Sleep apnea is a condition that affects approximately 60 million people in the United States, and 10 percent of people 65 and older experience it. Sleep apnea is a condition that causes blockage in the upper airway while you are sleeping. This blockage reduces or stops air flow for a short amount of time at regular intervals while you are asleep.
If you or your partner notices that you snore or gasp for air, or even stop breathing while you are sleeping, you may have sleep apnea. This condition is not just a simple annoyance, it may increase your risk factor for many health disorders from asthma to heart disease if you do not treat it.
If your health care provider has suggested treatment options for sleep apnea such as using continuous positive airway pressure therapy (CPAP), this may be covered through your Medicare benefits. You should know all the details about what sleep apnea is, what causes it, what the risk factors are, and whether you have Medicare coverage for its treatment so you can make the right decision about your health care.
What is Sleep Apnea?
There are three main types of sleep apnea:
• Obstructive sleep apnea is the most common type. It happens because muscles in the throat relax during sleep and cause blockage of air.
• Central sleep apnea occurs when the brain is not sending the right messages to the muscles that control breathing.
• Complex, or treatment emergent central sleep apnea, is the result of having both obstructive and central sleep apnea at the same time.
Symptoms that are associated with obstructive and central sleep apnea may include the following:
• Noisy snoring
• Periodic interruptions in breathing while asleep
• Gasping for air while asleep
• Having a dry mouth when you wake up
• Headache during the day
• Sleepiness during the day
• Moodiness
• Lack of concentration
You may have a higher risk of sleep apnea if you are overweight or have a larger than normal neck size. Men tend to experience sleep apnea more than women, and the risk increases with age. Also, lifestyle habits such as smoking, drinking alcohol, or taking drugs like sedatives may increase the chance of sleep apnea. You may also be at a higher risk for sleep apnea if you have difficulty breathing through your nose. This could be due to a cold, allergies, or anatomical abnormalities.
If you have sleep apnea and do not treat it, you may have a higher risk of the following conditions:
• High blood pressure
• Heart problems
• Type 2 diabetes
• Metabolic syndrome
• Liver problems
• Daytime drowsiness that affects mood, concentration, and that increases the likelihood of motor vehicle accidents
If you have sleep apnea, your physician may suggest that you make some lifestyle changes like losing weight, quitting smoking or drinking alcohol, or getting your allergies under control. These changes may help alleviate your sleep apnea. But, if they do not bring relief, CPAP therapy may be your best option.
Does Medicare Cover Sleep Apnea Treatment?
If your health care provider has diagnosed you with obstructive sleep apnea, your Medicare benefits may cover Continuous Positive Airway Pressure (CPAP) therapy. The machine that provides this therapy falls under Medicare coverage for durable medical equipment (DME) and is covered by Part B.
Medicare allows an initial trial period of three months with a CPAP device. If you choose to continue using it for longer, Medicare covers the cost, but your doctor must provide documented proof that you meet the conditions for using the device, and that the trial period shows that CPAP therapy is helping your sleep apnea.
Your out-of-pocket costs through Medicare are usually 20 percent of the Medicare-approved rental for the CPAP machine and additional supplies like tubes and masks. You are also responsible for your Part B deductible. Medicare will help pay the rental fee to the Medicare-approved supplier for 13 months. After 13 months, you own the device.
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