I am from Denmark, a small country who is a member of the EU. (And no we are not the capital of Sweden). I have read some posts here about health care, insurance, and how SA is diagnosed and treated.

I was thinking that with your new president and his promises to improve health care, it would be interesting to hear how it works in most of the EU countries.

There are big differences in our health care system. First and foremost, in Denmark and most of Europe, we have a Public Health Care System, where the government pays for all services and equipment. Few people have a private insurance (in Denmark about 5% of the population). Even our insurance system is different because our insurance covers the same as the public system. The only difference is that with insurance you can use one of the few private clinics. However, this advantage is very small, because our public system has a maximum treatment guaranty to 1 month (especially for Denmark and some other EU countries). If the public system cannot meet it, you can free choose a private clinic.

Although our public system works very well, we've had trouble with the recognition of SA as a disorder requiring treatment.

The U.S. began diagnosis and treatment of SA, much earlier than here in Denmark and the most of other EU countries. Apart from a few pioneers the sleep medicine first started really in earnest in 2002. So we are in some ways behind the U.S. when we talk SA.

A few years ago, in-lab sleep studies (PSG) were also the gold standard here. But then our public system realized, how many potential SA sufferers there exist, and because of new technology allows it, they changed the guidelines for studies and treatment of SA (together with a lot of other countries). This means that today we can find and treat at least 10 times as many for SA, for the same resources.

Our system is built in 2 levels:

Level 1:
All who are referred to a sleep apnea study starts here. Typically, it will be your own doctor having regard. Within a month, you will receive a call for a sleep apnea study. Do you have a private insurance you can have an appointment within one week.

This study is a "partial Polygraphy" in-home test, where you sleep in your own bed one night. These devices measures primarily on respiratory problems and desaturations.

The day after the test you will meet up at the sleep lab, and have a conversation with a sleep physician. If it is found that you have sleep apnea he will transfer you directly to a specialist nurse in the sleep center, where you are supplied with an AUTO CPAP (We don’t have DME’s), are testing various masks and will be instructed in the use of equipment.

So already on day 2, you are in treatment. Then you will have a date for a new sleep test (with CPAP) 3 months later. This 3 month is our “titration study”.

If this proves that you are well treated you will have a yearly control, and they will read your data card. Masks and equipment can be replaced regularly as needed.

If during this test is evidence of other sleep disorders or that reading has not provided the expected impact they will send you to the 2nd Level

Level 2:
This is very specialized departments.

There you will undergo a full PSG sleep study - still as an "in-home" study. This test involves an additional set of measurements - including ECG, possibly the pressure of esophageal, PLMD, and many others depending on the assessment.

Subsequently, a sleep specialist will take a position on the way forward.


In many ways I think this system is good because we get a huge number in treatment. The downside is that there probably are some who "pass through" between Level 1 and Level 2 - specifically, I am afraid that some part with UARS may fall through.

I think this system will spread to more and more countries, including the US. Some US sleep centers already use this system.

Henning