Frequently Asked Questions

Home sleep testing is used to find out whether obstructive sleep apnea is present. It is most helpful when someone has a high likelihood of having the problem. A variety of devices can be used to perform a home sleep test. Sleep Medicine Associates uses WatchPAT devices (WatchPAT One, WatchPAT 300) that are well validated and that provide information about wake and sleep, abnormal breathing during sleep, snoring, oxygen levels, positioning, and information about heart rate and some arrhythmias. In general, home sleep testing devices obtain less information about your sleep than sleep studies performed in a sleep lab.

Answering some questions can determine whether a sleep test at home is appropriate for you. Take the assessment.

A home sleep test is appropriate when you have signs and symptoms of sleep apnea including snoring, snorting/gasping/apneas, and are not rested from a night of adequate hours of sleep.  An assessment can help determine whether a sleep test at home is appropriate.

Take the assessment

If you do not have signs and symptoms of obstructive sleep apnea, home sleep testing is typically not appropriate.  Evaluation of central sleep apnea, sleepiness disorders such as narcolepsy, evaluation of parasomnias such as REM behavior, and movement disorders in sleep such as leg movements are best done in a sleep laboratory.

Significant lung disease

Heart failure

Neuromuscular disease affecting the respiratory system

If hypoventilation is suspected by your doctor

Chronic opioid medication use

Severe insomnia

Stroke

Whether you pay cash for the home sleep test or use your health insurance coverage will determine how much you pay for a home sleep test. If you need to see the sleep doctor to get a prescription for the sleep study, this will increase your overall cost.

If you have a prescription for the study and are paying with cash, you will pay $249.

If you have a prescription for the study and are using health insurance to cover the cost, the amount you pay will be determined by factors that include how much your insurance allows for the home sleep test code (95800), your remaining deductible, and any copay or co-insurance amounts that may be due.

The following is needed to schedule a home sleep test:

1. A valid prescription for a home sleep test
2. An assessment or health care provider documentation that a home sleep study is medically necessary
3. A Sleep Medicine Associates, P.A. account has been created

Valid prescription

• A prescription for a home sleep study has been faxed to SMA by your healthcare provider
• Or you have a copy of a valid prescription for a sleep study that will be uploaded later in the scheduling process
• Or a telemedicine appointment with Dr. Cocanower has been completed with a prescription for the sleep study written

Assessment/documentation

• Your healthcare provider faxed medical notes that adequately document appropriateness of home sleep testing and medical necessity
• Or a telemedicine visit with Dr. Cocanower has been completed documenting appropriateness of home sleep testing
• Or you have completed an assessment that indicates home sleep testing is appropriate and you have a valid prescription for the home sleep study

Then Create an account with Sleep Medicine Associates, P.A. (SMA)

Create account

Most health insurance products provide some coverage of home sleep testing.  The code for the device that you will use at SMA is 95800.  There are other home sleep testing codes so make sure that you use the code provided when checking with your insurance carrier regarding coverage of home sleep testing and the allowable amount for the sleep test.  If using your health insurance to pay for your home sleep study, be aware of coverage details (such as is pre-authorization required, is a visit with a doctor or healthcare provider needed before the home sleep study will be covered) that can create barriers or result in delays in having the home sleep test.

Some health insurance companies require that a prior authorization (PA) be obtained to have coverage for the home sleep study.  If this is not obtained before the study, insurance may not pay for the test leaving you responsible for the sleep test charges.  Providing accurate insurance information before the sleep test is performed will avoid this problem.  If a PA is needed, a note in your medical record from your doctor or healthcare provider that documents the symptoms you are having and that a home sleep test is necessary and appropriate may be needed.  If your insurance requires medical documentation and this has not been done, you will need to see your doctor or healthcare provider to facilitate this or you can arrange for an appointment with Dr. Cocanower so that the needed information can be documented.

The advantage of using health insurance to help pay for sleep testing, office visits, etc. is that your costs for the services obtained may be less than if paying for the cost of your healthcare without insurance.  The disadvantage of using your health insurance is that this may create additional hurdles to obtaining the desired services as a prior authorization may be required before services will be covered by insurance.  If your insurance requires a prior authorization for home sleep testing, this will involve your healthcare provider documenting the rationale for ordering a sleep study including symptoms you may have.  If you pay cash, provided your assessment indicates that you are a reasonable candidate for home sleep testing, no additional visits may be necessary before having the sleep study.

Your appointment will be with David A. Cocanower, M.D., a board-certified sleep physician with more than 25 years of clinical sleep medicine experience.  Trained in internal medicine, pulmonary and critical care, and sleep medicine, he has spent most of his career focused on the evaluation and management of sleep disorders.  He has medical licenses to practice in Kansas, Missouri, and Indiana.

Currently, telemedicine is the only format available for patient visits.   Though there can be drawbacks to telemedicine visits (ie. internet issues, examinations can be limited), the use of telehealth in sleep medicine improves access to care, typically is adequate to provide excellent care, and many patients prefer this type of visit because of convenience.

During your consultation appointment, your sleep history, medical history, sleep testing results and treatment options (if applicable) will usually be reviewed.  A limited virtual exam will also be performed.  You will be asked to complete questionnaires that are found on the patient portal prior to your consultation appointment.  These questionnaires provide Dr. Cocanower with important information about your sleep health and facilitate an efficient and effective visit.  Completing the questionnaires also helps prepare you for the visit by prompting you to think through aspects of your sleep and wakefulness that you may not have considered.  Appointments typically last from 30-45 minutes depending on the complexity of your medical and sleep history.

