CPAP without prescription

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Other than being illegal what is the danger in using a CPAP machine without a prescription?
 
Can you even purchase one without a prescription ?

The settings are not user adjustable. How would you know what pressure settings to use without having a sleep study and then having a doctor analyze the results and prescribe the pressure settings.

It's not just blowing air. It's delivering an exact pressure to keep your airway open. Without a sleep study you are guessing. And that's why a prescription is required to purchase a cpap.


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mrindian said:
Can you even purchase one without a prescription ?

The settings are not user adjustable. How would you know what pressure settings to use without having a sleep study and then having a doctor analyze the results and prescribe the pressure settings.

It's not just blowing air. It's delivering an exact pressure to keep your airway open. Without a sleep study you are guessing. And that's why a prescription is required to purchase a cpap.


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You can buy anything off the Internet, from my understanding most of the machines analyze their efficacy.
 
Henning said:
You can buy anything off the Internet, from my understanding most of the machines analyze their efficacy.
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I guess that's the difference from going to a reputable seller vs a fly by night seller. Go to www.cpap.com. You can not by a machine from them without a prescription.

The machine do analyze how many Apneas you have per hour but they don't change there pressure settings. Since those are set by the dr prescription.


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mrindian said:
I guess that's the difference from going to a reputable seller vs a fly by night seller. Go to www.cpap.com. You can not by a machine from them without a prescription.

The machine do analyze how many Apneas you have per hour but they don't change there pressure settings. Since those are set by the dr prescription.


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I'm sure the instructions are available to adjust the pressure. Yeah, the Internet pharmacy business changed the face of the medical provider industry. You don't need a prescription for much anymore and education is a few key strokes away.
 
In theory yes. Probably not a great idea. You could buy say a resmed s9 or similar auto-cpap with variable pressure and then go into the set up menu (not hard) and set the pressure for a wide range. The machine would basically auto-titrate you by adjusting the pressure accordingly. It would also provide some data about what your AHI was with the machine.

Just about any doctor could write you a prescription for a cpap though. According to cpap.com

The prescription can be written by any of the following care providers:

Medical Doctor
Doctor of Osteopathy
Psychiatrist
Physicians Assistant
Nurse Practitioners
Dentist
Naturopathic Physicians

We will not accept prescriptions written by:

Chiropractor
Podiatrist
Optometrist
Psychologist

I do think insurance companies will eventually push for simple home study and script for an auto-machine set to a reasonable range it would save a lot of time and money. I think the sleep study business is a bit of a racket.

I just went through the whole sleep study thing two months ago it was a couple nights of bad sleep but in the end it was only a few hoops to jump through. It is not cheap and I have high deductible insurance. My employer does put some money in an HSA. I have not been through the SI process yet but don't see that as a huge roadblock from what I have heard. I think if the FAA would let the AME just sign off on a well treated patient that would make the whole thing a yawn as far as flying goes.
 
I think if the FAA would let the AME just sign off on a well treated patient that would make the whole thing a yawn as far as flying goes.
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This is why many AMEs (including Bruce) and many airmen (including me) want "well treated OSA" to be part of CACI. Bring everything the current protocol requires, and let the local AME issue.
 
CPAP do not adjust pressure automatically - that's why the "C" means "constant". There are APAP machines ("automatic") that do sense apnea episodes and adjust pressure.

However, the sleep study is where the correct minimum pressure to minimize apnea episodes is established.
 
gkainz said:
CPAP do not adjust pressure automatically - that's why the "C" means "constant". There are APAP machines ("automatic") that do sense apnea episodes and adjust pressure.

However, the sleep study is where the correct minimum pressure to minimize apnea episodes is established.
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Got me on a technicality there. Again in theory you could set the machine from say 3 to 12 or higher and then see what the average pressure the machine was using to "break" the apneas and narrow the range. Not a good idea but you could.
 
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mrindian said:
Can you even purchase one without a prescription ?

The settings are not user adjustable. How would you know what pressure settings to use without having a sleep study and then having a doctor analyze the results and prescribe the pressure settings.

It's not just blowing air. It's delivering an exact pressure to keep your airway open on modern units. Without a sleep study you are guessing. And that's why a prescription is required to purchase a new cpap.
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I fixed that for you.

You see them on Craigslist all the time. Also there are number of CPAP user internet forums on which individuals list used CPAP machines for sale. I've never heard of a law against individuals selling a CPAP machine.

Getting masks would be a bit more challenging, since you really don't want a used mask.

On most units the settings can be adjusted, just Google 'clienican settings' for your unit. There will be a 'secret' code to enable them.

