Do I need a doctor to use a cpap

[TalonNYC]

You really SHOULD get medical monitoring, which is why I was hoping someone found out where this person physically was, and could direct them to free or low-cost help in their specific geographical region.

[bdp522]

I DO think everyone deserves god medical care--Geat medical care even...but it isn't gonna happen in the USA. My insurance paid for my sleep studies, but did nothing about an incorrect titration. My family MD knows I self titrate and I have his blessing. He told me to figure it out for myself and I did. He now has patients call me to help them. Many insurances here choose the sleep centers by the lowest bid, not the quality of the machines, techs or MDs involved. My Family MD is an excellent MD but knew very little about OSA. He does his best to learn along with me.
IF ther are NO other medical issues and you have 'run of the mill' OSA, I STILL think doing it yourself is just fine.

Brenda

[nichola]

I DO think everyone deserves god medical care--Geat medical care even...but it isn't gonna happen in the USA. My insurance paid for my sleep studies, but did nothing about an incorrect titration. My family MD knows I self titrate and I have his blessing. He told me to figure it out for myself and I did. He now has patients call me to help them. Many insurances here choose the sleep centers by the lowest bid, not the quality of the machines, techs or MDs involved. My Family MD is an excellent MD but knew very little about OSA. He does his best to learn along with me.
IF ther are NO other medical issues and you have 'run of the mill' OSA, I STILL think doing it yourself is just fine.

Brenda

But that is exactly my point. The OP has no idea if they have 'run of the mill' OSA because they dont even have a diognosis of sleep apnea, let alone just run of the mill OSA. They are just making a guess (one that is educated by this forum im sure, but a guess none the less).

You GP is learning along with you as most do, but he is also im sure doing basic diagnostic reviews and questions when you see him, which can show him indications of any problems. Thats why I suggest having a medical practitioner monitor people.

[moresleep]

While there are certainly small risks associated with Cpap use, even with a doctor, most of those risks are there. Really, if you run into trouble, it's not going to be while you have the doctor around--unless you're a Michael Jackson-type celebrity, that is, and look what happened to him... What is important is that there are MAJOR risks for an OSA sufferer who does not use Cpap. As for a Cpap machine being considered a deadly, prescription-only item, that's an exageration. In some countries, including I am told, Australia, where the Cpap was invented, a prescription isn't even required.

A fully-data-capable machine is nice; but, notice that those studies showing patients were pretty accurate in titrating themselves tended to use manual machines, without data. In fact, I seem to recall that in one study, they taped over the LCD, so that the patient would not know the current pressure setting.

Sure, in a perfect world, we'd all have ready access to labs and doctors; but, this has always been a far from perfect world.

[nichola]

Actually you do require a prescription in Australia for CPAP. You fdont require it for the mask though

again like I said... i did not call it deadly. You are the one exagerating. I said their can be serious complications to CPAP. An air pocket in the skull is VERY serious, and thats just one of the complications. Yes they are rare, but they happen.

[rested gal]

I do understand your point though and I thoroughly agree but sometimes reality steps in and things can't go the way we would like for them to go. So we do the best we can given what we have to work with. Is it perfect? No. But sometimes it is all we have.

I understand your point too, Nichola. I think Pugsy's "but sometimes" comment applies to many uninsured, unemployed people. And for some of those people, even this...

Even if someone cant afford a sleep study they should be able to afford at least to go see a doctor on a 6 monthly basis and be monitored. and to go originally at least to have a check up and eliminate other possibilities.

...would be an additional financial hardship to add on top of the cost of buying themselves a machine and mask, somewhere, somehow.

About Dr. Phillips' presentation:

And reading further she does not appear to be advocating no sleep study, but without titration (given that her research criteria noted people's AHI levels)

I think she is very much advocating no sleep study at all -- given that she encourages physicians to use their clinical diagnostic judgment to identify likely OSA cases.

Oh and she also is advocating for HEALTH PPROFESSIONALS to be prescribing based on their assessments... not on self diognosis.

