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Not only conflict of interest, but possibly a violation of the Sherman anti-trust laws (it doesn't have to be a big company). Like any other prescription you get from a doctor, you should be able to take that prescription to any pharmacist (or in this case a DME provider) of your choice to have it filled. I did some searching on this subject the other day (but didn't have a whole lot of time). What I DID find on one item that came up was a reference to the AMA Code of Ethics. I just don't see how they can MAKE you buy the equipment from THEM.

It ain't ethical (and maybe not legal either)!

Den

rpalmer wrote:
Am I just being paranoid?

Rol

Nup, It is a conflict of interest as I see it.

In my case my family doctor sent me to a respiratory specialist (doctor). He sent me to a Sleep Clinic. The Sleep clinic did the 2 nights & recommended a cms of 15. They are the ones who than advised what CPAP gear was on the market & who to go visit to see it & buy it from. They did (as has already been discussed at length) warn against AUTOs *but* left it to us to decide for ourselves.

My family doctor has *no* idea what xPAP gear I have. My respiratory specialist has no idea what xPAP gear I bought. The sleep clinic know because I told them & they are being very supportive about it.

That is how it should work.

But the issue here is that we don't have the quirky laws you seem have in the US re xPAP nor a draconian health regulatory body to threaten anyone.
But, the biggest difference here seems to be the involvement of health insurance companies. That seems to be the spoiling factor there.

As an aside ...
The new ResMed S8 I have just been looking at has written on the bottom ...

"CAUTION: USA ONLY: Federal law restricts this device to sale by or on oder of a physician"



Cheers

DSM

_________________

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

I have both the Remstar Auto and my newly purchased Goodknight 420E. Personally, I've never experienced a pressure "runaway" with either. Thinking about it, I'm not sure I even know what that means. Does it mean that the pressure keeps going up to the upper apap limit for no apparent reason? Anybody have a comment in this regard?

I do have a leakage problem with my FF mask which I use whenever I have nasal congestion, ususally due to pollution or allergies here in big D (normally use a Breeze). This case I have a built in safety valve since the FF mask blows it's seal at any pressure over about 12. I can't imagine any of the FF masks keeping a seal at higher pressures. Maybe some folks are confusing large mask leaks with "runaways" but this is a mask problem, not an apap problem.

Last night just for the heck of it I set the apap minimum pressure at 8 which is about my 90% pressure and the max at 15. With the Breeze the machine ran very nicely most of the time right at 8 with an occasional excursion to 11 obviously in response to obstructive apnea. AHI for almost 7 hours was 2.4.

Reading some of the papers on the subject, there seem to be so many variables in how some people respond to cpap or apap. For me apap is just great resulting in lower pressures most of the night and AHI's under the magic 5 number. I haven't called the lady in Australia yet because I'm still digesting some of the papers on the subject, which she should be doing btw.

Meanwhile however, it seems to be plain old common sense that patients should be provided with a good apap machine unless the doctor has some good reason why it should not be provided, which I have not heard yet from anybody other than the somewhat nebulous "runaway" argument. Apap obviously works very well for many of us in this forum but if it doesn't work for some, possibly because of mask problems associated with higher pressures, then you can always turn the apap off and go straight cpap. What the heck is so complicated about this approach?

dsm wrote:"As an aside ...
The new ResMed S8 I have just been looking at has written on the bottom ...

CAUTION: USA ONLY: Federal law restricts this device to sale by or on oder [sic] of a physician"

Good old USA.... The last bastion of ludicrous regulations. What one must surmise was originally devised to protect us, has, in this instance, resulted in preventing us from making a move without lining someone else's pockets. Certainly I am at much greater risk of dying from swallowing a bottle of pills I can easily legally obtain WITHOUT order of a physician than I am from buying a glorified leaf blower.

GRRRRR!

neversleeps wrote:Good old USA.... The last bastion of ludicrous regulations. What one must surmise was originally devised to protect us, has, in this instance, resulted in preventing us from making a move without lining someone else's pockets. Certainly I am at much greater risk of dying from swallowing a bottle of pills I can easily legally obtain WITHOUT order of a physician than I am from buying a glorified leaf blower.

GRRRRR!

Unfortunately, neversleeps, I think that's called The Law of Unintended Consequences. As our Big Nanny in Washington seeks to control more & more of our lives, this is the inevitable result.

Or as Thomas Sowell wrote: "The government forces those who sell pharmaceutical drugs to list the possible side effects, even if only a few people will suffer those side effects. Unfortunately, the government itself never tells us about the bad side effects of the things it prescribes."

I think DSM lives in Canada, and they certainly don't take a back seat to anyone when it comes to government regulations, so it's interesting that he has so much more freedom when it comes to Dr/Sleep Clinic/DME/xPAP issues.

DSM's right. That is EXACTLY how it should work!

fstanmyre wrote:Does it mean that the pressure keeps going up to the upper apap limit for no apparent reason?

Yes. And if you experience it you know there's nothing nebulous about it...

O.

you can always turn the apap off and go straight cpap. What the heck is so complicated about this approach?

Fred, I agree absolutely. A versatile autopap machine that can always be easily set to simple CPAP if "straight pressure" is what's needed makes sense to me.

