Having trouble sleeping? A sleep study can pinpoint the reason and get you back to dreamland.
Many people experience changes in their sleep patterns as they age. How do you know if your sudden lack of sleep is caused by age, sleep apnea, or something else? That's where sleep studies come in. Your doctor may recommend a sleep study to determine the cause of your sleep issues.
Here's what you need to know about Medicare and sleep studies. But before we answer the question, "does Medicare pay for sleep studies?" – let's learn about sleep apnea and other conditions that might affect your rest.
What happens during a sleep study?
Also known as polysomnography, a sleep study is simply a type of diagnostic test during which medical technicians monitor your heart, breathing, and brain activity. Other body systems may be measured as well, depending on the reason your doctor ordered the study.
As the name implies, the goal of a sleep study is to see what happens to these body systems while you sleep. And, whether any issues pop up that could explain your sleep issues.
Potential sleep study diagnoses include sleep apnea, sleepwalking, sleep paralysis, insomnia, and periodic limb movement disorder, the most common which is restless leg syndrome.
Your healthcare provider will review the results of your sleep study and make recommendations based on those findings.
Does Medicare pay for sleep studies?
Medicare Part B (medical insurance) covers Types I, II, III, and IV tests if you have symptoms of sleep apnea. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
Medicare Part C, more commonly known as Medicare Advantage, combines your Medicare Part A and Part B benefits into a single plan that resembles the private health insurance you likely had through an employer at some point. By law, every Medicare Advantage plan must provide the same coverage you get with Original Medicare (Parts A and B). However, nearly every MA plan – 99% – also provides additional coverage. Check with your plan to see if they offer additional sleep study coverage.
If you have Original Medicare and a Medicare Supplement Insurance plan, it should help pay your out-of-pocket costs. Better known as Medigap, most Medicare Supplement plans cover your Part B coinsurance at 100%. Medigap Plans K and L cover it at 50% and 75% respectively.
You can compare Medicare plan costs and benefits easily with our Find a Plan tool. Just enter your zip code to start reviewing Medicare plans in your area.
What is sleep apnea?
Sleep apnea is a disorder in which a person periodically quits breathing. You may have sleep apnea if you snore loudly and feel tired after a full night's sleep.
Types of sleep apnea
There are three types of sleep apnea.
Obstructive sleep apnea (OSA) occurs when your throat muscles relax and block airflow into the lungs.
Central sleep apnea (CSA) occurs when the brain doesn't send proper signals to the muscles that control breathing.
Another type of sleep apnea, treatment-emergent central sleep apnea (or complex sleep apnea), occurs when someone who previously had OSA develops CSP due to treatment involving a CPAP machine.
Symptoms of sleep apnea
The symptoms of OSA and CSA are similar. They may include the following:
- Loud snoring
- Episodes in which you stop breathing while sleeping
- Gasping for air during sleep
- Awakening with a dry mouth
- Morning headache
- Excessive daytime sleepiness
- Difficulty paying attention while awake
Some of these symptoms you may be aware of yourself. Of course, you may only be aware of some symptoms if your spouse or partner reports them to you.
Types of sleep studies covered by Medicare
Medicare covers the following sleep studies:
- Type I: Medicare covers polysomnography (PSG) to diagnose obstructive sleep apnea if the test is performed in a sleep lab facility.
- Type II and Type III: Medicare covers these types of sleep tests when used to diagnose OSA if performed unattended in or out of a sleep lab facility – or attended in a sleep lab facility.
- Type IV: Medicare covers sleep testing that measures three or more channels, one of which is airflow, to diagnose OSA. The test may be performed unattended in or out of a sleep lab facility – or attended in a sleep lab facility.
- A sleep testing device that has three or more channels, including actigraphy, oximetry, and peripheral arterial tone, is covered when used to diagnose OSA. The test may be performed unattended in or out of a sleep lab facility – or attended in a sleep lab facility
Of course, your doctor will recommend the type of sleep test that is best for your situation.
Other sleep disorders
Sleep apnea is just one sleep disorder that could be causing you grief. Other sleep disorders include insomnia, narcolepsy, and restless leg syndrome.
People with insomnia have trouble going to sleep or staying asleep. Still, others with insomnia wake up early and cannot go back to sleep.
People with insomnia often experience excessive daytime sleepiness. Insomnia is sometimes a side effect of medications, substance abuse, or depression. Learned insomnia may result from stress – combined with the fear of being unable to sleep.
Narcolepsy is sometimes described as sleep attacks – when a person falls asleep in unusual circumstances, such as during physical activity. Narcolepsy is sometimes called irresistible sleepiness and coincides with sudden muscle weakness. Sometimes a narcoleptic episode follows strong emotions or surprises.
Restless legs syndrome
Restless legs syndrome (RLS) is characterized by an unpleasant sensation or ache in the lower legs. This condition often causes sleep issues.
Other problems that can occur from lack of quality sleep
The lack of sleep can cause many problems, such as daytime sleepiness and irritability. However, lack of quality sleep also can lead to an increased risk for falls, depression, attention and memory problems, high blood pressure, diabetes, stroke, and obesity.
When to see a doctor if you have problems sleeping
Make an appointment with your doctor if you have symptoms of sleep apnea. Again, those may include loud snoring, gasping, awakening with a dry mouth, morning headache, and excessive daytime sleepiness.
You may have some of those symptoms – but not all of them. It's important to note that not everyone who has sleep apnea snores. Ask your healthcare provider about any sleep problem that leaves you tired and irritable.
Medicare coverage for CPAP therapy
If you are diagnosed with OSA following your sleep study, your doctor may recommend continuous positive airway pressure (CPAP) therapy.
During CPAP therapy, a mask or nose piece delivers constant and steady air pressure to help you breathe while asleep.
Medicare may cover a three-month trial of CPAP therapy to see how well you respond to this type of treatment. This treatment can be extended if it proves effective.