What is Sleep Apnea: Overview, Symptoms, and Medicare Coverage

Last Updated : 09/15/20185 min read

According to the National Heart, Lung, and Blood Institute (NHLBI), sleep apnea is a common disorder that affects about 12 to 18 million Americans. According to the NHLBI, about half of all sleep apnea sufferers are overweight, and more men than women usually have it.

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A person with sleep apnea can have pauses in breathing or shallow breathing during sleep. Here’s what you need to know about sleep apnea symptoms and possible Medicare coverage of treatment.

What is sleep apnea?

Simply put, sleep apnea occurs when your breathing pauses or becomes shallow when you sleep. The pauses in breathing can last from a few seconds to minutes, according to the NHLBI. These pauses may happen 30 times or more each hour, causing your sleep quality to suffer. The most common type of sleep apnea is obstructive sleep apnea, where the airway collapses or becomes blocked while sleeping.

According to the National Heart, Lung, and Blood Institute (NHLBI), if left untreated, sleep apnea may increase the:

  • Risk for high blood pressure, heart attack, stroke, obesity, and diabetes
  • Risk for heart failure (or make the condition worse)
  • Likelihood of arrhythmias (irregular heartbeats)
  • Chance for work-related or driving accidents

What are common sleep apnea symptoms?

According to the NHLBI, most people aren’t even aware they have the condition because it only occurs during sleep. The American Academy of Sleep Medicine says you may wake up tired and not feel refreshed each morning, or nod off periodically during the day—this is because your body is waking up many times during the night, even though you may not be conscious of this.

According to the American Academy of Sleep Medicine, the most common sleep apnea symptom is loud or frequent snoring, though not everyone who snores has sleep apnea. The snoring may be punctuated by frequent pauses and followed by gasping or choking sounds. Usually a spouse or family member is the first one to notice sleep apnea symptoms.

According to the NHLBI, other sleep apnea symptoms or signs may include:

  • Morning headaches
  • Daytime sleepiness
  • Memory problems
  • Inability to concentrate
  • Waking frequently during the night to urinate
  • Dry mouth and sore throat upon waking in the morning
  • Irritability, depression, mood swings

According to the American Academy of Sleep Medicine, factors that increase your risk for developing sleep apnea may include:

  • Excess body weight (a major risk factor)–body mass index (BMI) over 25
  • Age (more common between young adulthood and middle age)
  • Gender (more common in men than women)
  • Hypertension (high blood pressure); extremely common in people with sleep apnea
  • Family history of sleep apnea
  • Large neck size

How is sleep apnea diagnosed?

According to the National Heart, Lung, and Blood Institute (NHLBI), a doctor can make a diagnosis of sleep apnea based on your medical and family history, a physical exam, and results from a sleep study–your doctor may recommend a home sleep apnea test or a sleep study test performed in a lab. A sleep study test is the most accurate way to diagnose sleep apnea.

A sleep study can be done at a certified sleep lab or center. During a sleep study, you are connected to a number of health monitors and observed overnight while you sleep. During a home sleep apnea test, you wear a small monitor while you sleep and return the equipment to a sleep specialist who will interpret the results. This can help identify sleep and breathing patterns that suggest sleep apnea.

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 What treatments are available for sleep apnea?

According to the NHLBI, mild sleep apnea may be relieved with lifestyle changes (changes to daily activities or habits) or mouthpieces. For moderate to severe sleep apnea in adults, breathing devices or continuous positive airway pressure (CPAP) is the most common treatment. Some people with sleep apnea may improve with surgery.

Medicare coverage of sleep apnea treatments

Your doctor may order a sleep study test for you if you’re showing symptoms of obstructive sleep apnea. In this case, the sleep study will be covered by Medicare Part B (medical insurance), but your costs will be 20% of the Medicare-approved amount (after you’ve met the Part B deductible amount). For more information, please see this article about Medicare coverage of sleep studies.

If you’re diagnosed with obstructive sleep apnea, you may be eligible for a three-month trial of CPAP therapy under your Medicare Part B benefits. If your Medicare-assigned doctor can show the treatment is helping you, Medicare may cover the treatment for as long as it’s medically necessary; your Part B deductible applies and you pay 20% of allowable charges. Keep in mind, if your state is covered under the Competitive Bidding Program for medical equipment and supplies, you will be required to rent your CPAP machine from a supplier specially contracted with Medicare (search here on Medicare.gov).

Would you like more information about coverage of sleep apnea under Medicare plan options? I’m happy to help you. Request information by email, or schedule a phone call at your convenience by clicking one of the links below. Click the “View profile” link to learn more about me. You can see a list of plan options you may qualify for in your area by clicking the Compare Plans button.

For more information:

“What is Sleep Apnea,” National Heart, Lung, and Blood Institute (NHLBI), last updated July 10, 2012, http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea

“Sleep Apnea—Symptoms and Risk Factors,” American Academy of Sleep Medicine, last modified June 22, 2016, http://www.sleepeducation.org/essentials-in-sleep/sleep-apnea/symptoms-risk-factors

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