Answers to common questions about PAP therapy

Does my health insurance cover PAP treatment for obstructive sleep apnea?

Most health insurance companies provide coverage benefits for treatment of obstructive sleep apnea and PAP therapy is usually considered a durable medical equipment benefit. It is well recognized that untreated sleep apnea contributes to poorer health and to increased health care costs making the treatment of sleep apnea cost effective if treatment is applied expertly and patients are compliant with treatment. The extent of coverage benefits may vary among insurers, and within an insurer’s offered plans, so it is important to be familiar with your plan coverage details.

How long does my health insurance company rent the device before converting to a purchase?

Health insurance companies vary in their rental and purchase policies. All insurers have a defined allowable amount that they will pay for a PAP device, and this amount varies with insurer, the plans an insurer may offer, and the type of PAP device being supplied. For some plans, the allowed amount is paid over a defined period of time (ie. 10 months) with monthly payments made to the supplier. The portion of the monthly payment a patient is responsible for will be determined by their insurance plan and will be affected by co-pays and the amount of deductible that may have already met. Other insurance plans may rent for a period of time (ie. 3 months) and have an option to purchase the device if a patient is benefitting from the therapy and using the device enough to meet the plans’ use requirements. The amount paid by the insurer at the time of purchase of the device is typically determined by subtracting any rental amounts already paid from the allowed price set by the insurance company. The portion of the purchase payment a patient is responsible for will be determined by their plan coverage details, by co-pays, and the amount of deductible that may have already met.

Does my health insurance company cover replacement supplies?

If a health insurance company covers the treatment of sleep apnea with PAP equipment, coverage for replacement supplies is also typically provided. A patient’s portion of the cost of the supplies will be determined by their plan coverage details, by co-pays the patient may be responsible for, and by the amount of their deductible that remains.

How often can I replace my mask or other supplies?

Health insurance companies vary in the frequency with which they will cover replacement masks, and other supplies such as filters, mask components, and tubing. If you are a current Ultreia Health patient it is likely that you were given a schedule for replacing supplies that is standard among common plans that are offered, though this may need to be modified to reflect your own plan’s coverage schedule. In general, mask cushions and mask pillows are often covered for monthly replacement, and mask frames and headgear every 3-6 months. Disposable filters are often covered for monthly replacement, though non-disposable filters every 6 months. Tubing is often covered every 3-6 months. The replacement schedule that your plan uses may be different from what is noted above and though Ultreia Health staff can provide help with the timing of supply replacement, it is your responsibility to know the schedule that your insurance plan uses for covering new supplies.

What about purchasing my PAP equipment and supplies online?

PAP machines and supplies are available for purchase from online retailers. In general, insurance plan allowable amounts for PAP machines and supplies are often similar to what an online retailer may charge. Typically, when equipment is purchased online, insurance benefits are not used. Patients without healthcare insurance, or with very high deductibles may choose to purchase equipment and supplies online if they can find better pricing. There are many variables however that can affect whether the “deal” one gets online is a better price than what you would get using a durable medical equipment supplier in your geographic area. These variables include what features the PAP device has, and the manufacturer brand of equipment (machine, mask). The amount of help that may be needed in setting up the PAP device, and fitting/refitting masks must also be considered as an online supplier without a local presence will find it difficult to provide this assistance. At Ultreia Health, the individual attention and support that a patient receives exceeds what is typically available in the local market, and far exceeds what an online supplier provides.

How much of the night should I use my PAP equipment?

Your PAP device should be used throughout the entire sleep period to obtain the maximal benefit from the treatment. For most individuals this goal requires time and effort to achieve. There is benefit from using the device, however, if that goal is not reached, or is taking a long time to reach. Individuals vary in how they acclimate to the therapy, and the benefits that they perceive from using their PAP device. Typically the most vulnerable time of sleep for abnormal respiration to occur is in the last third of the sleep period when the amount of REM sleep is increased. This is often when individuals have taken their mask off and are sleeping without their PAP treatment.

Do I have to use my PAP equipment every night?

Your PAP device should be used on a nightly basis, and throughout the entire sleep period to obtain the maximal benefit from the treatment. Frequently the question of nightly use comes up in the context of a short trip away from home and whether the PAP device should be taken on the trip (see FAQ 12). However, the benefits of consistent use of the treatment include feeling better, having more energy, being less sleepy, improvement in thinking clarity and memory, and many more. Some individuals will notice return of symptoms with missing one night of treatment, whereas some may not notice symptoms for several days, or at all (if they didn’t have many symptoms prior to PAP therapy). Beyond symptoms and physiological stress associated with not using the PAP device, increasingly, insurers have minimum requirements for PAP use or compliance that must be met for them to continue making payments on the equipment. Frequently the metric to determine adequacy of use for insurers is 4 hours of PAP use on 70% of nights. Your specific insurer may have different rules for continued coverage. Most PAP devices given to new users will have software that allows for monitoring of days, and hours of use, along with collection of other data that can help with ongoing management of the PAP treatment. It is important that new users communicate with their prescribing physician, and Ultreia staff if they are having trouble using the PAP device consistently, and for at least 4 hours per night. This communication will facilitate changes that can be made in the therapy to improve compliance, and also provide the basis for letters that can be sent to the insurer requesting additional time to improve the use of the device. If in spite of interventions to improve compliance, your use remains less than what is required for payment, you can make the choice to continue to use and pay the equipment charges, or change to a different form of sleep apnea treatment.

Do I need to use the humidifier that came with the PAP device?

