POLL: OTC CPAP?

FWIW...I am in total agreement with jnk's thoughts and as you all might imagine..I voted yes.

Maybe there should have been a third option...IF you don't have insurance to pay for your equipment would you like to see CPAP stuff be OTC?

Most of the "nos" seem to be tied to potential out of pocket costs and I do understand that is a BIG concern for anyone.
My insurance dings me 20% every time I purchase a mask and I sure wouldn't like paying full retail but I would still like to see cpap stuff (and that includes machines) be OTC. I would hope that with OTC availability and price competition, that retail prices would become more in line and not jab people so badly. Though if we look to places like Australia and others where cpap is available retail...those prices make a person choke for sure. So I don't know if it would happen here in the US. But I could hope.

A few "nos" tied to the contraindications that are possible and since everything in life has contraindications if one looks very deeply at into them...do we stop doing/using/taking anything that has a contradiction for someone somewhere?
It's not rocket science for the majority of people who have plain jane vanilla OSA. Do we want to make things more difficult for those people just because of a few others mayb/what if situations?

My stomach doesn't tolerate NSAIDs in any fashion....Should we make all NSAIDs RX only because of my own contraindications and problems with it?

Nothing in life is a perfect fit for everyone. I see both sides point of view but I still lean to OTC for most people.

Pugsy wrote: . . . total agreement with jnk's thoughts . . . .

Oh MY!

You had better qualify that, my friend, or else I'm gonna have to be a LOT more careful what I say around here!

Even I don't agree with half the things I say on this forum.

I'll mentally add to your phrase "jnk's thoughts [so far in this one thread]."

jdr999 wrote:I think you're over simplifying this. If this was really as easy as picking up a machine at the local discount store and slapping a mask on people wouldn't need all the help this forum provides and the one year compliance rate would be a heck of a lot higher than it currently it.

Until they start making idiot-proof machines and mask technology greatly improves to the point that mask fit and leaks are no longer an issue self-help isn't going to be the most effective option in my opinion.

Why are you comparing the efficacy of self-treatment against physician treatment? Why aren't you comparing the efficacy of self-treatment with no treatment? In fact, why aren't you looking simply at whether self-treatment is typically worse than no-treatment as you standard for using governmental force to limit the health treatment options of presumably competent adult citizens?

If we are going to go that route, I think the most effective option would be for you to employ a full-time doctor to monitor you sleep lab style in your bedroom every night and adjust your therapy in real time. Since that would be more effective, I don't think we should allow you to simply have a doctor write you a prescription and send you off on your own to sleep. That isn't the most effective treatment, and apparently the affordability, practicality, or personal choice factors aren't valid considerations when weighed against potential efficacy.

jnk wrote: I'll mentally add to your phrase "jnk's thoughts [so far in this one thread]."

I agree with pretty much with all your thoughts (not in just this thread but in others as well) and the way you explain things and even when you don't agree with yourself.
You always bring up very valid points and try to look at things from both sides even if you leaning more to one side than another.
And sometimes I can't tell if you are even leaning.....which I suspect was your intent all along.

I just didn't always see the need to tell you that I agreed with you and if I really can't add much to a discussion then I sort of just sit back. Lots of time for your comments (and other people's comments) in all sorts of threads I have set back and thought "+1" but just didn't type it. Just not something I have a habit of doing but doesn't mean I don't think it.

I always enjoy your comments and they are often thought provoking...which is good. It's been extremely rare that I didn't/don't agree with you but even when I might not totally agree, I do see where you are coming from on it and I have to accept that what you say makes for very valid thoughts and/or point of view.
The only person who has to agree that I am always right is my husband. Everyone knows that.

I expressed my position on the value of forum posts earlier today in a PM to another poster in this thread:

me egotistically quoting me wrote:"Any meaningful post will attract some posts by people who disagree. That's OK. That's what forums are for. If this stuff wasn't somewhat controversial with widely differing opinions, we wouldn't be talking about it on the Internet with perfect strangers.

