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From: want - cpap on 12 Jan 2006 13:02
Does anyone know of source for new auto CPAP machines without a
prescription? Looking for a PB 420E
From: David H on 12 Jan 2006 14:16
want - cpap <ask(a)youmayget.com> writes:
> Does anyone know of source for new auto CPAP machines without a
> prescription? Looking for a PB 420E

I suspect used may be the only way.

Curious, if you know you have a problem, someone obviously Dx'd you at
some point. A prescription may be a phone call away.

From: want - cpap on 12 Jan 2006 18:47
On 12 Jan 2006 13:16:05 -0600, David H <david(a)invalid.com> wrote:

>want - cpap <ask(a)youmayget.com> writes:
>> Does anyone know of source for new auto CPAP machines without a
>> prescription? Looking for a PB 420E
>
>I suspect used may be the only way.
>
>Curious, if you know you have a problem, someone obviously Dx'd you at
>some point. A prescription may be a phone call away.

No, I have not been diagnosed, but I know I snore very loudly, and my
wife has said & recorded me, so I do have the stopping of breathing
for like 5 or 10 seconds. I don't have any of the other symptoms I've
read about, tiredness, falling asleep in the daytime, etc., but I am
overweight, and I have never had my tonsils or adenoids removed, which
did give me problems as a kid. I probably have a mild case, but the
snoring is not mild to my wife. I have a friend who has access to the
machines & settings and he set loaned one to me for a weekend,
downloaded the results and reset it. He said that I had 7 apneas(?)
over the 3 days while wearing the thing, and reset it for I think
between 7 & 16? I've been wearing it for the last week or so with good
results. Anyway, it really does work well. My wife was freaked and had
to keep touching me to make sure I was still alive, I was so quiet. I
didn't get any "euphoria", extra energy or anything upon waking, but I
did sleep better, only waking when the mask leaked a few times and it
went into overdrive trying to overcome the loss of pressure. Also I am
loath to be diagnosed as OSA since it will cause problems with my
Pilot's Medical Certificate. The morass of FAA bureaucracy is
astounding - a friend went thru it, didn't fly for nearly a year,
dropped over $3000 in "tests", and now has to re certified every year
for the rest of his life, even though he has it entirely under control
and never showed any evidence of daytime sleepiness, which I agree
should make you think twice about flying an airplane. Anyway, I would
just prefer to buy a new machine of the type I want , then a used
machine that I know nothing about. As far I have been able to find
out, my HMO doesn't cover this stuff anyway, until every last possible
"cheap" solution has been tried. This machine seems like a good quick
reasonable solution.
From: Andy Hall on 12 Jan 2006 20:43
On Thu, 12 Jan 2006 23:47:46 GMT, want - cpap <ask(a)youmayget.com>
wrote:

>On 12 Jan 2006 13:16:05 -0600, David H <david(a)invalid.com> wrote:
>
>>want - cpap <ask(a)youmayget.com> writes:
>>> Does anyone know of source for new auto CPAP machines without a
>>> prescription? Looking for a PB 420E
>>
>>I suspect used may be the only way.
>>
>>Curious, if you know you have a problem, someone obviously Dx'd you at
>>some point. A prescription may be a phone call away.
>
>No, I have not been diagnosed, but I know I snore very loudly, and my
>wife has said & recorded me, so I do have the stopping of breathing
>for like 5 or 10 seconds. I don't have any of the other symptoms I've
>read about, tiredness, falling asleep in the daytime, etc., but I am
>overweight, and I have never had my tonsils or adenoids removed, which
>did give me problems as a kid. I probably have a mild case, but the
>snoring is not mild to my wife. I have a friend who has access to the
>machines & settings and he set loaned one to me for a weekend,
>downloaded the results and reset it. He said that I had 7 apneas(?)
>over the 3 days while wearing the thing,

Typically the results reported by the machine (I have one) are number
of apnoea events for a night, although it could be cumulative for the
three days.

