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Sleep Apnea and CPAP Machines


Sleep – we all need it. We all crave that 8 hour, fully rested feeling that gets us going through each day. However, many people suffer from different types of sleep disorders. Among these is Sleep Apnea. What is Sleep Apnea? What are CPAP Machines? Most importantly, are they covered under group benefits?

What is Sleep Apnea?

Sleep Apnea is a sleeping disorder in which breathing continuously starts and stops. People who suffer from sleep apnea may notice that they snore loudly through the night, or feel tired after a full nights rest.

The most common form of sleep apnea, Obstructive Sleep Apnea (OSA) occurs when the muscles in the back of the neck relax during sleep. This causes the airway to collapse and restricts air flow to the lungs. The brain registers the inability to breathe and briefly wakens the individual so that they can take a breath. Often the awakening (or apnea) is so brief, the individual doesn’t remember the incident. This can interrupt sleep several times an hour.

Dangers of Sleep Apnea

You might ask, is sleep apnea really dangerous, or is it just inconvenient? Studies show that sleep apnea can increase complications such as high blood pressure, heart disease, stroke, Type 2 diabetes and liver problems. What is the link between sleep apnea and CPAP machines?

When your practitioner (physician or nurse practitioner) suspects sleep apnea, a sleep study will typically be required. There are two types of tests that one can undergo so that the required treatment can be determined. A Level 1 study takes place overnight in a sleep lab, whereas a Level 3 study takes place in the comfort of your own home. For mild cases of sleep apnea your practitioner may recommend changes to your diet and sticking to an exercise regimen to improve symptoms. However, for moderate to severe cases, a Continuous Positive Airways Pressure (CPAP) machine may be prescribed.

Do Provincial Health Plans cover CPAP Machines?

Provinces and territories have varying levels of health programming in place to assist residents with the purchase or rental of CPAP machines and related accessories. Some, like, Manitoba, Ontario and Saskatchewan, offer assistance to all residents. Other provinces may limit the assistance to residents on income related provincial health plans. Learn more about Pharmacare.

Claiming for CPAP Machines

Where provincial programs are in place, The Co-operators will limit the reimbursement of eligible expenses for breathing equipment to the out-of-pocket maximum established in the province of residence.

A claim submitted for a CPAP machine must include the sleep study. The sleep study indicates the Apnea-Hypopnea Index (AHI) which measure the severity of the apnea, as well as the blood oxygen saturation levels. In order for your claim to be eligible, the AHI must be greater than 15.

Coverage for sleep apnea and CPAP machines or accessories is subject to a lifetime maximum which varies by plan. Contact us for a free quote or to learn more about the benefits packages we offer.

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