Sleep study covered by Medicaid in NY?

Hi,
A friend has been struggling with insomnia.
There is no obvious signs of sleep apnea. I have been awake at times when she was sleeping and I didn't notice any stopped breathing or loud snoring but I didn't listen for long - maybe 30 min without me really focusing on her..

My friends biggest complaint is hearing her heart beat loudly which keeps her awake. Her mother, Father, and grandmother all Have been Heavy snorers.

No issues like high blood pressure. She does have a lot of stress and anxiety right now because of life events.

I know.sleep studies look for all sorts of things, not just sleep apnea.

Anyone have a diagnosis of additional issues causing insomnia, not just sleep apnea?
Anyone know if Medicaid in NYC covers sleep studies?
Anyone know of a sleep good center in NYC (Queens or Manhattan)?

Thanks in advance for your help.

CpapWife wrote:Hi,
A friend has been struggling with insomnia.
There is no obvious signs of sleep apnea. I have been awake at times when she was sleeping and I didn't notice any stopped breathing or loud snoring but I didn't listen for long - maybe 30 min without me really focusing on her..

My friends biggest complaint is hearing her heart beat loudly which keeps her awake. Her mother, Father, and grandmother all Have been Heavy snorers.

No issues like high blood pressure. She does have a lot of stress and anxiety right now because of life events.

I know.sleep studies look for all sorts of things, not just sleep apnea.

Anyone have a diagnosis of additional issues causing insomnia, not just sleep apnea?
Anyone know if Medicaid in NYC covers sleep studies?
Anyone know of a sleep good center in NYC (Queens or Manhattan)?

Thanks in advance for your help.

Hi CpapWife,

People who have witnessed my dosing off without the machine have said I showed no signs of sleep apnea. But yet, three times, I have been diagnosed with moderate sleep apnea via one home study and two full-scale ones.

As a result, your friend could still have sleep apnea, particularly if there is a family history of snoring. Snoring doesn't always equate to the condition but many times, it does.

So if I were her, I would contact NY Medicaid to find out what the coverage is for sleep studies and how she could get a referral for one.

Best of luck.

49er

That being said, sleep studies do not address insomnia as such because they diagnose 'sleep' disorders that occur when patients are asleep. Just wondering if she has seen someone for her stress, anxiety, etc, been referred to e.g. a neurologist or psychologist who specializes in sleep problems - the more appropriate people. There are knowledgable people here who've dealt with insomnia, but in connection with known apnea, not just on its own, though as 49er said, I suppose she could incidentally have apnea as well.

My friend has gone thru the route of trying anti- anxiety pills and a little with sleeping pills - her mother sees an neurologist (Alzheimer's) and some of her mothers caregivers have given my friend prescriptions. But the pills either do not work consistently or she feels horrible and can't use them.
She has also tried other things like exercise, tapping, acupressure routines done daily, enjoying life, group support, friend support, etc, Overseeing her mothers care has just taken a huge toll over the years and with her mothers downturn the last year, the stress is higher and no amount of help really relieves it. Yes she had in home care and mom is now in a nursing home.

As you all know not getting decent regular sleep just makes things even more difficult.
So we are wondering at the root cause of the not sleeping well and if a sleep study might add some understanding,

I know of one person who was diagnosed with cortisol issues on a sleep study (sleep apnea was ruled out). I know they monitor brain waves,'must monitor heart as well as o2, so we thought they might see something not seen in a quick office visit.

On a typical night she sleeps 5-7 hours of sleep but wakes not rested, on a bad night she barely dozes, tossing and turning all night.

Sleep is not directly connected to how difficult her day/week was or any decernable activities of the day (e.g. If exercised, if took a play day, etc.).

I had suggested a psychiatrist rather than a regular Dr that she had seen as i thought they would be more knowledgeable.
I didn't know a neurologist might have knowledge.

CPAPwife, I would definitely urge your friend to have a sleep study. Just because she is dealing with stress with her mom, doesn't mean she can't have a sleep breathing disorder. And as I mentioned before, the fact that she has a family history of snoring should give the doctor motivation to schedule her for one.

