a person's path to a doctor's office being blocked by a group of tall city buildings

The Influence of City Life on Sleep Apnea Diagnosis and Treatment

This article is second in the series: Sleep Apnea’s Health Disparities.

People with obstructive sleep apnea (OSA) who live in rural areas face a number of access barriers that prevent them from getting the diagnosis and treatment they need.

But living in more populated areas (cities and suburbs) can also bring its own set of challenges.

This time around, we’ll look at diagnosis and treatment barriers for city and suburban people living with OSA.

The city’s surprising barricades

Life in the countryside isn’t perfect. Plenty of roadblocks to good healthcare exist in these far-flung regions. But when it comes to sleep, having dark skies at night, quiet evenings, and fresh air gives people living in rural settings certain advantages.

In the cities and suburbs, resources may be more accessible, but obstacles to OSA diagnosis or treatment still exist.

Getting to the sleep clinic

In cities, you can find sleep clinics everywhere, maybe even right down the street from your residence. But third-party protocols – from insurance payers or hospital system networks – may override that quick visit down the block. Your sleep study could be assigned, instead, to a clinic clear across town.

Economic disparity explains this barrier to access.1 People living in areas with lower home values may have less access to the healthcare services they need. They also may not own a vehicle and rely on public transportation.2

a bus, a subway train, and a taxi

Car considerations

A doctor’s appointment clear across town can be hard to make if you can’t find parking. For those without a car, taking multiple buses, trains, or subways to get there (often after dark, and leaving early in the morning) means some people won’t make their appointments.2 Keep in mind, too: all that extra time lost can result in lost wages and added childcare expenses.3

Insurance roadblocks

Because they’re so expensive, sleep studies require preauthorization from insurance payers. Someone with suspected OSA may need multiple visits:

  • A daytime screening session
  • An overnight diagnostic study (at home or at the lab)
  • A second overnight study to determine treatment
  • Multiple follow-ups following treatment protocols

Also, treatment for any insured person depends on how comprehensive and generous their coverage is. Some policies offer bare-bones coverage to PAP therapy, for instance.

Insurance and PAP alternatives

Your access to other treatments – like hypoglossal neurostimulation or oral appliance therapy – also depends upon your coverage. When a doctor doesn’t prescribe alternatives to PAP, it may be because insurance won’t cover them. Out-of-pocket costs run too high otherwise.

Medicare or Medicaid providers further limit patient services and supply options to a much smaller number of sleep clinicians and suppliers.4

poll graphic

Community Poll

Have you ever experienced an insurance roadblock?

Jumping through hospital 'hoops'

And speaking of systems, hospital system consolidation creates a whole new labyrinth for patients.5

When buyouts and mergers happen, doctors move to new systems. Our access to them may change if they’ve left our preexisting networks. Changes in hospital networks mean more “hoops” to jump through to get the care you need, not only for OSA, but for any chronic condition requiring maintenance.

Be prepared to advocate for yourself wherever and whenever possible; it can be easy to fall through the cracks when hospitals make large shifts and changes in policies or protocols.

telemedicine shown by a phone that has a cord which turns into a stethoscope

Is telemedicine real?

It is, but you still may not have access to it.

COVID-19 has certainly prioritized the telemedicine option to more safely deliver care to more patients, but some doctors are still learning its technical ins and outs.6

Even in big cities, some sleep clinics aren’t set up for virtual care. Either they can’t yet deliver on online appointments, or sessions may be limited to screenings and follow-ups.6

However, the HSAT (home sleep apnea test) partnered with a prescribed automatic positive airway pressure (APAP) treatment option can cut down on safety and scheduling barriers for some.7

Pollution as a factor

Finally, cities – by the very nature of living in close quarters – deliver an environmental hit when it comes to sleep health.

Air quality

Air quality is of specific concern to people with OSA. If you live near industrial or highly trafficked areas, then you’re likely dealing with air carrying higher levels of particles, which make it hard to breathe. This doesn’t guarantee you’ll develop OSA, but even light smog aggravates sleep apnea, especially if it’s untreated.8 Thankfully, if you have OSA and treat it with PAP, you benefit from filtered air for several hours every night.

Noise and light

These 2 forms of pollution don’t impact your breathing while you sleep. But consider this: if you’re already struggling to use PAP – your mask doesn’t fit right or you can’t tolerate air pressure – noise and light pollution won’t make it easier. Noisy neighbors, living next to a major arterial or airport, super-bright LED streetlights, and 24-7 lit-up business signage in downtown residential areas can make sleep harder in the city.1

Share your experience

Have you experienced barriers to sleep apnea diagnosis or treatment because of where you live? Join our forum discussion – read what others in our community have to say and share your experiences.

This article is part of a series: Sleep Apnea’s Health Disparities. Check out the other articles in this series!

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The SleepApnea.Sleep-Disorders.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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