CPAP machines and Emergency Services Health

A man sleeping on a bed

On this page

  1. Symptoms
  2. Getting tests
  3. What Emergency Services Health covers
  4. Sleep studies
  5. Post sleep study
  6. CPAP masks and attachments

Research has shown that sleep disorders like sleep apnoea not only affect emergency worker's alertness and mood, but are also linked to general health problems including diabetes and cardiovascular disease.

With Emergency Services Health’s cover, you can claim benefits to help cover some of the costs of sleep apnoea treatment.

To start, we’re going to guide you through the warning signs, how to get tested and what we cover to help you get the treatment you need.

More symptoms than just snoring

Sleep apnoea can affect anyone, but is more common if you are; middle aged or older, snore, are overweight (because your throat is narrowed by fatty tissue), have sleep apnoea in your family, or have a naturally narrow throat or nasal passages.

The most common symptoms include;

  • Pauses in breathing while you’re sleeping, which other people may notice
  • Snoring (vibration of your throat during sleep)
  • Tossing and turning during sleep
  • Waking up gasping or choking
  • Tiredness and feeling unrefreshed after sleep.

Don’t wait to get tested

If you’re in any of the groups mentioned above and have some of these symptoms, the first step is to see your doctor.

Depending on the severity of your symptoms, they may refer you to a sleep specialist or sleep clinic.

To help prepare for seeing your doctor, we’ve compiled a checklist to do before you go.

What does Emergency Services Health cover for sleep apnoea?

Members with Gold Hospital or Gold Combined cover, who have served waiting periods, can have parts of several different aspects of sleep apnoea treatment covered.

Sleep studies 

In sleep studies, many body functions like heartbeat, oxygen levels, breathing rate and brain activity are measured continuously while you sleep.

You’ll either undergo the sleep study at home or in a hospital depending on the recommendation of your sleep specialist.

You can read a quick summary about what to expect here, but it’s important that if you do shift work you let your sleep specialist know.

If your treatment is done in hospital as an in-patient and you’ve served your waiting periods, you won’t have to pay an excess or copayment with Emergency Services Health.

There may still be out-of-pocket costs though, which your doctor will explain to you as part of providing informed financial consent. 

Next steps

If the results from your sleep study indicate that you have moderate to severe sleep apnoea, you may need other treatments, including;

  • A continuous positive airway pressure (CPAP) machine , which feeds pressurised air into a face mask to hold your throat open while you sleep.

We cover both the outright purchase or the hire of a CPAP machine under our Gold Hospital cover and Gold Combined cover. 

A benefit of 80% of the charge  up to a maximum benefit of $2,000 (four-year rolling annual limit applies) for CPAP machines. 

To be eligible for a benefit that covers a CPAP machine for sleep apnoea treatment, members must either have a hospital admission for a sleep apnoea test or a referral from a specialist physician trained in sleep apnoea.

Masks and attachments

A benefit of 80% of the charge   up to a maximum benefit of $400 applies to additional masks and attachments for the machine (inclusive of the overall $2,000 CPAP benefit). 

This covers the supply of replacement masks relating to a recognised CPAP machine for the treatment of obstructive sleep apnoea as diagnosed by a specialist physician and attachments that will prolong the life of the CPAP mask or machine.

CPAP attachments are items that will extend the life of the mask or machine and can include straps, filters, tubes, tube elbows and nose pads.  

Items such as CPAP travel bags, batteries and wipes are not payable.

Please note that there is a 12-month waiting period for CPAP machines and CPAP attachments.

Please also not that this item must be purchased within Australia, from a provider that has an Australian Business Number (ABN).