C&P Exam for Sleep Apnea: DBQ Questions and Preparation Guide

The C&P exam for sleep apnea is unique compared to other disability claims because it heavily relies on objective sleep study results combined with subjective daytime symptom assessment. Many sleep apnea exams use the VA's Disability Benefits Questionnaire (DBQ), which contains specific questions evaluating sleep disturbance, daytime somnolence, and functional impairment. Understanding the likely questions, reviewing your sleep study findings, and preparing clear descriptions of daytime effects significantly impacts your rating. This comprehensive guide prepares you for a successful sleep apnea C&P exam.

Understanding the Sleep Apnea C&P Exam

The VA C&P exam for sleep apnea includes:

Sleep Study Review: Examiner reviews your polysomnography (PSG) results and AHI score
Daytime Symptom Assessment: Fatigue, somnolence, concentration effects
Sleep Disruption Questions: Nightmare frequency, sleep quality, restfulness
Functional Impairment Assessment: Impact on occupational and daily functioning
Related Symptoms: Hypertension, oxygen desaturation events, treatment compliance
DBQ Completion: VA Disability Benefits Questionnaire specific to sleep disorders

The exam is conducted by a physician (MD, DO, or PA) with sleep medicine knowledge and typically takes 45-60 minutes.

Reviewing Your Sleep Study Before Exam

Critical Preparation: Obtain your sleep study (polysomnography) report and fully understand the findings.

Key Sleep Study Findings to Understand

Apnea-Hypopnea Index (AHI):

Measures breathing disruptions per hour of sleep
AHI = (Number of apneas + Number of hypopneas) / Hours of sleep
Classifications:
- AHI < 5: Normal
- AHI 5-14: Mild sleep apnea
- AHI 15-29: Moderate sleep apnea
- AHI ≥ 30: Severe sleep apnea

Your AHI is the single most important factor in VA rating.

Oxygen Desaturation:

How low your oxygen drops during apnea events
Lowest oxygen saturation (nadir)
Time spent below 90% oxygen saturation
Higher desaturation = more severe

Apnea Type:

Obstructive (airway collapse): Most common in service-connected claims
Central (brain doesn't send breathing signal): Less common
Mixed: Both types

Sleep Architecture:

REM sleep percentage (normal 20-25%)
Sleep stage distribution
Sleep fragmentation/arousals

Preparation Strategy: Know your AHI score. Understand your oxygen desaturation nadir. Be able to explain to examiner: "My sleep study showed AHI of 28, moderate sleep apnea" rather than "I have bad sleep apnea."

Expected DBQ Questions

Many examiners use the VA Sleep Disorders DBQ. Anticipate these questions:

Sleep Disturbance Questions

"How many nights per week do you have difficulty sleeping?"

Expected answer: Specific frequency (nightly, 5-6 nights weekly, etc.)
Not: "Sometimes"
Vague answers weaken claims

"Describe your sleep pattern. How many hours do you sleep nightly?"

Expected answer: Actual hours achieved (e.g., "I attempt 8 hours but only sleep 4-5 due to apnea events")
Detail wake events: "I wake 10-15 times nightly from apnea"
Mention restlessness, positioning changes

"Do you experience nightmares or night sweats?"

Expected answer: Yes/no with frequency
If yes: "3-4 times weekly, wake drenched in sweat"
These indicate sleep disruption severity

"Do you experience morning headaches?"

Expected answer: Specific frequency (daily, most mornings, occasional)
Morning headaches common with untreated sleep apnea from CO2 retention

"Do you experience restless leg syndrome or leg jerking during sleep?"

Expected answer: Yes/no with description if yes
Family member may report kicking during sleep

Daytime Symptom Questions

"How many days per week do you experience daytime somnolence (sleepiness)?"

Expected: Specific frequency (daily, 5-6 days weekly)
Impact: "I'm fatigued every day despite sleeping"
Severity: "I fall asleep during meetings, while driving"

"How severe is your daytime somnolence?" (1-10 scale)

Expected: Specific number
Mild (1-3): Slight tiredness
Moderate (4-6): Noticeable fatigue affecting activities
Severe (7-10): Extreme sleepiness preventing normal function

"What activities trigger your daytime somnolence?"

Expected: Specific situations
"Sitting in meetings, driving longer than 30 minutes, watching TV"
"Anytime I'm not actively moving; fatigue is overwhelming"

"How does daytime somnolence affect your work?"

Expected: Specific functional impacts
"I can't concentrate; missed deadlines due to fatigue"
"I've lost multiple jobs due to inability to stay awake"
"I require frequent breaks to stay alert"

"How does daytime somnolence affect your social functioning?"

Expected: Relationship, activity impacts
"I can't go to evening events; too fatigued"
"My marriage strained due to my unavailability from exhaustion"
"I've withdrawn from hobbies and social activities"

Functional Impairment Questions

"Are you able to work full-time?"

Expected: Yes/no with explanation
If no: "Sleep apnea prevents full-time work; extreme fatigue"
If yes: "I work 4-day weeks with accommodation; employer limit is 32 hours"

"What is your current employment status and any job restrictions?"

Expected: Specific job title and limitations
"I was a truck driver; can't drive long-haul due to extreme fatigue"
"Work part-time (20 hours) instead of full-time due to sleep apnea"

"How does sleep apnea affect your ability to concentrate?"

Expected: Specific examples
"I can't focus on complex tasks; fatigue prevents sustained concentration"
"Memory affected; can't remember conversations or instructions"

"Do you require accommodation in your job?"

