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Do you wake up exhausted after a full night’s sleep? Do you wake up with a dry mouth, sore throat, or headache? Do you frequently have difficulty concentrating and show signs of irritability during the day? Does your partner tell you that you snore loudly and stop breathing during the night? If the answer is “yes” to many of these symptoms, you might have sleep apnea, a potentially deadly condition in which the airway briefly become blocked during sleep, causing you to temporarily stop breathing.
Sleep apnea affects an estimated 25 million people in the U.S., and is often ignored or undiagnosed. This condition puts you at risk for diabetes, high blood pressure, stroke and a heart attack. If you have symptoms, talk with your doctor about whether a sleep study makes sense. Sleep studies may be performed at a hospital, a freestanding sleep center, or at home.
Weight loss and quitting smoking are potential solutions to sleep apnea. According to the Mayo Clinic, obese people have four times the risk of sleep apnea as those who are normal weight as fat deposits around the upper airway may obstruct breathing. Dr. Stuart Quan, professor of sleep medicine at Harvard Medical School, suggests using a wedge pillow or wearing a stuffed fanny pack to keep you from sleeping on your back. He estimates that 25% of people with sleep apnea have positional sleep apnea and sleeping on your side or stomach will reduce the severity of episodes.
If lifestyle changes are not effective, the standard of treatment is a continuous positive airway pressure (CPAP) device that pushes forced air through a tube connected to a face mask to keep your airway unblocked. Unfortunately, many people find these machines uncomfortable and bulky and so they stop using them even though they’re effective. Other options include small single use devices that fit over each nostril (Expiratory positive airway pressure device) and an oral appliance that helps keep your throat open. If all other treatments fail, surgery is sometimes recommended.
If your doctor recommends a sleep study, or if after you have a sleep study, a sleep device or surgery is recommended, be sure to contact your health plan for a prior authorization. Most GIC health plans use preferred providers for sleep studies and durable medical equipment and notification requirements apply. If you are in an HMO, you must have your sleep study performed at the plan’s preferred provider, and you must use the plan’s Durable Medical Equipment provider. Members of the GIC POS plans (Harvard Independence and Tufts Navigator) and the employee/non-Medicare UniCare State Indemnity Plans (Basic, Community Choice and PLUS) can use a non-preferred provider, but will have higher out-of-pocket costs is they do so. Medicare members should contact their health plan for information about purchasing or renting sleep devices. See your health plan handbook or contact your plan for details.
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