My problem is that it looks like you are sleeping with an alien on your face... It's disgusting...
6
My last partner clearly had sleep apnea and I urged him to get it diagnosed and treated. He went as far as getting a referral for the sleep study but never followed up. He was stubborn about it and that was that.
We broke up when he told me he didn't want to make a commitment to someone a few years older than himself because he wanted to be sure his wife could take care of him in his older years. I was clearly more fit and in better health than he but no matter. He was in his mid forties, I in my mid fifties. We ended the relationship.
I moved away and we lost touch but a couple years ago I found an article about his company and mailed it to him.
The reply came from a friend now living at his old address who included the obituary of my former partner. He had died of a sudden heart attack at age 59. It's a shame; he was a very intelligent, funny and creative soul. But stuboorn and short-sighted...
29
One thing that's overlooked here is how environmentally-unfriendly CPAP is. I am sent tremendous quantities of unrecyclable plastic attachments for my machine and if I refuse them, my insurance looks askance at my usage stats. I would hate to see CPAP machines being given out to people who don't even need them, "just in case."
14
Plumberb of CA described his suffering of sleep apnea which involved waking up after thrashing and kicking and swinging fists thinking it was a result of a deep seated hatred towards his wife.
I went through the same. Loud snoring, sleeplessness, punching my husband in my sleep and waking often at 4am.
Then we separated and all the symptoms went away.
True story. Sometimes we are just meant to sleep alone. Sometimes the threat to one's health doesn't come from within.
7
After resisting for a number of years, I finally had a sleep test 15 years ago and have successfully used CPAP since then. My wife reports much more peaceful nights both for me and herself. In line with the authors' comments about unnecessary costs, I find that the life of my machine of close to 10 years is now about over. However, despite that monitoring of my use has shown I use the machine every night, to obtain a replacement machine, my insurance company requires another sleep test. This is absurd and the inconvenience and cost is not warranted. Worse, since I have lost considerable weight recently a "sleep test" my not report actual apnea episodes, despite the fact that I still snore and have myoclonic jerks if I fall asleep without my mask. Another payday for the medical industrial complex. (And I am a retired physician).
23
My experience has been this: fortunately I went to a good clinic for an in-lab sleep test. I was lucky in that they told me I only had moderate sleep apnea and only If I was sleeping on my back. I could'nt make CPAP work, but I got a strap-on back pillow called ZZOMA that forces me to sleep on my side and I found that worked for me much better.
7
My experience has been this: fortunately I went to a good clinic for an in-lab sleep test. I was lucky in that they told me I only had moderate sleep apnea and only If I was sleeping on my back. I could'nt make CPAP work, but I got a strap-on back pillow called ZZOMA that forces me to sleep on my side and I found that worked for me much better.
2
In some countries this will mean you lose your driving license - Sadly this may stop people from getting help.
2
Medicare will not cover the test andtherefore sppleental ins will not cover the test. Vote for the candidates who want to create healthcare for all.
11
I went to a sleep study overnight and it was totally worth it. Getting used to a CPAP machine was easier than I thought and got used to it within two weeks. The best benefit was as solid night’s sleep. Which I have had for more than 10 years. They are much smaller today and conveniently pack for travel. And much quieter than when I first used one. My wife doesn’t have to hear me snore anymore; another benefit. I encourage anyone who is even slightly suspicious of their sleep pattern to get tested.
13
I resisted getting tested for sleep apnea for a long time, even though I strongly suspected I suffered from it and had been urged by people close to me to get tested. In retrospect, I think it was probably an aversion to the idea of spending a night in a sleep centre which made me procrastinate for years (something I now deeply regret).
Common symptoms are snoring and falling asleep while driving. My snoring was extremely bad and I fell asleep while driving numerous times. Finally, I had a car accident when falling asleep while driving on a highway, and escaped severe injury or (more likely) instant death only through a miraculous bit of luck. That scared me into action, and I called my doctor immediately. The test was done at home and as suspected showed severe sleep apnea. I trialled three CPAP machines for free (one week each) before selecting the one I liked me best. It took a week or so to get used to being masked and attached to it at night, but the difference in quality of life was immense. My doctor had told me that untreated I was getting about 3 hours worth of rest even when I managed to sleep 8 hours, due to not being able to enter deep sleep. My health drastically improved, I was far more rested and productive, and much happier. I strongly recommend testing to men over 40 suffering from chronic fatigue, especially if exhibiting other symptoms. On a side note, I am a lifelong insomniac, and using the CPAP has made it far easier for me to fall asleep.
12
I was diagnosed with sleep apnea. I stopped breathing 60 times per hour.
For the diagnosing they gave me a small machine to wear. Easy. Nothing to it.
The next day i returned the machine to the hospital. A week later i met with the sleep specialist. She told me the outcome of the test. Two doors down was the rep from the Cpap manufacturen. I was given a machine and explanation. The same night i used it and what a difference. The mask didnt bother me at all. No longer did i feel sleepy during the day. My energy level improved and i lost a lot of weight. The total cost to me??? ZERO.
Why? Because i had moved back to Europe for healthreasons and this was 100% covered as are 99.99% of procedures and medications. My monthly Premium is 110 euro. Living in the US was bad for my health.
In the Netherlands we have only private insurance. Unlike England and Canada. We truly have the perfect system.
24
Surprised not more mention is made of the "nasal patches" if the CPAP doesn't work for you they may be an interesting alternative...
5
Using BiPap saves my life. It got much easier and affordable once I got used to prowling the internet. Every bit of equipment, even replacement filters, requires an active prescription in my home state. But there's always online!
The best masks offered by my medical supplier hurt and the parts broke every few weeks ($35). They shot cold air onto my beloved's 's neck if we tried to sleep close and left nasty marks on my face. A few years ago I read about a soft mask on line, but no local medical supplier carried it or would even attempt to find it. So I bought it online ($40). It falls off a few times a night and I'm not sure it delivers air at the right pressure, but it allows me to sleep in any position, doesn't scare the cat, and doesn't leave marks.
I just replaced it through my sleep center, and my 30% co-payment is more than the online cost for the identical mask by the same manufacturer.
8
The self-adjusting CPAP machines can both diagnose sleep apnea and titrate the proper pressure. They have been available for years and the technology gets better each year. They are quite portable and there is little need for all of the nonsense the "sleep medicine" industry claims is needed through their outdated "standards of care." What should cost, at most, just a couple of hundred dollars to be tested at home ends up costing thousands. Then the other scam is double-testing, one to diagnose and one to titrate the machine to the proper pressure settings. This is no longer necessary since the machine auto adjusts and the setting (simply a range of air flow pressures that the machine will supply to the patient) can be easily set by the patient or a clinician. Of course I learned all of this only after being scammed with double testing (3000 a pop with a high deductible plan) and ripped off another 3000 for a machine I could have purchased at retail for about 600. Do the math -- nearly 10,000 out of pocket!! And there are many studies that prove all of this, but the sleep medicine industry and the hospital-affiliated sleep labs don't want to give up their cash cow. And beware the sleep medicine doctors that do not reveal that they have a financial interest in the sleep lab.
27
how the health care/insurance industries treat sleep apnea reflects exactly just how flawed the American healthcare system is. Once diagnosed you only need an occasional reading of your data chip to make sure you don't need adjustments. Instead "sleep doctors" - most of whom also own their own sleep centers insist on 6 month checkups and periodic sleep tests. technicians could easily oversee this treatment. this is an important treatment but the medical profession is making an unnecessary
killing off of it.
10
Really unfortunate you failed to discuss central apnea, a condition with a similar name but possibly lethal consequences if untreated. I have it and depend on a BIPAP machine to not die while sleeping. Recently I showed up for a colonoscopy appointment, got all hooked up on the table, then discovered whoever wrote up the orders, and whoever reviewed and approved them, didn't notice they had entered "obstructive" apnea instead of "central", which requires full sedation in a hospital. I could have had a seizure or stroke when they put me out, and died right there. Turns out the medical institution I utilize doesn't distinguish between the two conditions, probably because they both use the same word "apnea"...
11
Here's a better idea to save money. Why do "sleep" doctors even need to be involved with CPAP usage? I had an expensive home sleep study. My doctor wanted the outrageously expensive in house private sleep lab study. When he found out my insurance wouldn't pay he immediately lost interest in me. I got my machine and the air blew so hard I couldn't use it. He adjusted it and said he'd see me in 3 months. It was still unusable. In three months he adjusted again. Still unusable. If I only had a simple knob to adjust the air pressure to a comfortable level. But no, the doctor has to do the adjustment. Now the CPAP sits in the closet unused. Lots of money wasted.
6
@Mary - These machines typically have an easy way to adjust the pressure. eg: on the Resmed Airsense10 Elite if you press and HOLD the "home" button and press the round knob in the front at the same time a "clinical" menu option suddenly pops up at the top of the small screen where you can adjust the pressure yourself. They don't tell you about it but it's there (I googled and found how to do it). I found using the machine did help and when I bought a better pillow (firmer) it made it (the results) even better. I was using a soft pillow before.
14
I had a friend tell me, after sharing a room one night, that he thought I had sleep apnea. So I went to a contractor used by my health plan for a sleep study at home. The device used was quite difficult to employ properly, and interrupted my sleep all night. I slept perhaps an hour, but the contractor next day promptly advised I had severe sleep apnea and advised that I come back to be fitted for a CPAP device which they would supply.
I think that’s a serious conflict of interest. Diagnose and then profit from positive results.
Subsequently, I shared rooms with others several nights; no snoring nor gasping for breath noted. I used a recording app on my phone next to my bed for several nights and never heard anything but normal breathing sounds.
I do believe sleep apnea is a real and dangerous condition. But I also think the model in California regarding smog control on cars should be used here: you get diagnosed in a shop that, by law, cannot offer repair.
19
I'm a Canadian. From diagnosis to arriving home with my gleaming new machine took about four weeks. I was not out of pocket a dime. The thing changed my life and I never miss a night. Coverage for all!
35
My husband and brother both adjusted to their CPAP machines overnight and after their first nights said they had had their best sleep in years. So, when my sleep study showed that OSA was responsible for the fatigue that had caused me to put away my car keys and spend months not doing much more than lying on the couch, I was eager to use my new machine. What an initial disappointment! It took several unpleasant weeks to adjust. But adjust I finally did: I was able to use the machine comfortably, and my health was restored. Those of you just starting PAP therapy, don’t give up if it’s hard at first! And to echo the advice of others in the comments, check out the forums—they help immensely.
16
I suffered from sleep apnea for years.To wake up choking and gasping for air is a very uncomfortable and frightening ordeal. I finally got a machine and it did help, however, during that time I also went on diet and lost 20+ pounds. The machine eventually stopped working but the apnea never returned. I am convinced that my weight had substantial role in the original condition and I would encourage anyone suffering from sleep apnea to look into the connections of excess weight being a contributing factor in the condition.
15
@Blake
Good advice. However, some people, like myself, have sleep apnea even though we are thin. It’s called “central sleep apnea” because the problem is in the central nervous system and not an obstruction. My brain forgets to breathe, then remembers when the oxygen alarm goes off. In the process, my sleep is disrupted.
14
@John
Thanks for the reply. I am not suggesting that everyone who suffers from Sleep Apnea is overweight. My point is simply this... During all the tests and consultations regarding my Sleep Apnea, not ONE Doctor, therapist and or advisor ever asked me about my weight. This seems to me one of the first issues to be addressed in the early stages of developing a plan to ease the symptoms of Sleep Apnea. Yet, again, no one ever addressed it. My impression, based on my experience, is that the medical profession is in the business of selling machines to ease Sleep Apnea symptoms and the focus of those efforts deliberately exclude natural remedies such as weight loss. I have been off the machine for over two years now and I am a witness to that of which I speak.
11
I don't know anybody who has taken a sleep apnea test and came out without sleep apnea. They got me when I was in ICU after surgeries for a ruptured brain aneurysm with a subachranoid hemorrhage stroke. I was on a BiPap in ICU then sent home to figure it out from there. My doctor either doesn't know anything about what is going on or doesn't care. I could go out on the street corner and stop anybody and they would know more than my provider. I had a 70 in the hospital with a CPap and went to.9 with the BiPap. That started the upward climb and last night I had 21 7. I would think something is wrong but a trip to the sleep doctor and provider and I had some comfort settings adjusted by the provider and a 21.7 is better than 70 from my sleep doctor. His answer to the problem was possibly give me a stimulant for my daytime weariness and then asked me what I thought we should do. I don't know, maybe I could check with Dr. Google and get some ideas.
Sleep apnea, CPap and BiPap and all the other Paps are the biggest money makers the medical industry has found in a long time and as long as every article I read goes back to it being a way to stop snoring, nothing will convince me of anything else. And I have started snoring since using my BiPap and my sleep doctor sees nothing wrong with that at all. Somebody must have forgotten to tell him we are trying to stop snoring, not start snoring. Snoring bad, not sleeping worse but it's a cure...if you don't sleep, you don't snore.
10
Indeed, most sleep centers and sleep doctors have not facilitated the patient's journey for diagnosis and treatment of sleep apnea. Nor have they been honest about effective treatments for sleep apnea. Clinical studies show that CPAP is often not effective because many (if not most) CPAP users do not use their treatment for the entire night, or abandon soon after receiving the CPAP. As a head and neck cancer surgeon, I learned the importance of providing treatment options to patients with life threatening throat cancers. Now providing sleep apnea treatment in NYC exclusively with home sleep testing, and oral appliances as a first line treatment, and CPAP as a back up or for very severe cases, we diagnose and treat within 24 hours, and provide treatment options to our patients . It can be done! I created the BlueSleep center 10 years ago to solve just the problems described by the co-authors. But it was not at all clear from the article, that CPAP is not the best treatment for most people with sleep apnea. Our findings on the effectiveness of oral appliance therapy (Mandibular advancement devices)have been presented and published in the medical and lay press. Jordan C Stern, MD. Founder and Director, BlueSleep
7
@Jordan C Stern, MD I'll look into that, thanks for the suggestion. CPAP is what I use and another method was not suggested. Your solution would be easier, and would be helpful if it works during camping trips.
6
@Jordan C Stern, MD Thanks for the advice. I use a CPAP and I don't have any problems with it but I would much prefer something simpler.
2
Kudos to Carroll & Frankt for being disciplined "honest analysts" and NOT claiming, or even mentioning, that CPAP leads to better cardiovascular outcomes, because it has been shown in the most rigorous tests, randomized controlled trials, to not have any significant effect.
