Dr. Barbara Phillips and whether CPAP should require a prescription

Janknitz wrote: ↑

Tue Jan 15, 2019 7:00 pm

But SOME people have more complex sleep apnea, and without proper diagnosis and testing will not be properly treated.

Clever manufacturers will print cpaptalk.com on the boxes

Midwest_non_sleeper wrote: ↑

Tue Jan 15, 2019 7:04 pm

....and here I am, just a dumb cop, wondering why there is a discussion about beef going on in a CPAP forum.

"thread drift"... we're good at it.

I may have missed something... but

Pugsy's truck was having issues so she installed a nose ring and in the process the bed fell off of the truck exposing a can of worms. She is recovering nicely because the price of hamburger is down.

Am I close... ?

Are we back on track now... ?

So far no prescription needed but care should be exercised when working on trucks.

palerider wrote: ↑

Tue Jan 15, 2019 7:26 pm

Midwest_non_sleeper wrote: ↑

Tue Jan 15, 2019 7:04 pm

....and here I am, just a dumb cop, wondering why there is a discussion about beef going on in a CPAP forum.

"thread drift"... we're good at it.

I'm not concerned about it, I just thought it was interesting. I've seen some pretty interesting drifts.

HoseCrusher wrote: ↑

Tue Jan 15, 2019 7:45 pm

I may have missed something... but

Pugsy's truck was having issues so she installed a nose ring and in the process the bed fell off of the truck exposing a can of worms. She is recovering nicely because the price of hamburger is down.

Am I close... ?

Are we back on track now... ?

So far no prescription needed but care should be exercised when working on trucks.

I'm pretty sure you nailed it, good work.

Any thread that stays on topic shows a complete lack of imagination.

jnk... wrote: ↑

Tue Jan 15, 2019 9:16 pm

Any thread that stays on topic shows a complete lack of imagination.

(Snickers)

Janknitz wrote: ↑

Tue Jan 15, 2019 7:00 pm

One other thing about OTC CPAP machines--most people have run of the mill OSA that will respond to treatment with a CPAP/APAP. It's not that hard to self-diagnose and treat. But SOME people have more complex sleep apnea, and without proper diagnosis and testing will not be properly treated. They may think their do it yourself treatment is sufficient, or they may give up because it doesn't work. There is something to be said for a proper medical assessment and prescribed treatment.

This is a good point. For some people, these machines can be dangerous if mis-used, which is probably why the Rx was required in the first place.

If prescriptions weren't required, would some people buy them and just turn the pressure to max? Can't that be harmful?

Janknitz wrote: ↑

Mon Jan 14, 2019 3:44 pm

I really don't think most of the general public is able to self-treat their apnea unless they stumble on a place like this where we can teach them to do it.

Also, even with the best machine, it's hard to get used to using it. I got my first machine in 2007, tried it for about six days, and gave up. If this board had existed then, maybe I could have asked questions and gotten more encouragement.

So if we are faced with a choice between:

• the current system, where a doctor writes a CPAP prescription, the recipient gets the machine, and nobody does anything to help them learn to use it, or
• a new system, where no prescription is required, anyone can buy a machine, and nobody does anything to help them learn it,

then I'm not happy with either answer.

As I mentioned in another thread, I very much wish I had found this group before getting my prescription last year -- because I was prescribed a brick and didn't know it.

JerryL wrote: ↑

Wed Jan 16, 2019 1:04 am

This is a good point. For some people, these machines can be dangerous if mis-used,

This is not a correct statement.

JerryL wrote: ↑

Wed Jan 16, 2019 1:04 am

Also, even with the best machine, it's hard to get used to using it. I got my first machine in 2007, tried it for about six days, and gave up.

That's a personal opinion, not a universal truth.

Really, whether OTC or Rx, a support group like this has got to be part of the therapy or no one is going to get the best therapy. What goes on here has taken years of experience by the "pros" and the willingness to try some strange things by the rest of us. Is a doctor really going to have us try ( I think it was) Zonker's headband method?

If a support group / forum was strongly recommended OTC might have a chance (at least on the non-economic side of things).

JerryL wrote: ↑

Wed Jan 16, 2019 1:04 am

If prescriptions weren't required, would some people buy them and just turn the pressure to max?

In my experience, the poorly informed who learn how to change the pressure always turn it down instead of up.

Many medical professionals (docs/nurses/pharmicists/etc.) are more than willing to be helpful to patients who have dosage questions, whether the drug/therapy requires a prescription or not. Many OTC drugs can be VERY dangerous to patients with certain conditions. On the other hand, with the possible exception of heart-failure patients, slightly-pressurized air is much less likely to be harmful to anyone anywhere at any time. The principle of using the smallest dose that is effective is the primary principle of dosing that would not suddenly disappear into thin air by making PAP therapy obtainable without a prescription. As one poster here likes to say, this isn't rocket surgery.

palerider wrote: ↑

Wed Jan 16, 2019 3:37 am

JerryL wrote: ↑

Wed Jan 16, 2019 1:04 am

This is a good point. For some people, these machines can be dangerous if mis-used,

This is not a correct statement.

Thanks for the correction. I'm a newbie and still learning.

Here's why I said that. I was under the impression that if the pressure is set too high, a CPAP machine can have adverse affects. Is that incorrect?

JerryL wrote: ↑

Wed Jan 16, 2019 3:05 pm

if the pressure is set too high, a CPAP machine can have adverse affects.

I consider the statement to be an often-repeated myth in the sense of it being a strawman argument used by DMEs against giving patients control of their own therapy.

Most pressures set in straight CPAP are "too high" for some portions of the night and often "too low" for other portions of the night. Thus the beauty of the advent of APAP--which is when the machine decides the pressure. If a machine can be trusted to do that, certainly an informed patient can be trusted even more to set parameters and even straight pressures.

A few harmless central apneas now and then are not really "adverse" as an effect. So there is generally no need to worry about the phenomenon when it occurs. Aerophagia can be considered adverse, but no one chooses to experience it and people definitely know when they do.

Bottom line is that when a patient has data, he knows not to raise pressure to the point that it hurts his data rather than helping it. So the "too high" worry is mostly a nonissue in patient-oriented practice in which the patient is balancing his own comfort with effectiveness of treatment pressures as confirmed by data.

jnk... wrote: ↑

Wed Jan 16, 2019 3:14 pm

Most pressures set in straight CPAP are "too high" for some portions of the night and often "too low" for other portions of the night. Thus the beauty of the advent of APAP.

That makes sense. And it's connected to question I just asked in another thread, which you might be able to answer.

When a CPAP machine is purchased through a traditional prescription and DME supplier, the pressure is set in such a way that the new owner can't change it. The machine might physically be able to run at any pressure, but the software has been instructed to never deviate from 9cm (or whatever).

Are AutoPAP machines given any programming that the owner can't override? For example, if the prescription says "Needs variable pressure between 6cm and 15cm," would the DME supplier set 15cm as the max pressure -- so even though the machine is physically capable of going to higher pressures, the user cannot do anything to increase pressure over 15cm? Would they set a minimum pressure as well?