Life Insurance with Sleep Apnea: CPAP, Severity and Your Rates

If you have been diagnosed with sleep apnea, you can almost certainly get life insurance. The question is what you will pay, and the answer depends mostly on two things: how severe your apnea is, and whether you are treating it consistently. A well-controlled case with a CPAP report that shows nightly use is a routine file at most Canadian insurers. An untreated severe case is not.

This guide is for Ontario adults with obstructive sleep apnea (or the less common central sleep apnea) who are shopping for term or permanent coverage, and for people who have a sleep study booked and want to know what comes next. It explains what underwriters ask, how they read your sleep study and CPAP data, what a rating costs, and how to present your file. We are insurance advisors, not sleep physicians, so nothing here is medical advice.

The short version:

• Mild apnea, treated or not, is often standard rates at many insurers.
• Moderate or severe apnea on CPAP with documented compliance is frequently standard, sometimes with a small rating.
• Moderate or severe apnea that is untreated, or where the CPAP is not being used, is typically rated or postponed.
• New diagnoses are usually postponed for a few months until treatment is established.
• Other conditions travelling with the apnea, especially high blood pressure, high BMI and diabetes, are assessed alongside it and often drive the final result.

If you want to skip to costs, the table further down shows what a rating adds. If you want the reasoning, keep reading.

Why insurers care about sleep apnea

Sleep apnea means your breathing repeatedly stops or becomes shallow during sleep. Underwriters care because untreated moderate to severe apnea is associated in long-run data with higher rates of high blood pressure, heart disease, stroke, irregular heart rhythms and daytime accidents, all of which show up in mortality tables. The apnea itself is not what the insurer is pricing; it is the downstream effects when it is not controlled.

That framing is helpful, because it explains why treatment changes everything. A CPAP used every night largely removes the mechanism that creates the risk, and underwriters generally price accordingly. It also explains why they ask about weight, blood pressure and blood sugar in the same breath: those are the conditions that either cause the apnea or result from it.

How underwriters read your sleep study

Almost every insurer will want the results of your sleep study (polysomnography, or a home sleep test). The number they look at first is the apnea-hypopnea index (AHI), which counts breathing events per hour of sleep. The standard clinical bands, which underwriters generally follow, are:

Severity	AHI (events per hour)	How underwriters commonly view it
Mild	5–14	Often standard, with or without treatment, if no significant related conditions
Moderate	15–29	Standard to mild rating if treated and compliant; rating likely if untreated
Severe	30 or more	Standard or modest rating possible with strong compliance; significant rating or postponement if untreated

Underwriters may also look at the lowest oxygen saturation recorded during the study, how much time was spent below a certain oxygen level, and whether the follow-up study on treatment shows the AHI has dropped into the normal range. A pre-treatment AHI of 45 that falls to 3 on CPAP tells a very different story from a 45 with no follow-up.

If your study is more than a few years old, or your weight or symptoms have changed significantly since, some insurers will ask for an updated one. Your sleep clinic can usually arrange this.

CPAP compliance is where most cases are decided

For moderate and severe apnea, the treatment question matters more than the diagnosis. Underwriters want to know three things:

1. What treatment you use. CPAP or BiPAP is the most common and the easiest to document. Oral appliances, positional devices, surgery and weight loss are also recognized, but the insurer will want a follow-up study showing they worked.
2. How consistently you use it. Modern CPAP machines log every session. Your clinic or equipment supplier can generate a compliance report showing nights used, hours per night and residual AHI. A common expectation is use on a large majority of nights for at least four hours, though insurers vary and a longer nightly average helps.
3. How long you have been on it. Three to six months of documented use is a typical minimum before a full decision. A year or more of steady use is stronger still.

This is the single most useful thing you can prepare before applying. Request the compliance report from your clinic and have it ready. It shortens the underwriting process considerably and often turns a rated offer into a standard one.

If you have a CPAP and do not use it, be honest about that. The insurer will find out from the report, and an application that claims nightly use contradicted by a download showing 20% compliance damages your credibility on everything else in the file. It is far better to spend a few months building a real compliance record and apply afterwards.