Yes, you're absolutely right about that. Dr. Phillips' presentation was aimed at health professionals. I have a feeling though, that if the original poster described his financial situation and symptoms to her and asked her if it would be ok for him to try cpap without a physical evaluation of any kind, she would say, "won't hurt to give it a try." That's just my guess.

[Madalot]

Seems like a good opportunity for me to chime in on this one - since I can relate to it on a personal level.

I am 100% sleep lab diagnosed and doctor monitored -- every step of the way. But anyone that knows me knows I do NOT have ordinary sleep apnea -- far from it.

My husband -- he sees his regular doctor every 6 months and feels fine, but my observations of him indicate he most likely has obstructive sleep apnea. He snores like crazy, stops breathing frequently during the night and an overnight pulse ox test (with my recording monitor) showed oxygen levels into the mid to upper 80's.

Unfortunately, the insurance he has (different from mine) has a horrendous deductible (his 6-month check ups are handled differently and don't apply toward the deductible) -- we simply cannot afford to send him for a sleep study. We do not have the cash for it. Plain and simple.

Since the forum member loaned me an S9 VPAP *AUTO* for a trial with my situation, the owner of the machine offered to let us keep it and see if I could convince my husband to give it a try.

I spoke to several "experts" here about how they would recommend we set it for my husband's trial.

First night, my husband used it all night (8.4 hours). Said he slept pretty well and thought he might have felt a bit less sleepy the next day. He snored slightly for the first hour or two, then it stopped. He also seemed more settled than he usually is, not moving around nearly as much. His ONLY complaint (more a comment) was feeling a bit dry the next morning, but we have plenty of room to increase the humidity.

The data the next day -- AHI of 1.0, EPAP of 9 (we started at 7) and with PS set to 4, the IPAP was 13.

But most likely, he has basic sleep apnea (we're fairly certain he has no underlying medical problems since he does see his GP every 6 months). We can most likely get a cpap machine and set it to 9 or 10 for him.

In our situation, he refused to spend the money on a sleep study (especially since he feels fine) but my complaints of his snoring (and concern when he stops breathing) DID concern him. Since we had the opportunity to use an auto machine to attempt to titrate him, we decided doing that was better than doing nothing.

[rested gal]

most likely, he has basic sleep apnea (we're fairly certain he has no underlying medical problems since he does see his GP every 6 months). We can most likely get a cpap machine and set it to 9 or 10 for him.

In our situation, he refused to spend the money on a sleep study (especially since he feels fine) but my complaints of his snoring (and concern when he stops breathing) DID concern him. Since we had the opportunity to use an auto machine to attempt to titrate him, we decided doing that was better than doing nothing.

Good for you, and for him, for giving that a try.

It was nice to already be "fairly certain he has no underlying medical problems since he does see his GP every 6 months" , but even without that reassurance I'd have said "go for it, give it a try." Easy for me to say, not being a doctor and all.

[archangle]

These machines are prescription only for a reason.

The main reason they're prescription only is to generate additional revenue for the medical mafia.

However, if you try to do it yourself, you may not find the right pressure, and will still suffer from the affects of apnea. This can be serious or even fatal. You might get no benefit, or you may only partially relieve your apnea.

Without competent support on usage, masks, etc., you might not solve your problems and give up on CPAP. There are also some problems like leaks that can spoil your therapy, even if you keep doing CPAP. Unfortunately, lots of doctors and DMEs are so incompetent, this might still happen.

Without medical monitoring, you may be treating for sleep apnea when your real problem is some other serious medical condition.

Some people will develop central apnea on CPAP machines. Central apnea can be just as bad as "normal" obstructive apnea, but usually can't be treated by a normal CPAP machine. People with central apneas need careful adjustment and monitoring or perhaps a different kind of CPAP machine.

There may be a some risks to doing CPAP. Some people will develop unnecessary central apnea if their pressure is too high. CPAP can dry out your sinuses and throat and cause problems associated with that. You can get stomach problems from swallowing air. You might get reflux. There might be some risk of infections. There might be some other risks like air bubbles somewhere they shouldn't be, etc. Good medical help may reduce these risks. Maybe.

