“The field [of sleep medicine] has only been around for 50 years, and it hasn’t yet become a big part of doctors’ training,” said Dr. David Kuhlmann, director of sleep medicine at Bothwell Regional Health Center in Missouri and spokesperson for the American Academy of Sleep Medicine. “Sleep apnea is becoming increasingly recognized, but it still has a long way to go in terms of integrating it into mainstream medical practice.”
For patients, sleep apnea can be difficult to self-diagnose and easy to ignore. “It’s not like a heart attack or stroke where one moment you’re fine and the next moment you’re not,” said Dr. Kuhlmann. “It’s a gradual decline, so it may not gain the same attention as something that happens more suddenly.”
For what it’s worth, my experience trying to get treatment was consistent with the AHA’s concerns—getting sleep care is a surprisingly difficult and solitary process. I wouldn’t have thought to get a sleep study at all were it not for my wife’s intuition. No doctor has ever suggested sleep medicine as a possible treatment for my symptoms, and workers at the sleep clinic were genuinely surprised that I found the place without a referral. From the outset, I was navigating my condition alone, and seeking treatment based on a hunch—I may as well have looked for answers on an angsty WebMD forum.
Getting insurance approval for my first sleep study was an agonizing, months-long battle that I nearly gave up on. My provider didn’t want to cover the cost of the study—totaling about $500, which is cheaper than a mammogram at a New York hospital—because I don’t share many risk factors with the average sleep apnea patient: I’m not obese, I’m under 40, my blood pressure is fine, and my neck isn’t thick enough to crush my airway in my sleep—which is a thing, apparently.
These barriers to entry for basic sleep treatment seem counterintuitive. Sleep apnea affects people of all ages and body types, and obesity isn’t even a risk factor for central sleep apnea, which involves brain signals as opposed to airway obstructions. From an insurance provider’s perspective, covering a $500 sleep study as a preventative measure seems like a wise investment when compared to a lifetime of treatment for diabetes or heart disease.
After a series of declined claims and unsuccessful phone calls, I nearly paid for the study myself. But my provider relented in the end, after my doctor suggested that my hallucinations were a risk factor for sleep apnea.
I spent a mostly sleepless night at a small, ramshackle clinic in South Brooklyn, hooked up to several dozen wires and belts that monitored my breathing and movements. I wouldn’t get my official results for a few days, but the technician who monitored me said the results were clear from the start of my test: “You definitely have sleep apnea,” he said. “Without a doubt.”
My results were shocking. I knew I was a loud snorer, but I didn’t know I was on a fast-track toward an early grave. Over the course of about six hours, I’d stopped breathing 199 times, placing me well above the highest severity threshold for sleep apnea. Each time I stopped breathing, my blood oxygen level plummeted from 94 to 87 percent, a dangerously low level that causes brain and heart damage, if not death.
With those results in hand, my insurance provider became much more accommodating though the rest of treatment. I had a CPAP within weeks, and as long as I use it regularly for the first six months, the machine won’t cost me a dime.
The process of getting sleep treatment can be opaque and frustrating. It requires a fair deal of self-determination, education and advocacy. But the benefits of CPAP therapy—even the short-term improvements to your daily life—vastly outweigh the pain of the process. If you’re tired all day, or you keep your friends awake with your snoring, or you suffer from terrifying hallucinations, consider this your wake-up call: Get a sleep study.
