CPAPtalk.com

For me, the real question is how dangerous is a CPAP machine when used inappropriately.

Doing anything in life involves risks and benefits. Presumably there are risks to using a CPAP. Our society has apparently decided so far that only people who have been trained (i.e. M.D.'s) have sufficient skills to make a wise decision as to whether the risks of using a xPAP are less than the possible benefits.

So what are the risks?

John M

What's happened with other things that have been made OTC? Besides insurance not covering them, I mean. Do people just go out and buy them to see if they help, or do they see a doctor?

To John_M, there's a risk of central apnea, but I think the real risk is people using them improperly, seeing no effect (or seeing no effect because they didn't really need one) and then discouraging people who *could* benefit from trying it.

I think I like BDP's idea best. Allow people who've been dx'ed to buy them OTC but create some sort of card you have to show.



To the person who suggested allowing "regular" pharmacies to carry them, my DME is Walgreen's, and no, they're not much cheaper that I can tell. (Good, though. I highly recommend.)

Apnea is so complex, I think it would be dangerous to put OTC without a psg, simply for one reason:

Central Apnea

Say, you guess you have apnea, but don't know anything about central apnea or spontaneous arousals or plm. You could spend a lot of money on something that might not help, but potentially could make you worse off in the case of going central. I think the machines would have to get more sophisticated (even more than they already are) before this would be a possibility.

jen

For LyleHaze

I certainly would consider lending your brother your machine and letting him see if it detects apneas at a low setting and whether a higher setting gives relief.

If with a setting of say 4, an automatic detects a large number of apneas it would be evidence that the problem was what he thought it was, sleep apnea. He might then conclude a full study was worth it. (of course, if it did not detect apneass, a full study might be worthwhile to look for periodic limb movements or other problems.) Even though a full study would seem called for in either case, I suspect he would be more likely to get one after he had tried a machine.

If you machine was used to get a setting, he could then look for a cheap CPAP and have guidance as to where to set it. Studies show the settings from auto machines are typically what comes out of a lab.

If he did have the cheap machine already, you might consider using it for a while (with settings from your machine)and letting the auto titrate him.

Restedgal has recounted elsehwere here how she identified her problem and treated it without a sleep lab test.

One of the strongest arguments for sleep lab tests as stage one (even though auto-titrating machines often give the same values) is that many would not try hard enough with CPAP if there was doubt aboout the diagnosis.

Many have found it was cosiderable effort to adjust to a mask and to find the right fit, etc. After a sleep study that left no doubt that you had an apnia problem, people are motivated to keep trying.

If they merely had a suspicion of a problem, I suspect many would try a mask, find it was uncomfortable, and then give it up (many do that even now of course). With a clear study, properly explained, and some help in mask fitting, I suspect more keep trying until they made it work and adjusted to wearing a mask.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, auto

jabberwock wrote:Hmmmm, interesting concept Brian...

The biggest bonus I can see (for Ontario anyway) is that presumably they would cost a lot less than the ridiculously overpriced machines sold by DMEs here. It would be interesting to see if it would still be cheaper for us to buy at cpap.com, even with the exchange rate and possible duty charges.

It definitely is. Look at the prices on CPAP.COM versus what you pay a DME. Then consider how close the US and Canadian dollars are right now and the fact that you don't have to pay duty on the items because they are medical equipment.

My Mask from DME - $200
My Mask from CPAP.COM - $Around 60 (can't tell.. site is not working for me)

My Machine from DME - $1300 + $300 "service plan"
My Machine from CPAP.COM - Around $550 (can't tell.. site is not working for me)

Rob

LyleHaze wrote:So there's an interesting point for this discussion. How many people have OSA and want to treat it, but are not willing to be officially diagnosed?
If it were your brother or sister, would you help them?

Lyle,

Most definitely I would help them. I would be willing to help anyone I know to get them using the equipment if the symptoms are there but there were some reason blocking them from seeking treatment.

As for OTC xPAPs, I agree that most of us here are here because we want to be informed patients and in charge of our health. There are too many sheeple out there who just follow the doc's orders and don't push back, research, question, etc.

Yeah, I go to WebMD, but more to confirm a diagnosis than to find a "disease of the week." I was the silly person who looked up the symptoms of appendicitis (actually I was looking for the side symptoms were prevalent on) prior to calling the doctor at 3:00 a.m. because I didn't want to bother them if it wasn't anything serious. Then when she told me to go to the ER, I said "well couldn't it just be a pulled muscle - I was weeding a lot today..." She replied that she couldn't diagnose a pulled muscle over the phone and I should go to the ER. I did. Appendix came out.

When the doc first prescribed a sleep study, when I backpedaled after he first tried to push Provigil at me, that's when I went on the Internet and collected all the information I could about sleep disorders. I figured out that I really wasn't a candidate for Narcolepsy but I sure had all the symptoms of OA and had had them for a long time.

I knew before the study that I had OA, RLS and PLMD. It was just a confirmation for me. I found out some interesting things that needed addressing in addition to just Apnea (high leg movements with arousal, RLS medication not correct, lack of Delta sleep, etc.) But the main issue was SDB and treated with xpap.

I was so frustrated in the amount of time it took between getting the order for the study and actually getting my equipment. That was almost 4 months! If machines were available OTC, I doubt I would have purchased one prior to the study even knowing I most likely had OA. Too cost prohibitive. But, if my doc had prescribed an APAP with data capabilities to check and titrate me and insurance covered it, I would have done so.

It does irk me that we need a prescription to get equipment. It also ticks me off that we don't always get the equipment we want without a fight. Every time I see how much insurance is charged vs. what they pay out (contracted rates) I flip. There is so much seriously wrong with the medical/insurance community today I don't even know where to begin. If I'm Joe Blow (no pun intended) walking in off the street without insurance I would have paid about 30k for my sinus surgery. With insurance writeoffs, etc. they were paid about 5. I think that's so backwards.

I don't think anyone off the street should be able to just go get an xPAP, but with a note (not a script per se) from their doc, they should have access to whatever they want to buy. I would probably prefer to see standards of care instituted instead where the mask fitting would have to be done in a setting where the patient could lay down, possibly even nap, try all kinds of positions, masks, etc. with a trained person fitting them and showing them how to use the mask properly. I would also like to see it SOP to have follup calls and visits, with data reviews for those with data capable machines, to ensure that treatment is effective. If I were getting this type of service from my DME I wouldn't complain at the amount insurance is paying them. But it's more like "here's your equipment, good luck and see you in 6 months for new hoses and masks." Now THAT should be illegal!