Sleep apnea is not just loud snoring or a little nasal congestion. Chronic sleep apnea leads to severe health problems, and if your apnea is so severe that it interferes with your ability to work, you may qualify for Social Security disability.
When someone has sleep apnea, there are periods of time where you’re unable to move your respiratory muscles, and that stops air flow through your nose and mouth. You can stop breathing for 10 to 30 seconds at a time, and in some patients, this cycle happens up to 400 times per night! When breathing stops, carbon dioxide levels rise to unsafe levels, waking you during the night.
If you’re overweight, you are more likely to develop sleep apnea, because the fat tissue in the neck can further compress the airway.
There are two different kinds of sleep apnea: central and obstructive.
Central sleep apnea is a rare condition caused by a central nervous system disorder. The brain doesn’t send the proper signals to the respiratory muscles, so breathing is affected.
Obstructive sleep apnea is much more common, occurring in 90 percent of all patients with apnea. This type of apnea occurs when there is a blockage of the windpipe (trachea) that brings air into the body. Excess fat in the throat can cause it, but the tongue or tonsils can also create the blockage.
Certainly, sleep apnea results in very poor sleep. People with apnea sometimes fall asleep while driving or in the middle of a conversation. Daytime alertness is affected, and it begins to take a toll on your memory and cognitive abilities, too.
When apnea is left untreated, it can lead to far more serious health issues like high blood pressure, heart disease, strokes and heart attacks.
When it comes to sleep apnea and social security disability, most people will have a hard time qualifying. You will likely only qualify if you have serious complications caused by sleep apnea.
The Social Security Administration (SSA) has a Blue Book in which the agency lists all ailments that qualify for disability benefits. For sleep apnea, SSA lists respiratory and other impairments caused by sleep apnea. For example, if you have chronic heart failure caused by sleep apnea, you will likely automatically qualify. Pulmonary conditions like chronic pulmonary hypertension or cor pulmonale are also listed. SSA gets very specific, stating that pulmonary hypertension will qualify if mean pulmonary arterial pressure is above 40 mm Hg. If apnea causes severe behavior issues or cognitive impairments, it can qualify as an organic mental disorder.
There are two things you must prove to SSA before receiving benefits: a medical diagnosis and a sleep apnea case severe enough to prevent you from working.
Regarding medical diagnosis, you must have detailed records from your physician showing your apnea diagnosis and showing any chronic conditions that you have as a result of the apnea. If you have one of the automatic qualifying conditions listed above, such as pulmonary hypertension, you must show test results. For example, you must show that you’ve had a cardiac catheterization test that has shown your mean arterial pressure to be above 40 mmHg. You also need to show that you’ve tried sleep apnea therapies without much success, such as the wearing of a positive airway pressure device like a CPAP (or APAP or BPAP) machine at night.
Second, you must show SSA that your sleep apnea is so severe that it prevents you from working. You should certainly provide notes from your own doctor, but SSA will conduct their own assessment of your ability to work. It is called a residual functional capacity or RFC assessment, and it shows the level of work you are capable of. The SSA will look at how fatigue affects your work and how any other conditions like heart conditions factor in.
If you don’t already have a statement from your doctor about your work capabilities, you need one. The doctor needs to be thorough and list any restrictions you may have. For example, your sleep impairment may be so bad that your doctor limits you from operating heavy machinery for fear that you might fall asleep while driving. You might have exertion limitations too, like limits on how much lifting you can do.
SSA will consider your doctors notes and they’ll do their own RFC assessment. They’ll look at your job requirements and your restrictions to make a determination. If you are unable to perform your current job, SSA will look for other jobs you might be able to do. An exception is usually made for adults over age 50 because you’re so close to retirement age anyway. Also, if you have very little education, you might be exempted because you are more limited on jobs you qualify for. Most people with sleep apnea can do sedentary work (more commonly known as a “desk job”. However, some people have very severe and limiting restrictions that prevent even desk job work. In these cases, you will likely be awarded benefits.