Disability Benefits for Sleep Apnea

Sleep apnea is a fairly common condition where a person stops breathing briefly while sleeping. Although a common symptom of sleep apnea is loud snoring with pauses that are followed by a choking sound, not everyone who snores has sleep apnea.

Types of Sleep Apnea

There are two types of sleep apnea. The most common type is obstructive sleep apnea, which occurs when tissue in the back of your throat slackens and causes the airway to be obstructed. Obstructive sleep apnea is often associated with obesity and snoring.

Another, much less common type of sleep apnea is called central sleep apnea. This occurs when the brain (part of your central nervous system) stops sending the correct messages to the muscles that are involved with breathing. Central sleep apnea may be related to heart failure and certain kinds of brain damage.

Complications From Sleep Apnea

Although many people are unaware of their sleep apnea, some people have severe cases where they are constantly being awakened by their breathing disruptions and get very little sleep. Even when people with sleep apnea aren't aware of their disrupted sleep, they often are very tired during the day. People with sleep apnea also may feel irritable and depressed and have headaches in the morning.

But sleep apnea can be much more serious than loud snoring and feeling tired. When you stop breathing during an episode of sleep apnea, the oxygen levels in your blood decrease (hypoxemia). This fluctuation in oxygen levels can lead to a condition called pulmonary vascular hypertension (high blood pressure in the veins that carry blood from the lungs to the heart), which can lead to an enlarged heart and heart failure.

Qualifying for Disability for Sleep Apnea

The Social Security Administration (SSA) no longer has a disability listing for sleep apnea, but it does have listings for breathing disorders, heart problems, and mental deficits. If you meet the criteria of one of the listings due to your sleep apnea, you would automatically qualify for disability benefits. Some ways to meet the listings for complications caused by sleep apnea are having severe cognitive deficits, mood disturbances, and/or behavioral issues; chronic pulmonary hypertension; or chronic heart failure/cor pulmonale (right-sided heart failure).

Listing 3.09 states that chronic pulmonary hypertension can qualify automatically for disability benefits if mean pulmonary artery pressure is equal to or greater than 40 mm Hg (as determined by cardiac catheterization while medically stable). Listing 4.02 has lengthy criteria for when chronic heart failure will qualify for disability, and finally, listing 12.02, which covers organic mental disorders, discusses the criteria needed to qualify for disability based on mental issues like intellectual difficulties, memory problems, depression, and/or anxiety. To qualify for benefits under this listing, you must be able to show that you have either:

• a loss of intellectual ability of at least 15 I.Q. points, memory problems, or disturbances in thinking, such as hallucinations or disorientation as to time or place, that cause restrictions in your daily activities, difficulties in concentration or pace, or problems with social functioning
• personality changes with mood swings or other mood disturbances such as depression, explosive temper, or impulsivity that cause limitations in your activities, problems getting along with people, difficulties in focusing and getting things done, or recurrent periods of decompensation (getting worse), or
• a chronic organic mental disorder that has lasted at least two years and has significantly impacted your ability to do basic work activities. You must be taking medication or receiving psychosocial support, and also have repeated, extended episodes of decompensation (or evidence that increasing demands on you even a little will probably cause you to decompensate) or an inability to function outside of a supportive living environment for one year (with evidence you will continue to need that environment).

The majority of people with sleep apnea will not qualify under one of the listings discussed above, but there is another way to qualify for disability.

Residual Functional Capacity

If you have a diagnosis of sleep apnea but do not meet one of the listings, the SSA will look at your “residual functional capacity,” or “RFC.” Your RFC assessment is used by the SSA to determine what kind of work you are still capable of doing despite the limitations from your medical condition.

The SSA will look at how tired you are in the daytime and how that affects your ability to work. For example, if you suffer from significant daytime sleepiness you probably should not operate a vehicle or other heavy, dangerous machinery. The SSA will also look at how other conditions impact the work you can do. For example, if you have heart problems, you may not be able to lift more than a few pounds. If you have difficulties with thinking, remembering, concentrating, or getting along with people, the SSA will prepare a mental RFC assessment.

If the SSA finds that you are capable of performing the job you used to have or any other job consider, the SSA can deny your claim. But if the SSA determines that the symptoms associated with your impairment and treatment are so limiting that there is no job you can perform, you will be awarded benefits under what is called a “medical-vocational allowance.”