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Comment by 6177c40f | Hacker News Reader

Tangentially- Why, in America, do we need a doctor's prescription to purchase a CPAP machine? Of course, I know plenty of bad reasons why, but I'm wondering if there are any legitimately good reasons at all? This reminds me of the situation with hearing aids, where the FDA recently reduced the barriers to purchasing them and this appears to have been a good move.

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They’re pretty dangerous if used improperly. CO2 buildup can even be fatal.

Like, obviously rebreathing CO2 is deadly, but that's more of a "plastic bags and children" kind-of issue. Luckily your body doesn't like the feeling of breathing in CO2 so it is uncomfortable if you leave the mask on without running the machine, but even then, it vents a decent percent when you exhale.

I'm not sure what a doctors prescription does for this. I imagine the doctor is just a middle man in most CPAP journeys. As-in, the doctor is not the one who provides or trains you to use the CPAP. A third-party medical device provider does (Also, the training is a two minute, "put-the-mask-on and use distilled water, now sign here" kind-of-thing)

Edit: BTW I think the deadly thing is how long it takes to get a CPAP, from scheduling with a doctor to finally seeing them and getting a device it takes like 6mo to 1+ year. EVEN IF THEY THINK YOUR CASE IS VERY BAD. (I went to a sleep doctor in a hospital and they said I had one of the worst apnea cases he had seen, it still took another 3+mo from that point to get a device...)

You have 1. a device manufacturer, 2. a third party device seller, and 3. a sleep doctor. It takes time to get seen by a sleep doctor who then orders a sleep study device that needs to be provided by party 2 who gets it from party 1. Party 2 then provides results to party 3 who then prescribes a device, party 2 then needs to give you one of there devices if they have them in stock, if not they need to order them from party 1.

IMO there are two middle men here, the doctor and the device shop.

If you get a prescription you can get devices directly online (from sites who are just a more market-competitive version of party 2 above), but sometimes ResMed and Philips only sell there newer devices to people in the middleman scenario described above. E.g. for the first year or two of the ResMed AirSense 11, online shops (still requiring prescriptions) were not able to sell them.

It's a scam 100%.

Have CPAP, not really any way to "mess up" outside of putting a bag over your head.

Does the prescription come with magical CO2 scrubbers?

All the prescription does is set some baseline parameters. Most CPAPs you can buy are APAPs anyway and modify the parameters on the fly.

> All the prescription does is set some baseline parameters. Most CPAPs you can buy are APAPs anyway and modify the parameters on the fly.

And training on how to use it property is also provided. I would not be shocked if the number of people using tap water would sky rocket if there was zero barrier to having one.

Recently got an rx. The RX itself was worthless (4-20, not dialed in for me). Insurance refused to pay for a titration study as not medically necessary, so I had to join special CPAP forums and learn how to titrate myself.

But yah, no training was given at all. No reason I couldn't have picked it up at Walmart and used on my own.

Training is not actually required to be provided by anyone, manufacturer, government or otherwise. There’s plenty of online shops selling you the prescription which come with at best a short user guide that you can probably find online. They come with no aftercare, and you’re just given a device (usually unlocked) and the pressure recommendation preset. That’s it.

The current state of CPAP prescriptions is total bullshit.

> There’s plenty of online shops selling you the prescription which come with at best a short user guide that you can probably find online. They come with no aftercare, and you’re just given a device (usually unlocked) and the pressure recommendation preset. That’s it.

Don't these problems get worse without prescriptions?

The bar is already so low, it's not going to get noticeably worse. If the standard already is minimal training, then having more places provide just as minimal training is not going to noticeably change anything.

Lower prices and a streamlined process would certainly mean more people are going to be getting CPAPs but that seems like a net positive if anything. Sleep apnea affects millions of people and is generally extremely tough to get treatment for. And that's not due to the "safety risks" (there are very few if any in day to day use) but rather an entrenched set of companies and providers that obviously benefit from this.

I thought they typically had safeguards to prevent this, but maybe not all models do. Not trying to be obtuse here- but how is this different from the fact that I could go to a hardware store and buy a propane space heater with zero restrictions, then ignore the instructions and use it in an unsafe way? Why don't we require some kind of professional to "prescribe" us a space heater then?

It isn't, but it's a good excuse to let entrenched industry collect their rent.

xPAP use actually increases CO2 elimination, which is why it can lead to Treatment-Emergent Central Sleep Apnea. You'd have to fall asleep with the device off to get meaningful CO2 rebreathing, which is neither an easy feat nor particularly different whether you've been prescribed or not.

I'm wondering how that happens.

All CPAP masks have vents in them to prevent CO2 buildup, and those vents work regardless of the pressure settings.

I have a Resmed Airsense 10 with nose pillow, and if the meshed vent gets wet it does not work so well anymore. I experience this as a shortness of breath and wake up from it. I can imagine that this is dangerous for people who don't wake up from this. I have a replacement so I can swap in the middle of the night if neccessary. I regularly clean the mesh with warm soapy water and an electric toothbrush and I replace the mesh every 6 months.

Can you clarify what you mean by mesh vent, and what it is exactly you replace? I could not find any info. My father uses this machine so you have me worried.

You can use a Resmed AirSense with a nose pillow or a face mask. I only use the nose pillow. It covers the nostrils. You breathe through the nose. The mouth stays uncovered. If you manage to keep the mouth closed while sleeping, this is enough. Between the tube and the nose pillow there's a piece with two mesh vents. When the CPAP increases the pressure, some air is vented through the meshes. When you breathe out, most of the breathed air leaves by the vents. I feel the air: when breathing in only a little and when breathing out a lot. It is a fine mesh creating some resistance but it works because when you breathe out, you temporarily increase the pressure and the mesh lets your stale air out. However when the mesh gets wet by condensation, not enough stale air is vented and you get the feeling of not having enough air. It feels like the head being under the blanket. The first time this happened I was confused. Now I know to recognize and to avoid this situation. If the room air is very cold, this can happen because the air you breathe out can condensate. If you use an air moisturizer, you need to find a balance between temperature and too much moisture. You need to position the tube such that moisture can't flow downwards to the nose pillow.

This all sounds a bit complicated and dangerous, but in reality this works surprisingly well. It really works and it is helpful. I know CPAP devices are a nuisance and need a lot of time and dedication to get used to, but they are able to fix sleep apnea. They give me a good sleep. I needed about three months to find the sweet and deep sleep we humans all need thanks to this bloody contraption. It is a hate-love relationship.

It sounds like you're using the Resmed P10 nasal pillow. I've tried that before and agree the mesh vents get clogged easily (not just because of condensation, but also because it gets dirty easily).

There are other similar pillow masks out there that don't have that problem. I found the Philips Nuance, Philips Dreamwear, and F&P Brevida to not have any venting issues. The Brevida has a cloth mesh that still works when wet, and probably is the best if you want that "resistance" feeling on exhale.

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