The people at the sleep lab had no difficult diagnosing that I have sleep apnea. The treatment – using a continuous positive airway pressure (CPAP) device – has given me restful sleep for about three years now and may well have saved my life.
I am hardly alone in this among people with diabetes, who disproportionately suffer from sleep apnea. This is so important to us that I have written three previous articles here about it, most recently “Successful Sleep Apnea Therapy.”
While almost half of those of us who have diabetes also have sleep apnea, few of us are getting the treatment we need. There aren’t enough labs, meaning that people often have long waits for treatment and have to travel far to get to one when they can get an appointment. It’s likely too that the dread of spending the night in a sleep lab stops them from getting tested. Just like it stopped me at first.
Soon, however, you may be able to see for yourself whether you have sleep apnea in the privacy and comfort of your own home. Just this month the federal government reopened the issue of whether its diagnostic coverage criteria for CPAPs should allow other forms of testing besides sleep labs.
As long ago as 1991 studies began appearing in the professional literature slowing that home testing works just as well. Three years ago, Dr. Terence M. Davidson, the director of the Head and Neck Surgery Sleep Clinic at the University of California San Diego’s School of Medicine, informed the government that 14 studies involving 747 people showed “excellent correlation” between home and lab sleep testing.
On the basis of Dr. Davidson’s request, the Centers for Medicare & Medicaid Services (CMS) in 2004 and 2005 reviewed whether it would reimburse for home testing. But nothing much came of it.
Now, it’s taking another look. First came a big study in the February 6 issue of Annals of Internal Medicine. The study concluded that lab tests have no advantage over home sleep testing. Then, this month CMS accepted a formal request from the American Academy of Otolaryngology-Head and Neck Surgery.
Of course, the government isn’t known for fast action, and this will be no exception. From now until April 13 it will receive public comments. The due date for a decision is September 14.
The eventual CMS decision will reverberate far beyond Medicare and Medicaid. Few people recognize that CMS stands at the pinnacle of a nascent national health care system. Most health insurance companies follow its lead. For example, industry insiders tell me that they have heard of very few private payers that now reimburse for home studies.
All the people in the sleep business – except perhaps the doctors who own sleep labs – seem delighted that health insurers may soon start reimbursing us for home sleep testing. Sleep Review magazine convened panel of industry experts, who discussed the implications of the CMS review, and they were all positive about it.
“Allowing more patients to have access to sleep studies is good for everyone,” an industry source tells me. “This is great.”
The only thing that might not be great would be that if you have a good reason to suspect right now that you have sleep apnea and delayed testing while waiting for the fine wheels of government to grind. Eventually, it will be easier to get tested for it. But I am sure glad that I didn’t wait.