Gasping for air: Buying life insurance when you have sleep apnea

Sleep deprivation can have serious consequences on your body's health. When you don't get enough sleep, you're vulnerable to a number of health problems. Your body's immune system is weak and robbed of its ability to heal from disease. Sleep is essential for healthy cell growth.

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The National Institute of Neurological Disorders and Stroke estimates that 40 million people have chronic long-term sleep disorders. One of the more serious is sleep apnea.

Apnea is a sleep disorder that causes a person to stop breathing for short periods during sleep. Depending on the severity, a person can stop breathing five to 50 times during one night. These episodes are apneas. When airflow stops, there is a substantial drop in blood oxygen levels. Severe sleep apnea can be potentially fatal if left undiagnosed and untreated.

In the United States, 12 million to 18 million people suffer from sleep apnea, according to the National Heart, Lung and Blood Institute.

Sleep apnea and life insurance

While sleep apnea is highly treatable, it raises a red flag on a life insurance application.

"Sleep apnea affects the price you pay for insurance depending on whether you are compliant with treatment and don't exhibit behavior that [worsens] the disorder," says Jack Dewald, chair-elect for the Life and Health Insurance Foundation for Education, a nonprofit insurance-education organization.

Habits that exacerbate sleep apnea include refusing treatment, obesity, smoking and drinking alcohol. Ironically, sleeping pills can also make apnea worse.

"It becomes a bad cycle of sleeping pill use for excessive sleepiness, which only increases the amount of apneas a person would have during the night," explains Dewald. "They wonder why they are still sleepy in the morning and throughout the day."

Risks and death

There are three kinds of sleep apnea: obstructive, central and mixed. Obstructive apnea is the most common and occurs when air stops flowing in the nose and mouth because there has been a collapse in the upper airway. Central apnea is when the brain fails to signal the breathing muscles or diaphragm to breathe. Mixed apnea is a combination of both. If sleep apnea is left untreated, it gradually worsens.

Death by sleep?

A 2009 study by the Johns Hopkins University School of Medicine shows that sleep apnea can increase the risk of death by as much as 46 percent, particularly in men age 40 to 70.

The study looked at 6,441 people age 40 and older and compared their mortality risk to those who don't have sleep apnea. Men with severe sleep-disordered breathing have twice the risk of dying compared to other men in the same age group.

Researchers at Johns Hopkins found that just 11 minutes of interrupted sleep can result in the individual?s blood oxygen level dipping dangerously below 90 percent of the normal level — and this nearly doubles their chances of dying.

"Unlike medical conditions that are inherited, such as coronary artery disease or Munchausen's syndrome, sleep apnea is very controllable and very manageable — if they know they have it," says Dewald.

Untreated sleep apnea can cause cardiovascular problems such as heart disease, high blood pressure, memory problems, weight gain and headaches, according to the National Sleep Foundation, a Washington, D.C.-based research and advocacy group.

Sleep apnea can also lead to driving accidents and injuries while on the job, due to excessive drowsiness.

The American Sleep Apnea Association reports that people who are the most at risk for developing the disorder are male, over age 40 and obese. Women become more risk after menopause, but anyone can have the condition, including children.

"Most people with sleep apnea are generally overweight," says Dewald. "Wives and girlfriends often complain that they snore when they sleep, and they usually go to the doctor to get checked out because they are feeling unusually tired."

Life insurance applications lead to treatment

Dewald says that frequently people with sleep apnea who apply for life insurance are not aware they have the condition until symptoms show up during the application process.

"It shows up in their medical records, where they've complained of feeling fatigued to their doctor," says Dewald. "Also, you might also learn they were brought to the ER after getting into a car accident because they fell asleep at the wheel. That would be another hint to look further."

Self-help guide for
mild sleep apnea

Go on a diet.
If you lose 10 percent of your weight, you will see an improvement in symptoms.

Don't drink, smoke or use sedatives.
Certain medications relax the muscles in the throat, adding to the severity of sleep apnea.

Sleep on your side.
Some people with sleep apnea believe their condition is worse when they sleep on their backs.

Get lots of pillows and elevate your head 4 to 6 inches.
This can reduce snoring and help you breathe better.

Get your sleep cycle in order.
People who keep regular sleep hours will sleep better and have a vast improvement in symptoms.

Use nasal spray, a nasal dilator or antisnoring strips.
This helps keep your nasal air passages clear.

Source: American Sleep Apnea Association

If a life insurance company suspects sleep apnea, it would need to investigate by having the applicant attend a sleep lab and take what's called a polysomnogram or PSG. This device measures how someone sleeps and how many apneas they have per hour.

Depending on the causes, sleep apnea can be treated through weight loss, a smoking-cessation program and/or the use of a mouth device that affects the flap of muscle at the back of the mouth that closes off the nasopharynx when someone swallows or speaks.

Other possible treatments include use of "continuous positive airway pressure" (CPAP), a ventilation pump with a nose mask that applies continuous pressure to the throat in order to keep it from closing up. CPAP provides one level of pressure. A "bi-level positive airway pressure" (BIPAP) pump with a nose mask is similar to CPAP and offers two levels of pressure. It provides higher amounts of air when a person breathes in and adjusts to lower amounts when a person breathes out.

While a nonsmoker with sleep apnea would likely be offered a standard rate for life insurance, some insurers will offer better rates for people who have the disorder under control.

"Most people with milder degrees of sleep apnea will qualify for insurance without an extra rate," says Dr. Brad Heltemes, vice president and senior medical director for ING Financial Services. "Those with a more severe form of sleep apnea generally have to show consistent compliance to the usual treatment of CPAP. If they can show that they have positive airway passages as a result, they can also be eligible for a policy that isn't rated."

You can also go under the knife. Surgeries for sleep apnea include removal of the fleshy flap at the back of the mouth or the use of radio waves to shrink tissues blocking the air passage.

While CPAP seems to be the only consistent form of treatment, "when it comes to other types of treatment, what's really important for insurability is that we have the records from the sleep study," says Heltemes. "That usually gives us a good idea of how they are responding to treatment."

Still, once you've been treated, Heltemes notes that if you're renewing a term life insurance policy, some insurers may require a follow-up sleep exam that shows a good response to treatment.

If you apply for insurance and have not followed your treatment plan for apnea, or are not even aware you have it, some life insurers may require a six-month waiting period before approving your application.

"If there is a resolution and an improvement of symptoms after six months, we would revisit that application," Heltemes says.

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