The CPAP racket

Miscellaneous and Personal Stuff I Must Share
1

Does anyone understand why CPAP machines are so difficult to get, are so expensive, are such a pain in the ass? To get mine (my insurance will cover one machine every five years) , I’ve got to go through the testing (a pain, but I get it), get a prescription, get a provider, get it mailed to me.

If it breaks, I’m screwed. If I want a spare, I’m screwed. If God forbid I forget to pack one for a trip, I’m screwed.

Every other medical procedure or device is available for good money if I’ve got a good reason, but I’ve got to move heaven and earth to get this one device on which I depend for a good night’s sleep.

Can someone explain it? Seems like a racket to me.

2

Which part are you asking about? The requirement that a doctor writes a prescription for one or that you can’t buy them locally?

I assumed you were asking about the doctor signing off on it until this…

I’m quite sure we can find plenty examples of medical procedures or devices that you can’t (legally) buy without involving a doctor, no matter how much money you throw at it.

3

try cpap.com. They will happily sell you a cpap machine at retail if you upload a scan of your prescripton. For that matter, so will Amazon.

4

I’m talking about how complicated the entire procedure is, and the expense. Waiting for an appointment to see a qualified doctor, who sets up an appointment with you a few weeks later for a sleep study, who submits the results to a provider who (maybe) sends you the right machine a month or two afterward, and the whole shebang costs 1000s of dollars for a device that I could probably make in my garage. You’d think I was talking about a nuclear powered proton divider or something. It’s just air and a delivery system.

5

The simplest medical devices are expensive. A CPAP machine is complicated and potentially dangerous. That makes it very expensive. I think there’s some upselling going on with these machines. That generates more profit for the manufacturer and the seller which is often a sleep clinic.

The entire sleep industry is kinda scammy around the edges. Sleep apnea is real but sleep studies tend to find it too often. After I was required to get a sleep study to diagnose erythrocytosis I was told I had sleep apnea. My pulmonary specialist looked over the results and snorted “That’s not sleep apnea”.

6

Access to health care varies widely, I guess. I got to see a doc within about a week, and I think that day I came home with an at-home sleep study kit: it was a device the size of a deck of playing cards that strapped to my chest. The strap monitored my breathing effort, while a nasal cannula detected actual movement of air, or lack thereof. There was also a pulse oximeter. I mailed it back the next day, and I think I got a call within a couple of weeks to go visit a DME supplier for a machine.

While the at-home sleep study was quicker and more pleasant than one conducted somewhere else, it still did slow things down. Unfortunately there isn’t really another way, at least not yet, to determine whether a patient has sleep apnea that’s severe enough to justify a CPAP.

Why a prescription? I guess they want to make sure it’s properly set up for you. The pressure settings are adjustable, with the settings hidden in a menu that’s only supposed to be accessible to service providers. Thanks to the magic of YouTube, it’s not hard to get access to those menus yourself if you want to make changes yourself.

If you want a spare, you’re not screwed. It’s nice to have insurance cover the cost, but not required. Insurance covered a CPAP machine for me, which I have been using at home for 5+ years now. A couple of years ago I paid out-of-pocket for a travel-sized CPAP; all I needed was a copy of my prescription - which my doc was happy to provide, since I had already been tested and found to be in need. It’s much more convenient for travel purposes, and of course can serve as a backup if my primary CPAP conks out.

7

I got my first CPAP from the classifieds. The previous owner (an elderly lady) had died and the family was selling the device (a pretty recent model, from Philips Respironics) for a few hundred bucks. I was doing a sleep study in that period, and when the doctor diagnosed my apnea and prescribed a CPAP, I showed him my used device and he declared it fit for purpose and programmed it per his recommended pressure parameters.

8

My travel CPAP, that i paid about $600 ($600!!!) for out of pocket, is basically a CRAP machine. I wake up constantly with it and have taken to carrying my bigger machine on trips.

I see no reason on earth why CPAP machines aren’t adjustable by users along with all the WARNINGS!! DANGER WILL RObiNSON!!! warnings they want to attach to the thing. The nurse who did my sleep study was all over the map–“Looks like you need 8.0 pressure, but here it looks more like 9.0 and here it goes up to about 11, let’s settle on 10.0 for now, ok?” If she can dither like that, I’m supposed to believe that the setting is definitive science and I’m risking life and limb by tweaking it myself? Only I can’t (unless I go online and find out ways to tweak it contrary to the provider’s wishes.

And the waste! The provider ships me a dozen mouthpieces every few months, S, M, L, XL, despite my telling them that the M mouthpiece works just fine and I don’t need all the others. But no, they keep coming in the mail.

9

Well, someone’s got to feed the landfills… they get really hungry and cant feed themselves.

10

Yeah, because the tricky part of titration is getting the obstructive apneas as low as possible with as few central apneas as possible.
(Obstructive apneas are when your physical ability to breathe is interrupted, central apneas are when your brain stop sending breathing signals. A CPAP machine can detect events and try to open your airway . . . it can’t get your brain to work correctly.)

11

Alternatively, you could look for a CPAP user affinity group on social media, connect with people who use the sizes you don’t need, and arrange some trades, like the SDMB does with postcards/greeting cards…

12

I’m going back and forth on getting a CPAP machine.

