Protection Products

Ask an Underwriter: Don’t lose sleep over your sleep apnea cases


Sleep apnea is one of the most common, and often underdiagnosed, impairments we see in underwriting. It affects up to 18 million people in the United States alone.1 It can be defined as a disorder that causes someone to have one or more pauses in breathing or shallow breaths while sleeping, lasting anywhere from a few seconds to a few minutes. Typically, normal breathing starts again, sometimes with a loud snort or choking sound. These breaks in the sleep cycle can leave someone tired throughout the day, otherwise known as excessive daytime sleepiness, or EDS.


The most common type of sleep apnea is obstructive sleep apnea, or OSA. It happens when the tongue, tonsils or other tissues in the back of throat block the airway, causing someone to have shallow or paused breathing. Central sleep apnea is less common and happens when the brain doesn’t always signal the body to breathe when it should. Obstructive sleep apnea is most commonly seen in individuals who are overweight, but keep in mind that it can affect anyone.


Sleep apnea can have many negative long-term effects on health and mortality risk, including: 

  • Hypertension or high blood pressure
  • Lung damage
  • Heart disease and heart failure
  • Stroke
  • Arrhythmias or abnormal heart rhythms
  • Pre-diabetes and diabetes
  • Fatigue-related motor vehicle accidents and work accidents
  • Depression


The severity of sleep apnea can be determined by overnight polysomnography (also knowns as PSG, or a sleep study). This test determines an individual’s apnea-hypopnea index (AHI), the number of apneas they have per hour, and it also documents their blood oxygen levels. Treatment is recommended based on the study’s findings. And, the success of treatment is normally documented by a follow-up sleep study.



Basic treatment includes weight loss, the avoidance of stimulants (such as alcohol) before bed, and adjustment of sleep position. A CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure) machine is considered the “gold standard” of sleep apnea treatment. It prevents the collapse of the airway by pumping airflow during inhalation by face mask or nose cushions. Successful treatment includes regular, nightly use of the machine; however, some people cannot tolerate the device, mask and associated noise.


In recent years, popular alternative treatments have included:

  • Oral Appliance: Mouth device worn to prevent the collapse of the tongue and soft tissues in the back of the throat by supporting the jaw in a forward position; approved by the American Academy of Sleep Medicine as first-line treatment for mild to moderate OSA
  • Night Shift: Device worn on the back of the neck that begins to vibrate when users sleep on their backs
  • Winx Sleep Therapy System: Mouth device that generates negative pressure in the oral cavity, which draws the soft palate and uvula forward and stabilities tongue position



A life insurance offer for clients with OSA is determined by the severity of the disease, measured by AHI and oxygen levels during a sleep study. Favorable client conditions include mild disease (low AHI and minimal low oxygen levels or hypoxia), consistent use of CPAP/BiPAP (or possible alternative treatment), controlled blood pressure, no co-existing heart or lung disease and no risky motor vehicle events. 


Favorable cases can sometimes be considered unrated. For example, a client with mild sleep apnea who is compliant with CPAP/BiPAP, and has normal blood pressure with no associated impairments would not be rated, and they may be eligible for all preferred classifications with some carriers. Other cases may range anywhere from standard and up, depending on the severity of sleep apnea and compliance with treatment.


The Ash Brokerage underwriting team leverages our experience, carrier relationships and resources to identify viable solutions based on your client’s individual circumstances and insurance needs. For your next sleep apnea case, use our helpful questionnaire. And, contact us so we can suggest ways to help you obtain the most favorable offers. Let us awaken the possibilities!


About the Author

Lisa Oleski has been brokerage underwriting for the past 20 years. She is passionate about treating each case she touches as an opportunity to exemplify the Ash difference, with the ultimate outcome of finding the most favorable solutions for advisors and their clients.



Learn More

1National Sleep Foundation, Sleep Apnea:

Underwriting Sleep Apnea