Many CPAP machines 'auto adjust' as they monitor your sleep quality, so if you are the gambling type you could get something like a Resmed S-9, set the intial pressure at 4, and the max at 20, and see what settings it settles down to.

You'll want to tweak your settings in any case.

Of course if your problem is something other than OSA then you might die of your real problem while you're playing home doctor.

Really, you need a real sleep study to know where to start with your settings. Consider asking your Dentist, a lot of them will give you a take home study machine because they want to sell you a $2K mouth piece. The take home study is much cheaper and much less torturous.

Another thing to consider is going to another country for your study. Certainly if you are spending your own money a sleep study would be cheaper in almost any other country.

Or just man up and tell your family doctor what your symptoms are and listen to her advice.
 
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The easy test to see if you have sleep apnea is to use a blood o2 sensor on your finger for several nights.

If you have sleep apnea you will see your blood o2 levels decrease. My dr didn't think I had sleep apnea so he gave me one to wear for two nights. My o2 levels went to 78 during the night so the sleep study was ordered.

In the sleep study I had 80 episodes per hour. My prescription is for a level of 6 on my cpap and I'm at 3 episodes per hour on the cpap. Anything under 5-7 is considered normal.

It took 4 months to get my si from the FAA. I received a 6 year letter that requires a yearly visit to my sleep dr to make sure I'm ok. Then he writes a letter to the ame and I'm good to go for another 12 months. Since I have to do this annually I just get a second class in case I ever get my commercial license.

Gary


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FYI the status letter doesn't have to come from a sleep doc. I get mine from my regular primary doc and it's been accepted each time.
 
Honestly, the way CPAP (lumping APAP/etc into this for those who are pedantic) works in the US is a major waste.

If your doctor thinks you might have apnea they should just send you home with a loaner APAP machine for a week. That will cost all of $100 if they let you keep the mask, though that could probably be disinfected and re-used. Then you bring back the machine and they read the card and for 95% of patients that will probably tell them everything they need to know - whether you have apnea, and whether it is effectively treated with a $400 machine (if you pay cash - your typical hospital will charge $1200 for it). All of that costs way less than a sleep study. Sure, it doesn't tell them as much, but it tells them what they need to know.

For the 5% of people who the machine doesn't properly treat or doesn't tell them what they need to know, then you send them for a sleep study and do things the usual way.

An APAP machine will figure out what needs to be done to treat obstructive apnea almost all the time. I'm not aware of any safety issues from using them either, unless you're dumb and try to use them for somebody who should be in an ICU on a ventilator.

Now, I ended up being diagnosed with complex sleep apnea which means I need a $3500 machine instead. That will treat everything the cheaper machines can handle, but it can also handle some situations that are much more rare. There are also machines like BiPAPs that are intermediate in price and can handle a few problems an APAP can't handle.

The reason that you can't just buy an APAP at Walmart is the same as the reason you can't just buy glasses that correct for myopia at Walmart without a prescription - it would put a lot of doctors out of business. Sure, there are people who need more than just an APAP, just as there are people who need more than just a pair of matched spherical lenses, but when you look at how many people do without either due to cost it really is dumb how we do things now. A bit of triage would greatly reduce costs while still making more advanced care available to those who need it.

Disclaimer, I'm not a doctor. I have, however, been through three polysomnograms, have complex sleep apnea, and have dealt with doctors qualified to write prescriptions for equipment for the above without really understanding complex sleep apnea (which is a common problem if you talk to anybody with the condition - most doctors just rubber-stamp a prescription for an APAP and leave it at that).

If you're interested in sleep apnea I highly suggest going over to cpaptalk.com. It is a pretty similar community, just oriented around a different interest.
 
rich0 said:
Honestly, the way CPAP (lumping APAP/etc into this for those who are pedantic) works in the US is a major waste.

%<snip>%

For the 5% of people who the machine doesn't properly treat or doesn't tell them what they need to know, then you send them for a sleep study and do things the usual way.

%<snip>%

If you're interested in sleep apnea I highly suggest going over to cpaptalk.com. It is a pretty similar community, just oriented around a different interest.
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I don't disagree with most of what you said, but I do wonder what happens in the above scenario if one has Central Sleep Apnea (brain induced mis-firing of sleep/breathing signals)? instead of Obstructive Sleep Apnea (OSA)? I suspect it runs the pressures up and down trying to eliminate the Apnea episode and then finally gives up?
 
gkainz said:
I don't disagree with most of what you said, but I do wonder what happens in the above scenario if one has Central Sleep Apnea (brain induced mis-firing of sleep/breathing signals)? instead of Obstructive Sleep Apnea (OSA)? I suspect it runs the pressures up and down trying to eliminate the Apnea episode and then finally gives up?
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My ResMed does distinguish between central and obstructive apneas. How accurate it is, I have no idea, since all I know about medicine is what I learned on Marcus Welby and Scrubs.
 
