Medicare's CPAP Guidelines

for Adult Coverage Updated 

By Dave Jackson

© 2001 by Dave Jackson. All rights reserved.

Washington, D.C. (October 30, 2001) -- The Centers for Medicare and Medicaid Services (CMS), formerly known the Health Care Financing Administration (HCFA), announced today that positive airway pressure devices used for non-invasive treatment of apnea will be covered with more up-to-date guidelines.

Following the recommendations of researchers, manufacturers, patients, sleep advocates, and others, CMS decided that the former policy for coverage of Continuous Positive Airway Pressure (CPAP) devices used for the treatment of obstructive sleep apnea (OSA) were out-dated.

Under the new guidelines, CMS will revise the guidelines for coverage of CPAP use in treating apnea for adults if they have an Apnea-Hypopnea Index (AHI) of 15 or more per hour.

For those with more mild cases of apnea, fret not. CMS will be revising its guidelines for those who have an AHI of five and 14 events per hour if documented symptoms of excessive daytime sleepiness (EDS), impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke exist.

The AHI is equal to the average number of apneic events and hypopneas per hour, and, according to the CMS' new guidelines, must be based on a minimum of two hours of sleep and be recorded by polysomnography (PSG or sleep study) using actual recorded hours of sleep, meaning that the AHI may not be extrapolated or projected.

Two hours of recorded sleep is consistent with current accepted practice.

Apnea is defined as a cessation of breathing or airflow for at least 10 seconds. Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds, with at least a 30% reduction in chest wall movement or airflow as compared to baseline, and having at least a four percent oxygen desaturation.

The sleep study must be performed in a facility-based sleep study laboratory, according to and not in the home or in a mobile facility.

Sleep apnea refers to a collection of conditions and syndromes that have periods of apnea, a temporary cessation of breathing, as key occurrences, and was originally described in the early 1800s.

One of the first accounts was written by Charles Dickens in 1837, called The Posthumous Papers of the Pickwick Club. Subsequently, William Osler coined the term "Pickwickian" to describe the obese, hypersomnolent patient in 1918.

Over the years, various sleep apnea syndromes have been described and classified into three main types: central, obstructive, and mixed.

Central sleep apnea refers to apnea syndromes with origins in the central nervous system. In simple terms, the brain forgets to tell the lungs to take a breath. The most common type of apnea is obstructive sleep apnea (OSA), which is caused by the collapse of the upper airway during sleep. Mixed apnea, however, refers to apnea with both central and obstructive characteristics.

Copyright © 2001 David F. Jackson (Scoop0901). All rights reserved. The information contained in this article may not be published, broadcast, rewritten or redistributed without the prior written authority of Dave Jackson.

As of October 1, 2002 at 11:27:08 AM EDT (-0500), the U.S. population was 
288,181,442. With estimates that about five percent of the population suffers from

obstructive sleep apnea, that means there are potentially

14,409,072 apneics in the U.S.

As of October 1, 2002 at 11:27:08 AM EDT (-0500), the world population was 
6,253,616,576. With estimates that about five percent of the population suffers 
from obstructive sleep apnea, that means there are potentially

312,680,829 apneics in the world.

Awake In Philly is a support group for individuals who have been diagnosed with at least one of the recognized sleep disorders, as well as anyone else impacted by those with sleep disorders. The information on the Awake In Philly website is not intended to replace medical advice, nor is any information to be misinterpreted as an attempt to diagnose, treat, cure, or prevent any disease. 

If you have questions about any of the medical conditions mentioned on this website, especially if you suspect that you (or someone you know) has sleep apnea, please contact a qualified medical professional immediately. The information is intended to provide support, guidance, and encouragement to others contending with the many challenges of sleep disorders. The goals of Awake In Philly are to support, educate, and inform those who feel the impact of sleep disorders, as well as the general public. Medical advice should only come from qualified, licensed, and trained health-care professionals.