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Obstructive sleep apnea (OSA) affects an estimated 2% to 9% of adults, though experts believe there are many more undiagnosed cases. Medical interventions for people with OSA include mouthguards, continuous positive airway pressure (CPAP) therapy, and surgically implanted devices.

We’ll take a close look at how CPAP therapy works and who might be a good candidate for it, as well as how much a machine costs and what you can expect health insurance to cover. We’ll also provide answers to frequently asked questions and tips for troubleshooting common issues.

What Is a CPAP Machine Used For?

People with OSA don’t breathe effectively while they sleep due to an obstruction in their upper airway. Their tongue or airway tissue physically block their breathing passage, causing them to snore, gasp, choke, wake up, or stop breathing. CPAP machines work to keep the airway clear by delivering enough pressurized air to prevent it from collapsing. The continuous stream of air helps to combat snoring and apnea-related events.

How Does a CPAP Machine Work?

A CPAP machine has three main components: a mask, a hose, and a machine. The machine has a fan that draws air into the device, which it then filters and purifies. With your doctor’s help, you can set the machine’s pressure level, which is measured in centimeters of water pressure.

A thin hose connects the machine to a CPAP mask. The hose should have a tight seal to both the device and mask, and it should be long enough to keep you from feeling restricted. The mask fits securely over your nostrils, mouth, or both, depending on the style. Pressurized air travels from the machine, through the hose, and into the mask, where it reaches the airway.

What Qualifies You for a CPAP Machine?

The first step to getting a CPAP machine is scheduling a doctor’s visit and a sleep study. During the study, a physician measures your apnea-hypopnea index (AHI). Apnea occurs when your breathing stops for 10 or more seconds, while hypopnea is shallow breathing related to partial airway collapse.

Physicians determine your AHI by dividing the number of apneic and hypopneic events you experience by how many hours you sleep. This measurement reflects the severity of your OSA and helps your doctor determine if CPAP therapy is the right treatment plan for you. Additionally, insurance providers typically refer to your AHI when determining whether you qualify for coverage.

The Benefits of Using a CPAP Machine

After introducing CPAP therapy to their nightly routine, many individuals experience better sleep, improved quality of life, and controlled symptoms . Those who live with untreated OSA wake often during the night, whether they realize it or not, which has multiple adverse effects.

Though there is no cure for sleep apnea, addressing it can improve your overall quality of life and help prevent life-threatening medical issues. Untreated OSA can result in irritating symptoms, like snoring, headaches, dry mouth, and brain fog. It can also lead to more severe problems , such as heart disease, stroke, and heart attacks.

Tips for Avoiding Common Issues With CPAP Devices

While CPAP devices can have a positive impact on people’s lives, they can be tricky to operate and uncomfortable if set up incorrectly. CPAP machines have multiple components and accessories, and it is important to use them correctly so that the device works effectively.

You need to ensure that the components are compatible with one another, especially if you purchase them from different manufacturers. Additionally, since sleeping positions affect how masks fit, you may need to alter how you sleep or choose a mask that works well with your favorite sleeping position.

CPAP mask compatibility: Almost all modern CPAP masks are compatible with the machines they attach to, with a few notable exceptions. Some older mask models and mini CPAP devices may require an adapter to connect correctly. Before purchasing a mask, double-check that the style will work with the hose and machine you intend to use.

Use a CPAP humidifier: When you breathe normally through your nasal passages, your nose works as a kind of humidifier, making the air more comfortable to breathe. When you use a CPAP machine, your nose cannot warm the pressurized air fast enough to keep up with the machine. This can cause dry mouth, a runny nose, and other cold-like symptoms.

Using a CPAP-compatible humidifier can make therapy more comfortable. However, it’s important to choose a humidifier with appropriate temperature settings to maintain proper moisture levels and prevent your face from feeling damp.

Get used to wearing a CPAP mask: Adding a new item to your sleep routine can be difficult to get used to, especially with an accessory as noticeable as a mask. There are many different mask styles, and some have a more streamlined fit than others. However, regardless of which kind you choose, it will take time to adjust to wearing a mask while you sleep.

Wearing a CPAP mask can be difficult for some side and stomach sleepers, as pillows can interfere with how masks fit. To avoid discomfort, you can buy CPAP-compatible pillows designed to accommodate a mask and hose.