Either way, 7 apnoea events in either a day or 3 is in effect, zero. A
patient with a bad OSA case can have 50+ apnoea or hypopnoea
(limitation, of air flow due to partial collapse of airway) events per
hour. That would be a very different proposition.



> and reset it for I think
>between 7 & 16?

This ia probably the pressure limit settings for the machine in cm of
water. Most autotitrating machines default to a range of 4 to 20cm
but have a facility to set upper and lower limits.

Try to get the pressure stats as well. The machine should have
maximum, 95th percentile and median pressures. Based on what you are
saying, I would expect all to be near the low end for almost all the
time.


> I've been wearing it for the last week or so with good
>results. Anyway, it really does work well. My wife was freaked and had
>to keep touching me to make sure I was still alive, I was so quiet. I
>didn't get any "euphoria", extra energy or anything upon waking, but I
>did sleep better, only waking when the mask leaked a few times and it
>went into overdrive trying to overcome the loss of pressure. Also I am
>loath to be diagnosed as OSA since it will cause problems with my
>Pilot's Medical Certificate. The morass of FAA bureaucracy is
>astounding - a friend went thru it, didn't fly for nearly a year,
>dropped over $3000 in "tests", and now has to re certified every year
>for the rest of his life, even though he has it entirely under control
>and never showed any evidence of daytime sleepiness, which I agree
>should make you think twice about flying an airplane. Anyway, I would
>just prefer to buy a new machine of the type I want , then a used
>machine that I know nothing about. As far I have been able to find
>out, my HMO doesn't cover this stuff anyway, until every last possible
>"cheap" solution has been tried. This machine seems like a good quick
>reasonable solution.

Generally, it is not a good idea to use a CPAP machine without having
had some form of diagnostic test. More common, because they are
cheaper in terms of initial purchase price, are fixed pressure
machines. These are set up, normally after a lab test where a
technician adjusts pressure while the patient sleeps (titration test);
although in some countries it is more common to use an autotitrating
machine to do the job and then to use the figures to set a fixed
machine.

However....... there is a small risk, in certain patients, that
excessive pressure from a CPAP machine can trigger another form of
apnoea callede central apnoea. Basically, this is a range of
conditions where parts of the brain and or nervous system are
implicated - i.e. the normal mechanisms for inhale/exhele are not
signalled properly. In these cases, the patient is partly aroused
from sleep from the effect of a change in blood gas composition.
It is also possible (although seems to be very rare in adults without
other breathing disorders) for excessive pressure to trigger the
stretch receptors in the lungs and fool the brain that breathing has
happened.

THerefore for these, but more typically because an apnoea patient
could have other compromised health issues, in most countries, CPAP
machines are prescription only and suppliers will not deliver them
without a prescription within their own legislative area. They might
to another country.

So one has to say that what you are suggesting is not without risk,
although autotitrating machines are designed such that they can detect
and deliberately not respond to central apnoea events involving >10cm
pressure.

I can see your motivation for not wanting to go for OSA diagnosis. In
some countries, OSA screening is actually done with an enhanced form
of autoCPAP machine with additional sensors and is very effective for
diagnosing those with >70 or <50% likelihood of having OSA. Borderline
cases can then be referred for a more complex test such as a
polysomnogram (PSG). In many areas of the US, I understand that PSG
is the first diagnostic test used - it certainly picks up most sleep
disorders and in more detail, but it costs (in one way or another).

Given what you've described, I would have thought that discussing with
an ENT specialist would be more appropriate. Do take care about the
basis for this however. While it may be reasonable for certain
procedures such as adenoid or tonsil surgery to be carried out, there
are some surgical procedures that have and in some cases are still
carried out for OSA. Generally, these are a bad idea when they
result in tissue removal, such as UPPP, since they can make matters
worse and may not be reversible.

There may be some even simpler solutions such as sleeping on side
instead of back, avoiding alcohol in the evenings (relaxes the
airways) and, dare I say it from a position of weakness, taking on the
kilogrammatic challenge.


