Illustration being redrawn
Horizontal timeline with 5 milestones: diagnosis with OAHI of 15 or more, 3-month first approval, 4 hours a night, 12-month renewal, joker
timeline-parcours-convention-en · 1200×400px · infographic
What is the CPAP convention?
In Belgium, CPAP treatment for sleep apnea runs through a convention between the NIHDI and accredited specialist centers. It is not reimbursement in the usual sense: you do not pay first and claim the money back.
What the convention is NOT
- ✗You do not buy a CPAP device
- ✗It never becomes yours
- ✗You do not choose the model
What the convention IS
- ✓An accredited center lends you the device
- ✓Your health insurance fund pays the center directly
- ✓You only pay a small co-payment
The center takes care of everything: diagnosis, medical follow-up, maintenance, repairs and replacement.
The 3 treatments covered
Who is eligible? The conditions
To be covered under the convention, you must meet all 3 of these conditions:
Condition 1: a diagnosis confirmed by polysomnography
You need a polysomnography (PSG), a full sleep study, at an accredited sleep center. It is the complete test with every sensor (brain, breathing, oxygen, movement, heart rate…).
| Your age | Required index | What it means |
|---|---|---|
| 16 and over | OAHI ≥ 15/hour | At least 15 obstructive apneas or hypopneas per hour of sleep |
| Under 16 | OAHI ≥ 5 OR OAI ≥ 1/hour | Thresholds adapted for children |
An important change in 2017
Before 2017, you needed an AHI above 20 (all apneas counted) and an arousal index (ArI) above 30. Since 1 January 2017, only the OAHI ≥ 15 (obstructive apnea-hypopnea index) counts. Simpler, and more precise.
Condition 2: proof that CPAP works for you
A second test must show that CPAP improves your breathing. There are two ways to do it:
Option 1: titration at home
- • You sleep one or more nights at home with an auto-CPAP
- • The device adjusts the pressure and records it
- • The doctor sets your final pressure
- • A respiratory polygraphy, at the center or at home, checks that this pressure works
Option 2: titration at the center
- • You spend a second night at the sleep laboratory
- • The pressure is adjusted while you sleep
- • Whether it works is checked the same night
Condition 3: no better-suited treatment
The center must check that CPAP is the best treatment for you: weight loss, sleep habits, possible ENT surgery (especially in children), other underlying conditions.
Step by step
Suspicion and referral
Your GP, ENT specialist or pulmonologist suspects sleep apnea (snoring, constant tiredness, sleepiness, pauses in breathing that someone has noticed). You are referred to an accredited sleep center.
First consultation
The center doctor takes a full history: medical background, symptoms, lifestyle, clinical examination. They decide whether a sleep study is needed.
First night: the diagnostic sleep study
One night at the sleep laboratory. It measures brain waves (EEG), eye movements, muscle tone, breathing, oxygen, snoring, position and heart rate. If your OAHI is 15 or more per hour, the diagnosis is confirmed.
Second test: CPAP titration
A test of whether CPAP works for you (at home or at the center, see the conditions above). If CPAP improves your breathing, the treatment is approved.
Request to your health insurance fund
The request for coverage (a form and a medical report) goes to your health insurance fund. In practice, the center sends it. Expect an answer within a few days to 2 weeks.
Approval
Your health insurance fund approves coverage for 3 months. Coverage cannot start before the day after the test that proved CPAP works, nor go back more than 30 days before the fund received the request.
Equipment and training
The center gives you the device, a mask that fits and all the accessories. Full training: how to use it, how to clean it, how to adjust the mask, what to do if something goes wrong.
Regular follow-up
The center regularly checks your usage (hours a night), whether the treatment works, the state of your equipment and how comfortable you are.
How long it all takes
Allow 4 to 8 weeks between the first consultation and starting CPAP at home, depending on appointment waiting times and your health insurance fund.
The 4-hour rule, ON AVERAGE
Mandatory
You must use your CPAP at least 4 hours a night ON AVERAGE to stay covered by the convention. Note: it is an average over an assessment period (at least 2 months for the first renewal, at least 9 months after that), not a minimum every single night. A night without the device counts as zero.
8 hours one night, nothing the next
✓ Averages 4 hours: fine
4.5 hours every night
✓ Above the threshold: fine
5 hours on weeknights, nothing on weekends
✗ Averages 3 h 34 min: below the threshold
What happens if you average under 4 hours a night?
