Several new sleep apnea devices have hit the market in recent years, but the one generating the most attention is Inspire, an implantable nerve stimulator that treats obstructive sleep apnea from inside the body while you sleep. Beyond Inspire, the landscape includes next-generation CPAP machines with smart features, daytime tongue-training devices, compact nasal valves, and updated oral appliances. Here’s what each one does and who it’s designed for.
Inspire: The Implantable Nerve Stimulator
Inspire is a small device surgically placed under the skin of the chest, similar to a pacemaker. It works by sending mild electrical pulses to the nerve that controls your tongue. During sleep, those pulses gently push your tongue forward with each breath, keeping your airway open. You turn it on at bedtime with a handheld remote and turn it off in the morning.
The FDA has progressively expanded who can use Inspire. It’s now approved for people aged 22 and older with moderate to severe obstructive sleep apnea (an AHI between 15 and 100 events per hour) and a BMI up to 40, a significant increase from the original BMI cap of 32. Younger patients between 18 and 21 with the same severity range also qualify, and teens aged 13 to 18 with Down syndrome and severe sleep apnea are eligible as well.
In the pivotal STAR trial, a therapy responder was defined as someone whose breathing disruptions dropped by at least 50% from baseline and fell below 20 events per hour at the 12-month mark. The trial also included a withdrawal phase: after 12 months, responding patients were randomly split into a group that kept therapy on and a group that had it turned off, confirming the device was responsible for the improvement rather than a placebo effect.
The European Respiratory Society classifies nerve stimulation as a “salvage treatment” for people who cannot tolerate standard CPAP therapy. Most major insurance providers cover Inspire, but you’ll typically need to demonstrate that you tried CPAP and couldn’t use it consistently before approval is granted.
Smart CPAP Machines
CPAP remains the frontline treatment for moderate to severe sleep apnea, but the machines themselves have changed considerably. ResMed’s AirSense 11, one of the most widely prescribed models, auto-adjusts airflow pressure on a breath-by-breath basis rather than blowing at a single fixed setting all night. It lowers pressure while you’re falling asleep through its AutoRamp feature, then gradually climbs to your prescribed level. During exhalation, a separate pressure-relief mode reduces resistance so breathing out feels more natural.
The device connects to the myAir app, which scores your previous night’s sleep and offers personalized coaching tips. A voice-guided Personal Therapy Assistant walks new users through setup and includes a “Test Drive” tool to help you acclimate before your first full night. The machine can also receive software updates over the air, meaning new features can arrive without a hardware swap. An integrated heated humidifier, touchscreen controls, and a gender-specific therapy algorithm round out the current feature set.
These upgrades matter because the biggest problem with CPAP has never been its effectiveness. It works extremely well. The problem is that many people stop using it. Machines that auto-adjust, ramp slowly, and coach users through the learning curve are designed to close that compliance gap.
Daytime Tongue Stimulation Devices
One of the more unusual newer approaches is the eXciteOSA, a mouthpiece you wear for 20 minutes during the day, not at night. It delivers mild electrical stimulation to the muscles of your tongue, essentially a workout that builds tone in the muscles lining your throat. The idea is straightforward: stronger tongue and throat muscles are less likely to collapse and block your airway while you sleep.
The FDA-cleared protocol calls for 20-minute daily sessions over a six-week training period. It’s currently indicated for snoring and mild obstructive sleep apnea, not moderate or severe cases. European guidelines note that the evidence base for myofunctional therapies like this is still limited. These devices occupy a narrow lane: useful for people with mild symptoms who want to avoid wearing anything at night, but not a replacement for CPAP or other treatments in more serious cases.
Nasal EPAP Valves
Devices like the Bongo Rx take a completely different approach. These are small silicone inserts that sit in your nostrils. They let you breathe in freely but create resistance when you exhale, building up positive pressure in your airway during the exhale phase of each breath. That back-pressure acts like a temporary splint, helping keep your throat open.
The key difference from CPAP is that the positive pressure only exists during exhalation. During inhalation, the pressure drops to near zero or even slightly negative, which means there’s a window where your airway can still collapse. For people with mild to moderate sleep apnea, that may be enough. For severe cases, the gap in protection during inhalation is a real limitation. The tradeoff is convenience: these devices are tiny, portable, need no electricity, and produce no noise.
Updated Oral Appliances
Custom oral appliances, sometimes called mandibular advancement devices, push your lower jaw slightly forward during sleep, which pulls the tongue base away from the back of your throat. They’ve been around for years, but the devices themselves keep improving. ProSomnus launched its EVO Guided appliance in 2025, expanding a line designed for more precise jaw positioning.
Clinical guidelines recommend custom, titratable oral appliances as a first-line treatment for mild to moderate sleep apnea. “Titratable” means the device can be incrementally adjusted to find the jaw position that works best for you. For people with severe sleep apnea who can’t tolerate CPAP, oral appliances serve as a recommended alternative. Over-the-counter, one-size versions exist but are not what guidelines endorse. The custom versions, fitted by a dentist trained in sleep medicine, consistently outperform generic options.
How to Know Which Device Fits
Your severity level is the single biggest factor in determining which devices are on the table. Mild sleep apnea (5 to 14 events per hour) opens up the widest range of options: oral appliances, nasal EPAP valves, tongue-training devices, or positional therapy. Moderate to severe cases (15 or more events per hour) narrow the field. CPAP is still considered the standard, with oral appliances and Inspire available for people who genuinely can’t make CPAP work.
Body weight matters too. Inspire’s BMI cap of 40 excludes some patients, and excess weight around the neck and throat can reduce the effectiveness of oral appliances and EPAP valves. A sleep study, either in a lab or at home, provides the AHI number that drives these decisions. Without that baseline, no provider can match you to the right device.
Cost and insurance coverage vary widely. CPAP machines are broadly covered, oral appliances often require pre-authorization, and Inspire typically requires documented CPAP failure before insurers will approve the procedure. Nasal valves and tongue stimulators are more likely to be out-of-pocket expenses, though their price points are lower than surgical options.