TL;DR
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside and out. This guide explains how PMI interacts with chronic conditions like sleep apnoea, helping you make an informed decision about your health cover. Does PMI cover sleep studies and CPAP therapy?
Key takeaways
- Obstructive Sleep Apnoea (OSA): The most common form. It occurs when the muscles in the back of the throat relax and collapse, physically blocking the airway.
- Central Sleep Apnoea (CSA): A less common type where the brain fails to send the correct signals to the muscles that control breathing.
- At least 1.5 million adults in the UK have diagnosed Obstructive Sleep Apnoea.
- Worryingly, experts believe up to 85% of people with OSA remain undiagnosed. This suggests the true number of sufferers could be closer to 4-5 million people.
- How it works for sleep apnoea: You would be required to declare your diagnosis, any symptoms (even undiagnosed snoring or daytime fatigue), consultations, or treatments. The insurer would then apply a specific exclusion to your policy for sleep apnoea and any related conditions.
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside and out. This guide explains how PMI interacts with chronic conditions like sleep apnoea, helping you make an informed decision about your health cover.
Does PMI cover sleep studies and CPAP therapy?
The short answer is that standard private medical insurance (PMI) in the UK does not typically cover the diagnosis or long-term management of sleep apnoea, including sleep studies and CPAP therapy.
This is because sleep apnoea is classified as a chronic condition – a long-term illness that requires ongoing management rather than a short-term cure. UK private health cover is designed specifically to treat acute conditions: new, unexpected illnesses or injuries that are curable.
Understanding this fundamental distinction is the key to navigating private healthcare for sleep-related breathing disorders. While insurers will generally not pay for your CPAP machine or the sleep study that diagnoses the condition, a good policy remains an invaluable asset for other unforeseen health issues.
Understanding Sleep Apnoea: A UK Snapshot
Before diving deeper into insurance specifics, let's clarify what sleep apnoea is and its impact in the UK.
What is Sleep Apnoea? Sleep apnoea is a serious medical condition where a person's breathing repeatedly stops and starts during sleep. These pauses, called 'apnoeas', can last for 10 seconds or longer and happen hundreds of times a night.
There are two main types:
- Obstructive Sleep Apnoea (OSA): The most common form. It occurs when the muscles in the back of the throat relax and collapse, physically blocking the airway.
- Central Sleep Apnoea (CSA): A less common type where the brain fails to send the correct signals to the muscles that control breathing.
Prevalence in the UK Sleep apnoea is a significant and underdiagnosed issue in the UK. According to NHS England and the British Lung Foundation, it is estimated that:
- At least 1.5 million adults in the UK have diagnosed Obstructive Sleep Apnoea.
- Worryingly, experts believe up to 85% of people with OSA remain undiagnosed. This suggests the true number of sufferers could be closer to 4-5 million people.
Symptoms and Health Risks Recognising the symptoms is the first step towards getting help.
| Common Symptoms | Associated Health Risks (If Untreated) |
|---|---|
| Loud, persistent snoring | High blood pressure (hypertension) |
| Witnessed breathing pauses | Increased risk of heart attack and stroke |
| Gasping or choking in sleep | Type 2 diabetes |
| Excessive daytime sleepiness | Heart failure and arrhythmias (irregular heartbeat) |
| Morning headaches | Increased risk of work-related or driving accidents |
| Poor concentration | Depression and mood changes |
The significant long-term health risks associated with untreated sleep apnoea are why it's classified as a chronic condition requiring lifelong management.
The Crucial Distinction: Acute vs. Chronic Conditions in UK Health Insurance
The single most important concept in UK private medical insurance is the difference between acute and chronic conditions. Insurers build their policies around this principle.
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Definition | A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. | A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, has no known 'cure', comes back or is likely to come back. |
| Duration | Short-term. | Long-term, lifelong. |
| Treatment Goal | To cure the condition and return you to your previous state of health. | To manage symptoms, slow progression, and maintain quality of life. |
| PMI Coverage | Covered (subject to policy terms). | Not Covered. |
| Examples | Cataracts, joint replacement, hernia repair, appendicitis. | Sleep apnoea, diabetes, asthma, hypertension, arthritis. |
Because sleep apnoea requires ongoing management with therapies like CPAP and has no definitive "cure," it falls squarely into the chronic category and is therefore excluded from cover by all standard UK PMI providers.
