Private Health Insurance For Sleep Apnea

Dealing with sleep apnea is a nightly struggle for many Australians, often leaving them unrested and with a reduced overall wellbeing throughout the day. While there are effective treatments available, it can be just as challenging trying to figure out whether you’re covered for sleep apnea services on your health insurance.

In this guide, we’ll discuss the intricacies of sleep apnea, including its signs, symptoms and treatment options. We'll also help you understand what Medicare covers, what you can get out of private health insurance for sleep apnea, and ultimately how to get a more restful night’s sleep.

What is sleep apnea?

Sleep apnea is a surprisingly common – yet often undiagnosed – sleep disorder. In fact, around 5% of the Australian population have it, including one in four men over the age of 30.

It’s a condition characterised by recurrent interruptions in breathing while you sleep. These interruptions, called apneas, are usually brief but they can happen several times throughout the night.

There are also a lot of other various health complications caused by, or related to, sleep apnea because significantly disrupted sleep cycles are linked to many other health conditions.

Some of the different types of sleep apnea you could suffer from, include:

• Obstructive sleep apnea (OSA): The most prevalent form of sleep apnea, OSA, occurs when the muscles in the throat relax too much during sleep, causing a temporary blockage of the airway. It generally results in loud snoring, gasping or choking as your body struggles to resume normal breathing.

• Central sleep apnea (CSA): CSA is less common and happens because your brain fails to transmit the right signals to the muscles controlling your breathing. People with CSA may have difficulty breathing while they sleep - which, of course, means you wake up.

• Complex sleep apnea syndrome (mixed apnea): This is a combination of both OSA and CSA. It’s sometimes referred to as treatment-emergent central sleep apnea.

What are the symptoms of sleep apnea?

The most obvious symptom is repeated interruptions to your breathing during sleep. But there are deeper signs and symptoms that may help you with an early diagnosis – and therefore get effective management (and better sleep) faster:

• Loud snoring: One of the hallmarks of sleep apnea is loud, chronic snoring. The snoring is often accompanied by pauses in your breathing.

• Pauses in breathing: Most people with sleep apnea experience brief pauses in their breathing while they sleep. These pauses can last for a few seconds to a minute or longer, and may be followed by gasping or choking sounds as your breathing resumes.

• Excessive daytime sleepiness: Sleep apnea disrupts your sleep cycle and leads to poor sleep quality. This results in daytime fatigue and excessive sleepiness, even after what should have been a full night’s rest.

• Morning headaches: Waking up with headaches, particularly in the morning, is a common symptom of sleep apnea. It’s often related to your reduced oxygen levels during your sleep apnea episodes.

• Difficulty concentrating: Cognitive function can be impaired due to sleep deprivation caused by sleep apnea. This can manifest as difficulty concentrating and memory problems.

• Irritability: Sleep apnea can lead to changes in your mood, including irritability, sudden mood swings and even symptoms of depression.

• Dry mouth and sore throat: Frequent episodes of breathing interruptions can lead to your dry mouth and a sore throat upon waking.

• Restless sleep: People with sleep apnea usually toss and turn during the night.

• Frequent night time urination: Known as nocturia, this can be one of the unexpected symptoms of sleep apnea.

• Decreased libido: Sleep apnea may contribute to a reduced sex drive and intimacy issues due to daytime fatigue and hormonal imbalances.

Not everyone with sleep apnea will experience all of these symptoms, and their severity varies widely. You may not even be aware of your sleep apnea condition because your breathing issues happen when you’re asleep.

That’s why it’s important to consult your doctor if you feel like you might have sleep apnea. They can point you towards a sleep study to get a proper diagnosis.

What does sleep apnea treatment involve?

The goal of sleep apnea treatment is to reduce your symptoms, improve your quality of sleep and ultimately reduce – or eliminate – any associated health risks. The type of treatment you get depends on the severity of your sleep apnea, as well as your overall health and personal preferences.

Here are some common treatment options:

• Lifestyle modifications: For mild cases, lifestyle changes can be very effective against sleep apnea. These include:

  • weight loss, as excess weight can contribute to airway obstruction.