During the approval period
The center keeps an eye on your usage. If it drops, they contact you to understand why (an uncomfortable mask, the wrong pressure, claustrophobia…) and look for solutions with you.
At renewal
If your average is under 4 hours (or the device recorded nothing because of a fault), you only get a 3-month approval, the "joker" as centers call it, instead of 12 months.
During the joker
If your average gets back to 4 hours or more (assessed over at least 2 months), you are approved for 12 months again. If it stays under 4 hours, or you stop during those 3 months, coverage ends and you cannot be covered under the convention again for 1 YEAR.
After a successful joker
For the next two 12-month approvals there is no joker: an average under 4 hours leads straight to the year without coverage. Once those two years are over, a joker is possible again.
After the year without coverage
You can apply again. The titration has to be repeated, and the diagnostic sleep study too if it is more than 2 years old or your situation has changed. The doctor adds a note explaining why treatment should work this time.
If you can't reach 4 hours a night
- → Uncomfortable mask: there are dozens of models (nasal, nasal pillows, full face, minimal). Ask to try another one.
- → Dry mouth: turn up the humidifier or switch to a full face mask.
- → Claustrophobia: start by wearing the mask during the day, in front of the TV.
- → Uncomfortable pressure: it may not be set right. Ask the center to adjust it.
- → You take it off in your sleep: that is common at first! Keep going, it gets better with time.
Approval periods and renewals
| Type of approval | Length | Condition |
|---|---|---|
| First approval | 3 months | Once your health insurance fund approves |
| Standard renewal | 12 months | Average use of 4 hours a night or more |
| "Joker" renewal | 3 months only | Average use under 4 hours a night |
| After a successful joker | 12 months | No new joker for 2 approvals |
| After a failed joker | Stopped for 1 year | Still under 4 hours a night after the 3 months |
| Restarting after a gap | 3 months | Coverage interrupted for 3 months or more |
When everything goes well
Months 0 to 3: first approval (3 months) ✓
Months 3 to 15: renewal 1 (12 months) ✓
Months 15 to 27: renewal 2 (12 months) ✓
Renewable for as long as you meet the conditions
When adherence is a problem
Months 0 to 3: first approval ✓
Months 3 to 15: renewal, but use under 4 hours
Months 15 to 18: 3-month joker
→ If it works: back to 12 months, with no joker for 2 years ✓
→ If not: coverage stops, 1 year without the convention ✗
What does it really cost?
| Your status | Per day | Per month | Per year |
|---|---|---|---|
| BIM (increased reimbursement) | €0.00 | €0.00 | €0.00 |
| Standard | €0.25 | €7 to €8* | €91.25 |
That price covers EVERYTHING
Device + masks + tubing + filters + humidifier + maintenance + repairs + replacement + full medical follow-up.
* The monthly cost depends on the number of days in the month (€7.00 in February, €7.75 in 31-day months). For your treatment, your health insurance fund pays the center €2.82 a day for the first 6 months (this starting rate includes the titration), then €1.79 a day. You pay €0.25 of that unless you have BIM status. These rates are not index-linked. The center can only bill you your share for a period that is already over, of 3 months at most, never in advance.
What's included in the convention
Equipment provided
- ✓ CPAP or auto-CPAP device (as prescribed)
- ✓ A mask that fits (nasal, nasal pillows or full face)
- ✓ Headgear to hold the mask
- ✓ Tubing
- ✓ Filters
- ✓ Heated humidifier if needed
Services included
- ✓ Full training (for you and the people you live with)
- ✓ Your GP is kept informed (at the start, then at least once a year)
- ✓ Regular medical follow-up
- ✓ Usage checks
- ✓ Professional maintenance of the equipment
- ✓ Repairs and replacement if something breaks
- ✓ Someone to answer your questions
About replacing accessories
On paper, everything is included: the convention forbids the center from charging you anything extra. The one exception is a repair or replacement caused by loss, misuse or poor care on your part. In practice, some centers limit new masks to one a year, because many consider the rate of €1.79 a day too low to cover the real costs. If your mask is worn out or no longer suits you, say so: the center is supposed to replace it.
Convention or buying your own: which to choose?
