What Is a CPAP Machine?
A CPAP machine is most often used to treat sleep apnea, a common condition that causes your breathing to stop and start again while you’re sleeping. Sleep apnea can affect your quality of sleep and can be identified by symptoms such as snoring, daytime sleepiness, dry mouth and morning headaches.
“Obstructive sleep apnea (OSA) develops when the throat collapses into the airway at night, triggering an obstruction to breathing,” explains Thomas Kilkenny, doctor of osteopathic medicine and director at the Institute of Sleep Medicine at Staten Island University Hospital in New York. “Untreated OSA causes a host of medical conditions including several serious cardiovascular issues, such as heart attacks, high blood pressure, strokes and arrhythmias.”
CPAP machines help by administering air pressure to the airway through a mask, functioning as a pneumatic splint to keep the airway open, says Dr. Kilkenny. “While wearing the CPAP, the airway no longer collapses, and OSA is treated.” While CPAP machines are most commonly used to alleviate sleep apnea, Dr. Kilkenny notes that they may also be used for other respiratory disorders like asthma, chronic obstructive pulmonary disease (COPD) and emphysema.
There are three types of CPAP masks:
- Nasal mask. This either covers the nose completely or just the bottom half of the nose and sits on the bridge of your nose, similar to a pair of glasses. It’s held in place with velcro straps and pushes pressurized air into your nostrils.
- Nasal pillow mask. This fits in the opening of the nostrils under the nose, making it a less bulky option and the more comfortable option for many people.
- Full face mask. This mask covers both the nose and the mouth and is best for people who tend to breathe through their mouth, since it delivers air into your mouth.
CPAP machines can be uncomfortable and often require an adjustment period, but they are effective. “CPAP therapy is the clinical gold standard treatment for sleep apnea, because it is the only therapy that is fully effective for nearly every patient and is extremely safe and well tolerated,” says Carlos M. Nunez, M.D., chief medical officer at ResMed, a medical equipment company based in San Diego, California. “Not only does CPAP help normalize breathing, oxygenation and sleep, it alleviates the daytime symptoms that are so common.” He adds that CPAP therapy can also help prevent chronic diseases like high blood pressure, heart disease, type 2 diabetes, hypertension, stroke and obesity.
To buy a CPAP machine you must first see a doctor. “CPAP machines are medical devices and must be ordered by a licensed physician,” says Dr. Kilkenny.
How Much Does a CPAP Machine Cost?
The price of a CPAP machine varies widely depending on the type of machine you’re considering—and your medical insurance coverage.
“Typically, the cost may range from $500 to $1,000,” says Roshini Singh, a national board-certified nurse practitioner working with 365 Wellness, a mobile primary care provider in Boca Raton, Florida. “There are maintenance costs to keep in mind as well, which will range on average $300 to $600 annually.”
Machines with more advanced features tend to cost more. “The latest model, top brand CPAP unit costs anywhere from $800 to $1,500 depending on the type of machine and accessories,” says Dr. Kilkenny.
Auto-adjusting positive airway pressure (APAP) machines can cost between $600 and $1,600. APAP machines are similar to CPAP machines, though APAP machines can automatically adjust the amount of pressure used based on sleeping patterns and will increase automatically if breathing slows or stops.
Bilevel positive airway pressure (BiPAP) machines, meanwhile, are able to provide two different air pressures for the sleeper’s inhale and exhale. These advanced machines can cost between $1,700 and $3,000 or more.
CPAP machine accessories are another cost consideration. Accessories must be carefully maintained and replaced regularly to ensure upkeep. Accessories include:
- Air filters. These should be changed monthly and typically cost about $5 or less per filter depending on the type of machine.
- Humidifier. Humidifiers should be changed at least every six months and can cost between $20 and $60.
- Tubing. Tubing should be replaced every three months and can range in price from $5 to $55 or more if you want heated options.
- Headgear and masks. These should be replaced at least every six months and can cost between $50 and $200 depending on the design and type.
- Mask cushions. These should be replaced monthly and can cost between $20 and $60.
- Comfort items. While not necessary, items like travel cases, special memory foam pillows, nasal moisturizing cream and cheek and neck pads can offer additional support for people who use a CPAP machine. These accessories can range from $10 to $150 depending on the item.
Does Insurance Cover CPAP Machines?
Medical insurance will generally help cover the cost of a CPAP machine that’s been prescribed by a health care provider. Insurance often covers essential CPAP machine accessories as well. “In most instances the patient’s insurance will pick up the costs of paying for the CPAP, as it is much less expensive to pay for the CPAP than trying to pay for the lifelong medical costs of untreated disease,” says Dr. Kilkenny.
