Sleep apnea affects millions of people all around the globe. There is more than one type of sleep apnea, but all of them have a nasty habit of disrupting your sleep and creating other health complications in the future. Due to this condition’s incurable nature, the best solution is to invest in a positive air pressure (PAP) machine to help you sleep through the night. However, for most people, the amount of money they have to spend on this equipment isn’t easy to fit into their budget.
The three main methods used to treat sleep apnea (based on what kind of apnea you’re experiencing) include CPAP (continuous positive air pressure), BiPAP (bi-level positive air pressure) and APAP (automatic positive air pressure) machines. All of these can have a huge price variance, so it’s important to know in advance how much you’ll have to spend on a quality piece of equipment. Not only that, but you often have to purchase the breathing mask and airflow humidifiers, adding to the overall cost. This is where we come in – this article was made to explain everything you need to know about which PAP machine you may want, and how much you’ll have to spend for it. Let’s get into it:
Sleep Apnea Overview
Sleep apnea is a disorder characterized by brief periods of interrupted breathing during sleep. It can be as serious as it sounds, which is why getting it diagnosed and treated is so crucial. You should do your best to find out what kind of apnea you’re dealing with because they don’t all require the same equipment. Here’s a list of symptoms you can look out for if you suspect you might have sleep apnea of any sort:
- Loud snoring or interrupted breathing during the night (typically reported by someone else in your home)
- Waking up with a very dry mouth
- Major difficulties staying asleep at night
- Moments where you gasp for air during sleep
- Excessive daytime sleepiness
- An inability to stay focused or alert during the day
- Frequent headaches, especially in the morning
If you end up visiting the doctor, make sure you’re thorough in explaining all your problems. Diagnosis methods used to detect sleeping disorders are pretty reliable, but you want to make it as easy as possible for them to narrow down the list of potential conditions. You may have to fill out a questionnaire or spend the night in a sleep lab, but it’s worth it. The results of these tests can indicate one of the following kinds of sleep apnea:
- Central sleep apnea (or CSA for short), a disorder that manifests as an inability of your brain to send signals to crucial muscles that control breathing;
- Obstructive sleep apnea (or OSA for short), which occurs when there is a physical blockage in your air passage as a result of your throat muscles relaxing;
- Mixed or Complex Sleep Apnea, which functions as a combination of the previous two, and is less frequent.
Unfortunately, all three of these conditions share one important downside – there is no real cure. However, that doesn’t mean you’re entirely out of luck, as PAP therapy is incredibly reliable and doesn’t require much effort to implement – outside of purchasing the necessary machinery. This is where the biggest part of your financial investment occurs. A sleep study doesn’t typically break the bank, but PAP machines can be quite expensive. How expensive? Let’s see.
PAP Machines and Their Prices
Positive air pressure machines function in a way that’s easy to understand without getting too technical. The star of the show is the airflow generator, which uses a fan to draw in outside air and then pressurizes and humidifies it. This air is then delivered to the patient’s nose and mouth through a breathing mask, connected to the generator through a tube. The pressure setting is measured in centimeters of water, and PAP machines tend not to deviate from the 4-20 cmH2O range. The exact range will often depend on the type of PAP machine it is. For example:
- CPAP machines are used to treat obstructive sleep apnea, and their air pressure settings hover around 12-15 cmH2O.
- BiPAP machines tend to operate on two different air pressure settings – one for inhalation (commonly referred to as IPAP), and one for exhalation (typically called EPAP). The IPAP value tends to hover around 16 cmH2O, whereas the EPAP rate is closer to 12-13 cmH2O. These machines are used to deal with central sleep apnea.
- APAP machines are used to treat mixed sleep apnea, and their pressure rate tends to vary more than with the other two categories, as they’re made to accommodate many breathing patterns. You can expect a range of 10-18 cmH2O for one of these.
PAP machines are considered by the federal government to be Class II medical devices. The same goes for masks and air humidifiers, which means that, by law, all of this gear requires a prescription to purchase. So how much are you expected to pay for one of these pieces of equipment? Bear in mind that an airflow generator is not the only thing you need to get, as in many cases, you’ll have to pay for the mask, or even the humidifier itself too. To put it simply, the prices will depend on whether or not you have insurance to cover for some of the costs.