"We can learn more from the people who disagree with us than we can from those who agree with us."

You are the exception that proves that rule; I learn a lot from you even though I am in such agreement with your approach to this stuff. Thank you for posting in this forum as you do, Pugsy. You are a big part of what makes this place the nurturing, thought-provoking, helpful place that it is.

And now back to the regular mental-food-fight of everyday cpaptalk posts . . .

djhall wrote:If we are going to go that route, I think the most effective option would be for you to employ a full-time doctor to monitor you sleep lab style in your bedroom every night and adjust your therapy in real time. Since that would be more effective, I don't think we should allow you to simply have a doctor write you a prescription and send you off on your own to sleep. That isn't the most effective treatment, and apparently the affordability, practicality, or personal choice factors aren't valid considerations when weighed against potential efficacy.

Stumbling back across my own post, it occurs to me that I sound like an ass sometimes. I tend to forget that conversational tone is lost and without that context to soften the words, my words alone can seem a little argumentative. Please forgive me if I come across that way. I don't mean to be argumentative. I'm usually just trying to demonstrate or explore the implications of the logical expansion various lines of reasoning.

We all do sometimes.

But a number on this forum miss the old days of posters like the beloved/hated/both Snoredog (no longer living) who tended to turn every thread into a knock-down drag-out one way or the other.

I found that kinda scary, myself. But it was a fairly common style back in the day, and people still managed to get help here.

I agree that most of us have no idea how we come across in a forum, since we tend to hear our own voice in our heads as we type.

Or is that just me?

And is that really my voice speaking in my head as I type these words? And if so, does the voice do the typing, or is it the typing that makes the voice?

Wait a minute, how do I make that voice stop????

Somebody heeeelp meeeeee!!!!!!

I say yes -- the current system installs multiple "gate-keepers" that keep prices high, curtail competition, and make it difficult for one to manage their own risk.

Imagine if you're poor and can afford only $600 to treat your sleep apnea and there's no welfare or insurance for you. Your only hope is to get some willing co-conspiritors to illegally sell you a used cpap and figure out some pressures, observe if you're snoring, and up the pressures until the snoring stops, and possibly purchase a cheap recording oximiter ($50) to see if you're desaturating during the night. After a few nights, see if you feel better.

Is this the best way? No. Is it better than no treatment at all. Empatically yes.

What do these "gate keepers" do for their money? They provide security and advice. But you can purchase their advice volunarily if you want it, and can afford it. But why should their expensive services necessarily have the force of law? Does the danger warrant the expense? Is a self-prescribed cpap machine more dangerous than long term excessive use of over-the-counter self-prescribed Ibuprofen that can lead to kidney damage?

I am loving this thread. I really don't think it will change a thing but it is good to hear everyone's opinions on this. If insurance covered it I think a few would think it should be used only with a doctor present but Michael Jackson had a doctor with him and that didn't work out well for him. The main thing for me is that not everyone has insurance here in the US. I am sure that may true in other countries as well. Everyone is entitled to the right to sleep. It is just a machine to blow air up your nose. If they were sold OTC they would be mass produced and the price would go down. Who knows maybe a company in China will make one even better than what we have now. Actually none of this will matter because it won't happen any time soon if ever.

I voted no, not for machines but a very big YES for supplies.
The only down side could be the influx of substandard supplies.

jnk wrote:A minute percentage of CPAP users ever find this forum.
For most with sleep-breathing issues, it IS an incredibly simple thing and absolutely harmless even if they don't actually have OSA, despite what the people in the biz would have you believe as justification for their job.

As famously supposedly said by one early researcher/clinician, the only way to actually hurt someone with a CPAP machine is to hit him over the head with one.

In my opinion.

Which I admit is not worth any more than anyone else's, no matter how strongly I hold it.

Hey, I'm just the new guy here. If everyone here feels that there is no more danger than in a bottle of Advil who am I to disagree?

