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Senior Citizen Opinions & Analysis
Sleep Problems Usually Covered by Insurance, Medicare Covering More
Medicare pay for sleep testing increased from $62 million in 2001 to $235 million in 2009; Medicare now covers dental
appliance for sleep apnea
By Michelle Andrews, Kaiser Health News
July 12, 2011 - The diagnosis and treatment of sleep disorders have come a long way in recent years. In the past, people
who snored might be advised to sew a tennis ball onto the back of their pajama top. The "snore ball" would discourage them from sleeping on
their back and might quiet their droning. Or a doctor might use the "dog index" to measure poor sleep: If your dog generally sleeps with you
but by morning has left the bed more than half the time, it may be because you're such a loud, restless sleeper that the dog has gone
elsewhere for some peace and quiet.
How things have changed. Now, doctors with special training diagnose and treat more than 80 sleep disorders — from
obstructive sleep apnea to narcolepsy — at special centers with labs where a patient's every sleeping moment may be recorded and measured.
Insurance usually covers the diagnosis and treatment of sleep problems, with some exceptions. For example, snoring on its
own is not a medical problem and insurance won't cover its treatment, to the great disappointment of many a snorer's bed partner.
Obstructive sleep apnea, which occurs
in at least 2 to 4 percent of Americans, is another matter entirely. The consequences of untreated
sleep apnea can be extremely serious.
Sleep apnea is an obstruction of your airway that's created when the muscles at the back of your throat relax during
sleep. The obstruction partially or completely stops your breathing, sometimes for a minute or longer, until your brain alerts your body to
wake up and you start to breathe again. This can lead to fragmented, poor sleep as well as reduced oxygen levels, which can worsen such
medical conditions as high blood pressure and diabetes and increase your risk of heart attack and stroke.
As awareness of the problem has increased, so has demand for testing and treatment. Patients with suspected sleep apnea
are typically sent to sleep centers where they are evaluated overnight while they sleep. In the past 10 years, the number of accredited sleep
centers has grown from 566 to 2,258, according to the American Academy of Sleep Medicine.
Snoring is a common symptom of sleep apnea, but some experts say sleep studies may be overprescribed. "Everybody who
snores doesn't need a sleep test," says Fred Holt, an ear, nose and throat surgeon in Raleigh, N.C., and an expert on sleep apnea who consults
on anti-fraud issues for attorneys, medical auditors and investigators. The risk of developing sleep apnea is higher in people who are
overweight, male, middle-aged or older, or smokers.
Medicare payments being studied
Medicare payments for sleep lab testing have increased from $62 million in 2001 to $235 million in 2009, according to the
Department of Health and Human Services' Office of the Inspector General, which is conducting a
study to review the appropriateness of Medicare payments for them. The study is due next year.
There are home sleep tests for problem sleepers as well, and their use is also on the rise, say experts. Rather than
measure more than a dozen body functions while a person spends the night in a sleep lab hooked up to sensors, home sleep tests measure only a
few functions while patients sleep in their own beds. Their cost is a few hundred dollars vs. up to $2,000 for a night in the lab.
Insurance will generally cover either type of test if it is prescribed by a physician. But while home sleep tests may
mean a smaller bite out of your wallet if you have a co-payment or a high-deductible plan, they're not the best choice for everyone, sleep
"Home sleep testing should be reserved for people that are at high risk for sleep apnea and who don't have a lot of other
illnesses like obesity or heart disease that might alter the sensitivity of the test," says Nancy Collop, director of the Emory Sleep Center
in Atlanta and president of the American Academy of Sleep Medicine.
Eli Walker snores and sometimes stops breathing for short times while sleeping. Walker, 63, read that there was a
correlation between high blood pressure, for which he took two medications already, and sleep apnea. He went to see an ear, nose and throat
specialist who sent him to a sleep lab near his Silver Spring home. Diagnosis: moderate sleep apnea.
Watson was prescribed a continuous positive airway pressure mask, which straps onto a person's face and directs
pressurized air into the airway, keeping it open. But after three months of trying to use it, he gave up. "I hated it," he says. "I couldn't
breathe naturally, and I didn't like the air blowing in my nose."
Watson finally found a good night's sleep with a specially fitted oral appliance that looks kind of like a sports mouth
guard. The appliance, which must be fitted by a dentist with special training in sleep medicine, repositions and stabilizes the lower jaw and
soft tissues so that the airways stay open. It typically works best with people with mild to moderate sleep apnea.
Good news for seniors: Private insurers have covered the dental appliances for years, according to Sheri Katz, president
of the American Academy of Dental Sleep Medicine. In January, Medicare began covering them, too.
>> More From This Series
Insuring Your Health
Some of this
information was reprinted from
kaiserhealthnews.org with permission from the Henry J.
Kaiser Family Foundation. You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign up
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