20 January 2019

Why CPAP Referral should NOT be required?

“Simplicity is a great virtue but it requires hard work to achieve it and education to appreciate it. And to make matters worse: complexity sells better.”  - Edsger Wybe Dijkstra (Dutch Essayist & Scientist – 1930 - 2002) 
A CPAP fixed pressure machine applies the same pressure all night. It is like a leaf blower that people use in their yards in that all it does is blow air. Should you require more pressure; a person can go into the settings and turn the knob to increase the pressure. There are plenty of YouTube videos on how to adjust the settings on the machine. The sleep medical specialists have made CPAP therapy complex when it is Simple! Why a CPAP Referral to a Sleep Specialist or a Prescription should NOT be required for majority of people?

The sleep apnea therapy for obstructive sleep apnea is Simple. Yes SIMPLE! Contrary to what the sleep medical specialists and others working in the industry are saying, it is NOT complex. The sleep apnea machine is like driving a car. If you have learnt to drive a car or record a program from the television or as a diabetic to inject yourself with insulin then you can drive a sleep apnea machine. 

On the blog pages Why is CPAP Compliance Rate Low? and Secrets to Success: Answer is FREE, I mention that there is an estimated 80% or more than 15 million people who are non-compliant, failing and non-successful on sleep apnea therapy. The sleep medical specialists and the equipment suppliers say that the high non-compliance and failure may be due to the patient. They take little responsibility for the high non-successful rate of patients. 

From various articles and from my own personal experience and from others detailed on the various sleep apnea forums, it is clear that a number of the medical specialists and others working in the sleep industry are arrogant, lacking any understanding of the issues that patients are facing and above all, have a lazy attitude to educating themselves and their patients as to how these machines truly work. As the specialists are not educating themselves and their patients, it will be up to you to educate yourself! 

The best technology is now available with fantastic machines and equipment such as the various masks. Use this technology to achieve what you want in life, fully rested and energized! Together with asking questions on the various sleep apnea forums and downloading a free copy of Sleepy Head or OSCAR software (listed on right hand side) a person can educate themselves and understand the results and take action as required. Tens of thousands of people have already done so!

By asking questions on the various sleep apnea forums, you will get a much faster answer than from a sleep medical specialist and be able to educate yourself from the veterans who have many years’ experience on the various sleep apnea machines. 

For the above reasons, a CPAP Referral or Prescription should NOT be required for majority of people. 

Why not let people have access to a CPAP machine without a prescription? Even better, allow patients to have an Auto Adjusting CPAP machine which only applies extra pressure as required during the night and to do so at a reasonable cost. This should make therapy much improved for many patients in relation to patient comfort and compliance. Further, the auto adjusting machine can be used as a CPAP fixed pressure machine should the patient wish to do so. 

In December 2018, Dr Barbara Philips, a sleep medical specialist made comments that consideration should be given to not requiring a prescription for CPAP therapy. In addition, in reply to the question: Could a person hurt themselves with a CPAP machine? Dr Phillips replied: 

“The only way you can really hurt yourself with CPAP is if you have heart failure. People with heart failure should be cautious about CPAP and should start CPAP only after evaluation and prescription from an expert in sleep medicine.”
You can read her full comments at: https://www.cpap.com/blog/sleep-specialist-no-rx-cpap-therapy.     

Did you know that in Hong Kong, a prescription is not required? Further, in Canada whilst a prescription is advised, it is not mandatory. Do the sleep specialists in these countries know something that other countries are not aware of? 

Refer to the International CPAP Survey Results at: https://worldsleepsociety.org/cpap-survey-results 

In addition, a CPAP Prescription or a Referral to a Sleep Specialist should NOT be required for majority of people so that the CPAP machine is made more accessible to people with obstructive sleep apnea. CPAP therapy assists in preventing heart attacks, strokes and other serious health issues as well as to assist in reducing motor vehicle accidents due to people “falling asleep.”  

What is preventing the major sleep equipment providers such as ResMed and Philips Respironics from selling the CPAP machines direct to Pharmacies and Chemists? These companies can also provide education and training to the Pharmacist and their staff? In addition, the Pharmacist will likely know the patient or customer much better than the sleep medical specialist due to dispensing medical and other health supplies to them on previous occasions. 

The Pharmacist can have the patient complete a health checklist and do a Home Sleep Study to see whether the patient has sleep apnea. For those patients who have been diagnosed with sleep apnea; it is estimated 80% of them have obstructive sleep apnea (OSA) requiring a CPAP machine. Obstructive sleep apnea is when the throat muscles obstruct your upper airway, blocking air from entering and leaving your lungs.  

The Pharmacies can sell the CPAP machine and educate and spend time on a regular basis with the patient. I'm sure you will agree that it is no different to dispensing over the counter medicine. This will overcome the current issues with sleep medical specialists outlined above and will provide a more personal service to the patient. 

By initially doing a home sleep study rather than a full study in a hospital, most patients should sleep a lot better in their own bed. This is most likely going to lead to much better outcomes for the patient than is currently happening around the world and the low compliance rate which may be as low as 30%. 

During and after a “trial” period of say 30 days on CPAP, where the patient is having issues such as central apnea, referral to a sleep medical specialist is necessary. In addition, referral will be required before any home sleep study is done should a patient have existing health issues such as COPD (Chronic obstructive pulmonary disorder) and heart conditions. 

A CPAP machine may cause many side effects and issues for the patient such as insomniaweight gain and mask problems and issues. In such instances, the Pharmacist and their staff will be more readily available and offer assistance than a sleep medical specialist who may not be available to see the patient for a few months. They will also eliminate or reduce any stress and anxiety that the patient may have by staying in ongoing contact with the patient. Especially as the patient may be experiencing a lot of pain and suffering and having terrible sleep. 

An additional reason using a CPAP machine is simple and that a CPAP Prescription should not be required for majority of people is that on the latest model of the Philips Respironics DreamStation CPAP machine there is a setting called CPAP-Check (C-Check) mode. Every 30 hours of therapy use, the machine can adjust pressure automatically up or down 1 cm H2O as required. There is a limit of up or down 3 cm H2O on the CPAP-Check Pressure setting.

This is a fantastic feature especially for those patients who live in remote locations or some distance from a sleep specialist and/ or whose cellular communication or internet connection is not good. Also, it may not be practicable for some patients to see a sleep specialist on a regular basis. 

Since starting on CPAP, I have purchased out of pocket, 2nd hand or used Auto Adjusting CPAP pressure and Bilevel or BiPAP auto adjusting machines. I have taught myself how to use these machines and to truly understand how these machines work without any medical training and no science or engineering background. Now I wake up feeling refreshed and energized each day. Details are on the blog page The Secrets to Success using CPAP and Bilevel

Using a CPAP machine is simple and a prescription or a Referral to a Sleep Specialist should NOT be required for majority of people. The exceptions would include where the patient has existing health conditions such as heart conditions and the health checklist and/ or home sleep study suggests referral to a sleep medical specialist is required. 

Should you be having issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day. 

“Have courage. Be adventurous and Go for it! Overcome your fear.” 
- Mrhelpful

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