Luckily, sleep apnea affects more and more people as the years go by, so it’s getting increasingly wide recognition. More people are starting to realize just how many health problems can arise if this disorder isn’t dealt with, which compels new insurance providers to provide coverage. Of course, this doesn’t mean every provider will have your back in this situation, but it shouldn’t be too hard to find one that’s good for you. Several factors influence how much coverage you will receive, and it’s important to go over them one by one. The list goes as follows:
- Deductible: In the world of insurance, a deductible is a set amount of money that you have to spend on a service or purchase out of your own pocket before insurance coverage kicks in. As a rule, the higher the monthly premium you sign up for, the lower the deductible is. You should expect to see numbers ranging from $300 to $3,000 with most insurance providers.
- Coinsurance: Once you reach your deductible threshold, the insurance company doesn’t necessarily pay everything from that point onwards. Coinsurance represents the amount of money (in percentages) that the patient still has to put forth on their own. For example, if the coinsurance rate is 25%, that means that a quarter of all post-deductible costs have to be covered by the client, while the insurance company pays for the remaining 75%. This rate will vary from plan to plan, and it’s hard to pinpoint an average value, so you have to poke around and find a good deal.
- Copays: Copays are essentially fixed fees for certain services (such as doctor visits) that the client and insurance provider agree upon. In most cases, these fees will remain within the $30-60 range, although this can vary depending on which provider you end up sticking with. In-network physician visits will almost always cost significantly less than out-of-network visits, so keep that in mind.
Various insurance providers may also implement special rules when it comes to PAP treatment coverage. For example, you may be asked to rent equipment from predetermined companies before you commit to a full purchase. This is done to make sure the patient is willing to follow through with the therapy, and that the money isn’t being wasted. The rental period can last for up to a year in most cases, but will typically be closer to six months. Special rules will differ based on who’s imposing them, so before you make any kind of commitment, contact your insurance provider and work something out.
With all this in mind, let’s look at the prices. PAP machines and related gear such as masks and humidifiers are well worth the investment, as they can massively improve your long-term health, but it’s still a good idea to carefully plan out your budget. To be able to make concrete plans, you need to know the price ranges you will be working with while browsing your options. In this article, we will be using average prices, so be mindful of any potential variance and surprises.
Let’s examine the machines themselves before anything else. If you are on the market for a CPAP machine, and you have adequate insurance coverage, you will usually have to pay around $225 out-of-pocket. A BiPAP machine is the most expensive option and will set you back around $675 on average, which is not a light sum by any stretch of the imagination. An APAP machine sits at roughly half of that price, with an average cost of $320. Without insurance, these costs are typically doubled, making some of these machines quite difficult to invest in for some.
Now for the side gear. An air humidifier is the most expensive piece of equipment in this category, with a cost that hovers around $82.50 with insurance. A full face mask costs somewhere around $77.50, which isn’t an unnoticeable sum but is pretty affordable. Nasal cradles cost $65, while nasal prongs and nasal pillows are easier to afford, sitting at $40 and $45 respectively. As with the machines themselves, you can expect the costs to be doubled if you don’t have adequate insurance coverage.
Other Cost Considerations
In some cases, you can get away with spending less money than usual. For example, some organizations offer subsidization programs for PAP therapy, allowing patients with sleep apnea to procure PAP machines, tubing, humidifiers, and masks at a much lower price than what you’d normally expect. Sometimes, the cost can go down to as little as $100 or less! Unfortunately, you may run into supply issues, or only have ownership of the equipment temporarily. In other cases, you may need to provide proof of financial hardship or something similar.
Your employer could also provide some much-needed assistance. If you are covered by a high-deductible insurance plan, you could be eligible for a health savings account. This account is owned by you, the employee, and both you and your employer can typically make deposits to it. The downside of having a high deductible is made up for somewhat by having access to health savings funds even before the threshold is reached.
Alternatively, you could receive support via a health reimbursement account. An HRA is owned by the employer, but held in the employee’s name. The employer is the only party that can make deposits to this account, but the upside is that you’re not forced into high-deductible insurance deals. A flexible spending account is similar to an HRA but allows the employee to make deposits as well. We recommend consulting your company’s human resource department to figure out which of these options are available to you if any.
Online purchases can be annoying to deal with. While there are online PAP retailers, they typically won’t make deals with insurance companies, which gives you the responsibility to act as a middleman between the two parties and submit claims to your provider to receive coverage.