A follow up appointment is used to review sleep study results, treatment options that may be appropriate, and to evaluate response to therapy that has been prescribed.  Generally, follow up visits will last 15-30 minutes depending on the complexity of issues being discussed.

Your health insurer contracts with healthcare providers ie. doctors and has specific allowable amounts for consultations (new patient visits), follow up visits (established patients), and sleep studies.  These amounts will be reviewed with you prior to visits.  Any co-pays you may owe associated with a visit will be paid in advance or at the time of the appointment and you may have additional costs if you have not met your deductible or have co-insurance due.  The visit codes for most consultations are 99203 and 99204.  For follow up visits, the codes typically used are 99213 and 99214.  For patients paying cash, the cost ranges from $135-175 for a consultation, or $90-125 for follow up visits.

Currently, only patients who are physically located in Kansas, Missouri, or Indiana can be seen by Dr. Cocanower as he is licensed to practice medicine in those states.  Contact the practice if you live outside those locations as this helps gauge interest that helps decision-making about states in which to add services.

Maintaining an open airway (throat area) during sleep is the strategy for treatment of obstructive sleep apnea.  Options include: 1) Positive airway pressure (PAP) that splints the airway with air under pressure; 2) oral appliance therapy that involves wearing a device that fits over the teeth and keeps the jaw from relaxing into the airway or advances the jaw to increase the posterior airway (throat area) size; 3) Surgical treatments include making anatomical changes to increase the size of the airway and inplanting a stimulator for the tongue (Inspire).  Surgeries to widen the palate and advance the lower jaw are also available; 4) Neuromuscular electrical stimulation of the tongue (eXcite OSA) is approved for mild obstructive sleep apnea; 5) Weight reduction, when appropriate, can reduce the risk for obstructive sleep apnea; 6) Positioning therapy is typically used to prevent back sleep; 7) Studies are ongoing to evaluate the use of medications to stabilize the upper airway.

Generally, devices used to treat sleep apnea require a prescription ie. PAP, oral appliance, eXcite OSA, some positioning devices, and medications that are being studied for treatment of sleep apnea.  Surgeries are typically performed by otolarygologists (ENT physician) or oral surgeons and involve presurgical assessment(s).

If you don’t have a healthcare provider (ie. doctor, nurse practitioner, physician assistant) to write a prescription for sleep testing or treatment, you can make an appointment to be evaluated by Dr. Cocanower (provided you are located in Kansas, Missouri, or Indiana).  Once evaluated, a prescription for sleep testing or treatment can be written if appropriate.

Treating sleep apnea improves the quality of sleep and reduces the risks for various health problems.  Left untreated, sleep apnea contributes to poor sleep quality, difficulty falling and staying asleep, and daytime tiredness and sleepiness. Medical disorders associated with untreated sleep apnea include high blood pressure, heart attacks, strokes, arrhythmias, diabetes, mood disorders, and dementia to list just a few.

Most people are familiar with health problems that can be associated with untreated sleep apnea including high blood pressure, heart attacks, strokes, arrhythmias, diabetes, mood disorders, and dementia.  The list of symptoms and health issues associated with untreated sleep apnea that you may be less familiar with includes:

• Erectile dysfunction (ED)
• ADD/ADHD
• GERD
• Headaches
• Atrial fibrillation
• Greater risk for seizures
• Nocturia (waking more frequently to urinate)
• Sweating during sleep
• Insomnia
• Restless legs

CPAP stands for Continuous Positive Airway Pressure.  This is a treatment for obstructive sleep apnea that involves an electrical device that takes air from the room, pressurizes the air and delivers the air through small tubing and a face mask to a person’s throat area, splinting open the airway to allow air to enter the lungs for more effective breathing.  Improvements in the therapy have resulted in devices that are smaller, quieter, and smarter than in the past.  CPAP is considered the treatment of choice for moderate to severe obstructive sleep apnea.  BIPAP stands for Bi-level Positive Airway Pressure.  It differs from CPAP in that the pressure delivered by the device drops during expiration (breathing out).  Traditionally, BIPAP has been used in patients requiring higher treatment pressures to improve comfort, to provide additional ventilation to patients with lung disease, and to address unwanted symptoms that can be associated with PAP treatment including dry mouth when mouth breathing, and bloating.

Inspire is the brand name for a hypoglossal nerve stimulator marketed by Inspire Medical Systems, Inc. The device is an alternative to PAP or oral appliance therapy and consists of an implanted generator with a sensing wire to detect breathing and a wire that delivers a stimulus to the hypoglossal nerve that controls the tongue muscle.  The system is turned on for sleep and treats sleep apnea by moving the tongue forward when a breath is taken so that the airway (throat area) is more open.  Various eligibility criteria must be met and the procedure is usually performed by an ENT physician.

Oral appliance therapy (OAT) for sleep apnea is a mouthpiece used during sleep to reposition the jaw and tongue to create more space in the throat area.  A dentist facilitates this treatment by evaluating the adequacy of the teeth and gums, obtains an impression of the teeth using a digital scanner, and oversees adjustments made in the device to optimize treatment