I think for most people with apnea, the risk of these complications is less than the very clear risks of untreated apnea. I'm not even sure all of these risks are "real."

I'm a good example of the risks of DIY CPAP. I went through the sleep study/doctor/DME/CPAP process in 2004. I got a dumb REMstar Plus CPAP machine with no data. I always used it and seemed to do OK. After a while, it became clear my CPAP doctor was just seeing me to ring up the cash register. Since my machine had no data, he'd have me in the office, basically ask me if I'm still using the machine, and charge me a big fee. He could have done the same think in 4 minutes over the phone. His clerk ticked me off nagging me to come back for another followup. I was busy and wasn't willing to schedule one right away. I would have eventually gone back, but she was being a female dog about it so I hung up on her and didn't go back.

Around 2009, I acquired a better CPAP machine. I looked up how to set it up. Unfortunately, I made a mistake on the setup and set it for manual CPAP at 8 instead of Auto. Since my manual pressure was 10, I figured 8 auto was OK. I felt OK, so I didn't worry about it. After a while, I started having nausea and heartburn. My normal doctor didn't know what it was, and I started getting heart tests, which didn't show anything. Luckily, I thought about the CPAP and fixed the pressure and got almost overnight relief.

I believe that I was suffering from inadequate pressure, not from anything caused by the CPAP. In particular, I think I was probably refluxing during my apneas.

I'm still doing DIY CPAP. I've learned a lot, and now monitor my treatment with a better CPAP machine and the software. I'm fairly confident that I'm being monitored better than my doctor would have done. If my data gets bad and I can't fix it, I'll go back to the doctor.

CPAP is not just a plug and forget thing. Even with a good auto machine.

If you decide to do DIY CPAP, realize that bad CPAP can be as bad as no CPAP. You are risking screwing up your therapy. You need to be committed to learning how to do it right. Also look for the signs that it isn't working and be willing to go back to the doctor if you can't fix it. Realize that apnea can kill you if you do it wrong.

[archangle]

I DO think everyone deserves god medical care

The problem is that too many of them think they are God.

And too many patients believe it, too.

[Madalot]

most likely, he has basic sleep apnea (we're fairly certain he has no underlying medical problems since he does see his GP every 6 months). We can most likely get a cpap machine and set it to 9 or 10 for him.

In our situation, he refused to spend the money on a sleep study (especially since he feels fine) but my complaints of his snoring (and concern when he stops breathing) DID concern him. Since we had the opportunity to use an auto machine to attempt to titrate him, we decided doing that was better than doing nothing.

Good for you, and for him, for giving that a try.

It was nice to already be "fairly certain he has no underlying medical problems since he does see his GP every 6 months" , but even without that reassurance I'd have said "go for it, give it a try." Easy for me to say, not being a doctor and all.

I mentioned it because it seems to be a concern of several people -- concern for other undiagnosed issues.

But I agree with you and in our situation, WOULD have done it even if he didn't see his doctor on a regular basis.

I think each person needs to decide what is right for them in their personal circumstances. I am obviously NOT opposed to people doing it on their own, especially when you consider what I do for myself!!

[rested gal]

I think each person needs to decide what is right for them in their personal circumstances. I am obviously NOT opposed to people doing it on their own, especially when you consider what I do for myself!!

You wrote exactly what I think, too... considering what I do for myself.

[bdp522]

I think each person needs to decide what is right for them in their personal circumstances. I am obviously NOT opposed to people doing it on their own, especially when you consider what I do for myself!!

You wrote exactly what I think, too... considering what I do for myself.

Ditto!

Brenda

[jamiswolf]

Archangle wrote: The main reason they're prescription only is to generate additional revenue for the medical mafia

A have to agree with this point. I'm an amputee and I can't buy a replacement prosthetic foot without an MD Rx. Not about safety but money.
Jamis

[chunkyfrog]

It would be nice if everyone could have access to medical care-
-but where there used to be cracks for a few to slip through;
now there are chasms that many cannot avoid.
I know of people who have used veterinary antibiotics on themselves and their families--
not because the drugs are expensive, but the doctor is.