How much does it cost?
A diagnosis of obstructive sleep apnea requires an overnight sleep study. Until recently, this meant sleeping in a lab, attached to measuring machines all night long. It was expensive, hard to schedule, and usually left you tired the next day. Austin did this, and it was one of the worst nights of sleep in his life. Still, he considers it worth it because it confirmed the diagnosis and made the need for treatment clear.
These days, sleep studies can be done at home with machines lent to you. Aaron was diagnosed at home, though it still required an appointment to explain how to use the testing machines. It cost a fair amount, and he had to return the machines the next day. All of this took time. Austin might have been diagnosed at home, but the machines he was given for home testing failed, another source of frustration and wasted time.
After the results came back confirming sleep apnea, we both had to have another appointment with a sleep specialist. That took more time and another co-payment, though its only purpose seemed to be to get a prescription for therapy. After that, we had to deal with a sleep center or respiratory device supplier for another appointment for equipment training and distribution.
All of this wasn’t cheap, neither for equipment nor for the time missed from work for the appointments. We’re lucky that we could do all this, but for many it is a barrier to care.
Insurance companies don’t make things easy, either. Each device can easily run $1,000; insurers don’t want to pay for equipment that isn’t used. To justify the expense, insurance companies usually monitor the machines’ use to make sure they’re being employed. While we enjoyed the app that told us how compliant we were being, others have found themselves being refused coverage by their insurance because the app reported they failed to use the machine enough.
Should doctors just give them out?
All of these issues make obstructive sleep apnea a condition that is hard to get a handle on. There’s failure on both ends. Many people who receive the diagnosis don’t make use of a therapy that might improve their lives. But even more go undiagnosed. This is not uncommon in the health system: Americans complain that many conditions, like attention deficit hyperactivity disorder and even breast cancer, are both under- and over-diagnosed at the same time.
Still, because of the number of cases of sleep apnea going untreated, some have proposed universal screening. Officials at the U.S. Preventive Services Task Force weighed in two years ago. They noted that the benefits of screening would include earlier diagnosis, leading to better sleep and quality of life. The harms include treatment side effects like discomfort in the nose or mouth area from using a mask.