Insurers Are Grumpy Over Booming Sleep Apnea Business : Shots - Health News Sleep apnea is a condition that can raise the risk of several serious illnesses, including heart disease. Testing for the condition is a lucrative business, and sleep labs have sprung up across the country. But as spending skyrockets, insurers are rethinking how they pay for testing to curb costs.

The Sleep Apnea Business Is Booming, And Insurers Aren't Happy

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


And let's stay on the subject of good night's rest. Somebody in your home may snore. Maybe it's even you.


Not me, Steve. I don't think it's me.


MONTAGNE: But whoever, it may seem harmless, but in some cases snoring can be a sign of sleep apnea, and that's a condition linked to numerous serious illnesses. Over the past decade, the number of accredited sleep labs that test for apnea has quadrupled. But testing isn't cheap and some critics argue it's gone too far. Here's Jenny Gold of our partner, Kaiser Health News.

JENNY GOLD, BYLINE: It's a Monday night and Lauretta Martin is here at the National Rehabilitation Hospital in Washington, D.C. She's wearing a pair of soft gray pajamas and fuzzy pink slipper socks.

LAURETTA MARTIN: I can't hear myself snore, but I guess I am a snorer 'cause my husband tells me I snore. So I am a snorer.


GOLD: As it turns out, Martin's husband was onto something. She was diagnosed as having sleep apnea, a condition where someone repeatedly stops breathing for several seconds or even minutes throughout the night. She's being fitted for a breathing machine called a CPAP that helps keep a snorer's airway open. She's also being covered in 27 electrodes in a rainbow of colors to monitor her every move.

MARTIN: It feels kind of funny. Can you loosen these up a little bit?

UNIDENTIFIED WOMAN: Yes, a little bit.

GOLD: The testing room feels a lot like a Holiday Inn, with striped wallpaper and a floral bedspread. It even comes equipped with WiFi, a flat-screen TV, and of course plenty of generic prints.

DR. DAVID GROSS: Usually somewhere in a sleep lab there's Vincent Van Gogh's "Starry Night." I mean it's against the law not to have that picture somewhere.

GOLD: Dr. David Gross is the medical director of the sleep lab, which is accredited by the American Academy of Sleep Medicine. He says more than three-quarters of the patients who come here are diagnosed with apnea. But he worries that overall most people with apnea are never diagnosed, despite the fact that it's known to be linked to heart disease and even dementia.

GROSS: I think the medical community is sort of dropping the ball to some degree. It's just sad when you walk through the hospital and you see these patients with heart failure - person might be 35 years old, he's 350 pounds, but no one's thinking that he has sleep apnea, which he statistically does.

GOLD: But the medical community has become more aware, especially as the population ages and grows more obese. And as the number of sleep labs has grown, so has spending by Medicare and insurance companies.

Dr. Fred Holt says some patients aren't getting basic exams first, so they're having expensive tests done that they don't really need. Or the labs prescribe CPAP right away without first suggesting strategies like sleeping on your side. Holt, the medical director of Blue Cross Blue Shield in North Carolina, is an expert on fraud and waste.

DR. FRED HOLT: We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value. This might be because of naivete on the part of the physician, or unfortunately it could be done for the sake of improving the cash flow of the business.

GOLD: In other words, just because you snore doesn't mean you have a chronic illness. And because there's little downside to spending a night in a comfy sleep lab, many patients are willing to give it a shot. But the tests can cost $1,900 a night, mostly covered by insurance.

Helen Darling is the president of the National Business Group on Health. She says doctors ought to focus on common-sense approaches to sleep apnea, like losing weight, before turning to expensive testing.

HELEN DARLING: This is a good example of something like where we have technology, we have financial incentives to use more of it than we've historically done, you have enough problems, including a growing obesity epidemic, you sort of put together the so-called perfect storm for driving up overuse and health care cost.

GOLD: Some insurers are starting to change the way they pay for sleep testing to curb those costs. Many now require a special pre-authorization and are asking doctors to consider using cheaper home sleep tests instead, which can cost about a fifth as much as a sleep lab.

For NPR News, I'm Jenny Gold.

Copyright © 2012 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.