by Kirsten Goddard, RRT, CRE, CTE
As a respiratory therapist at Edmonton Southside Primary Care Network, I often get asked to provide help regarding Continuous Positive Airway Pressure (CPAP). CPAP is a treatment for a sleep disorder called Obstructive Sleep Apnea (OSA). The questions asked are not usually around the disorder itself but about the financial cost of treatment. So here are some thoughts around funding options.
First though, what is Obstructive Sleep Apnea (OSA)? This is a sleep disorder where you have short pauses (apneas) of 10-30 seconds in your breathing due to an obstruction. The obstruction may be from the throat muscles, tongue, fatty tissue or a narrowing of the airway. These apneas occur over and over throughout the night leading to a disruptive sleep and possibly low oxygen levels. If not treated, OSA can lead to daytime sleepiness causing concern with daily tasks such as driving, increase risk of heart attack or stroke and reduce your ability to think in a clear way.
To diagnose OSA a sleep study is needed. There are many different private companies in Edmonton that provide this testing service. These companies typically offer Level 3 testing, which is done in the comfort of your own home. Most offer this test free of charge, provided you purchase your treatment from them, if needed. There is also a Level 1 test done in Edmonton, but this is by specialist referral only and will have fees associated with them, typically around $700 and a waitlist of over 12 months.
If a diagnosis is made, then treatment options are suggested. The most common treatment is Continuous Positive Airway Pressure (CPAP). Other possibilities are oral appliances, surgery or lifestyle modifications.
CPAP is the best treatment, but it can be difficult treatment to work into your lifestyle. CPAP treatment requires you to wear a mask over your nose and/or mouth that is attached to a hose that goes to a machine. This CPAP machine generates a steady stream of air through the mask, into your nose and throat that creates pressure to hold the tissue in your airway open therefore preventing the collapse (obstruction). This keeps you breathing normally all night long, preventing the frequent waking and reducing symptoms.
The problem is that CPAP is not cheap. They range in price but a basic machine will be around $1,500 to $2,000. You will also require some accessories such as a mask or a humidifier; this will increase your cost. Your private health insurance plan may cover all of the cost (or a portion of it).
But what if you don’t’ have private health insurance? With our easy access to technology you might say “I’m going to buy this online because it is much cheaper”. I advise against this. Yes, it may be cheaper up front for the machine, but it will cost you more in the long term as you will then have to pay for each visit to one of the sleep companies in Edmonton to help you get started. The sleep companies work for profit. If you do not buy a machine from them, why would they give you service for free? CPAP is only effective if you wear it every night. To become comfortable with this disease and the treatment, you need the knowledge and experience of the sleep professionals. They will make sure you get a good mask fit, adjust CPAP pressures accordingly, help you when things aren’t working correctly, assist with any repairs of the machine, etc. If you don’t purchase from them, every time you need help you will have to pay.
What if you can’t afford the cost? Most of the sleep companies will offer payment plans. Ask them about how they can help.
If you have a lower income and are a senior, you can apply for funding through Special Need Assistance for Seniors. They will pay a maximum of $1,600/machine (once every five years) and $200 for accessories (mask, humidifier, filters) every year. There is a catch though; you must have Level 1 testing to qualify.
If you are not a senior but do have a lower income, you may qualify for Alberta Works. CPAP is funded through Income Support program. They will pay $1,700 for a fixed pressure machine or $2,000 for an auto adjusting pressure machine. These prices include the cost of the accessories. They accept Level 1 testing as well as Level 3 (but there are some exceptions).
Assured Income for the Severely Handicapped (AISH) may also cover the cost of CPAP equipment with special authorization.
What about buying a used machine? Due to infection control issues and liability, the sleep companies do not sell used machines. Talk with them though. They may know of someone willing to sell a machine and can get the two of you in touch with each other. Buying used is similar to buying online. You will have to pay for each visit with a sleep company and that can start to add up.
So here’s my advice. CPAP is a very important therapy. When your physician gives you a referral for a sleep test, do your homework. Call some of the sleep companies in your area and ask questions. Do they charge for the sleep test? What are the costs of treatment (CPAP machines)? What are the visit costs if I buy my CPAP machine elsewhere but need help? If sleep test is positive for OSA, can I try a machine first to see if I can tolerate it? You will need to visit this company several times throughout the process, so start to develop a relationship with them.
Do your best to use the therapy every night. If you do, you will notice many improvements in your life. You may have better control of your diabetes, better focus and productivity at work, improved blood pressure, less headaches, etc. Most people notice such a change in their functioning after using CPAP that they won’t go even one night without it.
Even though it can be costly, CPAP therapy is the most effective treatment for Obstructive Sleep Apnea. In Alberta, we are certainly limited in funding options for this therapy. Speak with your sleep company about financial support. Obstructive Sleep Apnea is very detrimental to your health so treatment is very important.