Applying for Social Security Disability Benefits with Insomnia
According to the American Academy of Sleep Medicine, 10 percent of adults have chronic insomnia and as many as 50 percent have occasional or short-term insomnia, which can wreak havoc on the lives of those suffering from the condition.
The Social Security Administration (SSA) may be able to help you if insomnia is affecting your ability to work. It offers two types of benefit programs to provide financial assistance to those with a disability.
The Financial Costs of Insomnia
The main costs of insomnia are due to indirect costs from missing or under performing at work. Each person with insomnia misses about 8 days of work per year, reported a study published in Sleep magazine. This adds up to an estimated $63 billion of lost productivity in America every year.
Sleep Review journal reported the disease costs $1,500 annually for individuals with symptoms only and $5,000 for those with insomnia disorder, though only about a quarter of these costs are due to direct medical costs.
The main treatments for insomnia include medication and other sleep aids, and cognitive behavioral therapy (CBT) the Sleep Review journal explained. For most patients, sleep was improved after only a few sessions of CBT. Though, the cost of sessions can range from $150 to over $200 each, they may improve insomnia to the point that medication may not be needed.
Additionally, the article pointed out that among many conditions, insomnia is one of the most commonly associated with injuries, behind only diabetes and chronic pain. Depending on the severity of the injuring, this can add thousands of dollars to healthcare costs.
Medically Qualifying for Benefits with the Blue Book
When the SSA receives an application for disability benefits, it uses the Blue Book to determine if the individual meets the SSA's medical requirements. The Blue Book is the SSA's official list of disabling conditions that qualify for benefits, and if an applicant meets or equals a listing, he or she will be approved for benefits.
There is no specific listing for insomnia, but there are a number of conditions that are caused by insomnia included in the Blue Book:
- Section 4.02—Chronic heart failure: Systolic or diastolic heart failure resulting in the inability to perform daily living activities, three or more acute episodes in one year, insomnia and other sleeping problems, low systolic pressure, premature ventricular contractions, or the brain not being fully oxygenated.
- Section 4.04—Ischemic heart disease: A deficiency of blood supply due to blockage in the veins (ischemia) with depression, low systolic pressure, three ischemic episodes requiring hospitalization in one year, or a severe coronary artery disease.
- Section 5.02—Gastrointestinal hemorrhaging requiring blood transfusion: Hemorrhaging that requires three or more transfusions at least 30 days apart in a six-month period, needing two units or more of blood per transfusion.
- Section 5.06—Inflammatory bowel disease (IBD) with obstruction in the small intestine or colon caused by scar tissue (stenosis) that cause two hospitalizations in a six-month period, anemia, perineal disease, abdominal masses, involuntary weight loss, or the need to be fed through a feeding tube or catheter.
- Section 5.07—Short bowel syndrome (SBS) caused by surgical removal of at least half of the small intestine and requiring daily feeding through a catheter.
- Section 12.00—Mental disorders, which result in difficulties in daily living activities, social functioning, or maintaining concentration and persistence, such as:
- Organic mental disorders, with disorientation of time and place, memory impairment, hallucinations, delusions, changes in personality, mood disturbances, emotional instability, or loss of 15 or more IQ points.
- Schizophrenic, paranoid and other psychotic disorders delusions, with hallucinations, periods of unresponsiveness (catatonia), disorganized behavior, incoherence, illogical thinking, reduction in emotional expressiveness, inappropriate emotional, emotional withdrawal, or isolation.
- Depressive syndrome with loss of interest in most activities, loss of appetite and weight, insomnia and other sleep disturbances, loss of motor or mental function, decreased energy, feelings of guilt or worthlessness, difficulty concentrating or thinking, hallucinations, delusions, paranoia, or thoughts of suicide.
- Manic syndrome that causes you to be easily distracted or discard risks, or with hyperactivity, pressure of speech, flight of ideas, inflated self-esteem, decreased need for sleep, or bipolar syndrome.
- Anxiety-related disorders with motor tension, hyperactivity, apprehensive expectations, constant or needless vigilance and scanning, an irrational and persistent fear of a specific object, activity, or situation, severe and recurrent panic attacks, obsessive behaviors, trauma, or the inability to function outside the home.
- At least two years of medically documented history of any mental disorder causing the inability to do work activities due to mental decompensation or to function outside of a highly supportive living arrangement for a year or more.
If your insomnia is making it impossible for you to work, talk to your doctor about applying for Social Security for disability benefits.
Qualifying Without Meeting a Medical Listing
If your insomnia has not caused any other conditions, but you are unable to work because of its symptoms, there is another way to get benefits. The SSA also approves applicants based on a medical-vocational allowance. To be considered, your insomnia must last for at least year and must make you unable to work enough to earn at least $1,130, which is the SSA's 2016 substantial gainful activity minimum.
With a medical-vocational allowance, the SSA uses a long, detailed from about your physical and mental limitations, filled out by your doctor, to determine your residual functioning capacity (RFC), as well as your work history and education level, which you provide. The SSA uses the doctor-reported limitations to find the type of work you can do (sedentary, light, medium, heavy, or very heavy) and find jobs you could reasonably do or be trained to do with your education and work experience.
There are some symptoms that would affect your ability to work, such as extreme fatigue, low energy, daytime sleepiness, inability to focus or concentrate, poor memory, disturbances in mood, increased errors, or other conditions, such as heart disease, anxiety, depression, and digestive issues.
Getting approved for benefits with insomnia only is very challenging, and the SSA does not often approve claims for sleep disorders. However, older adults with a history of manual jobs or dangerous jobs, such as construction workers, firefighters, police officers, or those in the military will have a higher chance of approval than those with education or other industries.
How to Apply for Social Security Disability Benefits
Because approval with insomnia is so hard, talk with your doctor to make sure applying for benefits is the right choice. Many who are legitimately disabled are denied by the SSA. If the claims approved, it's often only after more than one appeal, which can take months or years. If your doctor isn't confident in your chances of winning a case, then it may not be worth the time and stress of applying.
If you meet the Blue Book listing for an co-occurring condition, or you wish to apply anyway, be sure to include all of the necessary medical evidence. Many applicants who should be approved are not, because they leave vital medical information out of their claim.
Important medical evidence may include:
- Medical imaging tests, like an X-ray, MRI, ultrasound, CT scan.
- An electrocardiogram (EKG/ECG) to test the electrical activity of your heart while at rest, exercising (exercise tolerance test/ETT), or while performing normal activities (Holter monitoring).
- Echocardiogram, which uses sound waves to create images of the heart.
- Blood tests.
- Colonoscopy or endoscopy.
- A sleep log, sleep inventory, or sleep study, which collect detailed information about how you sleep.
- Psychological assessment.
- A detailed report from your doctor and/or your cardiologist or psychologist describing the severity and limitations of your insomnia and other conditions.
- Reports of any surgeries and hospitalizations directly related to your insomnia or a co-occuring condition.
- List of all prescribed treatment regimens and outcomes.
You can apply for disability benefits on the SSA's website or at your local SSA office, However, applications for Supplementary Security Income must be done in person at an SSA office. Be sure to double check your application before you turn it in, as you could also be denied or delayed for missed questions and mistakes. Also, be aware that there is other necessary paperwork, such as tax information and personal documents. The SSA has a full list of required documents online.
If your condition worsens after you apply for benefits, alert the SSA immediately. The changes in your condition or new medical evidence could be helpful in getting a favorable decision on your application.
If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance.