Ensure proper fit: Using a CPAP machine that doesn’t fit properly can prevent you from getting effective therapy. Broken hose connections at either end can cause air to escape, leaving sleepers with the wrong pressure level. Additionally, an ill-fitting mask or improper seal does not successfully keep the airway open and allows air to escape.

To avoid these issues, make sure all connections are secure and ensure that the mask fits your face shape before using it.

How to Know if You May Need a CPAP Machine

OSA is the most common form of sleep apnea. The second type is called central sleep apnea (CSA). CSA occurs when the brain fails to activate respiratory muscles during sleep.

CPAP therapy is most appropriate for people with OSA. Common OSA symptoms include:

  • Snoring
  • Gasping or choking
  • Excessive daytime sleepiness
  • Brain fog
  • Headaches
  • Irritability

Though women can have OSA, severe OSA most often affects men . Certain people are at a higher risk for developing sleep apnea. This includes people who are overweight or obese, those with a large neck circumference, people who smoke or drink, and individuals with small airways. Consult your physician if you experience symptoms of OSA. Your doctor can help you determine if CPAP therapy is the best option for your individual needs.

Frequently Asked Questions

Do you need a prescription to buy a CPAP machine?

While you might be able to conduct an at-home sleep apnea test to self-diagnose, you must get a prescription from your doctor to buy a CPAP machine. The Food and Drug Administration lowered CPAP machines from a Class III to a Class II medical device designation in 2018, meaning that while they don’t pose a high risk, you still need a prescription to obtain one. While getting a prescription may be an initial hurdle, the process can actually help you thoroughly understand your diagnosis.

Following a sleep study, your physician can prescribe a CPAP machine and help you determine the most suitable device for your needs. They will also ensure it is set up correctly and that the pressure level is right for you. Additionally, physicians can help you troubleshoot your device and remind you when it’s time to replace components. Make sure to avoid retailers that sell CPAP machines that do not require a prescription, as these devices may not be approved by the FDA.

Does insurance cover a CPAP machine?

The first step to getting your insurance to cover a CPAP machine is getting a prescription from your doctor. During your sleep study, physicians measure your AHI. Insurance companies take your AHI into consideration when deciding whether or not to cover your device. The following numbers indicate AHI severity :
Mild: 5 to 14
Moderate: 15 to 30
Severe: Greater than 30

If you meet certain conditions, you can expect Medicare and Medicaid to cover at least a portion of your CPAP machine, regardless of whether your index is mild, moderate, or severe. If you don’t have Medicaid or Medicare, you’ll need to check with your specific insurance plan to determine coverage options. It’s important to note that even if your insurance pays for the machine itself, it may not cover tubing, filters, humidifiers, or other CPAP-related accessories. You may also need to meet your plan’s deductible before your provider covers the device.

How long does it take a CPAP machine to work?

How long it takes CPAP machines to work varies from person to person. Some users notice a difference the first morning following treatment, while it may take others much longer. Most people begin to notice benefits within a few weeks after first using the machine.

You are more likely to experience benefits from a CPAP machine if you get the right equipment and ensure it fits correctly. A CPAP-compatible pillow is a low-cost investment that can increase comfort and decrease the likelihood that your mask will come off during the night.

How much does a CPAP machine cost?

Like other sleep-related products, CPAP machines vary in price. Most machines range between $250 and $1,000, though items like filters, masks, tubing, or mask cushions typically cost extra. Your health insurance may cover a portion or all of your machine, though many providers don’t cover additional features.

Machines that have added technology or high-end components tend to cost between $500 and $800. In addition to the machine, you will also need to consider parts that need regular replacing. Filters typically cost between $5 and $30, masks usually carry price tags between $50 and $250 depending on the style, and mask cushions generally range between $20 and $100.

How do I purchase a CPAP machine?

You can purchase a CPAP machine after securing a prescription from your physician. Since your diagnosis is specific, you’ll need to purchase a machine that addresses your individual needs. You can choose to purchase a CPAP machine with or without help from an insurance provider.

If you choose to use coverage through your provider, they can dictate which machine to buy. This may be the most cost-effective option, as long as you are satisfied with the device the company recommends. You can also purchase a CPAP machine through numerous online retailers, though your insurance may not cover the specific machine you select.

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7 Sources

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