Could it happen?

[krousseau]

With the growing awareness of SDB and sales of equipment to treat it--how long before the insurance companies want to reduce their outlay and start pushing for the equipment to be OTC?
We know it is possible to diagnose and titrate treatment pressures for simple sleep apnea using an APAP. Some medical sources (B Phillips NSF) are already saying not everyone needs a sleep study and it is possible to self titrate using an Auto PAP device. They also cite the relative safety of self management. Though I'm sure they would advise the treatment to be overseen by a medical care provider-that is prudent due to the potential for co-existing conditions. Sure there is central apnea and RLS/PLMD-the central apnea would be screened for using the AutoPAP and RLS/PLMD isn't life treatening. People often realize they have it. Safety issues seem in line with (or lower than)-say the safety issues with some of the medications that have gone OTC such as Ibuprofen, Naproxen, Prilosec and Claritin. Some people-but not many can have serious side effects from these medications. The anti-inflammatories are responsible for a large number of cases of erosive gastritis. The insurance companies pushed for these meds to be available OTC.

[GoofyUT]

[quote="krousseau"]With the growing awareness of SDB and sales of equipment to treat it--how long before the insurance companies want to reduce their outlay and start pushing for the equipment to be OTC?
We know it is possible to diagnose and titrate treatment pressures for simple sleep apnea using an APAP. Some medical sources (B Phillips NSF) are already saying not everyone needs a sleep study and it is possible to self titrate using an Auto PAP device. They also cite the relative safety of self management. Though I'm sure they would advise the treatment to be overseen by a medical care provider-that is prudent due to the potential for co-existing conditions. Sure there is central apnea and RLS/PLMD-the central apnea would be screened for using the AutoPAP and RLS/PLMD isn't life treatening. People often realize they have it. Safety issues seem in line with (or lower than)-say the safety issues with some of the medications that have gone OTC such as Ibuprofen, Naproxen, Prilosec and Claritin. Some people-but not many can have serious side effects from these medications. The anti-inflammatories are responsible for a large number of cases of erosive gastritis. The insurance companies pushed for these meds to be available OTC.

[nosbig-nosbig]

News Flash!!!

We do NOT live in a perfect world.

Many if not most medical decisions are made based on economics.

Some treatment for a sleep disorder is probably better than none.

[krousseau]

I did not indicate in my first post whether I was for or against OTC designation.
Reckless???? It is a topic that needs to be discussed. If Monday's headline banner was about the FDA considering making APAP's OTC-would you be in favor or not. Who would you contact to express your view-what would your arguments be-and remember you could be with or against the insurance company lobby.

That APAP's report nonresponsive events as you describe means they have the potential to be used as a screening device (not diagnostic-just screening). The users manual would be a lot thicker and contain many warnings & legal disclaimers if XPAPs go OTC. Can you imagine the stickers on the machines?

Many people in the medical care system for SDB are disatisfied with their care, many are receiving substandard care. Many of these people feel that as much as their docs are doing they could do better themselves. Barbara Phillips MD of the NSF has written articles they could use to support their view.

Just because it may harm a "few" people doesn't mean it shouldn't/won't happen. Lots of people get erosive gastritis from OTC NSAID's-they are still available. I have a cardiac arrythmia--Claritin makes it worse--I doubt if I'm the only person with that problem. I'm comfortable with my analogy.

My opinion?? I don't like the idea. I think people should have a good workup for co existing conditions, a good sleep study to maximize treatment, and have regular evaluations of how treatment is going. I think they should receive assistance in initiating treatment and finding the best mask/machine etc. I think they should be taught to self manage their treatment between medical visits. Those unable to learn self management due to cognitive deficits should have more frequent evaluations.

My opinion?? IMO not many of us really get all that care from the medical care system? IMO the costs prohibit many from getting diagnosis and treatment. IMO I don't have the answers and I'm short on complete information--I would welcome a good cost/benefit analysis.

[Moogy]

MUCH more importantly, there are significant risks of harm in initiating (or SELF-initiating) CPAP therapy WITHOUT first investigating conditons that may be co-morbid with SDB and which may CONTRA-INDICATE CPAP. Those conditions MUST be competently ruled-out BEFORE starting CPAP, in my opinion. Just a thought.

Chuck

Chuck,

I am not as familiar as you are with the possible co-existing conditions. Can you list some of them? I think you have previously mentioned Cheyenne-Stokes, but what else?

Thanks,
Moogy

[Goofproof]

How much would it cost, to have a visiting nurse stop by my house three times a day to give me Insulin injections? Some things are more cost effective, by letting a patient with sound judgement, and information, control their own treatment. Should all the people in the world be allowed to run their own treatment? Not all, for sure, many aren't capable of even taking pills correctly.

For the people who can do it right, their treatment is much better than leaving it in others hands, after all it's our bodies, and we are the first line of defence, we should care more how we are treated. We aren't in it for the money, we have a larger stake in our treatment. Jim