About Sleep Apnea & Other Sleep Disorders

Overview of Sleep Disorders

4	About 70 million Americans suffer from a sleep problem; nearly 60 percent of them have a chronic disorder.
4	Sleep apnea affects about 20 million Americans.
4	An estimated 250,000 people suffer from narcolepsy.
4	More than 50 percent of Americans aged 65 and older have a sleep problem.
4	The prevalence of sleep disorders appears to increase with advancing age;an estimated 80 million Americans will have a sleep problem by the year 2010.
	The field of sleep medicine has evolved to treat sleep disordered breathing. Sleep disordered breathing refers to conditions where apneas and hypopneas are present during sleep. The most common form of sleep-disordered breathing (SBD) is obstructive sleep apnea (OSA), but sleep-disordered breathing also occurs in many other conditions experienced by patients.

Sleep Apnea Syndrome
Sleep apnea syndrome (SAS) is a breathing disorder characterized by apneas and hypopneas.

4	Apnea: a cessation of airflow for ten seconds or more
4	Hypopnea: a decrease in flow by at least 50% for 10 seconds or more.

Both apneas and hypopneas are associated with sleep arousal and/or oxygen desaturations of 3% or more. Apneas and hypopneas result from upper airway occlusion, either full or partial, or from a loss of the autonomic drive to breathe.

There are three types of apnea: obstructive, central, and mixed.

4	Obstructive Sleep Apnea (OSA)
	OSA is the most common type of sleep apnea. OSA occurs when upper airway occludes (either partially or fully) but efforts to breathe continue. The primary causes of upper airway obstruction are lack of muscle tone during sleep, excess tissue in the upper airway, and anatomic abnormalities in the upper airway and jaw.

4	Central Sleep Apnea (CSA)
	CSA affects only 5-10% of the sleep apnea population. CSA occurs when both airflow and respiratory effort cease. The cessation of breathing results from a loss of the automatic drive to breathe.

4	Mixed Apnea
	Mixed apneas occur when an initial central component followed by an obstructive component causes a cessation of breathing.
	Breathing resumes when the patient has a brief arousal from sleep, of which they usually have no memory. In severe cases, patients may have up to 100 events per hour, resulting in severe daytime symptomalogy.

Other Conditions for Which Sleep Testing is Covered

Narcolepsy
This term refers to a syndrome that is characterized by abnormal sleep tendencies, e.g. excessive daytime sleepiness or disturbed nocturnal sleep. Related diagnostic testing is covered if the patient has inappropriate sleep episodes or attacks (e.g., while driving, in the middle of a meal, in the middle of a conversation), amnesiac episodes or continuous disabling drowsiness. The sleep disorder clinic must submit documentation that this condition is severe enough to interfere with the patient's well being and health before Medicare benefits may be provided for diagnostic testing. Ordinarily, a diagnosis of narcolepsy can be confirmed by three sleep naps. If more than three sleep naps are claimed, you must submit persuasive medical evidence justifying the medical necessity for the additional test(s).

Impotence
This term refers to a syndrome that is characterized by abnormal sleep tendencies, e.g. excessive daytime sleepiness or disturbed nocturnal sleep. Related diagnostic testing is covered if the patient has inappropriate sleep episodes or attacks (e.g., while driving, in the middle of a meal, in the middle of a conversation), amnesiac episodes or continuous disabling drowsiness. The sleep disorder clinic must submit documentation that this condition is severe enough to interfere with the patient's well being and health before Medicare benefits may be provided for diagnostic testing. Ordinarily, a diagnosis of narcolepsy can be confirmed by three sleep naps. If more than three sleep naps are claimed, you must submit persuasive medical evidence justifying the medical necessity for the additional test(s).

Parasomnia
Parasomnias are a group of conditions that represent undesirable or unpleasant occurrences during sleep. Behavior during these times can often lead to damage to the surroundings and injury to the patient or to others. Parasomnia may include conditions such as sleepwalking, sleep terrors, and REM sleep behavior disorders. In many of these cases, the nature of these conditions may be established by careful clinical evaluation. Suspected seizure disorders as possible causes of the parasomnia are appropriately evaluated by standard or prolonged sleep EEG studies. In cases where seizure disorders have been ruled out and in cases that present a history of repeated violent or injurious episodes during sleep, polysomnography may be useful in providing a diagnostic classification or prognosis.