See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541330/
and, e.g., https://www.nejm.org/doi/10.1056/NEJMoa1606599
As CPAP advocates, I am sure they were greatly tempted to mention something, but they didn't, to their great credit. It makes me want to trust them on other things that they analyze and write about.
That said, their claim that CPAP "is associated with improvements in insulin resistance," is very, very flimsy, as their own cite, objectively read, indicates. There is no good RCT evidence of this and possible mechanistic explanations appear overreaching. Any diabetes associations are likely related to obesity, not night breathing, and even there it is unclear whether the obesity/obstructed-breathing causes the insulin-resistance/diabetes or whether the insulin-resistance/diabetes first causes the obesity/obstructed-breathing. Insulin-resistance is not a reason for CPAP.
But daytime sleepiness, snoring symptoms, and possibly a better mood are valid reasons, as Carroll & Flakt explain.
7
A surprising culprit used to cause me sleep apnea incidents. Through trial & error, I learned that using oil other than olive & coconut oil (for eating or on my skin, such as in moisturizing lotions) was directly related to the apnea incidents. If I used certain oil (even grape seed oil or 'edible' oil in smoked salmon packets) I woke up gasping for air that night. I inadvertently tested enough oils, over years, and now don't eat or put any oil except olive or coconut on my skin, ESPECIALLY NOT lotion with mineral/petroleum oil (99.9% of commercial lotions).
1
My advice: If you think you may have apnea or have been newly diagnosed, first read many articles on the online apnea forums such as cpaptalk, apneaboard, and freecpapadvice. Read about the problems people have, the different mask types, CPAP machines, dental devices, surgeries, and tips. If you have problems, ask people there for advice before you give up on treating your apnea.
If you get a CPAP machine, choose a DATA CAPABLE model that writes data to an SD card or has a way to download its data to a PC (most newer CPAP models do). Ask on the online forums before you buy/rent/sign up for a specific model. Then you can use the free OSCAR software to look at your data, see lots of graphs of how many apnea events you are having per hour, how many leaks, your pressure variations if an 'auto' machine. OSCAR works on Windows, Macs, Linux. People on the forums can tell you how to adjust the pressure on your machine. Start with minimal pressure but if your charts show you are still having high AHI and few mask leaks, you may need to raise it to keep your AHI (apneas per hour) less than five. Most newer machines allow you to see your AHI on its screen each morning, but that setting might be turned off by default. Typically you have to hold down 2 buttons on a machine to enter the hidden 'change settings mode' but people on the forums can tell you how to do it and tell you where to download a PDF of the DME manual for your model.
10
The difference in sleep quality is black and white. I was excessively drowsy while driving, painfully tired at work, and could notice the difference intellectually. With the cpap all the symptoms cleared up immediately. Quite remarkable.
I can't recommend this device enough, even if you have to pay for it out of pocket.
8
This is a good, objective article with a ridiculous lead photo that will likely turn off many who need CPAP treatment.
Bottom line: When you are soundly asleep instead of in the throes of apnea, you do not care about the mask or machine.
Modern CPAP technology is comfortable, quiet and health promoting, not some episode of madness like that image portrays.
8
In addition to the benefits for high blood pressure, CPAP therapy can reduce Left Ventricular Hypertrophy, enlargement and thickening of the walls of your heart's main pumping chamber. "Left ventricular hypertrophy is a common echocardiographic abnormality in severe obstructive sleep apnea and reverses with nasal continuous positive airway pressure.....LVH (Left Ventricular Hypertrophy) was present in high frequency in subjects with severe OSA (Obstructive Sleep Apnea) and regressed after 6 months of nasal CPAP therapy."
https://www.ncbi.nlm.nih.gov/pubmed/12907548
4
I was DX's with OSA about 30 years or so ago (I'm in mid-70s now), & started on CPAP. Adjusting to CPAP proved to not be difficult, & positive results were immediately evident, which made any getting used to the equipment well worth the minor inconvenience. My dad had the condition too, I'm 99.9% positive. I can clearly remember his apnea episodes - the loud snoring, sudden cessation of sleep, the explosive resumption of respiration as his sleep was interrupted. Unfortunately, back then the condition was not well-understood, & there were no effective treatments. Starting in his 40s he began a downward health spiral which I am convinced directly resulted from undiagnosed, untreated OSA - high blood pressure, stroke & finally, a fatal cerebral hemorrhage; all this at way too young an age. If you suspect you may have sleep apnea, by all means have a sleep study done. It may well result in a much better chance at a long & healthy life, as I'm sure it did for me.
8
I expect my untreated OSA to either kill me or disable me. I find this scary, not for myself but for the burden it would place on others. My wife moved to another bedroom years ago because the snoring was too much, and because my breathing stopping and starting was frightening. I experience chronic sleepiness. I sleep in parking lots. On the toilet. On public transportation. I sleep and snore through dental procedures. Movies, TV are impossible because I am asleep 20 or 30 minutes in. I also have micro sleep--where I nod off for seconds and miss whatever is going on in front of me (like narcolepsy). I am chronically depressed. I have been unemployed for 14 years (I am 66 now and still unemployed). I never manage to sleep more than about three hours at a time. I took modafinil, by prescription, for years to help me stay awake. It made me, most days, almost normal. I no longer have access to that. I appreciate hearing from others, people I've known personally or family member's stories about the the difficult process of going through sleep studies, CPAP trials and fittings and eventually arrive in a place where they feel their lives have been dramatically changed. I love hearing about positive results. I think that if I was Canadian maybe I would have had a solution years ago. Maybe my life would be different today. I don't know. Maybe, maybe not. I do know that the cost of the equipment, appointments, sleep studies, parts, etc. are beyond my reach.
4
@mjfranks CPAP treatment is available for limited or no cost to those who qualify, through such programs as CPAP Assistance. https://www.sleepapnea.org/community/cpap-assistance-program/
8
When I have a cold, sinus congestion prevents me from breathing through my nose. When I can't breathe through my nose, I can't use my CPAP machine. When I can't use my CPAP machine, I sleep badly. When I sleep badly, I don't recover from my cold.
3
@BP Nasal lavage with the appropriate liquid, non-addictive decongestants and nasal dilators can be of great help here.
4
After breaking my nose a half dozen times, I simply could not breathe through the nose without struggling for air. Heart attack (widow maker) high cholesterol, years of my wife claiming and complaining about snoring and not breathing for 10 second durations throughout the night. Testing indicated severe sleep apnea.
Opted for surgery where the nose is smashed with a hammer and the blocked nasal cavity is reconstructed. Results are I lost the annoying nasally tone in my voice, I sleep peacefully throughput the night, and occasionally awaken to my wife’s snoring.
11
@Mark wow! were you a boxer?
1
I wake up every hour sometimes. I did the oximetry and I lost oxygen in the mild range. Maybe I will go in for the next level.
However last night I tried elevated side sleeping, and I slept through the night. I can't stand anything in my nose and I may not even go for the next level appointment because the CPAP is not perfect for mild.
I also have NO risk factors so I'm thinking this may be a false positive. No snoring or gasping. Not tired when I wake up. I am 110 pounds with no other conditions. Also I have not slept through the night since I was 20 -- now 69. May just be something in my brain. Nevertheless, I am going to try deep breathing exercises and amp up my cardiovascular exercise. Did anyone even think of that advice?
1
@Mary Rivkatot... I would love to know what elevated side sleeping is !
1
Signals: My doctor brother observed me sleeping at the beach, snoring, and then being quiet. Then my right foot started to kick in the sand. This an indication of the body trying to wake itself up from a emergency no-breathing situation. He called over another doctor friend, and they observed. They diagnosed apnea. Secondly, dentists should be much more aware of diagnosing apnea. During routine visits, I complained repeatedly about super-dry tongue in the morning. The dentist never mentioned that this could be a sign of apnea (not to mention increased acidity, and thus cavities and bad breath).Thirdly, frequent nighttime urination. Prostate? Maybe not. CPAP solved all this for me.
6
@Mark My frequent nighttime urination wakes me up too -- but I have IC so is it chicken or egg?
1
It wasn't until 15 years ago when I heard an audio recording of my horrendous snoring and snorting that I took things seriously and saw a specialist and had a sleep study done. It turns out I had severe sleep apnea, my breathing stopping dozens of times per night with one apnea lasting almost a full minute. The morning I came home from the sleep study followup where the techs tested various pressures on me I felt elated, wide awake and full of energy like I hadn't had in years. In the 15 years since I have only slept without my machine maybe 10 time and each time I miss it. It truly is life changing. And the masks jeep getting smaller and less obtrusive and so do the machines.
12
@Gunnar same for me! I think back and worry what all that oxygen deprivation might have done to my brain, not to mention work performance, decision making, yawning, and sleepy driving.
4
This can be a life-changing, as well as life-saving, therapy.
Yawning incessantly at work, and having to pull over at rest areas to nap when on the road for work, my nurse wife insisted on a sleep study. The resulting diagnosis was “moderately severe” apnea where I stopped breathing over 20 times per night for over 45 seconds. I was not overweight, maintained otherwise good health, exercised, and fit none of the normal apnea patient profiles. I did, however, have a palette structure that contributed to the problem.
Since purchasing my CPAP nearly 20 years ago, I have exhibited none of the symptoms I once had. Full daily functionality was restored, and I am even healthier than before. I have become so dependent on the CPAP that I now cannot fall asleep without it.
I highly recommend it if you can get over the initial phase of getting used to the machine.
10
Sleep-on-your-side pillow for sleep apnea: Great one available in Japan, but not USA. (I viewed this on Japan World's TV channel in one of their programs called "Medical Frontiers," about Japan's solution to sleep apnea.)
Does anyone have any info on quality side pillows? The Japanese one is from head to almost full-body length; very high, say 1 ft.; and heavy -- so that it's impossible to change from being on your side while asleep. Wish I could find one like this to try in USA.
(I couldn't tolerate CPAP; nor did the tennis balls sewn into back of shirt work for me.)
6
@Lynn I wear a device that you strap on your chest with velcro which forces you to sleep on your side. It's called ZZOMA. (worked better than wiffle balls sown to my shirt back). You also can get a pulsox meter that you clip on a finger and it records your O2 saturation; then you can read it on a computer the next day.
I did the overnight sleep study and was given the CPAP and BiPAP as treatments. They didn’t work for me. I would wake up gasping for air after about 15 minutes. These treatments are good, but in my case they actually made my sleep apnea worse. I’m not over weight either, and my sleep apnea isn’t bad enough for the doctors to recommend surgery. So what’s left for me? Right now, I’m doing Smile Direct Club because the dentist said it would be best to fix my teeth before she made me a mouth guard. But we don’t even know if it’s actually going to work!!
2
@Jon
I used the sleep guard for 8 years after orthodontics in my 50's. On my recent trip to the dentist my bite was completely off. My upper back teeth were so tight I had a hard time flossing without breaking the floss. The lower bite wings had gaps between them. I was developing peridontal disease because food was being trapped between the teeth. I'm back to the sleep study with the CPAP coming. I've heard that it's difficult to get used to but so is aging.
5
PEOPLE WHO BREATHE CORRECTLY DO NOT SNORE OR HAVE SLEEP APNEA.
From Australian physiotherapist Tess Graham’s interesting and enlightening book “Relief From Snoring and Sleep Apnea.” She recommends breathing retraining, something only touched on my a couple of other commenters who mentioned regular didgeridoo playing as a fix.
These two doctors haven’t beaten sleep apnea at all. They are treating it, and that’s a good thing, but they haven’t beaten it anymore than a diabetic with an insulin pump has beaten diabetes.
2
Hi. I'm sorry but the underlying problem is that the airway muscles relax. The airway narrows and blocks. You can't retrain or exercise this problem away- the muscles, regardless of fitness or control, will always relax while we sleep. Keep your didgeridoo out of your bedroom.
4
@ss
Ok. Thanks for the opinion. I must say, your obsession with CORRECT BREATHING seems a bit odd to say the least.
2
I have used a CPAP machine for almost 20 years. My first machine was noisy, it it got quieter after some modifications several years later. I know have a six year old, more sophisticated machine that works fine. I have carried them with me around the world. Even five years ago, airport security were not very familiar with them. Now they are routine. Finding the right mask took quite a bit of trial and error each time, but my various pulmonogists were accommodating. When I first got one, I simply put it on and wore it through the night even though I kept waking up. I got used to it in a week, and now cannot sleep without it, but fall asleep in minutes with it, and wake up in almost the same position I went to sleep in. I feel better. I went to be tested because I was told that not only did I snore, but woke up gasping for breath. My father snore and snorted in his sleep, but back then there was zero awareness of or treatment for sleep apnea, so, he died in 1971 at 53. While smoking was probably the primary cause, I believe that sleep apnea contributed. Most people see is as a threat to their masculinity to get tested, and if they do, are reluctant to use the CPAP machine. I urge anyone to be open to the idea if they snore and feel tired during the day.
4
I can't sleep without a CPAP. But I can't get diagnosed with Sleep Apnea. The at-home test came back negative, but I've read that it creates a lot of false negatives. I went in for a sleep study, and I wasn't able to fall asleep and stay asleep because they wouldn't let me use a CPAP. Then they said that I hadn't had enough apneas to qualify -- well duh, I'd barely slept!
News flash: people don't abuse CPAPs. There is nothing fun or sexy or even comfortable or convenient about using CPAPs (apart from getting enough sleep for people who actually have Sleep Apnea). It's not oxycontin. If someone says they need a CPAP and if they're willing to try using one, they probably DO need one.
I like the idea of skipping the expensive sleep tests and just prescribing a one-month trial to anyone who asks for a CPAP. Then use the machine to diagnose how often apneas occurred. It's time to stop the insurance stonewalling and run-arounds and instead ensure that everyone can access the treatment their insurance is supposed to pay for.
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@Suzie Hi. I'm sorry about your situation, and it's certainly not the first time I've heard this. That's one reason why we like home sleep testing at our center- it's easier to sleep at home, of course, and it's easier to repeat the study if the first 1-2 tests don't show much apnea. No one really wants to use CPAP and they won't benefit unless they do really need it, so we assume a normal sleep test means we were unlucky on the night of testing. Apnea varies in severity night to night. With repeat studies, we eventually get enough data.
1
I could not tolerate my CPAP masks, tried 3 different ones, including the kind under your nose. I’m a side sleeper, and a restless sleeper, and could never get a good fit. I’ve also had 2 sinus surgeries.
