluate the effectiveness of hypoglossal nerve stimulation for managing obstructive sleep apnea and insomnia in a patient.

May 10, 2026

1320 Management of Co-Morbid Insomnia and Obstructive Sleep Apnea with Hypoglossal Nerve Stimulator

Key Points

Evaluate the effectiveness of hypoglossal nerve stimulation for managing obstructive sleep apnea and insomnia in a patient.
Patient was a 65-year-old male with multiple co-morbidities including insomnia and obstructive sleep apnea.
Initial interventions included APAP therapy, which the patient declined due to intolerance.
Hypoglossal nerve stimulator was implanted, and subsequent clinical visits tracked sleep quality and device adherence.
Post-implantation, the patient reported significantly improved sleep quality and reduced insomnia complaints.
Inspire compliance data showed device use averaging 59 hours per week.
Patient relied on eszopiclone only as needed, ceasing OTC sleep medication.

Abstract

Abstract Introduction Hypoglossal nerve stimulation should be considered in carefully selected OSA patients who remain PAP intolerant, particularly when comorbid insomnia complicates management. Report of case(s) Patient is a 65-year-old Caucasian Male with Congenital facial deformity (right side), HTN, HLD, allergic rhinitis, GERD, BPH, Nicotine dependence, insomnia, essential tremors, microvascular disease and chronic headaches. The patient was initially seen in the Sleep Medicine Clinic with complaints of symptoms suggestive of OSA (witnessed apneas, choking in sleep, EDS, fatigue, non-restorative sleep, unsure of snoring ) for the last several years prior to the visit and was being treated by his PCP for "Insomnia" with eszopiclone 3 mg (2015) and he was self-medicating with 3 tabs of Equate PM OTC. His primary reason for seeking consultation was to increase the dose of eszopiclone to 5 mg. No previous sleep studies were available for him. PSG completed in February 2024 showed AHI 22.6/hour, Oxygen nadir 71%, and he was started on APAP 6-16 cm H2O. Patient declined starting PAP therapy due to preferring to sleep on his back and concerns regarding his allergic rhinitis. A titration study was completed, and APAP 6 -12 cm H2O was ordered. He eventually became intolerant to APAP, and he was evaluated for HGNS and implanted in March 2025. Clinic visit on September 2025, the patient reported significantly improved sleep quality, restorative and consolidated sleep. Inspire compliance data revealed consistent device use averaging 59 hours per week. The patient noted improved daytime functioning with decreased insomnia complaints. The patient used eszopiclone only on a as needed basis and stopped using OTC Equate PM. Conclusion Insomnia is often both a consequence of untreated OSA and an independent contributor to poor sleep and quality of life. The hypoglossal nerve stimulator represented an effective alternative, leading to improved sleep outcomes, reduced insomnia severity, and strong adherence. Support (if any)

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