Perscriptions for CPAP Machines?

[SleepFast]

I am new and naive to the CPAP world of hospital sleep studies, prescriptions for machines, fighting with durable medical equipment folks, and taking control of your ongoing theapy. But I am not new to the field of screening for chronic conditions.

At my request, my primary physician wrote me an order for a sleep test. $7,000-9,000 and two months plus later, I had an auto CPAP, appropriate masks, and a titration level of 12 cm (8-16). And started feeling much better. You all know the drill. I've probably spent $1,000 plus in my own money for co-pays and other necessary equipment (hose buddy, hose covers, card reader, etc.). My insurance company paid at least $7,000 from what I can tell.

Meanwhile, I see that the same machine and masks I received are available on CPAP.COM for about the same amount of money I paid in copays. My first night on the machine it titrated me at 11.4 and quantified my AHI, AI, HI, and other goodies. I assume if the pressure was set to 2 cm in CPAP mode, it would have counted my untreated events, or something close enough for government work. Then with auto on, it could calculate my titration level.

At a basic gut level (I was an epidemiologist for 30 years) something seems wrong with the present multilayered OSA screening system given today's technology and the economies downfall. It appears there are as many as 10 million people in the US alone who remain undiagnosed with OSA. Many don't have insurance. Many don't have the time/energy to get screened. Many don't know the symptoms and consequences of OSA. All have a rough road to ride without help.

It may have been necessary to have an initial full sleep study in the past, but the new auto CPAP machines can probably screen for the great majority of SAs. Shouldn't these be made available to the symptomatic public for initial screening rather than a full blown sleep test? I'm sure their specificity and sensitivity would be great compared to screening mechanisms for many other diseases.

Is it possible to hurt yourself with one of these machines (any more than with a plastic garbage bag and minimal brain power)? Why the secrecy over setting titration levels and viewing results? Why the need for a prescription? I wonder how much the doctor's involvement can influence compliance.

I could go on and on about reducing the cost of other medical problems associated with OSA through earlier screening. And the cost effectiveness of a much simpler initial screening model. And the cost of having workers with fried brains. The cost case should be easy.

What am I missing here? Should we be pushing for better and less expensive mass screening for symptomatic individuals? Is there a model for this in other countries?

Again, I am new and naive:-) But seems like I've just had a very long run for a very short slide! Although I love the results.

[Georgio]

Now that you think of it, we are allowed to take aspirin, aren't we! I don't think you need a prescription in some countries.

[TSSleepy]

I certainly don't get it. I've already gone through months of BS to get an xPAP, and potentially have months more to go.

To buy an air pump...

I'm about ready to make my own.

[alnhwrd]

Yep, you can buy a gun, a car, drain cleaner, power tools, anytime you want but you need a prescription for machine that blows a little air. Partly its because, "thats the way we've always done it" and partly its because someone is making huge amounts of money doing it this way. mho.

[RipVW]

SleepFast wrote:

It may have been necessary to have an initial full sleep study in the past, but the new auto CPAP machines can probably screen for the great majority of SAs. Shouldn't these be made available to the symptomatic public for initial screening rather than a full blown sleep test? I'm sure their specificity and sensitivity would be great compared to screening mechanisms for many other diseases.

I agree!
From:
http://smart-sleep-apnea.blogspot.com/2 ... tests.html
Nonattended home automated continuous positive airway pressure titration: Comparison with polysomnography http://www.sleepsolutions.com/clinical_ ... o-CPAP.pdf Quote: Nasal APAP titration in this study correctly identified residual apnea equivalent to the use of PSG. CONCLUSIONS: Nonattended APAP is successful in many patients in determining a therapeutic positive pressure setting. Reported AHI via Autoset is similar to that of PSG.

[Slinky]

Well, keep in mind that too high a pressure can cause central apneas and too high a leak can cause a high reported pressure.

And someone w/an undisclosed lung problem such as blebs could be harmed by CPAP pressure, especially the higher pressures.

And there are those few w/some form of inner ear problem that CPAP pressure can harm and even cause permanent hearing loss.

And then there are all those other sleep disorders that CPAP can't compensate for and APAPs can't detect or Dx ....

Medicare seems to be contemplating a decent compromise: at home sleep study, if indicated an APAP for 3 months, if still problems a full in-lab sleep evaluation or titration. That's simplified but gives you an idea of what they have up their sleeve.