In addition, I attended a several week behavior modification sleep clinic, which was awesome; learned a lot.
However, the thing that’s worked best for me, recommended by an ENT surgeon, were “nose stents”. After trial & error, I prefer the brand Maxi Air Nose Cones. I’m surprised I never see nose stents mentioned in articles such as this? They work great, used for 10 years, aren’t expensive compared to the alternatives, and easy to travel with.
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@A Eaton Hi. I'm really glad this has helped you, but the cause of sleep apnea is a decrease in the size of the oropharynx, the airway behind the nose. Stenting the nose has a very modest effect on the size of the oropharynx. An analogy, and I admit a poor one, would be to open your mouth and suppose that also opened up your esophagus. Nose stents are not effective for most if not nearly all people who have substantial OSA. You need to "stent" the oropharynx, and that's exactly what CPAP does.
1
You barely mention corrective surgery, dismissing it as "reserved for the worst cases." Well, yes, my case was pretty bad but my surgeon still prepared me for a long siege getting past the insurance company - he said I would need probably three more sleep studies & they still wouldn't want to pay for it. This was in 1999 & his surgery did change my life. Back then it was "23-hour" surgery - I stayed in the hospital just overnight - I wouldn't be surprised if it were outpatient surgery now. These masks are terrible - I simply could not tolerate one. I should mention that I spent time researching the best surgeon in my region for this issue & once I located him & asked my PCP for a referral, he exclaimed, "I went to medical school with him & he was the smartest person in our class. If that's who you want to see, by all means I will refer you." Instead of selling an expensive new life-long gadget, let people know about the surgery that will fix this condition - in my case, 20 years later it's still fixed.
3
@Nancy Keefe Rhodes
I'm glad your surgery worked for you but it did not for me, in fact, I learned that surgery usually doesn't work in the long term. That said, I had a UPPP 20+ years ago and it worked well for the first 3-4 years. My surgeon clearly let me know it was possible this would not be a long term solution and he was correct. My snoring began again and my wife let me know it was as bad/loud as before. I didn't want to endure the discomfort of another painful throat operation and decided to consult with a sleep specialist doctor - and yes, they do exist and it was a great decision. I did a sleep study (inconvenient but not painful) and learned I had fairly severe sleep apnea. My breathing stopped approximately 65 times per hour). I eventually found a nasal mask that I like. It's not romantic but what's more important is my wife can sleep in peace because I no longer snore. Back to your original comment about surgery - it is possible to work but statistically it does NOT work most of the time. A CPAP solution is less invasive and does work.
3
My spouse complained for years about my snoring, but I never heard it so didn’t imagine it could be so bad. I did notice that I woke up gasping from time to time and heard that this could be apnea — but that was something that old men had and I was only 55 (LOL).
Then I read that sleep apnea was associated with high blood pressure and a light bulb went off. Doctors had told me that my BP was moderately high (135/80) since my 20s, when I was a competitive athlete and the BP readings made no sense.
I’ve been using the CPAP for 6 years now, my blood pressure has gone down, and I sleep longer at night. (Yes, fewer trips to pee). One of the biggest benefits for me has been the humidifier effect of the CPAP. I’ve always suffered from allergies and “bad sinuses”, such that colds and sinus infections were frequent visitors. Now, with warm, moist air keeping my sinuses open all night, I’ve had few colds or sinus problems.
No, a CPAP doesn’t cure cancer or dandruff, but it has made my life better and is well worth getting used to the nose mask.
12
I’ve used CPAP for 1996 and wouldn’t sleep without it. Before I got it I ad surgery to stop snoring. It didn’t work, just left my septum with a big hole. I’ve had numerous sleep studies. I’m ambivalent about them. It’s true that machines today can monitors you all night. I have one that defaults to min and max pressures and I’m good to go. The big thing is finding a mask that works for you. I’ve used dozens each has pros and cons. Look for deals that have return insurance. It’s well worth the time and expense. Good luck
3
I'm in the minority here. I spent two weeks wearing the "Elephant Man" -like tubing and each morning awoke to find the tubing on the floor or on either side of my mattress. I pulled off the breathing tubes in the middle of the night because, I guess, they were uncomfortable. I know I was wrong to give up so easily but I just couldn't go through another sleepless night worrying about whether I would sleep or not. Confused? So am I. And not even sleeping pills helped. Sure, I'm tired and irritable all day; and even though I manage to catch a few catnaps. I never, ever feel fully rested. My only remedy is to watch the impeachment hearings; they send me right into the arms of Morpheus. What will I do once they are completely over? Or maybe they are and I jam just so dazed and confused. I need help on many levels it would appear.
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@Jack
As a veteran CPAP user I must say that I truly love the comedic relief. I can so relate.
3
@Jack Don't give up. We can and do take off the CPAP unconsciously at night, when first starting treatment, until by regular use our brain recognizes that CPAP is the new "normal" and should stay exactly where it is. It can take 1-2 months of regular use, sometimes even longer, before you completely acclimate to it.
6
@Jack there are some other options available MAD device, and little patches for the nose. Good luck!
1
I have used a cpap machine for 20 years. You can buy almost new machines from people who stopped using them in a week for 25% on craigslist and program it yourself.
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I am a fan of physicians generally and am loath to criticize them. But I noticed, as did the authors, that this system seems to be set up in a fee-maximizing way. First, a visit with a sleep specialist doctor who did nothing but ask me why I thought I had apnea. He then referred me to a technician, who told me how to set up the at-home sleep study device. Then a return visit for the doctor to tell me that, in fact, I did have apnea, but -- not to worry - CPAP would be utterly amazing for me in every way, including causing effortless weight loss. (Not a pound, by the way.) Then a visit to a technician at an equipment supply store to fit it. Then a return visit at 3 months to tell me that I seemed to be using it correctly. I am puzzled why a specialist would need to see me at all -- the machines and the technicians did all of the work. But the specialist got the money. (And my loathing for sleeping with a mask on my face has gotten worse and worse over 1.5 years. That was especially disappointing after the sleep doctor's hard sell.)
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@Heliotrophic Thank you so much for your comments. That's exactly why the sleep doctors at our center have in fact stepped into a supervisory role much of the time, reviewing collected data and serving as a resource for our respiratory therapists. There are situations where a specialist is needed, and we focus our physicians on those more complicated (and frankly less common) situations. We minimize copays, simplify the process of testing and treatment, and deliver medical care that we strongly feel is higher quality and more cost-effective.
Oh, and by the way, obstructive sleep apnea sometimes causes few to no symptoms. For most people, it causes sleepiness, waking at night, and other issues. For others, it can be like high blood pressure: It's a medical problem that needs to be treated, but it really has no effect on how you feel, so treatment has no effect on how you feel day to day. That can be a little frustrating, when you've been told to expect much more.
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@Stephen: I appreciate your thoughtful answer. I hope other sleep centers (such as the one covered by my insurance) begin to take the common-sense approach you describe.
1
I was diagnosed with sleep apnea over 15 years ago and have used a CPAP every night since. It restored my energy, my sex life and improved my performance at work - all great so far. Eight years ago I took a job far enough from home to warrant buying a condo and staying there most weeknights. For my sleep apnea I qualified and got a second machine to keep in the condo. Even with the most modern recording at the time no one could merge the data from the two machines. Every time I tried to order supplies through insurance the answer was the same - you are only using your machine 50% of the time and do not qualify for coverage. The supplier was Apria and they were clueless. I totally agree the system does not make treatment easily available and in my case not sustainable.
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Agree Apria is clueless. Take your chip from home and use in condo.
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@Joe: If the machine is so helpful to you and the insurance is so important to you, why not do what many people do and bring the same machine with you from home? (BTW, CPAP machines are counted as a "freebie" in terms of allowed airline luggage on several -- maybe all --- airlines.)
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@Heliotrophic I have never had an airline count them as a "freebie." Airlines also won't check bags for free for people who have medical equipment such as CPAP -- which violates the Americans with Disabilities Act.
1
I have been using a CPAP faithfully, even during naps, for nine years. I sleep more soundly and wake more rested. My cardiologist feels that the lack of a CPAP did not cause a heart attack but was definitely a contributing factor.
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@MED
Regarding using the CPAP even for naps, what I am always wondering since my relatively recent diagnosis is - is sleeping without it harmful? Thinking of sleep like that is - weird.
(me encanta mexico)
@Steel I sleep/nap better with it than without. One small think is season is the filter which if using takes care of pollen, etc.
1
@Steel
When I sleep without CPAP, my oxygen saturation goes low - effectively I'm starving my brain for oxygen. It's not good. So I also use it for naps. I don't like the thought of even a half hour where I'm suffocating part of the time.
2
My husband's sleep study showed he has mild apnea. He was prescribed an oral device that is similar to wearing a Night Guard that people wear for teeth grinding that keeps the lower jaw slightly forward. It's worked great for a few years now and is comfortable, simple to use and travel with. A lot less obtrusive than CPAP but it seems some doctors aren't aware fo them. Check it out. I sleep a lot better too and his frantic body movements while sleeping have stopped as well.
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@Rebecca I too use an "Appliance"; works for me (and my spouse!) Minimizes snoring and no more dry mouth. Mine was custom made by a dentist and expensive, but worth every penny.
2
One of the effects of sleep apnea not mentioned in the article is epilepsy. After suffering two nocturnal grand mal seizures my neurologist recommended a cpap machine. It has made a great improvement in my life.
5
CPAP works for me and every friend I know who got one. We swear by it.
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Great article, goes through the basics of what is involved. The weak link in the entire process is getting the patient to identify the most comfortable mask for their particular needs and finding the right air pressure setting that works. (medical term is titration) The 3 types of masks are made in an almost endless variety of styles with subtle variations that makes finding the right one challenging. However, once you do get to the right set up there will be no going back. You will sleep more soundly, and much longer. You will not get up in the middle of the night to use the bathroom. You will return to having dreams again, indicative of REM sleep and if male, the return of morning wood. You won't be sleepy in the afternoon and can stay up past 930 pm. In short, if you test positive, especially with a high score, the benefits are huge. You don't have to be heavy to be a sufferer, however that is a risk factor and dropping the weight would be a better 1st step if you didn't suffer from sleep apnea while your weight was normal.
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The difference in my sleep using the CPAP vs not: night and day!
2
I would never have known I had sleep apnea if it were not for my cardiologist.
As a single person, I do not know if I snore or stop breathing while sleeping. However, I would wake up a few times a night to go to the bathroom. Been doing this for a few years not thinking anything of it because I went right back to sleep easily.
I also have high blood pressure and started taking my BP in the morning regularly. I noticed my BP was excessively higher upon waking up than ever; around 170/110.
After several adjustments to medications with no change, my cardiologist said we need to do a sleep test, "You may have sleep apnea." Took the test at home and diagnosed with severe sleep apnea, scoring 31 out of 35. I stop breathing for more than 10 seconds 31 times an hour. Normal for anyone is <5 times
The sleep center and the study was covered by my health insurance, as well as the issuing of all APAP (auto adjusting pressure) equipment, with a minor co-pay. Using the machine every night since May, 2019 along with the app, scoring 5 and below. Changed to a nasal mask and no issues.
The two major things I noticed – my BP is now at "normal" readings with less medication. – I no longer wake up to go to the bathroom two to three times a night. Sleeping all through the night until the alarm goes off in the morning!
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My first sleep study failed. The second one said my breathing was normal, but the doctor wanted to give me stimulants for my day time sleepiness, which was probably caused by medication. I left as fast as I can. That was a terrible idea, based on my experience with medication.
Some years later, when the threshold for sleep apnea had been lowered, I just met the threshold but my doctor told me a CPAP was not necessary and did not suggest any other treatment. I suspect that some weight loss might help, but the doctor did not mention it.
For me, relief seems to be elusive.
@Barbara
My apnea index is just above normal, about 5.7. Even so, prior to diagnosis and treatment, I was always fatigued throughout the day. The CPAP restored my energy and my life. Many years since then, however, I switched to using an oral appliance (www.themoses.com is what I use) that pulls my jaw forward during sleep, and so keeps my airway open. It's a lot more convenient and comfortable, with way less hardware. You might consider asking your dentist and/or your sleep doctor to recommend a dentist that could fit one for you.
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@Matt I wear one already, but thanks for the suggestion. Apparently what I have is not sufficient to "cure" my problem.
@Barbara
Just offering one more potential suggestion. I had two sleep studies that did not result in a diagnosis of sleep apnea. The second one was an at-home study.
Turns out that, according to my doctor, there are different reporting requirements for the at-home tests for insurance reasons which actually results in a lower number of apnea events being counted than are actually occurring.
If you've done an at-home test, that may be part of the issue. I LOVE my doctor at Georgetown University Hospital in DC. I've gone many rounds with many doctors so she's cleared a high bar with me.
It's taken a while to get the hang of the CPAP and I had to change out the masks but when I can do it, it does work. Two siblings, though, took right to their CPAPs and are 100% compliant.
Like you, I was offered stimulants by another doctor and refused due to reactions to medications and the desire to find and fix the underlying issue. Turns out I was right to trust my instincts. Glad you trusted yours.
Good luck.
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I told numerous doctors that I was tired all the the time. I wound up self diagnosing and it turns out I have a very bad case of sleep apnea. Only took 2 days to tolerate the machine with nasal pillows. sleeping much better now.
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I banned any food in a can, box or bag from my life.
A year later, no apnea or ambulance calling neck seizing reflux. Normal blood pressure. No more needed knee surgery. No more back pain. LDL dropped like crazy. Got small eclipse, iPad, earphones and a PT who does trauma-body work. I exercised like a snail.
Take a look at normal people; see the panned parade crowds of the Kennedy assassination documentary. They are all half our size. And not on steroids either. It’s shocking to see what has happened to us.
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What is the Eclipse you mentioned?
@Ray T. Plenty of people with so-called normal BMI ranges also experience sleep apnea. It's not solely a condition of overweight folks.
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@Ed, I believe it’s a brand of elliptical trainer.
My CPAP machine is my best friend.
1
I had apnea that was solved with surgery. I don't even snore anymore. But the recovery was painful and difficult for a couple of weeks. Swallowing was like a bomb going off in my head but Gatorade helped. But now, no problems.
1
What was the name of the proceedure? It would be helpful to know, thanks.
