[candiddevmike]

It's good that you offer self referrals, I think too many people avoid getting treatment due to the amount of time and energy it takes navigating the system. My journey to getting sleep apnea diagnosed started with discussing sleep quality issues with my primary care provider and a couple very expensive blood tests to rule out other things. Then I finally met with a sleep pulmonologist, who then put me on a multi month long wait list to get the sleep study equipment, and then another month after I finally had the results/justification to get my CPAP.

The CPAP worked OK, but I couldn't stand wearing the thing. I opted for surgery (UPPP, probably the most painful thing I've experienced), which has "cured" me (ironically I'm back on the multi month wait to verify my sleep apnea is gone via another sleep study). Do you recommend surgical or weight loss options to your customers? Could be a conflict of interest if you're set on recurring supply refill revenue...

[Clubber]

I think it's ridiculous that a CPAP machine requires a prescription. I wanted to buy one to try it but couldn't. Anyone know why this is? Is it just regulatory capture or is there a medical reason someone shouldn't be able to buy one?

[sithadmin]

For what it's worth, there are tons of generic APAP devices available on your usual 'big' online market places being sold under labels like 'resoiration device' or 'sleep aid'. Don't know if they're actually trustworthy, but they're out there. There is also a small but thriving secondary market for devices in online web forums (though for sanitation reasons, this seems like a very suboptimal workaround).

[asmithmd1]

You know what is more ridiculous? You need a doctor to write a prescription to use this machine that ices your leg or arm.

https://gameready.com/gr-pro-cold-therapy-unit/

I think it must be some quirk of insurance that they will only pay for something IFF it requires a prescription

[dimitrios1]

Depends on your health insurance plan. Many plans fund a health savings account that allows you to spend your money on any qualifying medical purchase, whether its OTC meds, medical devices, or heck even my yearly supply of band-aids and ibuprofen.

If something requires a prescription, it's usually because the company wants a liability chain to go through a doctor and their malpractice insurance, rather than bankrupt the company.

[yurishimo]

It can be dangerous if used improperly and since it's related to your health I suppose that requires regulation.

My grandmother died from complications with her CPAP machine (long story and user error) so I don't know that making them available off the shelf is a great idea. At least behind a prescription, more care can be put into the testing of the devices rather than churning them out by the lowest bidder for pickup at your local Walmart.

I've tried to think of other devices/treatments that are available OTC and I'm coming up short. Drugs are heavily regulated and quality tested. I think the big factor is that using the device requires unconsciousness which ups the risk if something goes wrong.

All speculation on my part.

[jjkaczor]

It is somewhat ridiculous - their logic is that it does require configuration/calibration to be setup initially for your pressure levels.

However - I am reasonably confident that given a prescription and some documentation - and a decent instruction manual/video, most people could get through it. (I certainly had no issues with downloading some software/utilities, yanking the SD card and examining my data during the first few months)

But - ultimately it is probably more about risk mitigation and liability for the doctor/sleep technicians and clinics who prescribe these things.

[pdonis]

> their logic is that it does require configuration/calibration to be setup initially for your pressure levels.

Which is ridiculous. By "configuration/calibration" they mean setting a value in the software settings. Something that takes 2 seconds and could easily be done by the user (in fact most CPAPs have the ability to have the user set it, but it's disabled by the manufacturer because of stupid regulations).

> ultimately it is probably more about risk mitigation and liability for the doctor/sleep technicians and clinics who prescribe these things.

If people could just go buy them in drugstores by their own choice then doctors and clinics wouldn't be on the hook for having prescribed them. Plus there would be more competition and the devices would be cheaper and more widely available.

[TylerE]

I have a Resmed machine and it's super easy to change the pressure.

You just do the super secret thing to enter "Clinician Mode".

The super secret thing?

Hold down the one input button for a few seconds.

[pdonis]

AFAIK this only works on certain models.

[rootusrootus]

It is sort of ridiculous, which is why companies make it fairly easy to work around. You go somewhere like 1800cpap and they send you an at-home test kit, you return that to them and they have a doctor look at the output. The doctor writes a prescription, then 1800cpap happily sells you whatever equipment you want. You won't even talk to the doctor. And I can't guarantee this, but I suspect the doc is incentivized to always find something worth writing a prescription for.

[floatinglotus]

If you have OSA and you want to put a mask on your face at night and manage the titration yourself, you’re seriously a candidate for the Darwin awards.

I would love to manage it myself of course, but treating OSA is not 100% as simple as using a CPAP. And if you are indeed stopping your breathing while you are sleeping, do you personally want to be responsible for setting the machine properly?

[candiddevmike]

You need a qualified respiratory therapist/pulmonologist/sleep doc to configure it for you (that's part of the prescription, how much pressure you need), otherwise you could really mess up your lungs (too much pressure) or make your apnea worse (too little pressure). They'll also do ongoing monitoring and adjust the levels remotely.

[sithadmin]

Not really true for most people with modern APAP machines. Most direct to consumer providers prescribe APAP these days and don't do a titration study to dial in pressures.

[astura]

Some machines have auto adjusting pressure - my husband has one.

I think this is his unit - https://lofta.com/products/resmed-airsense-10

>With auto titration technology, the AirSense™ 10 AutoSet™ monitors you- breath by breath and adjusts your therapy delivery to maximize outcomes

[TylerE]

Pretty much all newer machines do, and most insurance will happily give you one - at least Blue Cross will, as the cost difference over a plain CPAP is very nominal.

[csallen]

I've considered UPPP surgery. Can you describe the pain? How long did it last? Was it worth it?

[k12sosse]

It was miserable pain, wouldn't do it again. After surgery (months) I managed to stretch the insides and snored again. Also randomly choking while drinking water with no uvula.

Mine was about 20 years ago. Avoid UPPP for snoring.

My snoring was so bad that I would often wake up with my uvula dangling on my tongue, before the surgery.

[candiddevmike]

The pain was pretty bad, but I also avoided opiates and just used tylenol/ibuprofen. It feels like the worst sore throat you've ever had. The worst part was when it was dry--you had to constantly keep drinking water to keep it from getting dried out, which hurt really bad, especially if it was already dry (like when you wake up from sleeping). I'd say it lasted around 2 weeks, I was back at work a week or so after the surgery though.

There is a risk of having a tonsil hemorrhage with adult tonsillectomies (which I got with my UPPP, I think most do?). There is a vein/artery that runs right behind your tonsils and causes them to bleed really bad. Your surgeon will cauterize it, but a week or two after surgery your scabs start coming off, and if they come off too quickly you'll start bleeding. This bleeding won't stop on its own, you need to get to the hospital ASAP. This didn't happen to me thankfully but it was weighing on me pretty heavily from an anxiety standpoint.

I would absolutely do it again. My sleep apnea is gone, I have incredible sleep quality and am no longer a zombie. I was a good candidate for the surgery though--I had a really big uvula and medium sized tonsils, so it didn't take much to block my airway while I slept.