Diagnosing Sleep Apnea without Insurance

For people with Obstructive Sleep Apnea and their healthcare professionals, peer coaching article #4, updated 21 November 2011

These suggestions are written for people with a low income who don’t have healthcare insurance (or who have extremely high deductibles), and who are not eligible for Medicare or Medicaid.

Only a doctor can make a diagnosis. First, do your homework about sleep apnea. Second, find a doctor who is informed about sleep disorders.

1. Realize that if you do have sleep apnea, your judgment may be somewhat impaired due to the toll that oxygen deprivation takes on your brain, energy levels, life perspective, and initiative. Consider asking a family member or friend to help you take the steps below, especially if you are fatigued, confused, or depressed.

2. Become informed about sleep apnea. If you don’t have a computer, use a friend’s computer or library computer. Read about the consequences of untreated sleep apnea in the article “Are You Sleeping with the Enemy?” at smart-sleep-apnea dot blogspot dot com. Read “Evaluating Your Sleep” at the same web site.

3. Take online quizzes and print the quizzes and results for your doctor. The Berlin Questionnaire and Epworth Sleepiness Scale have the most credibility with doctors. Find the Berlin Questionnaire at http://www.swclab.com/images/PDFS/Berlin-Questionnaire.pdf  Find the Epworth Scale at http://www.stanford.edu/~dement/epworth.html  An excellent quiz from the book Sleep Apnea – The Phantom of the Night lists symptoms at http://www.healthyresources.com/sleep/apnea/phantom/orders/quiz.html Do not rely on these quizzes for a diagnosis. They are designed to raise awareness (yours and your doctor’s), not to diagnose.

4. If your energy levels, behaviors, symptoms, and quiz results raise a concern that you may have sleep apnea, realize that you need diagnosis. It may seem difficult or impossible to pay for a sleep study test and subsequent treatment. However, if you have untreated sleep apnea and it leads to heart disease, stroke, diabetes, a car wreck or some other serious condition affecting your work, it will be far more difficult to pay for treatment of that resulting condition. “An ounce of prevention is worth a pound of cure.” An upfront investment in seeing a doctor could save you untold costs of a more serious disease. A doctor may be able to prescribe a CPAP machine without a hospital lab sleep study. An overnight sleep study in a hospital can cost $1500 and up. If diagnosed, a low-end CPAP machine for treatment costs around $300 bought new online.

5. Become informed about sleep tests by reading “Sleep Study Tests” at smart-sleep-apnea dot blogspot dot com.  See the sections about these important options: an overnight recording pulse oximeter, an at-home test, a presentation for doctors, Not Every Patient Needs to Go to the Sleep Lab, and a split-night study.

6. Find a doctor. If you have a regular doctor or clinic, are they actively aware of sleep disorders and their consequences? An option may be a sleep doctor, a doctor who specializes in sleep disorders. Here are three ways to find one. Phone a local hospital sleep lab, and ask if they can suggest a sleep doctor. Or find local services at http://www.cpaptalk.com/sleep-apnea-services-locator.php  Or find a sleep doctor through the American Board of Sleep Medicine.

7. Show the doctor your quiz results and discuss your symptoms. Explain your lack of insurance and financial circumstances and discuss options. Be aware that private healthcare insurance and Medicare may require a sleep study before paying for CPAP equipment. If an overnight sleep study seems unaffordable, does the doctor ever use at-home screening? Some automatic CPAP machines with a display or smart card and software can be used for a split night study and titration (finding your CPAP pressure setting) at home. Does the doctor ever use an auto PAP for these purposes? Read these articles below and ask your doctor’s opinion:

A. American Journal of Respiratory and Critical Care Medicine, Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure? http://ajrccm.atsjournals.org/cgi/content/full/167/5/716 Quote: Home self-titration of CPAP is as effective as in-laboratory manual titration in the management of patients with OSA.

B.  Nonattended home automated continuous positive airway pressure titration: Comparison with polysomnography http://www.sleepsolutions.com/clinical_library/Unattended_auto-CPAP.pdf Quote: Nasal APAP titration in this study correctly identified residual apnea equivalent to the use of PSG. This correct identification allows the physician to accurately access the efficacy of treatment.

8. If you and your doctor decide on a sleep study or CPAP machine, get costs upfront. A doctor’s prescription is necessary for purchase of a CPAP machine. Internet CPAP sellers such as www.cpap.com are usually able to sell new machines at a much lower price than local Durable Medical Equipment suppliers, and provide advice as well. For information on CPAP machines, see http://www.cpap.com/cpap-machines.php

Want more? See the peer coaching articles at http://smart-sleep-apnea.blogspot.com , http://www.cpap.com FAQ Learning Center, or search http://www.cpaptalk.com or post a message there.

Not written by healthcare professionals. The information and opinions offered are not intended or recommended as a substitute for professional medical advice.

© Mile High Sleeper, August 2006 - 2011. All rights reserved. You may make copies of this message and distribute in any media for free educational purposes, as long as you credit the author and include this copyright notice and the web address smart-sleep-apnea dot blogspot dot com