Typically PAP devices are prescribed with a heated humidifier that serves to moisten the air delivered from the machine through the upper airway and into the lungs. The nasal passages have a membranous lining that has as one of its purposes to release moisture into the air passing through the passages on its way to the lungs. Because there is increased airflow over the nasal passages when using a PAP device, nasal congestion can result if the air being delivered is not adequately humidified. The use of humidification with PAP therapy, and in particular, heated humidification which is more effective at moisturizing the air, can reduce symptoms of nasal congesting that can lead to mouth breathing. The humidification level that is comfortable will vary from individual to individual, and the humidifier setting that is needed to reduce nasal congestion symptoms that otherwise would result from blowing drier air over the nasal passages will vary with the humidity level of the sleep environment. Typically, humidifier settings are turned up in the colder months of the year, and turned down during the warmer, more humid months.

What if my mask is leaking?

Finding a mask that is comfortable and seals well, without leaks, can be challenging. However, the number of manufacturers, and the many styles and materials used in the masks that are available today, has made finding a mask that works well for an individual much easier than in the past. A mask style that has less surface area touching the skin, such as nasal pillows, can help reduce leak, particularly in comparison to a full face mask. The facial contour of an individual will frequently dictate what style of mask is likely to work best. Replacing the seal on a face mask (triangular mask that fits over the nose, or nose and mouth), or the nasal pillows on a nasal pillows mask when leak is becoming more frequent, or when having to adjust the mask position more frequently during use can improve the mask fit and reduce leaks. Working closely with the staff at Ultreia Health to replace mask components as needed, and to optimize fit is important.

What if the machine pressure is uncomfortable?

It is important to contact the Ultreia Health respiratory therapist or your treating physician if you are having difficulty tolerating the pressure the PAP device is delivering. Most often, this occurs when the pressure is perceived to be too high. Higher pressure settings can result in difficulty exhaling, mouth leak, excessive gas and ultimately to non-use of the therapy. Settings perceived to be too low may be the result of the choice of a low pressure setting when an auto-PAP device is ordered, or failure to increase the pressure setting as a patient acclimates to the pressure of their PAP device. The Ultreia Health respiratory therapist and your physician can make the appropriate pressure changes to improve comfort with the treatment that can promote the use of the therapy.

Some users may have difficulty exhaling against the pressure of the air their PAP device is delivering, and this can lead to non-use of the therapy. This most often occurs with CPAP, but may also occur with other PAP modes. Being able to tolerate the pressure delivered improves with use of the therapy. Contacting Ultreia Health, or your treating physician to inform them that this problem is occurring is important. They may reduce the pressures until PAP is better tolerated, and then increase the settings to the original prescribed pressure. Alternatively, BIPAP can be ordered to replace the CPAP as the therapy reduces the pressure on exhalation making it easier to tolerate. Many manufacturers will supply CPAP devices with a relief setting that reduces the pressure briefly during the start of exhalation to improve comfort with the CPAP treatment.

What if my nose runs and I sneeze a lot after using the PAP machine?

Nasal congestion frequently results when insufficiently humidified air delivered by the PAP device passes across the nasal mucosal surface. Some PAP users may develop rhinorrhea (runny nose), and associated sneezing. Maximizing the humidity in the air delivered by the PAP device will typically eliminate the runny nose in persons who develop the nasal symptoms after beginning PAP therapy. A heated humidifier should be used if an individual has developed nasal congestion, or runny nose and currently does not use humidification. Travel from a more humid area, to a more dry area may require changes to be made in the humidifier settings to reduce nasal symptoms.

Individuals with dry nasal tissues as their baseline or with nasal mucosal irritation can develop worsening of the tissue dryness or inflammation, and nose bleeds, if adequate humidification is not provided. The tendency for nose bleeds will be increased for those on anti-coagulant therapy, or who have clotting abnormalities. Maximizing the humidity of the air delivered by PAP devices in these individuals is very important. At times, the type of mask may need to be changed to reduce bleeding tendencies. A nasal pillows mask being used in a patient with pressure settings that are high, and with a higher bleeding risk could be changed to a nasal, or full face mask that fits around the nose, rather than at the nostrils.   A PAP user who is having nose bleeds should contact the physician who prescribed the therapy.

What if my mouth is frequently dry when I awaken after using the machine?

Dry mouth upon awakening during PAP use is most often due to mouth leak that may occur during sleep. The tendency to open the mouth during sleep is promoted by nasal congestion, or underlying nasal obstruction that results in increased resistance to airflow through the nose. Higher pressure settings can also promote mouth opening. During REM sleep, the associated muscle relaxation can result in the jaw dropping and mouth opening, particularly if positioned supine. A combination of these factors will increase the likelihood of mouth leak occurring. A chin strap may be used to reduce mouth leak and the use of BIPAP may also be considered for a CPAP user having problems with mouth leak.

Do I need to take my PAP device with me when I travel away from home?

Travel with PAP therapy certainly requires more effort than traveling without it. However, the benefits of consistent use of the treatment include feeling better, having more energy, being less sleepy, improvement in thinking clarity and memory, and many more. Some individuals will notice return of symptoms with missing one night of treatment, whereas some may not notice symptoms for several days, or at all (if they didn’t have many symptoms prior to PAP therapy). Regardless of whether you notice symptoms returning if not using the treatment, there are physiological improvements with PAP use that you may not be aware of that include a reduction in the number of interruptions or arousals during sleep, more stable oxygen levels while asleep, and reduction in blood pressure surges that otherwise occur with apneas. Ultimately, if you choose to leave your device at home, the following interventions can help lessen the impact of not treating the sleep apnea on those nights: avoid alcohol before bed, sleep positioned on your side, or in a more upright position, take measures to reduce nasal congestion (consider allergy medication, Breathe Right strips), and avoid insufficient hours of sleep.