@sob It's called a UPPP, short for uvulopalatopharyngoplasty. Removes tissue from the top and the back of your throat. The uvula is the little punching-bag shaped thing at the roof of your throat. The surgery removes that, the tonsils and adenoids if you still have them, and other tissue, opening up your airway. It will not prevent your tongue from falling into your airway when you relax for sleep, so I sleep with my head elevated to keep it in my mouth. It was an extremely painful procedure, but worth it from my point of view.
@sob It was 20 years ago but the name took up the entire width of an 8x10 page.
CPAP is not as easy as the writer makes it sound. I am a small person and my lungs and throat felt like they were on fire on the lowest setting. If you sleep with your mouth open, a partial face mask won't work, as it depends on a closed mouth. Chin straps can make your jaws hurt or slip off in the night. If you have dry eyes, the mask can blow air on your eyes, making them drier. If you sleep on your left side, you will have the hose dragging across your body in an uncomfortable way. Wish it had worked for me, but it didn't.
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@Sandy Hill
I had this same problem, to some extent. My mouth would dry out, but it would without the CPAP (actually an apap is what I have) too. What I did is purchase some mouth tape. When I get a good seal with the tape, I get a great night's sleep. It seems to make a lot of difference.
@Sandy Hill did you buy a machine that adds water, which makes breathing more comfortable? If you sleep with your mouth open, check with your dentist and get a simple mouthguard, or buy one at a local pharmacy. It helps keep your mouth closed, aside from helping prevent grinding your teeth. My mask does not have a chinstrap. How many masks have you tried? My mask also does not push air in my eyes, because I made sure when I bought the mask that I purchased one that just fell over my nose and blew air down not up. And it does not move on me. I also have a small head. Deal with the hose!
@Sandy Hill I couldn't tolerate CPAP for reasons you cited and more. Tried different machines, masks, nose pillows, etc. Hated having anything on my face.
An oral appliance worked great for me. Unfortunately, Resmed has discontinued the one I use (Narval CC) as there is more money in CPAP machines and supplies (according to my dental appliance doc). Was just fitted for an Avant device https://somnomed.com/en/avant/ to replace my Narval since the adjustment bands are no longer available.
I was diagnosed with severe sleep apnia not long after suffering a mild to moderate stroke 13 years ago. I was fitted with a full face mask and a bipap machine. Fortunately, my insurance fully covered the costs at the time. The air pressure required to keep my airway open is quite high.The older machines had a variable pressure ramp-up rate that got to full pressure in 10-30 minutes. I couldn't tighten the old mask enough to stop it from 'farting'. If I fell asleep fast enough, no problem. Otherwise I'd have to restart the cycle until I was ready to sleep. I had to force myself to maintain the minimum required usage.
About 4 years ago I took another sleep study and was fitted with a newer, softer mask and a fully automatic bipap. The machine recognizes when I am breathing normally, and when I am not. Today I use it virtually 100% of the time. The only drawback is the cheek marks left by the mask.
For all the complexity and resultant expense of CPAPs, it's good to remember that they are only fans, a device to push air. I forgot mine once and found myself 700 miles from home. I can't sleep at all without a CPAP so I bought a Dust Buster from Target and a hose and mask for a hospital supply place. I put the dust Buster on blow instead of suck, and it worked fine. Not as good as my Res Med, but adequate.
I love my CPAP . Two years ago I decided to ride out Hurricane Florence. Six days without electricity. The marine battery I use for fishing, an inverter and my CPAP got me through that without any loss of sleep.
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@foggbird
Wow.
Great article and discussion - thanks!
I was diagnosed with "unusually severe obstructive sleep apnea" about a decade ago. I religiously used a BiPAP without difficulty for 5 years, until suddenly one night I couldn't tolerate it another minute. Luckily my ENT referred me to a dentist who fitted me with a "mandibular advancement device," aka "snore guard", which is feather light, flexible, easy to tolerate, unobtrusive - and effective! (BC/BS wouldnt cover the expense, however.) On Monday I'm being fitted with a spare device in case my current device breaks or gets left wherever I lost my latest pair of prescription sunglasses...
Based on my personal experience, I'm puzzled why these dental devices are apparently not a first line treatment for this serious chronic condition.
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@TMO This devise advances the lower jaw, ie. makes it stick out beyond it's normal position, and for many people is not tolerated well. The idea behind it is sound but the price is high considering what it is. Maybe more people would give it a try if it were just a couple of hundred dollars.
My understanding is that they can cause teeth to shift.
@TMO
I can use it due to TMJ.
I always found it easy personally to use my CPAP - first a mask, then nasal pillows. But the industry questionably maintains control of the machine settings - the force of the airflow -- by requiring it be done by prescription. Balderdash, there are many guides on the internet to setting your own machine. Thus, you can avoid another financial trap.
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Agree 100%. The patient MUST be able to control the airflow setting in order to tailor the machine correctly. The provider of the machine is a company that sells it and just sets a pressure prescribed by the doctor at the sleep lab. The doctor should educate the user on all the functions of the machine, and should be a partner in the process, to get the best outcome.
4
My doctor recommended a sleep study years ago, back when I was paying for my own health insurance... but after I got a $300 bill for the initial consultation, and learned that the study itself would cost me thousands, I cancelled the appointment and put it off for years. When I finally had employer-provided health insurance, I had the study, got the OSA diagnosis, and acquired a CPAP machine. It took some getting used to, but it definitely helped.
Around a year ago, when I still wasn't sleeping well, my doctor recommended a second study. Turns out I now have central sleep apnea as well (my brain forgets to tell me to breathe), which sometimes happens on CPAP. But my new BiPAP machine is much more comfortable to use: more secure headgear and more responsive to my natural breathing patterns. The very few occasions I've had to be without the machine have been terrible nights' sleep!
Even with good insurance, several hundred dollars are involved in getting diagnosed and getting the right equipment. No one who needs this life-restoring, and often lifesaving, technology should have to go without, or suffer with inappropriate or ill-fitting CPAP gear.
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Recently diagnosed and prescribed a BiPAP (bi-level CPAP). The biggest hassle has been getting a mask that is comfortable and works. The titration study (to set the machine) that followed the sleep study made no effort to find a comfortable, well-fitting mask. The durable medical equipment (DME) supplier would not let me try on a mask without buying it first ($150-$200). This is like going into a shoe store and having to buy a shoe before you can try it on. They take a guess and then you're stuck with it. Mayo clinic lists "the wrong size or style CPAP mask" as the number one reason people give up on treatment.
4
I'm a dentist, and as part of my exam I regularly check the openness of my patient's airways (you can probably check your own; google "Mallampati classification"). In my experience, I can usually identify patients who are at risk for sleep apnea.
If you suspect you may have sleep apnea, ask your dentist! We can help point you in the right direction. We also make appliances that some people find more comfortable than a CPAP.
3
I have been classified as a 2, 3 or 4 depending on who I go to. I don’t understand this metric; I don’t sleep with my tongue sticking all the way out which is how I’ve been observed. When I just open my mouth and rest the tongue on the bottom, the back of my throat seems to be covered.
I've used a CPAP machine for four years and wouldn't trade it for anything! My sleep improved many-fold after beginning the treatment. It took only a week or two to get used to the "pillow" mask that fits barely into the tip of the nose. The machine is silent and causes no problem. If you think you may need one, don't hesitate to check it out; you won't regret it. ....an elderly user.
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@Ed
Amen, Ed. I completely agree. I am forty-eight, have used one for over five years and it is a game-changer. I am more alert, have more energy, and can function better than I did before using it.
It takes time to adjust and it is normal to find yourself "ripping it off" at first. But after three weeks, I found it helped so much that there was no going back. Thank God for CPAP. I am very grateful. You have to give it time to adjust to it.
1
"Insurance companies don't make things easy." You got that right. After 16 years of using CPAP the insurance company decided that I needed another sleep study. Never mind that my original study showed 66 events per hour that diagnosed as severe apnea. But by now, the home study was required, not the facility one. I could not possibly endure 4 solid hours required of no CPAP without choking myself to death. I gave up after 90 minutes and put my CPAP machine back on. They later said I would not qualify for any insurance coverage for any related equipment. Now I pay hundreds out of pocket for all of my equipment even though I have a "top notch" health insurance plan. We truly are not the greatest country in the world.
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Very happy to have it since last year. Made a good change.
Only complaint is the insurance company trying to give me the runaround on approving the prescription. Their sequence of notices violated their own procedure for review and were completely confusing. With the doctor's help and the help of the independent insurance brokers to my law firm, eventually the insurance company approved.
Took to the machine well the very first night and don't have a problem with the masks. My AHI score went from over 20 (bad) to always under 5 (good) and usually under 3 (very good). Have used it every single night since I got it. Great technology!
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After years of denial--and hideous snoring that kept my spouse up at night--I submitted to a sleep study. Conducted at either a sleep center or home, it is a difficult night. BUT: I can tell you it was worth it. Once completing the process Aaron and Austin describe, I began using a CPAP machine with a full face mask. I adjusted in 3-4 nights. It has changed my life. I no longer fall asleep at my desk and am no longer a danger behind the wheel. The CPAP goes EVERYWHERE with me. I can't imagine not using it. In addition to improving my (and my wife's) sleep, my heart health has improved. Thankfully, we have a very good healthcare plan and there was minimal issues in getting the machine approved. I am required to visit the MD regularly so the machine can be read to confirm I am using it. Happy to do so in exchange for how well I feel all day. If you are diagnosed with OSA and a CPAP is prescribed, my message is to use it consistently and be patient as you adjust. I say again: dealing with this diagnosis changed my life for the better.
2
I am on Medicare and got a CPAP last year, similar experience as authors describe, two office visits for testing, third visit to supplier. With persistence, I got the charges: first visit billed at 7500, second at $8000; insurance paid $380 each time and I paid $90 each time. The machine from a supplier cost 1300, billed monthly, and supplies a total of another $300 or so. The supplier wanted to put me on auto-refill which would have much much more and wasteful in my opinion.
Based on my experience, I do not think universal testing is a good idea. Huge potential for abuse. I never saw a doctor, he just signed off on the "testing."
CPAP fixes snoring if you stick with it, which is hard. A full night of sleep is not easy. Results vary no doubt, but more oxygen is better than less so ....
When I was diagnosed about a decade ago, I used a CPAP machine for some two years--and hated it. Reluctantly (it seemed) my doctor gave me the name of a former dentist who specializes in sleep apnea devices. This remedy, manufactured in Australia using a model of my teeth provided by my dentist, was more expensive than a CPAP, but it was very comfortable and just as effective in reducing my waking episodes.
I now live in Spain and was worried that I would have difficulty replacing my device, which--I was told--had a three- to five-year lifespan. It was a great relief to discover that even in the small city where I live, there was an orthodontist who also specialized in treating sleep apnea. He recently confirmed that my six-year-old device was still fine, and he scheduled a checkup in six months. I was also relieved to learn that this same brand and model is manufactured in Barcelona and Holland. So if a CPAP isn't comfortable for you, don't give up. Find a dentist/former dentist who can help you obtain a quiet, less obtrusive dental device. Oh, sure, when I wear my dental device, my lips disappear (rather like a Muppet), but a good night's sleep is worth it.
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@JP Christy hello,this sounds wonderful as I could not get used to the mask. Can I ask the name of the device manufactured in Barcelona/Holland?
@JP Christy
A dental device is not right for just anyone with sleep apnea. I grant you, if it's the right solution for you - kudos. But a CPAP and a dental device are not the same.
1
@JP Christy happy this helps you. I tried getting a sleep appliance. My dentist said my mouth was not designed for the product. I persisted, got it approved through insurance, and bought it. And it did not fit my mouth comfortably enough for me to use it more than an hour. I tried and tried. Some people just don’t have mouths that are designed for the sleep appliance. In this case I should’ve listened to my dentist!
One thing to be added to this excellent article are the number of health conditions associated with sleep apnea. I don't know them all, but I do know some. I've read research articles on high blood pressure, cardiovascular disease, kidney disease, depression, anxiety, strokes, atrial fibrillation, obesity, type two diabetes, dementia, are among them. People who die from heart attacks in their sleep are often untreated OSA suffers, because the stress on the cardiovascular system can be intense.
Here's what happens to your brain when you have apneas: your sleep cycle is disrupted, especially the REM cycle and deep sleep cycles for many people. During REM, and during the deep stages of sleep, your brain and body recover/heal. Memory is stored during the REM cycle. So having disrupted REM/deep sleep cycles will affect your ability to function, Not to mention the health of your brain.
Getting used to wearing a mask can be difficult, some people may feel claustrophobic from it, in these cases perhaps a behavioral therapist could help. Certainly the bother and sometimes anxiety about wearing a mask are there. But nothing compared to the complications from health risks. Same with people who are somewhat phobic about getting a sleep study.
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Well said. Everything in this article also reflects my experience. As a 48yo healthy woman who's husband was getting less and less sleep as a result of constantly nudging me into another sleep position, I am deeply grateful for my CPAP (and travel CPAP) and the avoidance of the effects of sleep apnea. My husband even more so!
2
After catheter ablation surgery for atrial fibrillation of the heart, I was still having brief afib episodes about once a month. In the ten months since I started sleeping with a CPAP mask I have not had any afib episodes. The sleep study and sleep therapy program is part of the cardiology practice, because of the connection between apnea and afib.
2
@Howard
Yesterday my ENT told me there is a very strong link between OSA and atrial fibrilliation (as well as SVT).
could not tolerate cpap. the dental appliance has worked
wonders for my health!!
4
When I first heard that people in my area were sleeping with a mask strapped to their head, I told myself, 'Not Me!'
And when a smart physician had me get a sleep test done, I did well enough to leave the whole idea behind - The First Time.
Since then, I've had my oxygen level drop into the 70's without help. Did tyou ever wake up with a headache you couldn't blame on the flu?
I sleep with my mask 100% of the time now, even while taking naps. YES! - you can adjust to wearing hese things, believe me.
BUT maybe you're not 45 yet....
6
I, like many others, was diagnosed with sleep apnea after a really miserable, sleepless night at an in-hospital sleep center-over ten years ago. CPAP was a noisy Rube Goldberg contraption.
Six months ago, a medical event led me to revisit the issue, I got an in-home sleep study showing over sixty AHI events per hour. Seventy bucks. My private health insurance required I get a prescription from my PCP ($35), and work with a DME (Durable Medical Equipment supplier on a rental APAP (Automatic CPAP) and mask and other supplies.
