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Sleep Apnea and Social Security Disability

When chronic sleep apnea has lead to severe health problems, Social Security will consider whether the health conditions are so severe they keep you from working.

by: Beth Laurence, J.D.

Sleep apnea is a disorder characterized by periods in which a sleeping person is momentarily unable to move respiratory muscles or maintain an air flow through the nose and mouth, and thus stops breathing. People with sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping, and these short stops in breathing can happen up to 400 times every night.

People who are overweight have an elevated risk of developing sleep apnea. Many people affected by obesity have difficulty breathing when they sleep, as fatty tissues in the pharynx and neck can compress and block the airway. This causes carbon dioxide levels in the body to rise to uncomfortable and unsafe levels, and may awaken an individual several times throughout the night.

Consequences of Sleep Apnea

Patients with sleep apnea sleep very poorly and wake up in the morning still feeling tired. When sleep apnea is not diagnosed or treated, it can cause serious health risks. Sufferers remain tired throughout the day, sometimes falling asleep in the middle of a conversation or while driving. Other consequences of undiagnosed sleep apnea include heart attacks, high blood pressure,stroke, and heart disease.

Types of Sleep Apnea

There are two kinds of sleep apnea: obstructive apnea and central apnea. Nine out of ten patients are diagnosed with obstructive apnea.

Obstructive sleep apnea occurs when something blocks the windpipe (trachea), which is the passage that brings air into the body. Possible blockages include relaxed throat muscles, the tongue, tonsils, uvula, or a large amount of fatty tissue in the throat.

Central sleep apnea, by comparison, is rare. Central sleep apnea is related to the central nervous system, and occurs when the brain fails to send the proper signals to the muscles used for breathing, or when the signal sent from the brain is somehow interrupted. 

Sleep apnea may be relieved by wearing a positive airway pressure device (CPAP, APAP, or BPAP) at night. These are masks that are worn over the face to assist with breathing. 

Proving You Lack the Capacity to Work

The SSA will prepare an assessment of your “residual functional capacity,” or “RFC.” Your RFC is what you are capable of doing despite your impairment. Your RFC assessment is used by the Social Security Administration (SSA) to determine what kind of work you are still capable of doing. To prepare your RFC, the SSA will look at how your fatigue affects your ability to work and whether you have any other impairments, such as a documented heart condition, that limit your ability to exert yourself physically. Key to having a proper RFC assessment done is having your doctor write an opinion of your capabilities and restrictions. For example, if you suffer from extreme fatigue that causes you to fall asleep during the day, your doctor may restrict you from driving or operating dangerous equipment. Or, if you have heart failure caused by pulmonary hypertension, your doctor may limit you to lifting only a few pounds. Your doctor should also comment on how the sleep apnea affects your mental abilities, if you have documented trouble with your memory, concentration, pace, or social functioning.

The SSA will consider your RFC restrictions and the requirements of your prior job to see if you are able to do it. If not, the SSA will look for other jobs that you are able to do given your functiona limitations. Unless you are over 50 and have little education, the SSA is likely to say that there are desk jobs you can do with your limitations. But if the SSA determines that your restrictions are so limiting that there is no work you can do, you could be awarded benefits.

Learn more about how Social Security decides if you can work.

Automatic Disability Benefits for Sleep Apnea

While most people who have sleep apnea will have a hard time qualifying for disability, those who have suffered complications from sleep apnea are more likely to qualify. For instance, if you have pulmonary vascular hypertension, or heart trouble such as cor pulmonale, or a severe cognitive impairment caused by lack of sleep, you may be eligible for benefits. The SSA lists certain criteria for sleep-related disorders, and if you fulfill the requirements, you will automatically be approved for disability benefits.

Cognitive Impairment

Chronic sleep disruptions caused by apnea can affect daytime alertness, intellectual ability, memory, and mood. But to qualify for disability benefits because of these problems, your symptoms must be severe. The SSA requires that your sleep apnea has caused cognitive or mood changes that limit your activities, your ability to function socially, or your ability to focus and keep up with work because of one of the following:

personality changes
memory problems
mood disturbances
cognitive disturbances (such as delusions or hallucinations)
emotional instability or poor impulse control, or 
a loss of 15 I.Q. points or more. 

Cor Pulmonale 

       Cor pulmonale is an enlarged right heart ventricle caused by hypertension in the pulmonary veins. Years of sleep apnea can cause this type of heart disease. To prove that your cor pulmonale is severe enough to keep you from working, you must have either evidence of either: 

High blood pressure in the pulmonary artery; above 40 mm HG, or
Oxygen levels in your blood as low as or lower than the values in the SSA's disability listing for chronic pulmonary insufficiency.

Learn more about the disability qualifications for chronic pulmonary insufficiency.