Many patients ask themselves this. Both options have real advantages. Here is an honest comparison to help you decide.
| Criterion | Convention | Buying |
|---|---|---|
| Cost over 10 years | €900 (standard) / €0 (BIM) | €3,000 to €5,000 |
| Ownership | Never yours | Yours for life |
| Equipment | Often refurbished, older models | New, the latest connected models |
| Time to start | 4 to 8 weeks | Immediately (after diagnosis) |
| Usage requirement | 4 hours a night on average, mandatory | None |
| Access to your data | Through the center: limited | Direct and complete |
| Medical follow-up | Included and mandatory | Up to you to organize |
| Choice of mask | Limited by the center | Free, change whenever you like |
The convention is ideal if…
- ✓You have BIM status (completely free)
- ✓You have severe apnea (OAHI above 30) and need close medical follow-up
- ✓You have no budget to buy a device
- ✓You would rather have everything handled for you
- ✓You easily reach 4 hours a night
Buying may suit you better if…
- →You are not eligible (OAHI under 15)
- →You want to start treatment right away
- →You want the latest connected models
- →You travel often (travel CPAP)
- →You want to take charge of your health (full access to your data)
Frequently asked questions
Can I choose my sleep center?
▾
Yes. You can choose any accredited sleep center in Belgium. Pick one close to home: you will be going back for follow-up.
How much does the CPAP convention cost?
▾
€0.25 a day, so €7 to €8 a month depending on the length of the month (€7 in February, €7.75 in 31-day months). It is free if you have increased reimbursement (BIM). That covers the device, the mask, the accessories, maintenance and follow-up.
What happens if I move?
▾
You can change centers, except during the first 6 months of treatment. Tell your current center before you start somewhere else: otherwise days billed in error can be charged back to you. The new center takes over your file and handles the request to your health insurance fund.
What happens if my renewal is late?
▾
If your coverage is interrupted for 3 months or more, for example because the renewal request went in too late, you start again with a new 3-month first approval. If the gap is longer than a year, the diagnostic sleep study has to be repeated if it is more than 2 years old. Keep an eye on the end date of your approval.
Can I travel with my convention CPAP?
▾
Yes. Your sleep apnea does not take a holiday. Modern devices are compact, and some have a travel mode without the humidifier. Ask your center for a certificate for airport security.
My center is charging me for accessories. Is that normal?
▾
No. The convention forbids the center from charging extra for equipment and follow-up. The one exception is a repair or replacement caused by loss, misuse or poor care. If your mask is worn or leaks, say so: the center is supposed to replace it.
What is the difference between CPAP and auto-CPAP?
▾
CPAP (nCPAP) delivers a fixed pressure, the same all night (e.g. 10 cmH₂O). Auto-CPAP (APAP) adjusts the pressure automatically to what you need (e.g. between 6 and 14 cmH₂O). Auto-CPAP is generally more comfortable and is the more common prescription today.
Is my GP kept informed?
▾
Yes, the convention requires it: the center doctor informs your GP at the start of treatment, then at least once a year.
Is CPAP for life?
▾
Sleep apnea is usually chronic, and CPAP is often a long-term treatment. It can be stopped if your apnea goes away (significant weight loss, successful surgery…), after a new sleep study to confirm it.
My device has broken down. What should I do?
▾
Contact your center: repair and replacement are included in the convention. The rules set no deadline, so ask when you start how the center handles breakdowns (who to call, whether there is a loan device).
Does the convention CPAP belong to me?
▾
No. The accredited sleep center lends you the device, but it never becomes yours. If you want to own a device, you can buy one outside the convention.
Official sources
- NIHDI (INAMI/RIZIV), "Obstructive sleep apnea: cost of home treatment", page consulted in October 2026 (in French and Dutch)
- Convention between the NIHDI and sleep centers, in force since 1 January 2018 (articles 4, 10, 14, 15 and 17)
- NIHDI, circular to the health insurance funds on rehabilitation rates as of 1 February 2025 (convention 7.85 rates, not index-linked)
- Fifth amendment to the convention, in force in 2017 (introduced the OAHI ≥ 15 criterion)
Last checked: October 2026, against the NIHDI texts currently in force. If in doubt, refer to the official NIHDI documents or ask your accredited sleep center.
Find an accredited sleep center
The CPAP convention always goes through an NIHDI-accredited sleep center. Use our map of sleep centers in Belgium to find the one nearest you.
