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Sleep disorders: What insurance covers

Sleep disorders

Proper sleep can boost your ability to function well, live strong and feel great. The alternative is not so refreshing: Poor sleep has been linked to health problems such as heart attacks and strokes.

The National Heart, Lung, and Blood Institute recommends American adults get seven to eight hours of sleep a night, but achieving this can be difficult if you or a loved one has a sleep disorder.

General symptoms of a sleep disorder include waking up tired, having trouble falling or staying asleep, and feeling very tired during the day. Sleep disorders are typically managed through lifestyle changes, medications, relaxation techniques and psychotherapy.

Managing a sleep disorder can be frustrating and expensive. The good news is that many health insurance plans will cover treatment.

What are sleep specialists and sleep studies?

A sleep specialist is someone with expertise in sleep problems. The field of sleep medicine is focused on improving sleep quality and researching the factors that impact sleep. You should see a sleep specialist when your problems start affecting your job, relationships or quality of life.

During a visit with a sleep specialist, you'll discuss your health history and concerns. You'll also undergo a medical evaluation, which may include various tests or bloodwork. For example, you may undergo a sleep study, also called polysomnography.

Sleep studies help health care providers diagnose your specific sleep disorder or to know when to adjust the treatment plan for an existing problem. During a sleep study, a technician will record:

  • Your heart rate.
  • Breathing.
  • Brain activity.
  • Amount of oxygen in your blood.
  • Eye and leg movements.

Sleep studies often require an overnight stay in a hospital or clinic, but some can be done at home. Your health care provider will let you know if home testing is an option for you.

Common sleep disorders

Sleep apnea

"There are more than 50 different types of sleep disorders, but sleep apnea is the most common reason that people come to our clinic," says Dr. Neeraj Kaplish, director of sleep laboratories for the University of Michigan Sleep Disorders Center.

Sleep apnea is when your breathing is interrupted while you're sleeping. For example, you may stop breathing for a few seconds or even a minute or more. For some people, these breathing interruptions happen more than 30 times in one hour.

However, the continuous positive airway pressure, or CPAP, machine is "considered the gold standard in treating sleep apnea and is covered by most health insurance plans," says Kaplish.


Insomnia is when you have difficulty falling asleep or staying asleep. If you experience insomnia, you may lay in bed for a long time before finally falling asleep. Insomnia treatments can range from cognitive behavioral therapy (CBT) to medications. During CBT, you'll talk with a mental health professional about your thoughts and feelings and how these are affecting your life.

CBT can be helpful for managing stress and finding strategies to manage issues such as anxiety, which may be affecting your sleep. In general, medications for insomnia are covered by health insurance plans.

The Affordable Care Act (also known as Obamacare) expanded coverage for mental health services. Mental health services are now one of the 10 essential benefits that all qualified health insurance plans must cover starting in 2014 and covers medications, psychotherapy and counseling sessions such as CBT.


Narcolepsy is when you have uncontrollable "sleep attacks" during the day that last for a few seconds or minutes. For example, you may fall asleep during a conversation or while driving. As a result, people with narcolepsy often have driving restrictions. Narcolepsy is treated with lifestyle changes and prescription medications.

Restless legs syndrome

Restless legs syndrome (RLS) is a powerful urge to move your legs. RLS causes people to feel a tingling or prickly sensation in their legs, especially when they're lying down, which makes it difficult for them to sleep.

Certain substances such as alcohol and tobacco can trigger RLS, so it's best to avoid them. RLS can be treated with medication and nonmedication techniques such as massages, walking, or putting heat or ice on the affected leg.

Will my health plan cover treatment?

The ACA requires insurance companies to cover policyholders regardless of pre-existing conditions, including those with sleep disorders.

Discuss your sleep concerns with your primary care provider, and request a referral to a sleep specialist. Visits with specialists are generally covered by insurance plans if deemed medically necessary, although you may have a copay.

It's important to check your individual insurance plan for treatments and visits that are covered. First call your insurer to ask about coverage for your specific disorder.

Some coverages, such as the CPAP machine, fall under the category of durable medical equipment, or DME. Search your policy's DME section to learn if you will be responsible for a copay on such items.

Your physician's office or pharmacist can check whether certain medications are covered for your treatment. A generic version of the drug may save you money with a lower copay.

For more information about improving sleep quality or finding a sleep professional, visit or

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