POLL: OTC CPAP?

OK, since posting and voting no, I decided to actually research this myself (on the Internet, which means this is not conclusive). I am unable to find any evidence of CPAP dangers, so if that is true the only real risk to someone self-diagnosing is the possibility that they are using a treatment for something they don't have. I can live with that because we do that all the time.

I would prefer a more exhaustive search in medical literature before getting behind OTC xPAP machines completely, though.

Someone else worried that OTC would lead to sub-par products. That of course assumes we don't already have sub-par products from a relatively small amount of competition. At any rate, you can always choose to pay more for a brand you trust. That's kinda like generic vs brand medicines.

Personally I still think people should see their doctor first if only to rule out treating the wrong thing (I'm tired all the time, so I must have apnea, said the narcolepsy sufferer, or the man 2 days from a heart attack, etc). But the same is true about treating oneself with long term "acid reducers". So yes on OTC, but I still think a doctors consult is smart.

stage0 wrote: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.

That assumes you can access an RT that knows what they are doing and didn't sell you a brick with no data to make a few extra backs of profit. Most of them only access compliance data so they can get paid.


I would like to see them sold in a pharmacy the same as with drugs. You should be able to walk into any pharmacy with your piece of paper and buy it from the pharmacist. Training on how to use it can come from a pharmacy tech. They already teach how to use glucose metres, blood pressure machines and medications. A 4 hour accreditation course for the machine they sell should be enough to teach them how to set it up. If you have issues then they can make an appointment with an RT for follow up. They already do workshops on blood pressure and diabetes here as well as various vaccination clinics.

khauser wrote:. . . unable to find any evidence of CPAP dangers . . . .

According to ResMed in the S9 VPAP Auto Clinical Guide:

the ResMed dudes wrote:"Positive airway pressure therapy may be contraindicated in some patients with the following conditions: • severe bullous lung disease • pneumothorax or pneumomediastinum • pathologically low blood pressure, particularly if associated with intravascular volume depletion • dehydration • cerebrospinal fluid leak, recent cranial surgery, or trauma.// Patients should report unusual chest pain, severe headache, or increased breathlessness to their prescribing physician."

jnk wrote:

khauser wrote:. . . unable to find any evidence of CPAP dangers . . . .

According to ResMed in the S9 VPAP Auto Clinical Guide:

the ResMed dudes wrote:"Positive airway pressure therapy may be contraindicated in some patients with the following conditions: • severe bullous lung disease • pneumothorax or pneumomediastinum • pathologically low blood pressure, particularly if associated with intravascular volume depletion • dehydration • cerebrospinal fluid leak, recent cranial surgery, or trauma.// Patients should report unusual chest pain, severe headache, or increased breathlessness to their prescribing physician."

Considering the contraindications, those people would already be under medical supervision and dehydration can be fixed by drinking water. By the way neither my sleep doctor nor the RT ever told me that if I was dehydrated not to use my cpap. Since dehydration is usually caused by vomiting and/or diarrhoea - using cpap under those conditions would be rather difficult anyway.

BlackSpinner wrote: . . . neither my sleep doctor nor the RT ever told me that if I was dehydrated not to use my cpap. Since dehydration is usually caused by . . .

I believe that dehydration is mentioned because of its effect on cardiac preload, so emergency personnel considering PAP when reacting to a patient with certain cardiac issues may need to keep that correlation and contraindication in mind.

But I ain't no doc, so I don't really understand all that very well, myself.

I am trying to relate this to my personal experience.