Personally, I've never experienced a pressure "runaway" with either. Thinking about it, I'm not sure I even know what that means. Does it mean that the pressure keeps going up to the upper apap limit for no apparent reason?

Yes, that's what it means. Pressure running up to the top and pretty much staying there for no apparent reason, or more precisely, for no "good" reason. Runaways that are not being caused or continued by leaks of any kind.

The 420E auto that I dearly loved did that (pressure climbing and staying at whatever upper pressure I had it set for, even 19!!) until -SWS looked at my data and suggested I turn off IFL1 in the advanced settings. From that point on, the 420E behaved perfectly for me -- staying down around 9 or 10 most of the time.

Later, I bought a REMstar Auto from a lady who no longer needed it. She was having success with a dental device and was selling all her year-old "cpap" equipment. I had been following her posts for some time about her trials and tribulations not getting effective treatment, trying many different masks, and many different pressure settings.

On the REMstar auto she was experiencing constant pressure runaways...pressure climbing to whatever upper pressure she set. Same way the 420E had been doing me. Happily her REMstar never did a runaway with me.

I've read people reporting that the ResMed Spirit auto has done "runaway" pressure for them if the humidifier water chamber was filled above the "fill-line". I think I've also read that the Spirit's aggressive reaction to snores can also do it for a few people.

So, yes, pressure runaway on any autopap can and does happen for some people. That's why I think it's a good idea to keep a leash on the upper pressure setting... setting it no more than a few points above a person's titrated pressure, especially when using a new brand of autopap that you haven't tried before.

Helps also to have the software to take a look and see that the margin you've set at the top indeed does not have to be used. I want the extra cm's up there to be there for "just in case" I need more than usual on some night....not be a pressure the machine generally uses for me.

I'll hasten to say that it is unusual for "runaway" pressure to happen. Most autopaps work fine for most people, just as the two you're using are doing for you, Fred. Just because runaway pressure scenarios can happen to a few people (and did for about a month for me until I made a setting change) does not make me shy away in the least from using any autopap and recommending that others use them.

As with news, our ears tend to perk up and notice "bad news", paying little attention to good news. In the same way, I'd say people should NOT worry about the possibility of "pressure runaway" with autopaps. Most people report getting wonderful treatment from their autopaps. I sure do.

A few might experience pressure runaway, but it's usually easily remedied if you know what to do.

Or.... just switch the machine to straight cpap.

All said and done, I do think the reluctance and/or refusal of some medical professionals to prescribe autopaps (for whatever their reason) is a disservice to the many who might get much more comfortable treatment from an autopap rather than the straight cpap they're on.

I'm not a doctor, but I don't see how it could hurt to at least try other types of machine, be it cpap, bi-level, or autopap, to see what suits the person best. Any machine, no matter how advanced, can be set to straight cpap at any time, just as Fred said.

I have used both a ResMed CPAP and the ResMed AutoPAP Spirit, and have experienced runaways with both. Interestingly, I AM a heavy snorer ... Rested Gal probably has made a good observation.

Hmmmm!, a runaway with cpap?

I'm pleased, happy, thrilled (take your pick or use your own adjective) to report that I finally have my prescription in hand. Not only that, but the doctor actually prescribed an auto unit. In fact, he specifically prescribed the 420E and also specified a heated humidifier.

YIPEE! I've already faxed it to cpap.com and am about to followup with a phone call to get the order in.

My sympathies to anyone who has a doc who isn't as cooperative as mine is.

osij says she does experience runaways for no apparent reason. I suggest there is a reason and it needs to be deciphered. RG had the problem and found the reason. Anyhow, solution simple, if you can't find the reason, switch to straight cpap as long as you are getting AHI's below 5. If you are not getting the low AHI's then a good sleep clinic is the answer.

Good old USA.... The last bastion of ludicrous regulations.

Last bastion of ludicrous regulations, you say? Too bad you folk can't figure out gun control. It would seem to make more sense to encourage folk to take responsibility for, and control of, their health care and limit their access to those things that really hurt them, like guns.

I think DSM lives in Canada, and they certainly don't take a back seat to anyone when it comes to government regulations, so it's interesting that he has so much more freedom when it comes to Dr/Sleep Clinic/DME/xPAP issues

You are right about this... we have regulations up the ying-yang and some of them are good ones.

Derek's studies as I recall did show a significant Remstar response to snoring. If this is shown to be a problem during the sleep study it might have been better for the sleep lab or doctor to prescribe the Goodknight which does allow for adjustments to the machines response to apnea, acoustic vibrations(snoring), and flow limitation.. I've not fiddled with these settings yet, just using the defaults, but no doubt will in due course.

Anyhow point is once again, did fnorette's sleep lab prescribe the right machine for her particular condition?

WAFlowers wrote:I'm pleased, happy, thrilled (take your pick or use your own adjective) to report that I finally have my prescription in hand. Not only that, but the doctor actually prescribed an auto unit. In fact, he specifically prescribed the 420E and also specified a heated humidifier.

YIPEE! I've already faxed it to cpap.com and am about to followup with a phone call to get the order in.

Congratulations, Bill! Looks like the wait was well worth it.

We'll look forward to reading your posts in a few days reporting how much better you feel.

Rol

DSM lives in Australia.