Sleep apnea affects millions of people. Some do not notice they have occasional lapses in breath while sleeping. Others wake up feeling restless and achy after a long night of snoring. In more serious cases, sleep apnea can cause you to stop breathing dozens of times every hour. If you are diagnosed with severe sleep apnea, a physician may recommend a continuous positive airway pressure (CPAP) machine. Thankfully, if you receive Medicare benefits, you may be covered for the cost of the CPAP machine and accessories under certain circumstances.

Diagnosing Sleep Apnea

Obstructive sleep apnea (OSA) affects approximately 4% of men and 2% of women, but many of these cases go undiagnosed. Obstructive sleep apnea is caused when your airways are blocked, reducing blood flow to the brain. Loss of muscle tone in the throat is common as we age and can be a leading cause of sleep apnea. Weight, genetics, and enlarged tonsils can also contribute to OSA.

Symptoms of Sleep Apnea

The symptoms of sleep apnea vary, and can include loud and consistent snoring, gasping, or choking while you sleep. Many people wake up with chronic headaches due to elevated blood pressure caused by the airway blockage. Irritability, depression, and fatigue can also be signs of sleep apnea. If you are experiencing any of these issues, make an appointment to discuss your sleeping habits with your physician.

Serious Complications

Sleep apnea has been associated with:

  • Heart disease
  • Stroke
  • Mental health issues
  • Decline in cognitive function
  • GERD (gastroesophageal reflux disease)
  • Low energy

People who experience sleep apnea can be at a higher risk for cardiovascular disease, including irregular heartbeat (arrhythmia), heart attack, or stroke. Sleep apnea and GERD are often related to obesity, and when acid from the stomach moves up into the esophagus when the throat closes, people can experience reflux. Lack of energy and motivation caused by sleep apnea can lead to depression and anxiety issues. Declining cognitive functions can also be caused by severe sleep apnea.

Treating Sleep Apnea – The CPAP Machine

CPAP therapy is a common solution recommended by physicians to keep the airways from being blocked while you sleep with the help of pressurized air. Using an adjustable mask and hose, the CPAP delivers a steady stream of air, allowing you to get a healthy, good night’s sleep.

Medicare Part B’s durable medical equipment (DME) coverage will help pay the cost of a 3-month trial of a CPAP machine if you have been diagnosed with obstructive sleep apnea. The coverage can be extended if you meet with your physician who documents in your medical records that the CPAP is improving your sleep apnea. Medicare will pay the DME supplier for the first 13 months of your CPAP rental. After you’ve rented the CPAP machine for 13 months, you own it.

If you have Original Medicare, you will likely pay 20% of the Medicare-approved amount for the machine and supplies, and the Part B deductible applies. You will need to get your CPAP machine and accessories from a Medicare-approved supplier that accepts assignment. If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same benefits as Part A and Part B. Many MA plans offer additional coverage, so contact your plan directly for your exact costs.

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