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I would have to assume that the machine can not "break" a central apnea so if you are having enough of them to matter it would still show in your AHI regardless of the pressure setting and what it actually calls them.
 
I believe there is a physiological impact to over doing it with CPAP pressure. I'm not a doctor, and I can't give you specifics. The human body evolved to work within a fairly narrow range of temps and pressures.
 
kontiki said:
I believe there is a physiological impact to over doing it with CPAP pressure. I'm not a doctor, and I can't give you specifics. The human body evolved to work within a fairly narrow range of temps and pressures.
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And this is why the sleep study is a valuable thing. Not only can it isolate and quantitate the type and severity of apnea, it will also figure out what pressure (cm H2O) is required to provide effective treatment/therapy.

So to answer the original topic title... Sure, you can find them without prescript. But without the data from the sleep study and titration, effective results are going to be very hit and miss.
 
kontiki said:
I believe there is a physiological impact to over doing it with CPAP pressure. I'm not a doctor, and I can't give you specifics. The human body evolved to work within a fairly narrow range of temps and pressures.
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Too little pressure and the obstruction won't relieve effectively. Too much pressure and the great veins leading to the heart will collapse intermittently, affecting your cardiac output/blood pressure negatively.

The REAL sleep study/polysomnogram will monitor your saturation, a limited EEG, sense jaw movement, leg movement (restless leg) and your inspiratory effort. All of these parameters are used to determine the nature and severity of your sleep apnea. An APAP with a pulse ox sent for a home study MIGHT get it right… or it might not.

Can someone who understands the physiology and the equipment "roll their own" safely at home? Sure.. people in my line of work do that quite often.

Should the average lay consumer think they can do the same and achieve similar results? Hardly.
 
Since sleep studies are performed by the same group that sells equipment, it's all a scam.

I got my initial sleep study done, got my CPAP, then immediately changed it into APAP mode and adjusted the pressures as needed using analytical software that is available for free.

When I mentioned it to the doctor the last time they recommended I come in for a followup study, they told me I was breaking the law and they could report it to the MVD and get my drivers license suspended if I didn't come back in.

Guess how many "**** offs" they got.

It's one of the easiest self treatments out there, and being vigilant is the best way to ensure your own health. Because the doctor and the DME don't care about anything more than pushing product and making money.

Want proof? Try to get a copy of your rx so that you can order your renewables from a different, cheaper place like cpap.com sometime, and watch them try like hell to keep your business by scaring you or threatening you.
 
Try to get a copy of your rx so that you can order your renewables from a different, cheaper place like cpap.com
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This is easily dealt with. I asked my regular doctor to write out the same prescription on his pad that my original sleep doc created many years ago. He happily did it.

But I do feel the pain from your rant. Many of the DME's for CPAP equipment exploit the insurance system and the nativity of the patient. I was victim of this on my first unit. Fortunately I quickly learned and got out of that death spiral.
 
My conversation went very much like, "Hey, doc, I need a copy of my prescription so I can get supplies at a cheaper place." "OK, here you go."
 
none of this needs a script......cept for the CPAP if your buying new. Craig's list has them if you know what you want. All the supplies are available online. The ones that record the data are the preferred. (Res Med S8 or newer)

My friend got one from a family member.....set it up using some bracketing until the apneas per hour (AHI) were below 4. Started with 8 cmH2O....and kept adjusting each night until things minimized. It can be done....but YMMV. :D
 
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SkyHog said:
I got my initial sleep study done, got my CPAP, then immediately changed it into APAP mode and adjusted the pressures as needed using analytical software that is available for free.
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Where can one get this software and what is it called?
 
I got the machine and the mask from a DME the first time and subsequent equipment online. The DME while a slightly more expensive wasn't overly so. I use my masks and such until they wear out then get new one, none of this replace it every couple months stuff.

If I recall the way it worked was my Dr. set up the sleep study. He got the results and he wrote me the script. I could have taken it anywhere or got the stuff online.
 
BrianNC said:
Where can one get this software and what is it called?
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Search "Clinician's mode" for your particular brand and model. Somewhere on the net, someone posted the instructions.
 
AggieMike88 said:
Search "Clinician's mode" for your particular brand and model. Somewhere on the net, someone posted the instructions.
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Oh, I know how to do that. I was wondering about the software. I was thinking the software helped you analyze your sleep so you knew what to set it at.
 
it ain't rocket science....just monitor the AHI....make "small" adjustments in the pressure till you have regular nights under 4 AHI. You'll find the sweet spot where too less pressure makes the AHI go up and too much pressure makes it go up also.