The questions you should expect

Beyond the sleep study and treatment details, underwriters typically ask about:

• Daytime sleepiness, and whether you have ever fallen asleep while driving
• Height and weight, and any recent significant change (our guide to life insurance and BMI explains how build is assessed)
• Blood pressure readings and any medication (see life insurance with high blood pressure)
• Diabetes or pre-diabetes
• Heart rhythm problems, chest pain or prior cardiac testing
• Smoking and alcohol use
• Any depression or anxiety, which commonly overlaps with poor sleep

These are not trick questions. Each one is either a cause of apnea or a consequence of it, and a file where all of them are clean is a strong file. A file where the apnea is controlled but blood pressure and weight are not may still be rated, because the underwriter is looking at the whole picture.

Larger policies usually involve a paramedical exam with blood and urine tests, which will pick up blood sugar and other markers independently. Our article on the life insurance medical exam explains what is tested.

Typical outcomes and what a rating costs

Ratings in Canada are usually expressed as a percentage added to the standard premium, sometimes called a table rating. For sleep apnea, ratings we commonly see range from 25% to 100% above standard, with higher figures for severe untreated cases or where other conditions compound the risk.

For a healthy non-smoker, indicative monthly premiums for $500,000 of 20-year term life insurance are roughly $32–$48 at age 40 and roughly $48–$70 at age 45. These are illustrative ranges, not quotes; age, health, smoking status, coverage amount and insurer all change the number. Below is how a rating scales the premium at age 45, using the same policy. Illustrative only.

Underwriting result	Indicative monthly premium, age 45 non-smoker, $500K 20-year term
Standard	roughly $48–$70
Rated +25%	roughly $60–$88
Rated +50%	roughly $72–$105
Rated +100%	roughly $96–$140

For reference across other ages, see our guide to life insurance rates at age 45 and the broader breakdown of life insurance costs in Ontario.

Two practical points. First, a rating at one insurer often does not appear at another, because each company sets its own thresholds for AHI and compliance. Second, most insurers will reconsider a rating on request once you have a longer compliance history or a better follow-up study, so a rated policy today is not necessarily a rated policy forever.

If you have been postponed or rated

A postponement means the insurer wants to see treatment established before deciding. Typically they will name a period, often three to six months from starting CPAP. Use that time to build a compliance record and, if your clinic recommends it, complete a follow-up study.

If you need coverage in the meantime, there are bridges:

• Simplified issue life insurance asks a short list of health questions and generally does not ask about sleep apnea at all, or asks only whether you have been advised to use a CPAP and are not doing so. Amounts are lower and premiums higher than fully underwritten term, but it is fast. Our explainer on simplified issue life insurance covers the trade-offs.
• Group coverage through an employer is usually issued without individual health questions up to a set amount.
• A rated fully underwritten policy with a plan to request reconsideration in 12 months. Sometimes the rated premium for a year is a small price for having real coverage in place.

If you are rated, ask your advisor to check whether the rating is reviewable and what the insurer wants to see. Then diarize it.

Sleep apnea and other types of coverage

Sleep apnea affects disability and critical illness applications a little differently. Disability insurers care about daytime sleepiness and occupational risk, so a truck driver or someone operating heavy equipment with poorly controlled apnea can face exclusions or ratings that an office worker will not. Critical illness insurers focus on the cardiovascular picture, since heart attack and stroke are the largest claim categories. If you are considering critical illness insurance or disability insurance at the same time, mention it to your advisor so the applications go to insurers that view apnea favourably across all three products.

How Hayes can help

Sleep apnea is a case where the difference between insurers is real and predictable. We have a good sense of which of the 30+ Canadian companies we work with treat compliant CPAP users as standard, which want a longer history, and which are more forgiving of a higher BMI alongside the apnea. Before submitting, we can put your details in front of underwriters informally, without your name, and find out where the file will land best. Then we help you gather the sleep study and compliance report so the application moves quickly.

Our advice costs you nothing; the insurers pay us. Compare quotes from 30+ Canadian insurers in about 2 minutes, free and with no obligation, or contact us to talk through your situation with an advisor first.