PAP (positive airway pressure) therapy treats obstructive sleep apnea by delivering pressurized air into the airways to keep it open during the night while sleeping. PAP can reduce or completely eliminate sleep apnea (learn more about how PAP therapy works here).

There is significant evidence that treating sleep apnea with PAP therapy improves quality of life, reduces daytime sleepiness, reduces motor-vehicle accidents, improves hypertension and may reduce death due to cardiovascular events.

The most common device is called CPAP; however, there is another device called bi-level PAP or BiPAP that can be more comfortable for some patients. Learn more about how that device works and what's required to get approval from your insurance company.

The patient clearly has sleep apnea, but it's not severe enough for the insurance company to cover therapy. Why?

Unfortunately, there are varying opinions about how sleep apnea is diagnosed and when CPAP is the appropriate therapy.

Primarily, the difference is between how Medicare (CMS) and the American Academy of Sleep Medicine (AASM) define a diagnosis of sleep apnea. And many commercial insurances are starting to follow Medicare's guidelines for CPAP coverage.

In this post we'll explain what insurance companies, including Medicare, are looking for in a sleep study to determine coverage for CPAP. We'll offer suggestions of what to do if insurance won't cover CPAP.

Do you have a new PAP machine and no longer need your old machine?

Do you have an extra mask or tubing for your old machine that you never used?

Would you like to donate your unused or gently used equipment?

Chances are, if you've been using PAP therapy for more than a couple of years, you've got an old device hanging around. We're keeping an updated list of local and national organizations that can help you sell or donate your new or gently used equipment to those in need.

A study published this month in the Journal of the American Medical Association (JAMA) examined the unauthorized sales by private individuals of secondhand CPAP devices. While most health insurance plans cover CPAP (learn more here about coverage for these devices), the average cost of a device for those without insurance or with a high deductible can be prohibitive .

The study examined person-to-person sales of CPAP devices at a range of geographic locations, median incomes, population densities and number of sleep clinics. They sorted through online ads for CPAP sales and even placed anonymous postings on Craigslist to solicit information from potential sellers and buyers.

What did they find?

CPAP is the only treatment that is 100% effective for treating obstructive sleep apnea, but a lot of patients struggle with using the device properly and using it every night.

CPAP works by blowing air into the air way to keep the airway from closing at night (this closure is called an apnea, learn more about obstructive sleep apnea here). CPAP therapy consists of a flow generation device, called the PAP machine, or blower, tubing that delivers the air to your airway and a mask that is strapped to your face at night to allow the pressurized air to flow into your airway and your exhalation to come out.

While many people have no difficulty using CPAP and report the best sleep of their lives in the first weeks after they start therapy, this isn't the case for everyone. In this post we cover the top side effects of PAP therapy (any device- CPAP, APAP or bi-level, read about the difference between these devices here) and how you can reduce or even avoid them.

1. You don't have health insurance.

This is a no-brainer. If you don't have health insurance, but have sleep apnea, you will need to pay cash for your machine and supplies. 

If you're having a hard time making ends meet, check out the organizations listed in this post that offer free or low-cost CPAP and supplies.

2. You have a high deductible health plan.

Many Americans now have higher deductibles to meet before their health insurance benefits kick in (check out our guide for understanding your health insurance here). While we understand that having a higher deductible usually means lower monthly premiums and that some benefits, like preventative care, are covered before you meet your deductible, almost all plans require you meet your entire individual or family deductible before CPAP and supplies, or sleep studies, are covered. Especially at the beginning of the year, this can mean paying entirely out of pocket for your new CPAP and supplies.

Even if you have insurance, you may prefer to shop online and pay cash for CPAP and supplies. While most online suppliers will not bill your health insurance (most of them aren't contracted with any insurances at all) some will and many will provide you with a list of codes so that you can submit the bill to your insurance. While you won't receive anything back from your insurance, you will receive "credit" towards your deductible. Especially if you or another family members expects to use your insurance throughout the year, you want to make sure every dollar you spend out of pocket is counted towards your deductible (learn about in-network vs. out-of-network deductibles and coverage differences here).

You should also consider using your HSA (health savings account) or FSA (flexible spending account) funds to pay for CPAP and supplies online. Save your receipts!

Like iPhones, CPAP machines have changed a lot over the past few years. The latest models are even starting to look like Apple devices. These changes in the form and function of CPAPs serve very important purposes.

(1) If a CPAP machine is more attractive and user-friendly, someone diagnosed with sleep apnea is more likely to use it.

• They're quieter and smaller.
• It's easier to turn on and off (many turn on automatically once you put on the mask and start breathing).

(2) If the technology allows for wireless transmission of usage data, the CPAP supplier (for some of you that might be us, learn more about "smart machines" here) doesn't have to hassle patients for smartcard download. When compliance data is required by the insurance company, the provider can easily access the data (here's a post where we talk about our process).

• Your CPAP supplier can help you troubleshoot when you're having issues with therapy. They can even adjust the settings remotely on some machines.
• You have access to your usage data, either online or on an app. Knowledge is power.
• If/when your insurance company requires proof of usage for your device rental or purchase or when it's time for new supplies, your supplier can easily obatin the info and send it directly to the insurance company. No need to mess with shipping cards back and forth.

(3) New devices are better at treating sleep apnea. That's a big deal.

So, now that you want a new machine, you're going to ask, "How do I get a new CPAP?"

Are you enrolled in Medicare or have patients who are?

We reviewed Medicare coverage for sleep studies here.

In this post, learn about Medicare Part B coverage for CPAP and other PAP therapy (Part B covers certain doctor's services, out patient care, medical supplies and preventative services).

CPAP is hard. Proper education during the set-up and beyond is critical. Another key factor for success is support from your healthcare provider, family and friends, or other CPAP users (here's our post about a study that shows patients with family support have better CPAP compliance).

In this blog post we provide info about five of the best online support groups and educational resources for PAP users.

It's important to know the basic about the different types of PAP (positive airway pressure) devices that are used to treat sleep apnea. Whether you're newly diagnosed with sleep apnea or a more seasoned user or healthcare provider, this post outlines the basics of each of the devices.

Our goal is to help you understand the differences in the devices or better understand the device you're currently using. Ultimately, we want to help those who suffer from sleep apnea be successful with PAP therapy. Read on!