How Underwriting Affects Cover for Sleep Apnoea
Even if an insurer were to change its stance on chronic conditions, a new policyholder with sleep apnoea would still face another hurdle: pre-existing conditions. Underwriting is the process an insurer uses to assess your health and medical history when you apply for a policy.
There are two main types:
1. Full Medical Underwriting (FMU)
With FMU, you complete a detailed health questionnaire, declaring your entire medical history.
- How it works for sleep apnoea: You would be required to declare your diagnosis, any symptoms (even undiagnosed snoring or daytime fatigue), consultations, or treatments. The insurer would then apply a specific exclusion to your policy for sleep apnoea and any related conditions.
- Benefit: You have complete clarity from day one about what is and isn't covered. There are no grey areas.
2. Moratorium Underwriting (Mori)
This is the most common type of underwriting, often advertised as a "no medical questions" option. However, it's not a free pass.
- How it works for sleep apnoea: A moratorium policy automatically excludes any condition for which you have had symptoms, medication, treatment, or medical advice in the five years before your policy start date.
- The "2-Year Rule": This exclusion can be lifted if, after taking out the policy, you go for a continuous two-year period without needing any treatment, advice, or having any symptoms for that specific condition.
- The Reality for Sleep Apnoea: As a lifelong chronic condition, it is impossible to go two years symptom-free or without needing treatment (like using a CPAP machine). Therefore, sleep apnoea will always remain a pre-existing and excluded condition under a moratorium policy.
Expert Tip: Even if you haven't been formally diagnosed, telling your GP about severe snoring or your partner witnessing you stop breathing would be considered 'seeking advice' for symptoms. This would make the condition pre-existing under moratorium underwriting.
What Parts of Sleep Apnoea Diagnosis & Treatment Might Be Covered?
While the condition itself and its primary treatment (CPAP) are excluded, there are some very specific, nuanced scenarios where a PMI policy might provide limited assistance on the diagnostic journey. This is rare and highly dependent on the provider and your policy's terms.
-
Initial Consultation: If you present to your GP with new symptoms like fatigue or snoring (and have no prior history), your PMI policy may cover a one-off referral to a specialist (e.g., an ENT surgeon or respiratory consultant) for an initial opinion. However, the moment the specialist suspects or diagnoses a chronic condition like sleep apnoea, the PMI cover for that pathway typically ceases.
-
Diagnostic Tests (Sleep Studies): This is a significant grey area. Some top-tier policies with extensive diagnostic benefits might cover the cost of a sleep study (polysomnography) if it's part of investigating a broad set of symptoms before a chronic diagnosis is made. However, most insurers will view a sleep study as a specific investigation for a chronic condition and decline it. You should always get pre-authorisation from your insurer before proceeding with any diagnostic tests.
-
Related Surgical Interventions: Sometimes, OSA is caused or worsened by an anatomical issue, such as enlarged tonsils or a deviated septum. If surgery (like a tonsillectomy or septoplasty) is deemed medically necessary to treat a separate, acute problem (e.g., recurrent tonsillitis or breathing obstruction unrelated to sleep), it may be covered by your PMI. A positive side effect might be an improvement in your sleep apnoea, but the surgery cannot be for the primary purpose of treating the sleep apnoea itself.
The NHS Pathway for Sleep Apnoea: Your Primary Route
For the vast majority of people in the UK, the National Health Service (NHS) is the best and primary route for sleep apnoea diagnosis and treatment. The care provided is excellent and free at the point of use.
The Typical NHS Process:
- Visit Your GP: Discuss your symptoms (e.g., snoring, tiredness). Your GP may ask you to complete a questionnaire called the Epworth Sleepiness Scale.
- Referral: If sleep apnoea is suspected, your GP will refer you to a specialised NHS sleep clinic.
- Sleep Study: The clinic will arrange for a sleep study. This is often a home-based test where you take a small monitor to wear overnight. In some cases, an overnight stay in a sleep lab is required.
- Diagnosis: A specialist will analyse the results to confirm the diagnosis and determine its severity (mild, moderate, or severe).
- Treatment: If you are diagnosed with moderate to severe OSA, the standard treatment is a CPAP (Continuous Positive Airway Pressure) machine. The NHS will provide you with a machine, mask, and all necessary supplies completely free of charge. They will also provide ongoing support to ensure you are using it effectively.
The main drawback of the NHS pathway can be waiting times. With NHS referral-to-treatment waiting lists in England exceeding 7 million, it can take several months from your GP visit to receiving your CPAP machine.