I have Medicare Part A also. Six months later, I feel much better, more rested and more energy and its yet to cost me any money other than the $100 or so I spent to get a 12v adapter so that I can use the machine while camping.
To those who were, like me, discouraged by the old technologies, now is the time to go back and get Sleep Apnea treatment. You will not regret it.
Avoid sleep centers, they exist to line physicians pockets, not treat your apnea. With an optional SD card in your APAP you can use a free software reporting tool called OSCAR to really get involved and understand your treatment.
9
very good article, however, the comment that the surgically implanted device is for the "worst cases" is incorrect. only moderate sleep apnea is currently treated with the Inspire device. more severe cases are prescribed the cpap
4
I am very surprised that the authors, in this otherwise excellent article, didn’t say anything
about those of us diagnosed with severe sleep
apnea (in which the person has both the throat
obstruction, and a brain that is not sending
signals to respiratory system to breath. People,
like me, who have both types, have use a BIPAP
machine, with a full mask.
2
A few years ago I began choking after about ten minutes lying on my back in bed. I believe that's sleep apnea. Now I always lie on one side or the other, or face down. No problem.
3
@JGSD
I had that some problem. I got the home sleep study and found that I had severe OSA. Basically, the choking problem led me to find out I had many apneas per hour as well as hypopneas. In other words, the problem was not (just) the choking.
1
@JGSD
JGSD,
Precisely my same symptoms and solution. Why is this not more often suggested?
I had (male, mid 70’s) ”moderate to severe” sleep apnea as determined in a sleep test at my local hospital. That was when I had to sleep on me back due to a fractured pelvis (cycling fall) and knee replacement operations. I now sleep on my side in a vest with three tennis balls sewn in the back so I cannot sleep on my back. No more sleep apnea. it’s a step some folks might try.
5
@HonestJack I tried the tennis ball solution more than once. Never worked. Just ended up on my back with tennis balls kind of a spinal massage! Maybe bowling balls?
My husband had terrible apnea and you could hear his snoring down the street. He didn’t think it was a big deal and he didn’t want to wear a C-pap. He died in his sleep 8 years ago.
17
Although my insurance premium is expensive via Kaiser Permanente, I'm grateful how easy they made it for me to get a home sleep study and a loaner machine for the last 3 months. I will purchase a machine from them in January 2020,which will also wipe out my annual deductible for the year - a good thing. After that I'll comparison shop for replacement accessories (mask and hoses and filters) to see if it's less costly to purchase from Kaiser or outside vendors. Kudos to Kaiser, I just wish my annual cost of insurance were lower.
3
If you are looking for CPAP supplies, check out Amazon first. My wife has found it to be the cheapest place to get hers. No insurance required.
1
@Snore No More CPAP supplies, including masks, are cheaper online than in the local equipment suppliers.
Great article. Agree after your doctor does the verbal questions, and the patient has other risk factors like overweight ect. rent the eq. for a 30 day test. review the data in 30 days, then issue a prescription if warranted.
5
I was a female in my early 30s, weighing 120 pounds, when I went to my Internist complaining that I was waking up in the middle of the night. I slept alone at the time, and had no way of knowing what was really going on. She wanted to prescribe me sleeping pills. I explained I had no problem falling asleep I had no problem sleeping until something woke me up and then I’d go right back to sleep.I asked to speak with a sleep specialist. She became noticeably angry since I was refusing her recommendation and told me all I needed was sleeping pills. I insisted and she very reluctantly sent me to a sleep specialist. Of course I had OSA. Went through eight masks before I found one that worked for me. Very little help at the stores that sell the equipment. Ultimately found my mask online reading reviews. Moral of the story: don’t give up if your internist Doesn’t want to send you to a specialist. Find another Internist who will listen to you. Don’t give up on finding a mask that works for you. It’s a pain, but it is great for your health. Change your primary care doctor when you feel they are not hearing you.
23
After using CPAP and BiPAP machines for the last dozen years, I want to remind readers who find it difficult to adapt to CPAP machines, which provide continuous air flow, that BiPAP machines, which pause to let you exhale without having to breath against a constant in-flow, may be a better alternative.
Also, it's essential to find a mask that is comfortable for you. Consider type, size and brand: one size does NOT fit all. And whether you get a brand-new machine or a used one, it is also important to have it calibrated for your needs. It's nearly impossible to do this yourself unless you've been trained.
Finally, many equipment suppliers, in my experience, abuse both the insurance companies (including Medicare) as well as the patient/consumer, often charging a co-pay that exceeds the retail price while still gouging the insurance carriers. So, as Mama said, "shop around".
14
My sleep apena symptom is only snoring but I do have high blood pressure. I had the at home diagnostic test and I paid for my own machine since Visiting Nurse Asso. only offered me one choice and it was huge. I got online a travel sized APap with no water reservoir or heater. I think it was about $500. It took me about 3-4 days to sleep all night with it on. I trained for a few days by wearing it in the afternoon while reading.
THE BEST PART OF A CPAP IS THAT I DON'T GET UP TO PEE AT NIGHT ANY MORE. I don't wake up more refreshed, however, and I still could nap in the afternoon if I chose to.
4
@Karen Patterson I understand you remark about waking up to go to the bathroom. Been there, done that. I've told all of my physicians that this is a primary sign of sleep apnea and is something that they should ask of their patients.
1
A doctor once told me the mask comes off during the night for 50 percent of patients. Unless you address that, this advice really isn't that helpful.
2
@KatheM
You have to address that yourself. You can train yourself to sleep on your back and to move less.
@KatheM
I guess we have to find that doctor and correct him/her. The well chosen small piece of misinformation is far better than a 2000 word article on the subject.
4
@KatheM You can train out of that. The first few weeks, I paid attention to my own stats and mask fit tests. Also, I had a doctor who took the time to walk through mask fit options and choose one that works. I am a side sleeper with no issues.
2
The sleep apnea industry ignores an alternative inexpensive alternative to the machines. 10 years ago I got a snoreplasty which involved a single visit to a doctor and an injection in the back of my mouth which caused a portion of my airway including my uvula to disappear. I have had no nighttime breathing difficulties since. My doctor says nobody does any sleep studies about this procedure because it generates few profits for the medical industry. Many medical professionals I talk to have never heard about this. I wonder what it’s never mentioned in articles about apnea.
14
@James
That is interesting. My dentist remarked that the tongue keep growing as we age: if you add tonsils for those who have them, the uvula, and for many someone swollen tissues related to allergies, the airway can be restricted to cause snoring, and some interruption with breathing. The procedure you received would be simple and inexpensive.
@James
A LOT more info on this please. Call your doctor and get the correct name for the procedure for us please.
Google it. It’s the name of the procedure.
I was diagnosed several months ago. I was not given an options for a home diagnosis. So I had to undergo two sleep studies, meet with the doctor to discuss the results, consultant with the equipment company and purchase the equipment. The total cost before insurance was about $16,000. I have what is generally considered a "good" insurance plan but it has a $3,500 deductible. After paying my deductible and finding out that there are other co-payment requirement for sleep studies and equipment, my out-of-pocket costs so far (I continue to receive vague bills for miscellaneous medical charges) are at about $6,000.
At no time during this process was there any discussion of pricing. I must say I am shocked at how much expense I have had to incur on the very casual recommendation by my physician that I schedule a sleep study. It will not bankrupt me but it certainly demonstrates how broken our healthcare system is.
28
It cost me, personally, $250 to $300 to see the doctor for this. My insurance paid for the test, but nothing else. And as the doctor did things like have me come in to tell me he was writing the prescription for the machine - but not to give it to me, as NYS doesn't allow that anymore, it must go directly to a pharmacy or clinic), I just could not afford to go back to get a new one, or anything else.
5
I would like to confirm what others have said about challenges in getting diagnosed, and the clumsy, often expensive, process of getting CPAP gear through official channels. Your results will vary depending on the competency of your insurance company and health care providers.
There is a secondary market for these machines, it is possible to get one without a prescription, and using them at a low to moderate pressure setting is generally considered safe.
So for folks out there who would spend dollars and aggravation just to find out if they have sleep apnea, you may be able to shortcut the process by simply buying a refurbished machine and trying it yourself.
Search 'apnea forum' and 'second wind cpap', Spend some time doing your research.
16
@Midori
You answered my first question. Thanks
Tired during the day, I was diagnosed with more than mild sleep apnea and bothered my wife by gasping for breath at night. Tried the machine on a month test and my insurance approved full coverage. However, I could not justify the major expense for a simple machine. So I exercised more, ate less late at night, drank less alcohol, and lost fifteen pounds. Also no more GERD. I feel great and my sleep is undisturbed.
11
Glad you posted this!
Same....and isn’t it nice to realize, oh wow, I can control my life.
2
@Michael Thanks for posting this. Even when doctors prescribe cpaps, they commonly tell patients that exercise and weight loss really helps.
2
@Michael Side sleeping works miracle compared to any device on the market.
If you're having trouble with your CPAP for OSA (Obstuctive Sleep Apnea), please keep in mind that there some who have it even worse. I have a condition called Complex Sleep Apnea which combines OSA with Central Sleep Apnea, a condition in which the brain occasionally "forgets" to send a signal to the diaphragm to breathe. The treatment in this case is a special type of CPAP machine (Auto - SV) which continually "breathes" for you during the night should you forget. It took me several months to adjust to this machine.
5
My BIPAP machine cost $4100.00
I've been using a CPAP machine for over 8 years. I fall asleep within 5 minutes but often wake up after 3-5 hours and can't fall asleep again unless i remove the mask.
9
@Bob Bob; try to get used to sleeping on your side. This practice takes a long time and over; but is worth it. I got rid of any and all devices by side sleeping. Now I can sleep well. Use a thick hug pillow and a thin knee pillow to assist side position.
I also would wake up in the middle of the night, and not be able to fall back with the mask on. I started using a sleep med, which works perfectly. I’m going to start working off the med and see how that goes. I was Diagnosed about 15yrs ago (58) insurance was , and is painless. I switched my sleep Doc to my Primary. He has apnea, and is always able to give positive feedback. My entire life, anyone who knew me, also new that my sleep was a joke, to everyone but me , always tired , head in a fog not being able to focus. No matter how much I slept never felt rested I’m not overweight, but my chin sits back . I use a small nasal mask , for me if I eat the wrong foods, or otherwise become congested, it’s as if I hadn’t worn the mask when , I wake up. Cpap treatment I’m sure can be easy for some , but noncompliance is related to tolerance And noncompliance is high. The difference in quality of life is emmense, I always collected books, but was never able to read but a few. With my Cpap that has changed dramatically . Keep it clean , its not that difficult to do. It’s the nuances , air pressure , humidifier, mask choice and others. For me it was a rule out by my primary doc. At the time . So I tend to think about all the undiagnosed, and diagnosed who spend most of their waking hours, not awake
I’ve used a CPAP machine for years but had recurring problems with mask discomfort and fit. With persistence, a happy solution was reached so that it’s a good comfortable fit.
The CPAP travels with us and makes a big difference.
4
After years of migraines and exhaustion, a physician therapist told me he was sure I had an obstructed airway. I'm a member of Kaiser Permanente and within two weeks of contacting my PCP, I got a home sleep study, an appointment with a respiratory therapist and a CPAP machine which has changed my life. My insurance covered most of the cost and KP made it very easy. While KP isn't perfect, in this case I was grateful to have such seamless care!
20
Yes! I have had the same excellent experience with KP and CPAP.
1
My husband got a primary dr referral to a sleep dr & prescription for the ARES home sleep test. This cost us a co-pay of $75. Our insurance paid the rest but if out of pocket it would have been less than $500. The sleep dr read the results & even w a diagnosis of mild apnea, the CPAP machine has made a huge difference in both of our qualities of sleep. The equipment provider let my husband test devices for fit & rent machines monthly before choosing one to purchase. That is the advantage over just buying one online. They subtract the rental fees from the final price.
We were encouraged to take steps after reading “Why We Sleep” by Dr Matthew Walker, & the ties between lack of sleep & dementia. Both of our fathers had/have forms of dementia so we’re motivated to do what we can to lower the risk for ourselves.
8
@Lee - - - An unexpected asset of doing the sleep test is your body finally gets to exhibit to a professional some things you do in your sleep like unexpected limb movements and some tricky little things going on with your heart.
Hey, Pop, it's only one night.
I fell asleep while driving during daylight on a 4-lane highway in SC and ended up in the median at 80 mph. Lucky for my wife and I a tragedy was avoided. Still, I fought the idea that I had sleep apnea but my doctor ordered a sleep study and she literally saved my life. My health has returned with the nightly use of my CPAP machine. I now enjoy having a wonderful restorative night's sleep and a return to having plenty of energy during the day. No more snoring and keeping my wife awake. No more naps. No more nodding out in front of the computer or falling asleep in front of the TV. My heart is also happy that it's getting all the oxygen it needs while I'm sleeping. Wearing a mask at night is a very small price to pay for the return of wonderful, beautiful sleep.
26
I have been using a CPAP machine with a full face mask for at least 10 years. It has made my life so much better. I was tested at 37 events per hour, making me very tired during the day. I also developed Type 2 Diabetes. Now, I sleep really well, waking up rested and ready to start my day. The CPAP was a godsend.
12
After 25 years of using CPAP faithfully, my partner developed dysplasia (abnormal cells) on the inside of both cheeks - changes that are a precursor to cancer, and are usually seen in those who chew tobacco. Surgeon removed the lesions, and they are starting to recur. The only explanation is that CPAP device pressure on those areas over time caused changes in cell structure. An uncommon side effect - troublesome but worth it for 25+ years of sound sleep for both of us.
3
@Mary: “...the only explanation...”?? Please read up on the difference between association and causality! If your explanation were correct then there would be an epidemic of epithelial dysplasia among musicians playing wind instruments.
5
I saw the difference the very first night during the sleep test. It took NO time for me to get used to it.
11
It took me a few days to get used to my autopap but when I did I slept great, and so did my spouse, for the first time in over a decade. I enjoy burrowing completely under the covers at night in a cold room as though deep diving in the ocean. In my mind, I have converted the rhythm of the air sounds into waves on the beach. Getting replacement masks and all through the initial supplier was a total pain so I pay out of pocket for those items online. They cost about half of what the supplier was charging. It was mildly annoying to have to get an updated prescription when I decided to buy a travel unit (under 2 pounds, as opposed to the 9+ the other one weighs, which makes a difference since it's "carry on" at the airport). Sufficient, restful sleep is a beautiful, beautiful thing.
