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Sleep Apnea and Social Security Disability

How Sleep Apnea Affects You

Sleep apnea is a disability in which breathing stops repeatedly during sleep. In a regular six to eight hour period of sleep, someone with sleep apnea will stop breathing for a period of time, possibly up to a minute. This is due to air passages becoming blocked, many times due to a collapse in tissue in the back of the throat.

After a while, breathing will start again, often with a loud noise, known as snoring. While the brain tries to get air flowing again, the body is deprived of oxygen and the person may wake up or have shallow sleep.

Because the quality of sleep is drastically reduced and the individual may have been awakened several times, those with sleep apnea may still feel tired after a night’s sleep. In addition, the person may fall asleep during waking hours as a result of not getting sufficient rest due to the condition.

The three major types of sleep apnea are:

  • Obstructive sleep apnea. This is the most common type. Muscles in the back of the throat will relax and block the air passage.
  • Central sleep apnea. With this type, the brain stops sending messages to breathe during sleeping. Usually, this results from illness.
  • Complex sleep apnea syndrome. In this type, obstructive and central sleep apneas combine.

Two of the most common symptoms are snoring (which can interfere with relationships) and feeling tired after a night of sleep. There have been incidents, both on and off the job, as well as traffic and automobile accidents, that have been attributed to sleep apnea. Other symptoms are shortness of breath, insomnia and headache after waking. Many people have this for many years, and some have it for life. According to the American Sleep Apnea Association, sleep apnea affects more than 18 million people in the US.

The Medical Costs of Sleep Apnea

Although not as financially burdensome as other diseases, there is a significant cost to diagnosing and treating sleep apnea. If left untreated, sleep apnea can cause high blood pressure, heart disease and weight gain. There is a considerable cost to treating these symptoms with doctor’s visits, hospital stays and prescription medication. Also, the lack of recuperative sleep in sufferers can cause many things, such as increased likelihood of accidents and lost productivity.

In the Harvard University research paper “The Price of Fatigue,” it is estimated that the total economic cost of sleep apnea is anywhere between 65 and 165 billion dollars annually in the United States. The researchers itemize the estimated costs and give ranges of costs for each category. Their research sheds light on the hidden costs that this very common condition can yield over time.

Among its findings are:

  • The estimated hidden costs are between 45 and 80 billion in a year.
  • Traffic accidents related to sleep apnea related fatigue cost between 10 and 40 billion.
  • Lost productivity costs are estimated to be between 5 and 15 billion a year.
  • Workplace accidents are estimated to cost between 5 and 20 billion.

Medically Qualifying for Sleep Apnea

To qualify for Social Security benefits with sleep apnea, you will need to match your condition to a Blue Book listing. The Blue Book is a document that details all of the disorders that are covered under Social Security Disability. Section A of the Blue Book covers adult disabilities.

Sleep apnea is located in Section 3.10, titled Sleep Related Breathing Disorders. The symptoms from sleep apnea are evaluated under section 3.09, which deals with pulmonary artery pressure.

They are also evaluated under section 12.02, dealing with mental illness.

A person with sleep apnea can qualify for benefits if their pulmonary artery pressure is greater than 40 mm Hg. This could be achieved by visiting a physician and having blood pressure checked, as that is often affected by sleep apnea.

Additionally, another qualification is chronic pulmonary disease. This is one of several disorders that obstructs the airway and makes breathing difficult.

Section 12.02 also covers sleep apnea symptoms. This section deals with some of the emotional and psychological symptoms that a sleep apnea sufferer could be experiencing. It notes memory loss, as well as disorientation, changes in personality and mood, and the like.

Qualifying Without the Blue Book

Some people will still have sleep apnea and not meet the requirements that the Blue Book lays out. These people may still be able to receive benefits due to a Residual Functional Capacity, or RFC form. You can ask your doctor to fill out an RFC on your behalf, or a claims examiner from Disability Determination Services will fill out an RFC form.

This form will determine if the claimant is able to work or not due to your sleep apnea, its symptoms, and the effects of those symptoms in your life. For example, sleep apnea sufferers may show up to work more tired than others and have a higher risk of mistakes and incidents, so that will be taken into consideration when filling out the form. The claims examiner will also determine the medical history of the claimant, as well as in what capacity he or she can work, if any.

Sleep apnea could negatively affect those who are transportation workers, such as truck and bus drivers, along with train conductors and others who need to be alert to transport people and items safely. These types of workers could have an advantage in the RFC process as opposed to someone who works at a desk.

It is important to note that the education level, age, and skill set of the claimant will play a role in the decision regarding a sleep apnea application for disability. In regard to education, a person with a higher education is more likely to have more work opportunities available to them than a claimant with a lower level. Also, younger people are less likely to be awarded benefits because they have less work experience, have paid into the benefit program for less time, and are more likely to be able to work in the future than older applicants.

Applying for Disability Benefits

As with any diagnosis, it is important to obtain an actual diagnosis of sleep apnea before applying. To diagnose this, your doctor can give you a polysomnogram, which is a sleep study that will transmit information regarding breathing patterns and other information while you sleep.

To apply for Social Security disability benefits, a claimant has three options. You can call the Social Security Office at 1-800-772-1213. This line is available from 7 a.m. to 7 p.m. on weekdays. Additionally, Social Security Disability Insurance applicants can simply apply online. Claimants generally prefer this method due to its convenience.

The last method is to visit a Social Security office and fill out paperwork there. However, an appointment is required. After you have applied, you will generally get a decision within 3 and 5 months.