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)
Ghildiyal et al. (2026) studied this question.