In response to those folks who think that life style changes will solve obstructive apnea, they didn't for me. I am resigned that I will be tethered at night for the rest of my life.
A side note - I was hospitalized last year and "respiratory therapy" services were required to get my cpap - they charged thousands of dollars to Medicare (which ultimately paid about a 20th, with no co-pay to me), to wheel a machine into my room and follow my instruction about settings. Next time, I will bring my own from home.
18
When I was diagnosed with sleep apnea, I found that simply buying my own CPAP machine was less expensive than going through my supposedly good insurance benefits.
Unbelievably, the annual rental co-pay that durable medical equipment (DME) suppliers charged me was twice than the cost of simply purchasing the machine at a web site.
Since then, I have found that grey market machines, available without a prescription, were even less expensive. It is a shame that DME suppliers and the rest of the health system have made obtaining these important medically necessary devices so difficult.
38
@Stephen This is so true. Buying the machine I actually wanted was less expensive than my co-pay and the machine I have is much better. Without the machine I might well be dead. How insurance companies can scam people with a non-benefit is nuts.
7
I tried most available masks and finally settled on the "Wisp." I've been using it for many years--it's really easy to get used to, soft, pliable, and fairly small.
For those who find distilled water irksome... I've never used it in 15 years. I use tap water, which I empty each morning. I use soft cloths to dry the humidifier reservoir as completely as I can, then let it air-dry until night to make sure nothing can grow. Never a problem!
I love my CPAP. I much prefer breathing to not-breathing...
11
@MLChadwick Tap water leaves mineral deposits and other stuff that is in your local water to make it drinkable while distilled water has those removed which is why distilled water tastes bland. Tap water will leave some deposits and bacteria over time; that's why we are told to wash out the unit with soap and water daily which no-one ever does. I recommend that you look into a So-Clean or similar device. The treatment kills any harmful bacteria or viruses that might exist in your water reservoir and unit. Good luck.
2
Once you get one you'll still need a prescription to get replacement parts like a new mask. Seems like costs could go down dramatically without the unnecessary bureaucracy that is American healthcare.
9
@George Bukesky .0 You can order masks, cushions, tubing, etc online without a prescription.
1
@George Bukesky Get a prescription once and try the websites that accept it. I have been thrilled with CPAP.com but there are others.
@George Bukesky
You can get everything online. The local med supply places were so rude and never had replacement parts like filters for me when I went in. And they repackaged them which contaminated them. The first place would not replace my filter for over a year! There are websites of fellow cpap users online too.
1
I personally don't fully trust these processes for testing for sleep apnea and then treating it. Even though I am sure that some people have this problem, it's one of those things that generates quite a bit of revenue for some businesses. I'm not sure what the solution is - maybe what the authors recommend that doctors can provide this equipment to use at home to see if it solves whatever sleep problem people have.
3
@Roger Try waking up on the highway driving at 70 mph. That will convince you.
11
I was diagnosed with borderline sleep apnea after a sleep study. The study was horribly uncomfortable and I felt like i didn't sleep at all. I tried a CPAP but slept worse because of the device on my face and head. Plus having to clean it daily and keep distilled water to fill a tank. what a pain! Most of what keeps me waking is shoulder pain and I am seeing a doctor for that in two days. I bet a couple of cortisone shots will solve the problem. At least I hope so!
2
I sleep fine with my wisp. I also do something that is supposed to be a no-no. I run it through the dishwasher a time or two per week. (Don't separate the reservoir from the plastic top. The top can shrink and not fit.) I have never gotten sick and I don't replace parts as often. I've used it this way for several years.
2
@Susan in NH I had the same experience. And the photo that accompanies the article gives me shudders.
1
I used CPAP for close to ten years for my snoring and mild apnea. It was definitely helpful for snoring and preventing daytime fatigue. Over the past few years I began to struggle with the pressure settings and the fit of the various nasal masks. I finally had enough and saw a dentist who fitted me with a dental appliance. I find the dental appliance to be more comfortable and less intrusive than CPAP, and per my wife it is totally effective for snoring.
7
My dentist made me an appliance and I agree. And, it is so much easier with which to travel!
4
@Tim Could you say a bit more about that? - What kind of dental appliance?
@Flaneuse my dentist molded my teeth and had a plastic device that fit over them made - it locks in the front so I can’t open my mouth and therefore breathe through my nose while sleeping. It also apparently shifts my bottom jaw forward but I don’t notice that
If you are on Medicare, a CPAP is covered. The deductible depends on supplemental coverage. It is well worth the adjustment period getting used to it. My guess is that there are millions of un-diagnosed people suffering from it-- people who drive cars and over the road trucks, fly planes, run trains, etc. as well as others who are in a bad mood due to sleep deprivation and force others around them to deal with them.
8
I have been using a CPAP machine for almost 8 years and it completely changed my life. Although it's unusual for women to have sleep apnea, I have been a snorer since I was a child. Finally the snoring led to periods when I stopped breathing. In fact, without the machine, I stopped breathing 47 times an hour! I had become exhausted, and even though I took naps throughout the day, I never felt rested. I had to sleep in a different room from my husband because of my snoring was so loud. I woke up constantly all night long.
Fortunately Kaiser Permanente is focused on preventative health care. I was given a sleep testing machine to take home and it was confirmed that I had sleep apnea. I'm so grateful for the diagnosis. I feel that having to make a few appointments and take time to sort through the best mask or nose pillow, is time well spent because we're talking about spending a little time to get it set up and working... time that has completely changed my life for the better.
13
@amazing I have a similar story and would heartily agree. Except that sleep apnea is not rare in women, not at all. Somewhat more prevalent in men, but 1 in 10 women middle aged and over. 1.5 in 10 men. Important because when I asked my doctor to test me about 15 years ago, he said it was unlikely, since I was not overweight and I was a woman. So I went with that, not that eager to have a sleep study or a machine. About four years later another doctor picked up on my symptoms and the shape of my airway, and cajoled me into being tested, even though I told him it was unlikely because I'm a woman and not overweight.
It's clear now that I had it from childhood, it's often the shape of your airway that plays the biggest role. In childhood I frequently had dreams that I was drowning and could not breathe. Fortunately my tonsils were inflamed and I had tonsils and adenoids removed. This likely helped a lot.
6
KP definitely supports prevention! I got my apnea diagnosed through them without any hassle.
2
My Apnea was completely relieved by wearing a Dental appliance. I tested positive for moderate to severe apnea while sleeping on my back. The appliance is so light and easy to use. I went to a great dentist who only treats apnea. Sleep apnea dentists of new england
4
@Charles Bartlett I've tried two of these at my own expense, and each time, got more and more sleep deprived. It seemed ok initially, but built up over time. They may work for some, but not for many of us.
2
So much easier with which to travel, too!
I started with the CPAP machine 6 months ago and have felt a significant improvement in the quality of my sleep and my energy levels during the day. It took about a month to get over the initial adjustment, and now it feels like 'no big deal' to follow the nightly routine of masking-up before closing my eyes.
4
Anyone who had trouble with CPAP machines ten years ago should reconsider them now. I received a new machine three years ago and it works much better than my early model.
10
My husband’s CPAP changed his sleeping life; I don’t think he’d ever want to go back to not having it. But it costs us and comes in just under our deductible. We pay 5-800 a year for it. It’s worth it but I really don’t understand why our insurance doesn’t pay more for something that is obviously improving his health overall.
7
Oh my. I must be losing my memory. I read this article and never remembered any hassles when I was diagnosed with sleep apnea and got the machine. Of course it was maybe 20 years ago. In early 2001 I gave myself a massive rotator cuff tear and without going through all the details I had a triple by pass instead of repairing the tear. During my recovery I purposely lost 50 pounds, my resulting b.m.i. was normal and no more sleep apnea !
3
I love my CPAP, it has given me a new life now I have great mornings no more struggling to stay awake, my wife and kids love the extra sleep they are getting too. Thanks for the article I hope it convinces more people to get on a healthier path.
9
My husband jumped through the CPAP hoops and is finally sleeping better (and so am I!). I appreciate this article outlining some of the difficulties...but did you have to use the ominous photo of the snake-like tube and the slightly panicked person? Certainly images like this feed into the fears of people who need the device but are reluctant to try it.
23
Despite dreading the hassle, I traveled to Patagonia with my CPAP machine to use in the lodge where we stayed. I was never questioned at airport security and my fishing partner was able to sleep without the sound of sawing wood. No problemas.
8
Without my CPAP machine I stop breathing about half a dozen times a night. I'm fortunate to be one of those people who easily adapted to wearing the mask.
I'm also lucky to be a member of a class of people who might be called "insurance rich". I'm one of them. My $1000 APAP machine was covered by some combination of Medicare and my private insurance. The co-pay for replacement masks is excessive but affordable. My $10,600 one-night hospitalization for observation a few weeks ago will cost me $270.
I don't live in a mcmansion or own fancy cars, but I don't have to worry that the costs of medical care will be beyond me or wipe out our life savings. All we have to do is not live too long and run out of money to pay the premiums when we are both retired.
I hate the idea that there are so many millions who have to live in fear or pain because we don't have universal health care. Too expensive? Tell that to someone who is dying because they can't afford the inflated cost of insulin.
35
Unfortunately, some sleep apnea sufferers are light sleepers---meaning that the cpap mask actually interrupts their sleep. I struggled with cpap for a year. My sleep specialist insisted that I was always tired and sleepy while using cpap because I was depressed. Finally, my neurologist insisted that my sleep specialist perform a second sleep study on me while using cpap. The result? I had almost no REM or deep sleep while using cpap, and bounced back and forth between awake and light stages of sleep. So, I had to explore alternative treatments.
My husband, on the other hand, slept like a baby the first night that he tried his cpap and loves his machine.
CPAP is great when it works, but it is not for everyone.
13
@McCamy Taylor For you, try sleeping on your side.It will save your life. It took me a long time to get used to it; but all my effort fruited into a great sleep today.
I tried using a CPAP but then found out that the CPAP device can actually cause 'systemic sleep apnea' which means that the CPAP user can no longer sleep without the CPAP device. This is as bad as opioids in drugs. It allows the CPAP manufacturers to make all their users addicts.
For this reason, I have sought other ways to treat my apnea: an inflatable pillow to keep me sleeping on my side, as well as exercises to strengthen the epiglottis, which is my own particular issue. Surprisingly, just playing a Didgeridoo for 20 minutes a day can greatly diminish apnea symptoms.
The CPAP may be a life-saver to some, but people should be aware of its dangers.
7
"this is as bad as opioids...." well I wouldn't go quite THAT far..
3
@Nick
I am a sleep specialist (and CPAP user). CPAP is not "addictive". It does not cause "systemic sleep apnea syndrome" - something I have never heard of.
CPAP has no dangers other than discomfort. There are other treatment options for some patients, but they a re not always successful.
1
Dr. David Carley at the University of Illinois - Chicago has published extensive research that shows delta-9-THC (yes THC as in marijuana) significantly improves breathing in patients with obstructive sleep apnea. The National Institutes of Health funded Dr. Carley’s research. The amazing thing is that delta-9-THC has been on the market for 30 years, sold as Marinol for chemotherapy induced nausea and AIDS wasting disorder. Marinol and it’s generic equivalents have been proven safe for decades, and marijuana based products are widely used, but THC is still worrisome to regulators despite its legal status in half the country.
RespireRx Pharmaceuticals licensed the patent from U of I to develop THC for the treatment of sleep apnea but the company has yet to bring a product to market because the investment community and big Pharma are scared off by the uncertainty surrounding cannabis-based medicines, the costs of clinical trials to bring the drug to market, and the patent life that will remain after the long regulatory path. There are zero drugs to treat sleep apnea, which is a major problem in the US as the article explicitly states, but we will only get new medicines with adequate funding sources and streamlined regulations for drugs that have been proven safe and effective.
5
I've used my CPAP for about a year. Very positive results. Sleep apnea also raises blood pressure, so getting a positive oxygen flow during the night is very important. It is not sexy, and the mask and tubing must be cleaned, but I no longer fall asleep during the day and feel much better in general. A good device.
2
I use a ResMed Airsense AutoSet machine which I bought in almost new condition, on Craigs List for $240. I have been using CPAP for years and didn't want to go through a new sleepy study. I use OSCAR to monitor my sleep quality and this approach works for me.
5
I swear by my CPAP - sometimes a nuisance to lug around while traveling, but it is a lifesaver!
5
I agree with the comments made in the article regarding obstructive sleep apnea, especially that, if left untreated, sleep apnea will have devastating consequences including cardiovascular issues. The authors, however, left out that that there is another form of sleep apnea called central sleep apnea that is not associated with an obstruction. It is neurological in nature and, among other things, is associated with cardiovascular disease such as heart failure and Afib. The CPAP mask is not effective in treating this form but there is another solution. The implantable solution is sold by Respicardia, Inc. and does not have the hassles of putting anything on at night; it works automatically when a patient sleeps.
3
My cpap made my Afib go away. If you think you might have sleep apnea, get tested. This is nothing to fool around with. And I got used to the cpap in one night and now can't sleep without it.
7
I have narcolepsy. I would give anything to have sleep apnea instead. Count yourselves lucky that it’s possible for you to wake up in the morning feeling rested, even if you have to wear a CPAP to do it.
I definitely second the promotion of screening—not just for sleep apnea, but for all sleep disorders.
7
I have been using a CPAP for over almost 15 years. I was a real live wire before I had it, always stressed and snappish. Constantly struggling to stay awake when driving. My sleep study showed that my heart was stopping 81 times a night because of my apnea.
I swear by my CPAP. One only has to forget it once on an overnight trip to see how critical it is. If I'm forced to sleep without it, in the morning it feels like someone poured glass down my throat, on top of a pounding headache. It's better to not sleep at all than to sleep without it. And if I don't have my CPAP I'll snore so loud that no one under the same roof will be able to sleep a wink.
10
Warning ! This informative article on SA is full of important truths , but fails to mention that a diagnosis of Sleep Apnea will wind up on your health record at the MIB ( Medical Information bureau ) and can affect your access and coverage for health and life insurance , certain kinds of employment , your automobile insurance , your driving record and be permanent and hard to remove or update even if your health improves and you get rid of SA, or have a mild case .