In order to have insurance pay for a CPAP machine, you must have a proper evaluation for sleep disorders by a sleep specialist who likely would recommend a sleep study to confirm a sleep apnea diagnosis and would provide a prescription, says Dr. Nunez. “After receiving the diagnosis and exploring treatment options with your doctor, you should contact your insurance provider to learn what’s covered under your plan, as each provider has different levels of coverage for equipment like CPAP machines, masks and replacement parts.”
Insurance may cover all or part of the CPAP machine and accessories deemed necessary. How much of the cost is covered depends on the type of insurance coverage you have, where you live and your specific diagnosis. Many insurance providers analyze your apnea-hypopnea index (AHI) when determining coverage. Your AHI refers to how many times per hour of sleep you stop and restart breathing and is determined after you complete a sleep study. However, keep in mind that the criteria to qualify for a CPAP can differ from one insurance company or policy to another. “Usually, most insurances follow the recommendations of the Centers for Medicare and Medicaid Services,” says Dr. Kilkenny.
Sometimes insurance coverage comes with an associated copayment or deductible, Dr. Kilkenny points out. Insurance may also cover at least some accessories. “There is usually an associated maintenance program where the patients can get replacement pieces, such as new CPAP masks and hoses, covered by the insurance as well,” he notes.
CPAP machines are generally covered by Medicare, although Medicare typically doesn’t cover 100% of the costs. To meet the requirements, you’ll need to meet with a doctor and use a supplier enrolled with Medicare, be diagnosed with OSA with an AHI of at least 15 events per hour or between five and 14 events per hour if there is a comorbidity associated with OSA. You’ll also have to meet the Part B deductible, and then you’ll pay 20% of the Medicare-approved amount for the machine rental and accessories (this fee will vary depending on your coverage and deductible).
Once these costs are covered, you’ll need to prove that you are using it regularly. At first, Medicare may cover a three-month trial of CPAP therapy, which involves the machine and accessories. After that trial period, Medicare may continue coverage as long as you continue to meet with your doctor in person and your doctor documents that you meet certain conditions and that the therapy is proving to be helpful.
After that three-month trial, Medicare may pay for a CPAP machine rental for 13 months, but you have to use it on a daily basis. After that 13 months, you’ll likely own the machine.
You can still get a CPAP machine without insurance by paying out-of-pocket. “There are many online stores available that sell CPAP units and supplies for the CPAP such as hoses, masks and filters,” says Dr. Kilkenny. “However, the CPAP unit is a medical device and a physician prescription is still needed.”
How to Choose a CPAP Machine
When you need to use a CPAP machine, you may find that you don’t have much of a choice in what you get. Once you go through the doctor visits and tests to get insurance approval, the surgical supply company in the network of your insurance plan will send you one of the CPAP units they have in stock, explains Dr. Kilkenny. “Luckily, there are usually only two to three high-end CPAP manufacturers with available products in the U.S. that are commonly used,” he adds. “Patients can request a specific model, but what they receive depends on the models carried by the vendors.”
If you are not going through insurance, you have more freedom in selecting the machine and accessories you want. “As with anything, one may choose one product over another depending on their current budget and their specific needs,” says Singh. “At the end of the day, I’d rather a patient find the most affordable option that will offer the proper technology. I certainly wouldn’t want a patient to not have one because they feel that a more expensive machine is the only way to treat their condition.”
Before requesting or purchasing a specific model, keep the following guidance in mind:
- Find a mask that fits properly. You may need to test and get fitted for the mask that works best for you according to your doctor’s recommendations, says Dr. Nunez. This can depend on factors like if you’re a side sleeper and if you breathe through your mouth.
- Consider whether you want a humidifier. Some CPAP machines do come with optional features like a heated humidifier for added moisture in the airflow or a heated CPAP hose that allows for higher concentrations of humidity. “Wearing a CPAP may cause dry mouth, so having a humidifier built in would greatly reduce that,” says Singh. Including a humidifier will likely affect the overall cost, especially since humidifiers need to be replaced every few months.
- Determine the type of machine you want. The companies that make CPAP machines also make APAP and BiPAP machines. APAP and BiPAP machines are typically more expensive.
- Decide if you want to spring for more comfortable features. You can spend a little more to get premium features on a CPAP machine for extra comfort. “One such option is a pressure reduction mode that decreases the air pressure on exhalation to make breathing more comfortable,” says Dr. Kilkenny.
- Think about portability—and noise levels. Ask representatives of CPAP machine companies about noise levels of each machine and, if you travel often, look for CPAP machines that are portable, advises Singh.