My girlfriend wanted me to be tested for apnea. She said I snored, I scared her by seeming to stop breathing during the night, and I fell asleep during the day. I was in total denial. I insisted that I felt great every morning when I woke up and always insisted I had had a wonderful night's sleep. I didn't want to have a sleep study. I didn't want to be all wired up and sleep in a strange place. I didn't want to find out I had sleep apnea. I didn't want to sleep with a mask on my face, hooked up to a machine. But she was insistent, and I love her, so okay I was tested and diagnosed. Then came the titration night on a straight CPAP machine. Next day I felt horrible, the worst headaches and I don't get headaches. Okay, I communicate with my doctor, I've got centrals and mixed apneas, I'm tested on an ASV and I wind up going to bed at home with an ASV, and I have great results, for over a year and a half! (Except for one night about a year later when I accidentally set my machine to CPAP mode and have a memorable repeat of an absolutely horrible next day. )

Now let's wind the clock back and instead imagine this scenario: My girlfriend bugs me as described above - I relent and buy a CPAP at WalMart. I set it up and use it. Next day I have horrible headaches. Okay, she says, you need a few days to get used to it. Okay, 1,2,3,4,5,6,7,8 days and I'm screaming I can't stand it; I've never felt worse in my life! You see, I tell her - It's not apnea! This machine's gonna kill me! Okay, at least you tried she says. I stick it up in the closet and that's the end of that. She doesn't bug me anymore and I've still got apnea and she decides to stop complaining about my snoring, my periodic breathing halts, my falling asleep during the day; and life goes on until I drop dead from apnea or drive my car into a truck or over a cliff, maybe killing her and some other people along with me.

So I guess my point and my question is this: Nobody starts out assuming they have central or mixed apneas. Nobody starts out researching. Nobody starts out even knowing the difference. So if you sell CPAP machines at Walmart, what are you going to do about all the people who buy them as a first-time experience; it makes them feel horribly worse and they conclude that they either don't have apnea or that maybe they do but they conclude a machine will make them feel horribly worse? Obviously, that would be a very bad outcome.

So if you start selling CPAP OTC at Walmart's etc., how would you suggest resolving this potentially very bad outcome for people who have central or mixed apnea? I'm not advocating pro or con, but I am just wondering.

Best wishes, Nate

I do see where NateS is going and the point is very valid.

The OTC device would need to be smart enough to know when it's not treating the sleep disordered breathing effectively enough. At that point the machine would display a message, "Return me to Walmart - I'm not the right machine for you".

Without some sort of safety programming, should the pressure support be inadaquate i.e. Dx complex sleep apnea, a person could conceivably assume that all pressure support wouldn't work and give up.

At the moment it appears the ayes have it, that is however very good food for thought.

I agree with Nate, we should have an rx in hand...but.... we can get it filled at a Walmart pharmacy or wherever we want including a dme (can't believe I said that) That way we will have been prescribed the proper machine at proper pressures, but have the choice of going where we want to purchase our equipment. I also think that our supplies, including masks should not be tied to an rx... only the machine. I do not believe we should be able to go and buy what we want when we want without having been seen by a doctor first... just like being treated for an infection and need antibiotics, see the doc, get prescribed, then go and get your meds at the drug store .
I think that if it were a total free choice then we would be buying something just because we feel like it, not because we NEED it.

I generally go to a doc whenever OTC doesn't work for me, if the problem seems bad enough to warrant that.

And without an Rx requirement, I assume a thriving machine-try-out-rental business would exist if machines costs failed to plummet below $100 or so.

But the question, for me, is not whether sleep studies are possible or whether docs can help people with sleep troubles. I see the benefit of both for any who can afford such things.

The question, for me, is whether an Rx should be needed to buy a machine the rest of my life and whether discount stores should be allowed to sell them.

The question of machine purchases, in my opinion, should not be limited to purchases made by first-time buyers. Now that I know what I need, I would like to spend the rest of my life simply getting what I need for myself from the discount store of my choice as a repeat buyer able to pay what the machine is worth--not what the non-existent help of the brainless DME is supposed to be worth--which according to manufacturers is part of what I'm paying for when the prices are kept so artificially high by the cartel.