This is important to consider before visiting doctors and having a sleep study . As someone who had a sleep study at John Hopkins and was shocked to be told that I had a mild case that was discovered because my girlfriend was an RN awake at night to hear me snore and wonder if my breathing was being interrupted . I would not have done the sleep study if I had known how the diagnosis can affect my health record .
The article also fails to mention that SA is often improved or eliminated by losing weight and there are simple and inexpensive devices that can open your airway and improve snoring especially if one does not have a severe case .
Sleep Apnea sufferers be warned the diagnosis can be worse than the cure !
7
@VB What simple and inexpensive devices would you recommend?
@VB
Yes, I lost 80 lbs and almost immediately stopped snoring. But I still use my CPAP with nasal pillows instead of the mask.
1
@Someone
I was comfortable posting what I know to be true , but not being a physician do not want to recommend any device over the other , but just googling will bring up many options that less severe cases can benefit from .
I have found that diligently sleeping on my side rather than on my back has made a very big difference in my sleep apnea. It was recommended to me as a simple but effective approach by a Boston sleep specialist, and indeed I have found that to be true. I very much did not want to use the CPAP machine, in part because all the data from your sleep is sent to an outside lab for monitoring - at least when Medicare is paying for your CPAP. I'm surprised, given the demand in the marketplace, that some other, less intrusive method than CPAP is not being developed.
7
I would get drowsy driving home from work, fighting to keep awake in traffic. It was terrifying (no crashes fortunately). I always felt tired, and would nod off during the day or evening while reading (I love to read). My snoring and my twitching kept my wife awake. This went on for some time.
I mentioned this to my (wonderful) family practice doctor who ordered an at home sleep study. A few weeks later I met with an equally wonderful pulmonologist and was prescribed a CPAP. The provider brought it to my home where the clinician (RT?) fitted it.
I feel rested, my wife can now sleep, and no more nodding off. And the risks of serious outcomes described here are greatly reduced.
In short, this has no doubt saved my life, and probably prevented harm to people near whom I was driving.
My access to doctors of my choice and timely/smooth referrals made all this possible. We tried an HMO for one year and switched right back to a PPO plan the following year. I don’t believe my access to treatment for sleep apnea would have been as straightforward in an HMO plan. I’d urge anyone to reconsider their choice of an HMO.
This kind of experience reinforces my belief that every person has a right to quality healthcare. We’re not there yet, and I’m not convinced that Medicare for all is the solution. But we need to do right by each other when it comes to access; unfortunately the number of uninsured has started ticking up.
Thank you for writing this article.
10
What is not mentioned in this article is if you have sleep apnea and you are getting anesthesia for a procedure your doctor needs to know. I had an endoscopy last year and what should have been a fairly quick, routine procedure turned into a near disaster because at the time I didn’t know I had sleep apnea and my airways closed up. The doctors got the situation under control but I was told they had a panic for a few minutes. After that I had a sleep study and it confirmed sleep apnea. I had been complaining about my trouble sleeping for years but never made the connection. My family said I snored, I had morning and nighttime headaches and I was always exhausted. I tried more than one mask to find a comfortable fit but now I use it every night. The headaches are under control, I have more energy, and travel everywhere with my CPAP machine.
10
@R. Pasricha I routinely ask patients if they have sleep apnea. I plan for airway emergencies in all endoscopies. Telling your doc is a great idea, though; and remind them the day of the procedure.
2
You forgot to mention how these suppliers rip off Medicare and probably other insurance companies. Even though we are not paying we are shocked at what they charge Medicare.
13
@Mary Frances Bruce
I agree MFB. Hundreds of dollars for plastic tubes that cost pennies.
5
@Mary Medicare is not allowed to negotiate rates. The 'small business' lobby of device dealers is heard from loud and often in Congress.
My wife and I both were diagnosed with sleep apnea. Our insurance (not Medicare) would only rent machines, never buy them. If I remember, the rental was more than $100 per month each, and replacement tubing was also over $100 a time. When the insurance ended with my job they simply gave us the obsolete CPAPs. (They don't report anything to anybody, except 'clean me'.)
1
The barriers to treatment are absurd. I have been struggling to get a replacement for my unusable CPAP now for years. Most recently, Medicare insisted that I get another sleep study, which indicated what the two previous sleep studies and the CPAP's own analysis have indicated -- I have sleep apnea. The study cost Medicare far more than the new CPAP would have.
And I still don't have it. Linncare, the single medical supply company here (they keep buying up any new ones) won't do anything. The sleep doctors (I've tried several) say its up to Linncare. They're too lazy or greedy to do any work, and the insurance company too greedy, and Medicare too bureaucratic.
Health care in this country has become a bad joke. Who would use a CPAP if they don't need it? The situation is absurd.
16
@Josh Hill
As a sleep physician, I am constantly troubled by situations like yours.
Your doctors have no ability to force insurance companies or DME suppliers to provide CPAP machines. They have their guidelines which require sleep studies before replacing old equipment, compliance checks to confirm use of CPAP and office visits with physicians in order to continue dispensing replacement supplies. The DME companies have won the insurance contracts by promising lower costs.
You are correct, the system is designed to make it difficult, but your doctors cannot make them chance their rules.
Sleep Apnea often goes away with a better diet. Weight loss, elimination of lectin rich foods AND a vegan diet work well, plus a little more exercise. This is the very best and natural way to try first before anything else. If sleep Apena is there, the use of a mask might be needed until diet changes are realized, but there will be changes, and I've seen dramatic ones. Most of the other diseases associated sleep Apnea are also linked to diet.
As far a supplements, many of us are not producing enough serotonin and need supplements. Under no circumstances should one take Ambien or like medication, they are dangerous and highly addictive. Try tryptophan, and diet. This advice comes from decades of experience, your whole health can change, and quickly!
By stopping death by a thousand small bad choices, you may just feel wonderful and rested. If you can do nothing else, eat a plant- based diet for a start (and a little more exercise).
10
@Leslie S How do you know anything about someone’s lifestyle, diet and “choices?” Please avoid bringing weight stigma and diet culture into a conversation about the difficulty of obtaining medical care for a condition that many “healthy weight” people suffer from.
19
@Bethannm
Some enthusiasts never miss a chance to promote veganism. An opposite approach to diet helped me: Atkins. Basically that was the diabetic diet before insulin was available, and it does work to keep blood sugar low, and with it most fat storage.
I had sleep apnea badly, and used a CPAP. It helped a lot, so I'd not suggest not using one to anybody.
Exercise is always a suggestion. I'd be a poster child for lack thereof. Palo Alto's climate makes outdoor activity practicable year round, and even pleasant. I rode a bike when I was at Stanford. (I was young too.) In NJ with no sidewalks outdoor activity was dangerous, and very unpleasant for about 10 months of the year. In Florida it's OK in the winter months.
7
@bethannm
This is a dangerous assumption to make. My husband who has sleep apnea is in top physical shape, runs or swims about 20 miles a week, and has an excellent diet. He has all his life. While I am active and exercise and have a good diet, I am not in nearly as good shape as he is. I do not have sleep apnea.
18
The CPAP changed my life.
10
This article completely describes why I don't have a cpap and my son, w/ better income and insurance does. An excellent example of how the U.S. Health care system is killing people and causing poor health out comes.
20
@Paul You should be able to get an "at home" sleep study for pretty cheap. Then buy a CPAP online...if cost is the issue?
There's a very simple solution to all these problems. Just cut out the medical establishment and go DIY. Yes you will have some expenses but they will be one-time expenses.
Your partner will tell you if you have sleep apnea. But you can confirm it by a simple mail order test that costs $200-300. They ship you a small machine that you return and they will give you the results. In any event, if you think you have sleep apnea, you probably do.
While in theory you need a prescription for a CPAP machine, in actuality, there are many sources where you can buy them without. These are not pain pills, you can't abuse a CPAP machine, so the government really doesn't care all that much if you buy one. Craigslist is one place to start but if you feel that's too sketchy, look around, there are a number of suppliers who sell reconditioned and warranted machines that are sourced from DMEs and elsewhere.
to be continued...
23
Poor and interrupted sleep because of apnea in older adults is a likely risk factor for alzheimers. During sleep the brain, thru CSF, automatically flushes out organic detritus that leads to build up of brain destroying substance. Apnea impairs this life-saving process.
8
@Adam In the UK it's also a question in renewing a driving licence. It is a dangerous condition for other people you might run into, in a very literal way.
2
I am a health care provider and I urge my patients who have sleep apnea to try hard to get used to their CPAP machine. If they can do this they are in the long run much healthier than if they continue to have episodes of stopping breathing. All of this is discussed in the article. I have sleep apnea. I Find it very, very hard to sleep with a CPAP machine and the majority of patients unfortunately are like me and not like these authors. The machines have improved greatly but are Not silent. They can blow air on your face, dry your mouth and throat, the tubing prevents lying on. Your stomach or freely rolling around in bed. It requires weekly machine maintenance. It is not easy, however if you can enjoy the minority’s experience of tolerating it then the machines are great.
7
If you get a prescription for a cpap machine, do not get the machine through a medical supply company (such as Lincare) and /or through insurance. The supply companies charge far more than retail, and your insurance will be a headache. I paid off my machine through Lincare, but 3 years later started receiving new bills from them threatening collections. Took more than a year to get them to stop. Medical supply companies are very scammy in my experience. You should just buy the same machine from a retailer (several are online) for a much lower price. Seems counterintuitive, but you will ultimately pay more through insurance because they use medical supply companies, which will charge you outrageous prices. Yes unfortunately federal law requires you have a prescription to buy a retail cpap machine (because of lobbyists most likely, no good reason) but that doesn't mean you have to get bogged down in the mire of insurance nonsense and sketchy medical supply companies. Learn from my mistakes, once you have a prescription, find an online retailer you like and buy a machine free and clear.
20
I have discovered a healthy market in (barely) used CPAP machines. I bought one in perfect condition for $100.00 (a Phillips Respironics System One that retails for $3,500.00) for sale on our local Craigslist page. Even refurbished ones online are going to cost at least $400.00. Many people sell them because the cannot get used to the mask.
10
Our 18 year old son had breathing issues as a very small child. I could hear that he wasn't breathing properly when he slept. Needless to say, I spent years not sleeping as I worried about him and soothed him back to sleep. He also had other signs of a whey protein allergy (found in dairy). We took away the dairy and the issue seem to subside.
He introduced dairy into his diet as a teen. There were not any outward symptoms of an allergy. However, he was chronically tired, spaced out, needing naps and struggling to get his schoolwork done. It was hard to know if this was just normal teen age issues or something more.
A school roommate told him that he wasn't breathing at night. My mother had apnea, as did her mother. Our son was tested and then given a CPAP machine. The very dark circles have gone from under his eyes, he is happier, has more stamina and isn't sick all of the time. Phew!
15
As an ENT doctor specializing in treating sleep apnea, I really appreciate NYT writing this article and bringing attention to this very important but under diagnosed disorder. Although CPAP/BiPAP is unquestionably the best/cheapest/safest treatment for sleep apnea, only 50% of people can tolerate it. For those people with moderate to severe sleep apnea who can’t tolerate CPAP, surgery is often an option. I disagree that surgery is only for the most severe cases as patients with moderate sleep apnea may be very symptomatic and at risk for cardiovascular consequences. UPPP was very commonly performed in the past but as many commentators have noted, can be ineffective and lead to swallowing or speech dysfunction. New techniques allow us to look in the airway while the patient is sleeping to see where the airway blockage is occurring. We can then direct treatment to the specific area that needs to be opened. One treatment not mentioned is hypoglossal nerve stimulation (Inspire) which is a pacemaker like device that goes under the skin, monitors the breathing cycle, and stimulates the muscles of the airway to prevent airway collapse. This has been shown to reduce the severity of sleep apnea by 70% and allow people to go to sleep naturally without a mask and wake feeling rested.
15
The compliance rate for CPAP devices is atrociously low.
If you don't mind being on "life support" it's probably worth the money.
It's also worthwhile checking out the "Number Needed to Treat' evidence (NTT) to get an idea of its overall effectiveness, rather than depend on anecdotal reports that sound more like infomercials than science.
6
This is yet another side effect of the Obesity Epidemic. Two thirds of Americans are overweight and it is causing us to spend trillions more on healthcare than any other country.
It starts young and frankly never ends. While I may be considered extreme in the other side— I eat well, intermittently fast, work out 10-14 hours a week and run triathlons and marathons, I am convinced that bad eating and a sedentary sit all day and binge watch all night life style is destroying us. I have friends I went to school with (I am 58) who look and feel like they are in their 80’s and already in morbidity. It is all habits and life style. I for one do not want to go gently into the good night.
6
@Tim. Good for you on being a model for the rest of us. I too eat well, lead an active health lifestyle, and am far from obese. Oh, did I mention I have sleep apnea.
15
@Tim please don’t bring fat phobia, weight stigma and diet culture to a conversation about equipment for a condition that many “healthy weight” people suffer from.
12
@Tim
Agreed. Please avoid the fat phobia. As I mentioned above, my husband is in top physical shape; runs/swims about 20 miles a week and has for as long as I’ve known him (30 years). And he has sleep apnea. While I am active and healthy, I am not in as good shape as he is—and I’ve never had it.
8
"We Beat Sleep Apnea."
No, you did not. You still have sleep apnea; you merely are managing it, as I am managing mine. To have beaten it would imply that you could now have regular, high-quality sleep without your CPAP machine. You cannot, and neither can I. The machine does nothing to fix the underlying cause.
I am very grateful for my CPAP machine because it allows me to get high-quality sleep (on nights when I don't take it off in my sleep). I also do not believe it to be an acceptable long-term solution: I do not relish the idea that for the rest of my life I will need to be hooked up to a machine in order to fulfill a basic human need. I am disappointed that the medical research community has not yet come up with a better solution.
32
@Chris
Well.....the dental community came up with an alternative solution: oral appliance therapy. The compliance rate is much higher, which renders the treatment outcomes equal to CPAP. The convenience , comfort and lack of hoses make it an increasingly popular choice.
7
You and others suffering from this terrible disorder should be aware please that the medical research community—albeit the nutrition branch and not the ENT folks—has a solution that addresses the primary cause of sleep apnea for what a quick google search suggests is the vast majority of adult sleep apnea sufferers: obesity and overweight.
Honestly, it astounds me the sheer number of expensive, risky, and disruptive treatments of symptoms (CPAP, surgery, we modern humans would rather try than treating the underlying cause of this and the other leading causes of premature death and disability: eating a diet rich in fiber from vegetables, fruits, whole grains, beans, nuts and seeds.