Just keep in mind, once xPAPs aren't a script item, it won't be long and there won't be insurance coverage for them either - and if you think that is going to bring the price down .... even cpap.com's prices would be tough for many to come up with. And it can be dang expensive, even w/cpap.com's insurance, to go thru several masks to find the right one. Be careful what you wish for!!!

[LoQ]

Slinky, you raise some very important concerns about certain patients who should be more closely supervised. Thank you.

Just keep in mind, once xPAPs aren't a script item, it won't be long and there won't be insurance coverage for them either - and if you think that is going to bring the price down .... even cpap.com's prices would be tough for many to come up with. And it can be dang expensive, even w/cpap.com's insurance, to go thru several masks to find the right one. Be careful what you wish for!!!

My deductible is so high that it's all pretty much on my own nickel, and I initially went through a DME with their outrageous prices. So I'm in favor of lowering the price, even if it means no insurance. I effectively don't have any, anyway, unless something really major happens to me one year.

[RipVW]

Well, keep in mind that too high a pressure can cause central apneas and too high a leak can cause a high reported pressure.

And someone w/an undisclosed lung problem such as blebs could be harmed by CPAP pressure, especially the higher pressures.

And there are those few w/some form of inner ear problem that CPAP pressure can harm and even cause permanent hearing loss.

And then there are all those other sleep disorders that CPAP can't compensate for and APAPs can't detect or Dx ....

Medicare seems to be contemplating a decent compromise: at home sleep study, if indicated an APAP for 3 months, if still problems a full in-lab sleep evaluation or titration. That's simplified but gives you an idea of what they have up their sleeve.

Just keep in mind, once xPAPs aren't a script item, it won't be long and there won't be insurance coverage for them either - and if you think that is going to bring the price down .... even cpap.com's prices would be tough for many to come up with. And it can be dang expensive, even w/cpap.com's insurance, to go thru several masks to find the right one. Be careful what you wish for!!!

Good points, all, Slinky!

[GumbyCT]

It may have been necessary to have an initial full sleep study in the past, but the new auto CPAP machines can probably screen for the great majority of SAs. Shouldn't these be made available to the symptomatic public for initial screening rather than a full blown sleep test? I'm sure their specificity and sensitivity would be great compared to screening mechanisms for many other diseases.

Is it possible to hurt yourself with one of these machines (any more than with a plastic garbage bag and minimal brain power)? Why the secrecy over setting titration levels and viewing results? Why the need for a prescription? I wonder how much the doctor's involvement can influence compliance.

I could go on and on about reducing the cost of other medical problems associated with OSA through earlier screening. And the cost effectiveness of a much simpler initial screening model. And the cost of having workers with fried brains. The cost case should be easy.

While I agree that not ALL sleep disorders can be detected, even with at home screening, I do agree that we can do more with the data machines available. And I wouldn't call the auto's new, by any means. If they are not reliable then why are we using them?

While I also agree you can get more reliable results with a trained professional, the industry is plagued by scam and rip-off artists. It has become very much a money-mill. Perhaps they need to police their own.

What am I missing here? Should we be pushing for better and less expensive mass screening for symptomatic individuals? Is there a model for this in other countries?

Again, I am new and naive:-) But seems like I've just had a very long run for a very short slide! Although I love the results.

Does "Welcome to the Party Pal!" ring any bells? This business is "All about money" and likely to remain that way for some time.

I can only say "Sleeper BEWARE".
GumbyCT

[Slinky]

... Perhaps they need to police their own. ...

Yeah, sure, like the medical profession has always done such a great job of policing their own!!??!!

[Sleeptech010110]

I'm a tech, don't deal with the insurance side. But ya, those things are expensive, and yes, the tests are expensive, but people can and have had a bad reaction to cpap. COPD pt's are a particulary good example. They have MORE events the HIGHER the pressure. Their brain monitors CO levels instead of O2, so if they are getting enough, they stop breathing. Right now, a computer can't look at their breathing and determine what's wrong, it takes a lot more data than that. I've had pt's drop into the clinically dead range on oxygen levels as the paramedics were arriving... If they had bought a machine and tried it at home, who would have called 911?

Your health, resp drive, heart, cardiovascular system, and brain, are far too important and fragile to play around with without adequate training as to what can go wrong, and what to do if it does go wrong.