Ideally, your friend would see a sleep medicine doc who could be a neurologist, psychiatrist, or pulmonology who is board certified in this area. They would then order the sleep study. But again, she should check with NY Medicaid to find out how things work.

And by the way, even if your friend doesn't have apnea, she could still have a sleep breathing disorder called UARS, https://en.wikipedia.org/wiki/Upper_air ... e_syndrome. So in addition to testing for hypopneas or apneas, make sure RERAs are measured, which is usually an indication of this condition.

49er

CpapWife wrote:Anyone know if Medicaid in NYC covers sleep studies?

A quick Google search of "NY Medicaid sleep studies" turned up this official link. It's from many years ago, but since it's still on the official NY Medicaid site, it's probably still in effect:

https://www.health.ny.gov/health_care/m ... ct2004.htm

You have to scroll half-way down the page to reach the section on sleep studies. Essentially, the page says that sleep studies must be ordered by a physician specializing "in pulmonology, otolaryngology and neurology". Documentation of the need for a sleep study must be in the patient's clinical record.

You also ask:

Anyone have a diagnosis of additional issues causing insomnia, not just sleep apnea?

Lots of things can cause insomnia. Among them stress, many medications, depression, bipolar disorders, anxiety, circadian rhythm disorders. Those things, of course, are not typically tested for on a sleep test. And a lot of people just wind up with a diagnosis of "idopathic insomnia" that is considered "intractable" meaning: Insomnia with no known cause that does not respond well to treatment. And diagnosing idopathic insomnia does not (alas) require a sleep test; that diagnosis can be made based on nothing but a careful medical history. Unfortunately that also means that a lot of people who do not fit the standard stereotype of an OSA patient are misdiagnosed with idopathic insomnia rather than being referred for a sleep test. (Menopausal and post menopausal women who are not obese seem to be at particularly high risk of NOT being referred for a sleep test when one is needed because it's easy to write off their insomnia problems as being related to menopause rather than indicating there's a high risk of OSA/UARS problems.)

And it's also worth pointing out that things like PLMD, which is tested for on a sleep test, can cause non-restful sleep.

You also write:

My friend has gone thru the route of trying anti- anxiety pills and a little with sleeping pills - her mother sees an neurologist (Alzheimer's) and some of her mothers caregivers have given my friend prescriptions. But the pills either do not work consistently or she feels horrible and can't use them.
She has also tried other things like exercise, tapping, acupressure routines done daily, enjoying life, group support, friend support, etc,
...
On a typical night she sleeps 5-7 hours of sleep but wakes not rested, on a bad night she barely dozes, tossing and turning all night.

My best advice for your friend is this:

Start with the friend's primary care doctor. Your friend should talk about the fact that when she wakes up she does not feel rested even if she sleeps 5-7 hours. Nonrestful sleep on a night where you DO think you got 5-7 hours of sleep is a major symptom of things like OSA, CSA, UARS, and PLMD, all of which are diagnosed through the use of a sleep study. She should mention that she comes from a family of heavy snorers and that she does NOT have a regular bed partner. And because she does not have a regular bed partner, she cannot definitively rule out whether she snores or not. [Yes, you listened to her sleep for 30 minutes, but she could easily start snoring only when she goes into REM sleep much later in the night.]

She should mention the anti-anxiety pills and the sleeping pills that she has taken in the past have not worked well. She should mention that she's done a bunch of the standard lifestyle things that are often recommended for improving insomnia. And then she should ask her primary care physician for a referral to a sleep doctor whose background is in pulmonology, otolaryngology and neurology (rather than psychiatry) so that a Medicaid-approved sleep test can be ordered. (It's a bummer that NY Medicaid seems to require the sleep test be ordered by a specialist rather than a PCP.)

It's also worth having your friend think about her sleep hygiene since bad sleep hygiene will aggravate insomnia.

Medicaid does indeed cover sleep studies when they are documented to be "medically necessary". Your friend may have to jump through a lot of hoops to get the required documentation and authorization, then find a sleep lab that accepts Medicaid reimbursement. It may take some persistence on her part.