WASHINGTON — Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.
A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea — letting people snooze in their own beds instead of spending the night in a sleep laboratory.
It's a controversial proposal, but potentially a far-reaching one. About 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.
"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," said Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home testing.
Today, Medicare pays for a sleep apnea treatment called CPAP, which stands for continuous positive airway pressure. The sleeper wears a mask that blows air through the nose. But CPAP is approved only for seniors diagnosed in a sleep lab.
People are also reading…
Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. The public can comment on the proposal until next week; final approval is expected in March.
While sleep apnea is a problem for seniors, it's most common in middle-aged men. But private insurers now reluctant to cover home sleep apnea testing are expected to follow the government's lead, thus easing access for all ages.
Sleep apnea sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.
Sleep apnea stresses the body in ways that increase the risk of high blood pressure, heart attack, stroke and diabetes. Its trademark is bad snoring — the snorting, choking kind. Other risk factors: Being overweight, having small airways and apnea in the family.
There are dozens of sleep disorders. A night of slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.
But this lab-based procedure can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles' drive.
For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. A patient hooks it up at bedtime, and a doctor checks the recordings later.
A Canadian study published last year randomly assigned suspected sleep apnea sufferers to either a sleep lab or home testing, and it found they worked equally well.
Last month the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients, but the tests should be administered by sleep specialists.
Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, representing head-and-neck surgeons, requested the change.
In fact, Medicare concluded that a sleep-lab test isn't perfect, either, and thus it proposed that all patients get a 12-week trial of CPAP treatment. Only if their doctors certify they're being helped would treatment continue.
That's important, because about half of apnea patients prescribed CPAP struggle to use it, said Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent. Trying differently shaped masks, adjusting the air pressure or a humidifier to moisten nostrils could keep more patients in care, he said.
Medicare aims to combat risky type of snoring