Side note, events like that are very rare, but I personally would prefer the very rare to happen with medical personnel standing by with CPR, crash carts, and a phone with 911 ready to go, then at home where no one is there to help... That's why I'm so catious about pt's adjusting their RX'd pressures... Kinda scares me a little to find this place, lol:-)

My two cents:-P

[kebsa]

prescriptions are not required here in Australia but they are preferred, i have looked at a lot of the DME's that do online deals and while they will sell masks etc on line they want to deal with the machines in person. It is hard to imagine a person walking in off the street and buying expensive equipment and setting themselves up with out medical advice- i am all for a patient being actively involved in there medical care but it needs to be a partnership with treating health professionals- i would not dream of walking in of the street i trying to buy a cpap without a prescription

[Bearded_One]

... And I wouldn't call the auto's new, by any means. If they are not reliable then why are we using them? ...

AutoPAPs work well when used properly. Many autoPAPs are set wide-open -- 4 to 20 cmh2o, which can allow the machine to cause mischief. When set to a small (no more than 4 cmh2o) range, they generally work quite well.

[Wulfman]

I'm a tech, don't deal with the insurance side. But ya, those things are expensive, and yes, the tests are expensive, but people can and have had a bad reaction to cpap. COPD pt's are a particulary good example. They have MORE events the HIGHER the pressure. Their brain monitors CO levels instead of O2, so if they are getting enough, they stop breathing. Right now, a computer can't look at their breathing and determine what's wrong, it takes a lot more data than that. I've had pt's drop into the clinically dead range on oxygen levels as the paramedics were arriving... If they had bought a machine and tried it at home, who would have called 911?

Your health, resp drive, heart, cardiovascular system, and brain, are far too important and fragile to play around with without adequate training as to what can go wrong, and what to do if it does go wrong.

Side note, events like that are very rare, but I personally would prefer the very rare to happen with medical personnel standing by with CPR, crash carts, and a phone with 911 ready to go, then at home where no one is there to help... That's why I'm so catious about pt's adjusting their RX'd pressures... Kinda scares me a little to find this place, lol:-)

My two cents:-P

Your lack of knowledge of this field and other things is really scary.
If they had bought a machine and used it at home......NOBODY would have had to call 911.....because they would have been getting at least SOME better breathing in their sleep. Lots of people have and are bypassing the medical professions regarding this therapy. And, with the economy going in the tank and people losing their insurance, there's definitely going to be lots more of them.
At some point, when this therapy (for simple OSA) gets more simplified, the medical professionals are going to be exposed for the money-grubbers (grabbers) that they are.
This therapy is NOT that hard to figure out if a person applies a little thought to it.

Den

[rested gal]

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://ajrccm.atsjournals.org/cgi/reprint/167/5/716

Link to a Powerpoint presentation by board certified pulmonologist/sleep doctor (Dr. Barbara Phillips) at a meeting of the American Lung Association of the Central Coast - November 2004:
"Not Every Patient Needs to Go to the Sleep Lab"
http://www.alaccoast.org/pdf/Phillips_0830.pdf

Dr. Phillips, a highly respected doctor board certified in pulmonology and in sleep medicine, is of course, basing her views and presentation on the premise that the person has a primary care physician who is aware of the person's underlying health issues -- COPD, CHF, etc.

I agree, Sleeptech010110, that a well run NPSG sleep study is best. The more baseline data, the better. Plus, it can uncover other sleep disorders, particularly PLMS. But for the main bulk of OSA sufferers with plain vanilla OSA, this doesn't have to be rocket science. That begs the question, of course, "how do you know it's plain vanilla OSA without a full, attended, PSG sleep study?" Good question. Can't know that. However, we do what we think best for ourselves. "Think" being the operative word. Some people "think" things out and research things better than others.

At any rate, the vast majority of people probably prefer to put themselves entirely in the hands of medical professionals, do no "thinking" for themselves...just do what the doctor says.

I can understand why this place looks scary as all get out to people who are taught to go by the book, could lose their license if they don't, and see the "rare" and not-so-rare things that can go wrong. And who are dealing with people who stumble through the sleep labs on a daily/nightly basis... who are not the least bit interested in educating themselves about their own health problems...just want it "fixed"... and are not going to take any interest whatsoever in their own treatment.

Hope you stick around and keep learning, just like we are trying to do. The fact that you are visiting this "scary place" at all is a good sign that you are very interested in knowing what cpap users go through and are "thinking." Or maybe you've read over on binary, that there's an AWFUL website for cpap users, and came to take a horrified look-see. Hey, I've always liked to see opinions from both sides of the fence.