I do think that it would be a shame if those who really needed medical intervention didn't seek it because apnea is now a DIY endeavor. That's really my only concern.

I'd be perfectly happy if technology advanced and prices lowered -- that seems like a win-win to me. And since I'm a DIY CPAP'er anyway I wouldn't mind walking into a store and browsing the cpap isle just as I would walkers or blood pressure monitors.

I can certainly see how things are just too expensive today and how insurance/DME's make things more difficult than they need to be. Full disclosure - I do own a small DME (non-respiratory) so I can get supplies easier than most. So the financial side doesn't quite apply in my case but I can sure see how it affects everyone else. I see plenty of customers in my store visiting relatives who forgot to pack something or just need a quick replacement part. With the way the system currently is it's very difficult for these customers to find the help they need. In my neck of the woods only RT's stock cpap supplies and they have very limited office hours.. So yes, at the very least I think supplied need to be OTC.

But I still don't see how a brand new DIY CPAP'er will come home with a machine / mask combo that will work effectively right out of the box.

I think they should be available at local stores, but I'm thinking a prescription would be appropriate. A lot can go wrong when you're dial winging, but with the right education, a lot can go right. Also, it's a little too much like prescription glasses - it's good to get it right, when you can. ASV machines really don't belong in a prescription-free context. The only way to be sure you don't need the heavy artillery is to get a sleep study. This is my first impression. I'm willing to change my mind if someone could give persuasive reasons to the contrary.

I also think Respiratory Therapists should be paid the way other Physical Therapists are paid - on a per-session basis through insurance. To that end, RT's should also be held to a higher standard, including certification for training on CPAP, Oxygen, etc. (From what I've seen, the standards seem fairly low currently, because the RT I had at Apria clearly had just read the manual to figure out how to work a manometer and was a little hesitant about her settings, even though she had clearly been an RT for a while. I could be wrong about this, having only my own experience to go on.)

Clear certification standards, better training and per-session payments for RT's would allow them to have reasonable compensation without tripling the cost of a machine and supplies.

Ok I am rather confused. Some of you are saying xpap machines should have an Rx, yet you are happy to encourage someone to buy a machine off craigs lists and self treat themselves? IMHO that is the pot calling the kettle black.

Self diagnosis and/or self medicating is never a good idea. A resistered sleep tech or RT can see how a cpap machine is affecting a person's sleep that a program cannot perceive.

I really think there is too much fear factor involved in how many perceive CPAP therapy. If anyone is getting all the help they want or need via sleep Drs, techs and such like, then that is great. For a number of us it has been about educating ourselves (with the help of forums like this) re OSA, CPAP, etc and taking steps to make it work and buying our own equipment.
I understand that something like 80% of diagnosed OSA sufferers throw in the towel with CPAP therapy - I assume for various reasons. There will be those who don't understand the importance of treating OSA and just hate the idea of being hooked up to CPAP for the rest of their days (nights actually) so they give it away. But there are those (a good proportion) who just can't get it to work for them and after trying one or 2 masks and after several appointments with the sleep techs, they also give up on it and put the CPAP away in the cupboard. I could easily have been one of those who gave up, as it wasn't working for me through the medical system, but with the help of this forum and finding ways of obtaining equipment (often with the help of some kind forum member) my CPAP therapy is working. My sleep tech is really impressed with my data and how it is working out for me (All the gear I am presently using I have had to buy for myself) . I am not for one minute against the medical system but if I hadn't been able to find a way to buy the APAP (the brick I was given through the med system wasn't doing it for me) and masks I am using now I think I would be a "been there tried that" statistic along with the other 80% of diagnosed failures. So is it to be Buy and try or Can't buy and die(younger)? In some ways I couldn't really afford to spend what I have, but when I thought about the options I realised I couldn't afford not to. It would have been so much more affordable and easier to obtain if it had have been OTC.