I’ve had issues with snoring and minor apnea, but after a bout of Covid (my first) in July, it was much more noticeable. So I just recently finished the process of first appointment after PCP referral → interview → at-home sleep study → review.

The results? Mild Obstructive Sleep Apnea, which is in line with my personal (if groggy) evaluation. No central (deep sigh of relief), and over the course of 8 hours, only 3 full stops, but 86 partial obstructions with noticeable drops in blood oxygen and increase in heart rate.

The thing is I don’t use my health insurance much beyond preventative care, so most of my deductible remains - I’d be paying 80-90% out of my pocket. And the further I put Covid behind me, the closer I get to my prior levels of snoring/apnea, which while irritating, don’t quite justify over a grand of out of pocket costs.

Right now, for various reasons (appearance, health, being far to close to the edge of pre-diabetic in the last PCP physical) I’m working on weight loss. Slow but steady, which will also improve things, although to get to the goal BMI is probably going to take 2-3 years given fudge factor for holidays, etc.

So I totally sympathize with the OP - I don’t think it’s a racket, but it is 100% part and parcel of our for profit medical care system in the US.

Giving minor credit to the Sleep Study clinic I was at, they did not push me hard on the CPAP (technically APAP) - they’ll put together the prescription, and then if/when I do it, want to review, download, and customize once I’ve had 1-3 months of experience.

13

OK, there is a bit of a scammy part here. My DME supplier mails me parts, and there are two issues:

  • They set the prices such that after my insurance pays their portion, I still have to pay some of the cost. I could shop somewhere else where the total price is much lower than the total price they’re charging, but then I’d have to pay the full cost out of pocket, and the prices would be a little bit higher than I’m paying right now. So there’s a financial disincentive for me to change, and the end result is that the DME supplier is raking in big bucks on these parts. Seems very anti-competitive.

  • They send me parts on a schedule, and yeah, it’s way more than I need. Blame that partly on the insurance, I guess: they’re shipping only as many parts as my insurance will allow. But after five years, I have accumulated dozens of nasal pillows and filters, maybe half a dozen headgear sets, and about ten hoses. Some of it’s on me, I guess, in that I don’t swap out parts as often as I should. But if they still work, and I’m not getting infections (yes, I clean stuff!), then it seems wasteful to toss things just because X days have gone by. Anyway, I now have a pretty big box with maybe $1000+ worth of CPAP parts in it.

Are you paying anything out of pocket for this stuff? If they’re sending you parts you don’t order, you should be able to refuse shipment (or refuse payment).

14

I’m a bit puzzled. We get our supplies from a local company. We went to the store front in person to get our machines. They fit us for masks, and set up the machine. We get hoses, masks, etc. through the mail when we order. We both had to more or less rent to own the machines through insurence. When hubster’s 4th. Machine started to malfunction, the DME company provided a loaner until the found his old one was just old and needed replacement.

15

Only in the sense that you have to pay for a replacement, not that you can’t get a replacement. That’s an issue with insurance, and possibly lack of warranties on the equipment. It’s like dentistry, glasses and hearing aids – just not covered by most insurance.

My current replacement CPAP that I got when my old one started shutting off at random, I managed to buy somehow without a prescription. I can buy all the peripherals (mask or mask parts, hose) without a prescription. But I guess I’m going to have to get another sleep test when this one breaks down. It’s probably more than 10 years old at this point, so it could happen any time. I’m hoping I can do one of those at-home sleep tests that I have read about.

16

Lots of people don’t use their CPAP’s adequately (as much as is considered necessary in order to substantively reduce OSA), so I’d imagine they’re vetting people in the hopes of increasing compliance, along with any other motivating factors:

CPAP compliance is generally defined as using a CPAP machine at least four hours a night during at least five nights in a week. Unfortunately, nearly half of people prescribed a CPAP machine use their device less than four hours each night. Even in those who previously had good CPAP compliance, symptoms of OSA can return after just one or two nights of insufficient use.

17

Maybe Lumpy wants them?

18

I have a BiPAP machine which has dual pressure for inhale and exhale. The price for a new one runs about $1200.

A CPAP machine seems to start at closer to $500.

Its not a bad investment at all. I haven’t personally noticed any benefits, which sucks. Mine even tells me how many AHI I have per hour. Some bad nights I have 7-8 AHI, but most nights I have <2. I kept hearing how I’d have more energy, my depression would improve, blood pressure would improve, etc. I didn’t notice any of that. I think the only benefit I’ve noticed is I have fewer nightmares. I still use it though since it lowers the risk of cardiovascular disease.

19

I bought my extra machine on Ebay. It was roughly the same type and set to the same numbers already. Only $250 used.

The last time I ordered on cpap.com, they insisted on a prescription before sending a new mask. Have they always done this, or did something change? I can’t remember whether I gave them a prescription copy years ago or not.

20

I’ve bought parts and supplies for my travel CPAP from Amazon, no prescription required. I bought the CPAP itself from somewhere else, and they did require a prescription for that.

According to these guys, you do need a prescription in order to buy an “assembled mask” (this is distinct from the CPAP device itself):