Start at 8 and bump it 0.2 each night.....if the AHI goes down keep raising in increments of 0.2 till the AHI rises.....if not go back to 8 and go in the other direction and take away 0.2 each night.
 
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BrianNC said:
Oh, I know how to do that. I was wondering about the software. I was thinking the software helped you analyze your sleep so you knew what to set it at.
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Some softwares do. But much of what out there is poorly written and the interface to get the data off of the machine is pre-USB difficult.

But I think there was an open source project out there that could take the data from a variety of machines and make it a useful report. Forget the name of it though....


Best choice I found was for my DeVillbiss system, www.intellipap.com -- take the alpha-numeric codes from the display, input them into that web page, and you're shown lots of good detail.
 
Checkout_my_Six said:
it ain't rocket science....just monitor the AHI....make "small" adjustments in the pressure till you have regular nights under 4 AHI. You'll find the sweet spot where too less pressure makes the AHI go up and too much pressure makes it go up also.

Start at 8 and bump it 0.2 each night.....if the AHI goes down keep raising in increments of 0.2 till the AHI rises.....if not go back to 8 and go in the other direction and take away 0.2 each night.
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This is what I do with mine. I find I have to adjust it in the fall and spring (I assume it has to do with the dryer air and the humidifier). In the winter I find i need to bump the pressure up to keep my AHI down where it is during the summer. I find knowing how to monitor the results in the clinician menu and make slight adjustments quite nice.
 
I am a sleep tech. Auto machines recognize central apnea as central apnea and do not try to jump up the pressure. For a machine treat central apnea, you would need a timed bipap or an ST PIPAP, which is the big dog machine that gives you a kick to get you breathing again.

The big question is why are you having more than occasional central apnea? The answers would be brain damage or Opiate use. Not much more causes Centrals. well there is one more thing that you can get central apnea from. If you have copd and you can't blow out against the exhalation pressure, you have central apnea. Also if your pressure is really high and you trying to use a cpap at between say 15cm and 20cm, and you just can't quite breath out agaist it. That would show up as a central. So, the question is why do you have central apnea. If your pressure is too high, you will move to a bipap, if you have a brain dissorder, you will get a timed biapap and if you don't respond to that, you get the ST which is timed with a kicker.. If you have congestive heart failure and are having cheyne Stokes Breathing, you are in big trouble and you don't have long, but there is a new machine called the AVAPS that is really slick.. cost about $7 to 12k. It senses the cheyne stokes and has a servo motor to work with you, matching your exact pattern as you breath. it fixes most CSS patients. It also works with pulmonary fibrosis.. Tough diseases that I don't on any of you. sorry if this is scattered it is late and this is stream of unconscious.
 
Necro thread!

Or just sound asleep thread, in this case...
 
The C actually stands for CONTINUOUS not constant. It refers to the fact that there's always mild pressure applied even when not inhaling. APAP adjust the pressure based on where you are in the inspiration/expiration cycle. It has squat to do with being "adaptive" to apnea events. The simplest of APAP machines have two pressures (one for in and one for out). Yes there are fancier APAP machines but that's NOT the distinction between CPAP and APAP.
 
Different brands have different names for the levels of PAP machines. It sounds like some people are getting these confused.

Bottom level is CPAP. Puts out only one pressure. Never changes unless the machine is reprogrammed. That pressure helps keep the throat from blocking while breathing in.

BI-PAP puts out two pressures. Typically this is a higher pressure when you take a breath to help support the throat. A lesser pressure when you breath out so that you can exhale easier. This is often used for people that need a high pressure setting to stop their events, but then have a hard time breathing out against that pressure.

Auto-PAP is the highest level. It has a bunch more settings then just the two pressures. It boils down to a BI-PAP with a bunch of sensing equipment that can add even more pressure as needed when a central apnea event occurs.

Normal apnea is an obstruction when breathing. Tongue falls to the back of the throat, throat muscles deform and close the breathing tube, etc. Central apnea is a nervous system issue where the setting in the brain that checks your CO2 levels gets a little off sometimes. When that happens it takes a higher CO2 level in the blood to trigger the emergency breathing response. In fact it can get so high that you can actually cause damage to the body over time. When the PAP machine sees the characteristic signs of a non-obstructive event it quickly ramps the pressure way up to force air into the lungs and get everything reset.

This is all in layman's terms because I am not a sleep doc, or any kind of doc for that matter. But I do have complex sleep apnea (both central and obstructive) so I have done a massive amount of research on how my auto-apap keeps me from having a stroke.

If you really want the gritty details then there are apnea specific support boards where docs do hang out. That is where I got a lot of my information.
 
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