An abbreviated daytime sleep study (PAP NAP) has been used by some to address poor compliance and enhance individual comfort and tolerance of CPAP/BiPAP. PAP NAP combines psychological and physiological treatments into one procedure during an abbreviated daytime nap session (100 – 120 minutes).  Sleep technicians employ various coaching and monitoring techniques including mask and pressure desensitization, emotion focused therapy to overcome aversive responses to CPAP, mental imagery to divert the individual's attention from the sensations associated with CPAP and physiological exposure to CPAP.

An Abbreviated daytime sleep study (PAP-NAP) used as a supplement to standard sleep studies for all indications, including but not limited to, the following are considered integral to the primary procedure and (are) not separately reimbursable.

• Correcting non-compliance, or improving compliance with prescribed CPAP
• Decreasing anxiety/claustrophobia associated with CPAP
• Patient education
• Mask and pressure desensitization
• Cognitive behavioral therapy (CBT)

Limited data from a single study of PAP-NAP is insufficient evidence to form conclusions on the efficacy of this approach in improving compliance with CPAP. No professional guidelines currently recommend use of PAP NAP as a compliance enhancement.

Split Studies

It is not appropriate to bill diagnostic and titration studies separately when performing a split night study. This is considered one service.

Sources of information

1. BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2015) Diagnosis and medical management of obstructive sleep apnea syndrome. (2.01.18) Retrieved June 29, 2016 from BlueWeb (61 articles and/or guidelines reviewed)
2. Centers for Medicare and Medicaid Services. CMS.gov. NCD for sleep testing of obstructive sleep apnea (OSA) (240.4.1) Retrieved June 29, 2016 from MCPM
3. Krakow, B., Ulibarri, V., Melendrez, D., Kikta, S., Tohami, L., & Haynes, P. (2008). A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). Jounral of Clinical Medicine, 4, (3), 212-222. (level 4 evidence)
4. "Frequently asked questions about sleep coding" American Academy of Sleep Medicine, March, 2014.