--

..andy

From: normc on 12 Jan 2006 21:21
want - cpap wrote:
> On 12 Jan 2006 13:16:05 -0600, David H <david(a)invalid.com> wrote:
>
>
>>want - cpap <ask(a)youmayget.com> writes:
>>
>>>Does anyone know of source for new auto CPAP machines without a
>>>prescription? Looking for a PB 420E
>>
>>I suspect used may be the only way.
>>
>>Curious, if you know you have a problem, someone obviously Dx'd you at
>>some point. A prescription may be a phone call away.
>
>
> No, I have not been diagnosed, but I know I snore very loudly, and my
> wife has said & recorded me, so I do have the stopping of breathing
> for like 5 or 10 seconds. I don't have any of the other symptoms I've
> read about, tiredness, falling asleep in the daytime, etc., but I am
> overweight, and I have never had my tonsils or adenoids removed, which
> did give me problems as a kid. I probably have a mild case, but the
> snoring is not mild to my wife. I have a friend who has access to the
> machines & settings and he set loaned one to me for a weekend,
> downloaded the results and reset it. He said that I had 7 apneas(?)
> over the 3 days while wearing the thing, and reset it for I think
> between 7 & 16? I've been wearing it for the last week or so with good
> results. Anyway, it really does work well. My wife was freaked and had
> to keep touching me to make sure I was still alive, I was so quiet. I
> didn't get any "euphoria", extra energy or anything upon waking, but I
> did sleep better, only waking when the mask leaked a few times and it
> went into overdrive trying to overcome the loss of pressure. Also I am
> loath to be diagnosed as OSA since it will cause problems with my
> Pilot's Medical Certificate. The morass of FAA bureaucracy is
> astounding - a friend went thru it, didn't fly for nearly a year,
> dropped over $3000 in "tests", and now has to re certified every year
> for the rest of his life, even though he has it entirely under control
> and never showed any evidence of daytime sleepiness, which I agree
> should make you think twice about flying an airplane. Anyway, I would
> just prefer to buy a new machine of the type I want , then a used
> machine that I know nothing about. As far I have been able to find
> out, my HMO doesn't cover this stuff anyway, until every last possible
> "cheap" solution has been tried. This machine seems like a good quick
> reasonable solution.

FWIW:
1. Snoring is not, necessarily, a symptom of sleep apnea. Many people,
who do not have sleep apnea, snore.
2. Cpap was not designed/developed to stop snoring; however, those with
OSA, who snore, have reduced, if not eliminated, snoring using xpap.
3. I doubt that you would qualify for a cpap (even one from Awake in
America, as I suggested in another forum) with 7 apneas in 3 days (sic).
People with sleep apnea experience scores of events in an hour. You
would not even be diagnosed with sleep apnea, by a professional.
4. Why 'a friend' would continue to risk your health, after learning
you really don't have apnea, evades me.
5. In the case of apneic events of one spouse, the other spouse helps
to diagnose possible OSA by noting the lack of breathing, not being
quiet, which seems to be why your wife had to keep touching you to make
sure you were still alive.
6. You are right-on with regard to the FAA. The FAA desires to protect
the rest of us from those who don't realize the significance of sleep
apnea. Other pilots have posted here; however, they _DID_ have OSA.
IMHO, you don't. So I'm not sure what your concern is.
7. I, personally, would be reluctant to accept your statements about
the FAA. You clearly have a vested interest here.
8. Not sure what 'stuff' your HMO won't pay for. They will probably
pay for a test that will show that you don't really have apnea. I
wouldn't expect them to pay for a cpap, if you didn't have OSA.
9. From what you've written, your wife appears to have major issues
with your snoring. I would suggest that you vigorously pursue surgery
for your snoring. Tell your HMO you want to see a maxillo-faciale
surgeon to get an endoscopy (with video) of your airways. Before you
do so, make a list of all the problems you are having as a result of
your snoring. For example: You can't sleep. Your wife can't sleep.
You are both developing cognitive deficits, frustration, anger, and
depression from lack of sleep.

My apologies if you feel I am picking on you. However, I wouldn't have
taken the time to think about your problem(s) if I didn't want to help.
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