Comparing NHS vs. Private (Self-Funded) Options for Sleep Apnoea
If NHS waiting times are a concern, the alternative is to "go private" by self-funding your diagnosis and treatment. This means paying for everything out of your own pocket.
| Aspect | NHS Pathway | Private / Self-Funded Pathway |
|---|---|---|
| Cost | Free. All consultations, tests, and equipment are provided at no cost. | Expensive. You pay for every stage. |
| Waiting Times | Can be long (months) for appointments and tests. | Very short (days or weeks). |
| Choice of Specialist | Limited to the clinicians at your local NHS sleep centre. | Full choice of any consultant or clinic in the UK. |
| Equipment (CPAP) | Standard-issue, reliable NHS machine and mask. | Wider choice of the latest machines (e.g., travel CPAP, auto-adjusting) and a vast array of masks. |
| Process | GP referral is required. | You can often self-refer directly to a private clinic. |
What are the Costs of Private Sleep Apnoea Treatment in the UK?
If you choose to self-fund, it's important to be aware of the potential costs, which can be substantial.
| Service | Estimated Private Cost (2025) |
|---|---|
| Initial Consultation with Specialist | £200 – £350 |
| Home Sleep Study | £300 – £600 |
| In-Lab Overnight Polysomnography | £1,000 – £2,500 |
| Total for Diagnosis | £500 – £3,000+ |
| Treatment Equipment | |
| Standard CPAP or APAP Machine | £500 – £1,500 |
| Mask (nasal pillows, nasal, full-face) | £100 – £250 |
| Ongoing Supplies (filters, tubing) | £50 – £100 per year |
Lifestyle Changes and Wellness Support for Sleep Apnoea
While PMI may not cover CPAP, many modern policies include valuable wellness benefits that can help you manage the risk factors associated with sleep apnoea. These proactive tools can empower you to improve your overall health.
-
Weight Management: Obesity is the single biggest risk factor for OSA. Losing even 10% of your body weight can dramatically reduce the severity of sleep apnoea or even eliminate it in milder cases.
- WeCovr's CalorieHero App: To support your health journey, WeCovr provides clients with complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app. It's a fantastic tool to help you manage your diet and achieve your weight loss goals.
-
Reduce Alcohol: Alcohol relaxes the throat muscles, making airway collapse more likely. Avoiding alcohol, especially in the hours before bed, can make a significant difference.
-
Quit Smoking: Smoking causes inflammation and fluid retention in the upper airway, which can worsen sleep apnoea. Many PMI policies offer support for quitting smoking.
-
Sleep Position: Sleeping on your back often makes apnoeas worse. Positional therapy (using pillows or devices to encourage you to sleep on your side) can be an effective strategy for mild cases.
-
Digital GP & Health Support: Most private health insurance in the UK now includes 24/7 access to a digital GP service. This is a brilliant, convenient way to get quick medical advice and discuss lifestyle changes without waiting for an appointment.
How WeCovr Can Help You Find the Right PMI Policy
Even though sleep apnoea itself is not covered, having a robust private medical insurance policy is crucial for your peace of mind. It gives you fast access to expert care for a wide range of acute conditions that could arise in the future, from joint problems to cancer treatment.
As an independent, FCA-authorised broker with high customer satisfaction ratings, WeCovr specialises in helping you navigate the complexities of the market.
- Expert, Unbiased Advice: We work for you, not the insurers. We will explain exactly what is and isn't covered, ensuring you understand the policy's limitations regarding chronic conditions.
- Market Comparison: We compare policies from all the UK's leading providers to find the cover that best suits your needs and budget.
- No Extra Cost: Our expert advice and policy arrangement service is completely free for you.
- Added Value: When you purchase PMI or Life Insurance through WeCovr, you can also benefit from discounts on other types of cover, providing even greater value.
Our goal is to ensure you have the right protection for future, unforeseen health problems, allowing you to bypass long NHS waits for diagnosis and treatment of acute conditions when it matters most.
Do I need to declare sleep apnoea when applying for health insurance?
Can I get private health insurance if I already have sleep apnoea?
Will my PMI pay for surgery to 'cure' my sleep apnoea?
If my health insurance doesn't cover CPAP, what are my options?
Ready to secure your health for the future? Contact WeCovr today for a free, no-obligation quote and expert advice on finding the best private medical insurance UK for your needs.
Sources
- Department for Transport (DfT): Road safety and transport statistics.
- DVLA / DVSA: UK vehicle and driving regulatory guidance.
- Association of British Insurers (ABI): Motor insurance market and claims publications.
- Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.