But where I purchase an OSA-treatment machine, and how I purchase it, would not, to the best of my knowledge, prevent me from getting help from a doc or being sent to a sleep doc with other, perhaps related, sleep problems, if I am in a position to be able to afford to do that sort of thing.

If I can buy sleep medication OTC, which is very dangerous stuff, I ought to be trusted to choose to try mildly-pressurized air, even if I can't afford to see a doc.

I voted yes.

I got tired of waiting on Dr, Ins, DME ... I bought one off Craig's List!

Even though I went the medical route (sleep study and titration) I was using my CL machine a month before the DME got me one! And I did not know what I had been titrated at ...

Come to find out it was 4-7 "officially" ... But I had already found out that 8 cm H2O was not enough to stop obstructions ... Even now a year later ... 10.5 will not stop them! I have another sleep study scheduled with a differnt lab this coming Monday evening ...

If somebody were to buy a OTC APAP ... With proper instructions on how to use it, why they should use it, and if these problems show up ... Do this ... And as always if the DIY route doesn't work, or get you the results you want, you always have an option to see a professional ...

Our host is able to sell machines for much less than the DME's ... Why is that? Volume? Not greedy? Don't have to deal in ins co's?

Several of you seem to think that if this happens there is going to be a rush down to Walmart of the undiagnosed and untreated.

They are not going to do this. They did not do this when diabetes testing kits became available OTC. They are not going to do it with CPAP.

OTC CPAP is for us, the conscientious CPAPers. Just give us the freedom to buy what we want to buy.

jnk wrote:I generally go to a doc whenever OTC doesn't work for me, if the problem seems bad enough to warrant that.

And without an Rx requirement, I assume a thriving machine-try-out-rental business would exist if machines costs failed to plummet below $100 or so.

But the question, for me, is not whether sleep studies are possible or whether docs can help people with sleep troubles. I see the benefit of both for any who can afford such things.

The question, for me, is whether an Rx should be needed to buy a machine the rest of my life and whether discount stores should be allowed to sell them.

The question of machine purchases, in my opinion, should not be limited to purchases made by first-time buyers. Now that I know what I need, I would like to spend the rest of my life simply getting what I need for myself from the discount store of my choice as a repeat buyer able to pay what the machine is worth--not what the non-existent help of the brainless DME is supposed to be worth--which according to manufacturers is part of what I'm paying for when the prices are kept so artificially high by the cartel.

But where I purchase an OSA-treatment machine, and how I purchase it, would not, to the best of my knowledge, prevent me from getting help from a doc or being sent to a sleep doc with other, perhaps related, sleep problems, if I am in a position to be able to afford to do that sort of thing.

If I can buy sleep medication OTC, which is very dangerous stuff, I ought to be trusted to choose to try mildly-pressurized air, even if I can't afford to see a doc.

It seems to me that you've made a great argument that Rx for cpap should be for a lifetime - no expiry date.

Much of this discussion is predicated on the assumption that xpap prices would plummet if they were sold over-the-counter without a requirement for Rx. I have a feeling that prices might not drop nearly as much as people think. And if prices did drop significantly, it likely would be the result of a market-flood of poorly made, low-quality machines.

Anybody care to comment on this assumption that prices would drop significantly? Do you think this would happen for quality machines, too?

I want to buy off the shelf with no minimum pricing.

Hose_Head wrote:Much of this discussion is predicated on the assumption that xpap prices would plummet if they were sold over-the-counter without a requirement for Rx. I have a feeling that prices might not drop nearly as much as people think. And if prices did drop significantly, it likely would be the result of a market-flood of poorly made, low-quality machines.

Anybody care to comment on this assumption that prices would drop significantly? Do you think this would happen for quality machines, too?

They wouldn't drop by much. It is still a small market. They are still medical machines that need FDA approval which costs a lot. There are lots of patents on them which will prevent new players from entering the market. Also when people first buy them they are desperate and sleep deprived and not doing any research because they trust their doctors and other medical "specialists" involved.