Expected: Specific modifications needed
"Work from home several days weekly"
"Flexible schedule to rest when exhausted"
"No safety-sensitive duties; excessive fatigue prevents driving/machinery operation"

Treatment and Compliance Questions

"Are you using CPAP (continuous positive airway pressure) therapy?"

Expected: Yes/no with details
Hours used nightly
Compliance: "Use 4-5 hours nightly" vs. "Not tolerating well; minimal use"

"How well is your sleep apnea controlled with treatment?"

Expected: Specific assessment
"CPAP improves symptoms significantly; daytime fatigue much better"
"CPAP helps somewhat but residual symptoms persist"
"Unable to tolerate CPAP; symptoms unchanged"

"Have you had other treatment attempts?"

Expected: Medication trials, surgery, devices attempted
"Tried oral appliance; didn't work"
"Considered sleep apnea surgery but declined"

What to Bring to Your Exam

Essential Documents:

Appointment notice and insurance card
Discharge papers (DD Form 214)
Photo identification
Sleep study report (polysomnography results)

Supporting Documentation:

Baseline sleep study if available (shows progression)
Other sleep testing (home sleep apnea test, split-night study)
Physician letters confirming sleep apnea diagnosis
CPAP compliance data if applicable
Medical records documenting daytime somnolence
Employer documentation of work restrictions
Personal statement describing daytime fatigue impact
Family member statement (spouse often observes nighttime symptoms)

Helpful Optional:

Journal of sleep/fatigue for past 2 weeks
Work performance reviews showing concentration issues
Marriage counselor notes if relationship affected

Preparation Strategy

Document Daytime Impact

Create Detailed Functional Description:

Instead of: "I'm tired during the day" Say: "I experience extreme daytime somnolence 7 days weekly. I fall asleep during meetings at work, struggle to maintain concentration for more than 30 minutes, and my recent work performance review noted attention problems. I've nearly fallen asleep while driving twice. Evening social activities impossible; I can't stay awake. My marriage is strained because I'm too exhausted to participate in family activities."

Calculate Sleep Quality Impact

Quantify your sleep disruption:

"Sleep study showed AHI of 32 (severe)—meaning I have 32 breathing-stopping events per hour"
"That's 224 disruptions during 7-hour sleep—every 1-2 minutes!"
"With that many events, I get very little restorative sleep"

Highlight Occupational Impact

Specific examples of work effect:

"Previous job as truck driver: couldn't drive safely due to extreme fatigue despite being well-rested before shifts"
"Current job: employer accommodated me to part-time work; full-time impossible due to concentration difficulties"
"I've lost jobs directly due to sleep apnea fatigue"

Address CPAP Compliance Honestly

If using CPAP:

Provide compliance data
Note improvement: "CPAP helps significantly; much less daytime fatigue"
Or acknowledge persistent symptoms: "Still fatigued despite CPAP use; residual symptoms remain"

If not tolerating CPAP:

Explain why: "Can't tolerate mask; claustrophobic feeling"
Alternative attempts: "Tried oral appliance; unable to adjust"
This explains why untreated sleep apnea persists

Common Mistakes to Avoid

Mistake 1: Minimal Documentation of Daytime Impact

Simply saying "I'm tired" doesn't convey functional impairment.

Solution: Be specific about how fatigue affects work, relationships, activities.

Mistake 2: Not Understanding Your Sleep Study

If you can't explain your AHI or severity, credibility questioned.

Solution: Review sleep study report. Understand your AHI score and what it means.

Mistake 3: Inconsistent Sleep/Wake Claims

Saying you're always "extremely fatigued" but also saying you "do fine most days" appears inconsistent.

Solution: Be consistent. If severe, describe consistently severe impact. If variable, explain patterns: "Good days and bad days; bad days prevent work."

Mistake 4: No Occupational Impact Description

Not explaining how sleep apnea affects ability to work.

Solution: Clearly describe job changes, lost jobs, or accommodations needed due to sleep apnea.

Mistake 5: Poor CPAP Compliance Without Explanation

Using CPAP 1-2 hours nightly and claiming severe symptoms raises questions.

Solution: Either use CPAP consistently (supporting severity treatment) or explain tolerance issues preventing use.

Functional Impairment Rating Context

Understanding VA sleep apnea ratings helps contextualize your claim:

10% Rating: Mild daytime somnolence, minimal occupational impact 30% Rating: Moderate daytime somnolence, some occupational restrictions 50% Rating: Significant daytime somnolence, substantial occupational impact 100% (TDIU): Severe daytime impairment, unable to work

Your daytime symptom description determines where your case falls within this scale.

Post-Exam Timeline

What Happens:

Examiner completes detailed report
Sleep study findings incorporated
VA rates based on: AHI score + daytime functional impairment
Rating Decision issued (typically 30-60 days)
Compensation begins following approval

If Rated Lower Than Expected:

You have one year to appeal
Submit supplemental claim with additional daytime impairment documentation
Request higher-level review
Appeal to Board of Veterans' Appeals

Final Preparation Checklist

Conclusion

The sleep apnea C&P exam relies heavily on your sleep study findings (objective AHI measurement) combined with your clear description of daytime functional impairment (subjective but equally important). Understanding your sleep study results, providing specific examples of how fatigue affects your work and daily life, and demonstrating consistent occupational and social impact ensures the VA appropriately rates your condition.

Review your sleep study thoroughly, document detailed daytime impacts, and prepare clear occupational limitation descriptions. With comprehensive preparation addressing both objective test findings and subjective daytime effects, you'll present a compelling case for appropriate sleep apnea rating and compensation.

Attend your exam well-prepared, and you'll be confident that your sleep apnea receives appropriate VA recognition.