  • positional therapy, which involves sleeping in a specific position to minimise airway blockage.

  • avoiding alcohol and sedatives before bedtime.

• Continuous positive airway pressure (CPAP): CPAP therapy is a standard treatment for moderate to severe sleep apnea. You simply wear a mask over your nose or mouth during sleep, which delivers a continuous flow of air pressure to keep your airway open.

• Bi-level positive airway pressure (BiPAP): Similar to CPAP, BiPAP provides different air pressure levels for inhalation and exhalation. It’s often prescribed for people who find CPAP uncomfortable.

• Oral appliances: Dental devices can reposition the jaw and tongue to keep your airway open. They can be used for mild to moderate sleep apnea, or as an alternative to CPAP.

• Surgery: For severe cases or when other treatments are ineffective, surgery may be your only viable solution. Procedures include uvulopalatopharyngoplasty (UPPP), genioglossus advancement (GA), and maxillomandibular advancement (MMA).

Is there a sleep apnea test?

The most common diagnostic for sleep apnea is a sleep study (aka polysomnography).Your study is usually conducted at a dedicated sleep clinic, although it can be done at home using a portable monitoring device.

During your sleep study, your breathing patterns, oxygen levels, heart rate and brain activity are all measured. The data pulled will help doctors diagnose whether you do in fact have sleep apnea, and determine its severity.

How does Medicare cover sleep apnea?

Medicare only provides limited coverage for sleep apnea – both its diagnosis and treatment. While it partially covers the cost of sleep studies in public hospitals or approved sleep clinics, cover for treatments like CPAP therapy or oral appliances will depend on your eligibility.

To access more comprehensive cover for your sleep apnea issues and your subsequent treatments, it’s a good idea to seek out a private health insurance policy that includes what you need. For example, comprehensive health insurance (gold tier) or extras cover might cover what you need.

Average sleep apnea costs

Frequently Asked Questions

Does private health cover the cost of CPAP machines?

Some private health insurance policies might cover CPAP machines, but it depends on your tier and your chosen provider. Check your insurance plan for details and compare policies to help you find the best extras cover for sleep apnea equipment.

How does Medicare cover the cost of CPAP machines?

Medicare generally doesn’t cover the cost of CPAP machines, but it may provide partial rebates for sleep studies if they’re conducted in approved public facilities. Some CPAP therapies may also be covered for those who are eligible. It’s important that you speak to your doctor to understand if you’re eligible for any Medicare coverage.

Can you buy a CPAP machine without insurance? Yes, you can purchase a CPAP machine without insurance. Prices vary, and some people prefer to rent them rather than buy them outright.

How do I find the best health insurance for sleep?

To find the best health insurance for sleep apnea, make sure you compare multiple policies and look for coverage that includes sleep studies, CPAP devices and any relevant therapies. Also consider the premiums, waiting periods and inclusions to find the best private health cover for sleep apnea.

Sources

https://easycpap.com.au/pages/private-health-fund-cpap-cover 

https://www.resmed.com.au/knowledge-hub/are-cpap-machines-covered-by-medicare-or-private-health-insurance 

https://seal.com.au/australian-health-fund-rebates/ 

https://www.hcf.com.au/preparing-for-hospital/sleep-apnoea/treatment-options 

https://whttps://www.hcf.com.au/preparing-for-hospital/sleep-apnoea/treatment-optionsww.cpapaustralia.com.au/cpap-machines-faqs/ 

https://cpapvictoria.com.au/pages/australian-health-fund-rebates 

https://help.ahm.com.au/hc/en-us/articles/115010133287-What-are-Disease-management-appliances- 

https://www.medibank.com.au/health-insurance/understanding-health-insurance/faq/other-rules-paying-benefits/other-rules/ 

https://www.hcf.com.au/preparing-for-hospital/sleep-apnoea

https://www.healthdirect.gov.au/obstructive-sleep-apnoea 

https://www.cpapaustralia.com.au/cpap-machines-faqs/ 

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sleep-apnoea

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/

https://www.racgp.org.au/afp/2016/august/surgery-for-adult-patients-with-obstructive-sleep

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

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