Why A Kolkata Clinic Is Advocating for Insurance Coverage for Sleep Disorders
Major health insurance providers in India — both public and private — exclude sleep disorders from their plans. This coverage gap has serious consequences for patients.
New Delhi [India], January 02: A sleep laboratory in Kolkata is campaigning to normalize insurance coverage for Obstructive Sleep Apnea (OSA), a common but often misunderstood breathing disorder that disrupts oxygen flow during sleep. Research shows over 100 million Indian adults suffer from OSA, which can cause serious health issues if left untreated.
The Institute of Sleep Science, led by Director Somnath Maity, has been pushing for this change for years. Maity, a myofunctional therapist with decades of experience, points out the financial impact of neglecting sleep disorders: "Insurance companies are paying upwards of 5 to 10 lakh INR when these patients enter the emergency room due to heart failure. This could have been avoided if they had paid 1/10th of the amount for basic sleep apnea treatment when the patient was first diagnosed," he explains.
The core issue is that major health insurance providers in India — both public and private — exclude sleep disorders from their plans. This coverage gap has serious consequences for patients. At Maity's clinic in Kolkata, several cases highlight the problem. Sharmila Bhattacharya, a biology teacher, shares her husband Ayan's struggles with OSA. "He developed other health complications due to sleep apnea," she says. "He would sometimes lose consciousness on the road because of low oxygen levels, which could have caused a serious accident." Despite having two insurance policies, the Bhattacharyas were denied coverage for sleep apnea treatment and had to pay for a CPAP device out of pocket.
Another case involves Nabagopal Biswas, who was denied coverage for nasal polyp surgery, a key part of his sleep apnea treatment.
Doctors are puzzled by the insurance industry’s refusal to cover OSA. Dr. Dipankar Datta, an ENT surgeon and regional head of the Indian Association of Surgeons for Sleep Apnea, stresses that this is a serious medical condition. "OSA is not cosmetic — it’s life-threatening. It can lead to heart failure, stroke, diabetes, high blood pressure, asthma, dementia, and even road accidents," he says.
The financial challenges of sleep disorder treatment go beyond therapy and extend to diagnosis. Dr. Pallab Chatterjee, a pediatric pulmonologist, points out that expensive diagnostic tests such as polysomnography and sleep endoscopy, costing between Rs. 8,000 and Rs. 20,000, often deter patients from seeking proper diagnosis. "The high costs, combined with the fact that these tests aren’t covered by insurance, make patients avoid them altogether," says Dr. Chatterjee. "As a result, even when symptoms are apparent, the condition remains undiagnosed and untreated."
The consequences of untreated obstructive sleep apnea (OSA) are serious. Dr. Arup Das Biswas, former Director of Cardiology at IPGMER and SSKM Hospital, explains that sleep apnea can lead to heart disease in two ways. It causes hypoxia, disrupting oxygen supply and resulting in blood pressure and heart rate fluctuations. Additionally, it contributes to obesity, insulin resistance, and daytime sleepiness, all of which increase the risk of heart disease. Beyond cardiovascular problems, untreated apnea can also lead to neurological issues, like memory loss and cognitive decline.
The lack of insurance coverage impacts not just patients but also the broader healthcare system in India. Advanced treatments like Inspire Sleep, an FDA-approved implant that has shown success in the US and Europe, have not entered the Indian market due to the absence of insurance support. "The companies don’t see any profit in India," says Maity. "Even individuals who could afford the treatment out of pocket no longer have access to it."
Advocating for insurance coverage for sleep disorders in India is a tough challenge, but progress is possible. Healthcare professionals are pushing for policy changes similar to the 2023 IRDAI guidelines, which mandated insurance coverage for mental health disorders. These guidelines paved the way for insurance companies to offer cashless facilities for mental health treatment at approved institutions.
Maity and his colleagues have been trying to bring the issue to insurers’ attention since 2019. They suggest creating clear criteria to handle sleep-related claims and address fraud concerns. "But why deny access to necessary, life-saving treatments when doctors agree they’re essential?" Maity asks.
Addressing this insurance coverage gap could greatly improve public health and lower long-term healthcare costs across the country. "Standardized care will only be possible if there’s a change in policy," Maity says. With continued advocacy and awareness, the hope is that policymakers, healthcare providers, and insurers will work together to close this critical gap, ensuring millions of people with sleep disorders get the care they need.
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