For a start, there is a new book out by a group—headed by Dr Michael Greger—of highly knowledgeable, not for profit, treat-the-cause-not-the-symptoms types that I wish Drs Carroll and Frakt would have mentioned: How Not to Diet. Get it. Read it. Do it. In short order, the cause will likely be treated, and you can forget about expensive treatment of mere symptoms for good.
@Eric Gates how would this help my husband, who is in top physical shape, has an excellent diet and still has sleep apnea?
7
I am an American, aged 70, living and working in France. Five years ago, my wife mentioned that during the night, I often became restless and made gestures of which, the morning after, I was unaware. I consulted a somnologist at the university hospital of Poitiers; he asked me some standardized questions and I made an appointment for an overnight stay in the cardio-respiratory unit. I was fitted out with monitoring devices and slept uncomfortably and fitfully, after which I was diagnosed with obstructive sleep apnea. I was given a prescription and made an appointment with a CPAP device supplier who came to my house and fitted me out with a mask covering my nostrils only; it took about ten days to get used to it. A few weeks later the supplier returned; one function of the device is to record apneas, and it was found that mine had disappeared! The costs for the consultations, visits, device and mask are covered 100% by my (French) health insurer. Every 6 months the supplier returns and verifies that the device is indeed in use 5 or 6 hours a night (I have always been a light sleeper). I have also gotten used to traveling with the apparatus. According to my wife, I snore far less than before. As for daytime somnolence, on the other hand, I am not totally “cured”. All in all, the CPAP machine has significantly improved my quality of life - and at no cost.
20
Sympathy to sufferers and their sleep mates. Why not try a mandibular device? Small and discreet, these move the lower jaw slightly forward while wearing and prevent the snoring so often associated with the apnea. Ask at your dentist, doctor or sleep clinic.
3
@Catherine Taylor I was interested in this device, but found out that here in the US, insurance will rarely cover them. Why not? Because, while they may be about the same price as a CPAP, they only last about a year, while CPAPs last for several years. So the simpler, less intrusive therapy is discarded as too expensive.
5
By shifting the jaw forward, the mandibular device causes malalignment of the TMJ Joint and with chronic use can cause TMJ Syndrome. It is not to be recommended for treatment of Sleep Apnea, but is used to correct sleep malalignment and treat TMJ Syndrome.
6
@Donna
As a provider of oral appliance therapy, I would like to correct some commonly misunderstood points:
1. Most medical insurers do cover oral appliance therapy
2. The average life of an oral device is 3 to 5 years.
5
A CPAP is the best birth control device I've ever found. If you don't already have a partner, try to find someone who has a thing for Darth Vader.
31
Lol! 20 years ago I was diagnosed with sleep apnea and I was offered 2 choices. This machine or an operation to move my jaw forward, opening up my breathing passage. I chose the latter.
BTW, this operation and the dental work to adjust my bite was completely covered in the Swedish healthcare system. Not to mention the new confidence gained by correcting my receding jaw.
Heja Sverige!
3
@Ray Gunn Trying to sleep anywhere near someone gasping for breath due to untreated sleep apnea is worse.
8
@Ray Gunn. I would rather not be a widow, thanks. And the fact that my husband sleeps like a baby now (and quietly) makes all the difference in the world.
5
If you are newly diagnosed, be prepared for insurance to deny your claim. When my PCP filed the claim—even though the results were clearly within the range to receive a CPAP—insurance denied it. I then took the test results to an ENT, who lobbied the insurance company on my behalf.
Happy dreams!
2
Amen. 10 years ago, I was diagnosed with severe generalized sleep apnea. I have used my machine faithfully all this time but now need a new machine. But they tell me I need another sleep study. Tried the at home test, and they told me that they got no results from it, but they would sign me up for lab test. No thanks. I already know what I have, I just need a new machine. My insurance will pay for it, provided I can get a prescription. It's a ridiculous system.
22
I was a doubter. Now I'm a believer and a daily user of CPAP. I sleep ever so much better, I feel better, my wife is happier, and my blood pressure is much more easily controlled. The devices are quiet and relatively easy to transport. The only problem is hotels that insist on not having convenient AC outlets near the bedstands. For that I have to take an extension cord.
15
I had been using cpap for 20 yrs. i had count on one hand the nights that i can sleep w/o it. yes, it takes some work to get use to it but for me, it was worth the effort. as for what the sleep test is about, i would suggest potential patients do some research on it. it check more than just when you stop breathing. there is a whole host of other potential health problems that you could have.
7
Like others, I ended up having some issues with side-sleeping and leaks using a ResMed P10 nasal mask. So on a recent visit to my medical supplier, I asked if there were any new masks that might work better/be more comfortable, and they recommended the ResMed N30i (there is also an N30, so don't confuse the two). I've now used this for almost a month and I'm really liking it, and my app scores are up do to fewer leak issues.
Instead of nasal pillows, there is a membrane with holes that goes under the nose. The air supply tube attaches at the top of the head, which keeps it out of the way a lot more than the tube on the P10, which is right in front of your face. The air travels down the sides of the mask, which means that if you lie on one side and block the tube, the other side keeps the air supply going. There's one adjustable strap that goes around the back of the head to keep it secured, and it doesn't stretch like the headgear on the P10.
The other nice thing is that the nasal membrane section can be removed and replaced by nasal pillows (or vice versa if you get the P30i mask).
I've seen a lot of masks of different types sold on CPAP.com and Amazon.com, so there' probably something out there for everyone. The major thing I'm trying to do is get across that improvements in masks and machines do happen, and it is a good thing to ask about improvements when you check with your doctor or medical supply company.
7
@JayTee I've used cloth CPAP masks by circadiance.com for the past five years. I can't stand latex masks. The cloth masks from Circadiance are perfect for side sleepers like who can't tolerate the smell of latex. When I dig my cheek into the pillow the cloth mask will deflate like a balloon.
My CPAP has saved my life (my apnea is moderate). I've gone from AHI of mid-20s down to 1 or 2. Imagine how destructive it was to wake up every 3 or 4 minutes gasping for air.
And I could not stand a CPAP with a latex mask, so my cloth mask has saved my life, literally.
Kudos to the authors (Dr. Carroll and Dr. Frakt) for their excellent article. Sleep apnea is treatable. We need to do more to educate the public about treatment options.
7
I put off my doctor's suggestion to get tested for fatigue for more than a decade before I was diagnosed with sleep apnea. Ambien and melatonin were not much help. My testing occurred only after a new girlfriend insisted my snoring and breathing stoppages were both objectionable and scary. More than seven years later I now can say sleeping is not an issue. My adjustment and my nasal "pillow" device, like the writers, are fine. My only real issue with the CPAP is I must sleep flat on my back, which gets stiff because I don't seem to move all night - 6 to 8 hours straight is common - and I awaken in the same position. I can live with that.
6
Take your bed-partner (my term) to your appointment. OSA is easy to diagnose but rarely by the patient, it is the person sharing the room with you who knows you have it.
Interesting idea about simply giving out the machines but the issue is the masks. They make it or break it for a big percentage of people and for that the patient needs to spend some time with a pro, and that costs money.
Always take your machine and your mask to the hospital with you. We will give you one if you need/ask for it but our masks are single use; cheap plastic and most hospitals don't have nasal pillows because they are simply too expensive to have each size in stock.
Good luck and good night
6
i've been using a schnozalator for years. all night every night. made a huge difference in my life. early one morning recently the power went out and i woke up gasping and for the next three hours couldn't sleep more than a couple of minutes at a time without choking and gasping for breath. interesting that the article mentioned cardiovascular surgery. i had valve replacement surgery and bounced right back. couldn't live without the machine.
8
As someone easily subject sinus infections and almost continuous post nasal drip when they lay on their back for any length of time, the attempted use of Cpap machine during a sleep study was a disaster. Waking up choking repeatedly doesn’t really lead to a good nights sleep and a severe sinus infection 2 days after the test didn’t help either.
Just to complicate matters, I pretty much sleep almost face down which precludes an effective use of a mask. The sleep specialist just said I couldn’t sleep that way anymore. Seems that anyone that goes into a sleep study is prescribed a machine, not actually helped with your sleep.
3
@Bob
You may consider oral appliance therapy fitted by a specially trained sleep dentist. It allows you freedom in movement and enjoys high compliance rates.
3
I'm a lifelong snorer, my parents tell me I snored as a baby. My condition was completely unaffected by my level of fitness.
My fiance told me there would be no wedding unless I did something about my snoring and nightly gasping for air. I did two sleep studies. The difficulties described by the authors are absolutely accurate. I persevered and eventually talked my doctor into performing snoring surgery on me. He only agreed when I promised to undergo another sleep study after I healed. He was concerned that the surgery would eliminate the noise of my snoring but the dangerous sleep apnea would remain.
I underwent UPPP and a tonsillectomy to make room in my larynx. The surgery went well. I did not find it to be too painful. My surgeon was happy with the results and even commented that I had tonsils the size of an eight-foot man.
His concerns about the procedure were well-founded though. The second sleep study revealed that while my snoring was greatly reduced I still had a severe case of sleep apnea based upon my AHI as measured during the study. I was fitted for a CPAP soon after.
The device was a godsend, I'm not sure I would be alive now without it (I'm 52). It took me about a month to get used to it but now, 14 years later, I won't even take a nap without strapping on my mask (I tell myself I look like Maverick in Top Gun). If you suspect you have sleep apnea please get checked out. You will feel so much better and likely extend your life significantly.
31
I lost insurance coverage on my cpap machine when my company changed insurers. After some quick research I returned my machine to the distributor and bought a newer version on Craig’s List from someone who could not adapt. The cost was 1/4 of the distributor’s price. You Tube taught me how to hack the the settings and make settings adjustments & I removed the modem card that reported to the insurer. Amazon sells tubes, filters, masks, etc at a fraction of what insurers charge. CPAP saved my life, no more driving while nodding off, no midnight runs to the bathroom, no mid-afternoon slumps.
36
Perhaps my experience and condition was different than most, perhaps not, but I would definitely recommend that prior to a sleep specialist one sees an ENT doctor first.
Unfortunately I did not and went through the horrors of two sleep studies and CPAP failure. Had I gone to the ENT first I would have learned that my turbinates' were extremely enlarged. After surgery ALL of my sleep apnea symptoms were gone, my sleep restored, my life mine once again.
11
I was referred by my pcp for a sleep study in 2002 and subsequently started using a continuous-airway cpap machine in 2003. I found the machine noisy but some people consider it like white noise. Fast forward about 10 years and I did another sleep study and had different insurance and the supplier and the insurance company had me on a microprocessor-controlled bipap/cpap nachine that supposedly continuously adjusts (but reading some of the letters here it seems that is not totally dependable and reliable). I still use the machine (ResMed 10) but feel like I still wake up overnight. I was in compliance for a year (4 hours a day at least, every day) and then my insurance company coverted it to sale or paid for it after a year. The new machines have wifi to report your usage and also a memory card for when there is no wifi connection. I also looked into the mouth appliance but the insurance considers this adult orthodenture and it is not covered. So, what to do? Go back to the continuous cpap or keep using the adjustable bipap.
2
@Andy B
These days, oral appliance therapy is covered under the majority of medical insurers.
Over a period of many years, my husband saw several pulmonologists and “sleep specialists” and had severel sleep studies. He used a CPAP machine, which did not work for him. We finally discovered ourselves after searching on the internet that he has a condition called catathrenia. Although we described to the various doctors that he actually held his breath in his sleep, leading us to believe that he had central sleep apnea, they all shrugged their shoulders and never mentioned this kind of sleep disorder. Catathrenia is characterized by the sleeper holding his or her breath and then producing noise during exhalation, as opposed to snoring, in which noise is produced during inhalation. It was extremetly frustrating to have wasted so much time and money on visits to so called sleep specialists who apparantly never even heard of this little understood sleep disorder or even bothered to look into it. Judging from what little information is out there, it appears that a lot more research needs to be done on this condition.
10
The cpap machine saved my marriage.
9
Will the authors, Aaron E. Carroll and Austin Frakt, both please make a complete and verifiable disclosure statement identifying whether they have any financial or professional connections with manufacturers of CPAP devices? I'm serious - it's essential to know whether any author has been influenced, especially concerning medical advice. Thanks
51
The geniuses on wall street seem to have gotten wind of sleep medicine as a cash cow. This is the only reason I can think of why there are so many fly-by-night sleep clinics that seem to have websites but no hours or location in the Bay Area. This is what happens when we let the coke-fueled MBAs take over things that should be public goods. (ie, all necessities, including basic housing should be IMHO should be publicly run and available.) There is no end to the stupidity of the market.
8
I’m 70, and have used a CPAP for 6 years. In the last year or so I’ve had a lot of problems with leakage. Didn’t seem to be the equipment so much as the fact I’m a mouth breather and have a hard time keeping my mouth closed when sleeping. The answer? A chin strap! I now look totally like a cyborg when ready for bed, but who cares? My sleep is better than ever! I’m hoping that with the chin strap I can go to a nasal, rather than a full face, mask. My mouth stays securely closed and I feel like my head is in a comfy cocoon. Love it!
10
@Andie DeLuca I'm 76 and have been using CPAP for more than 30 years now. A couple of years ago I was switched to a BiPAP, which reacts to apnea incidents by temporarily raising the pressure to counter them. I also have switched to nasal pillows which are far more comfortable than any of the masks I've ever used. I can sleep on my side now too.
Now --- to solve mouth breathing problems, and this is going to sound nuts but it's not, I buy 3M Nexcare gentle paper tape at the pharmacy and at night just slap a 4" strip of it over my mouth before going to sleep. Bliss.
As mentioned, I'm 76. There's no way I would have achieved this age without CPAP/BiPAP.
3
Another big benefit of treating sleep apnea? Also helps with erectile dysfunction. For real.
5
Do an informal survey and see who has been prescribed the machine and who still uses it. If it is so wonderful why don't people keep using it? If you go in for the first sleep study and tell them that you snore and that you stop breathing when you sleep why do they cover you with electrodes, guaranteeing you an uncomfortable night of sleep, then tell you at the end that you woke up, stopped breathing and snored? Here's the bill. Then go in a SECOND time for the fitting of the machine, same electrodes, oh yeah, second bill. How many other medical conditions only offer one option? Need an adjustment, a different mask or another machine? Come in for another sleep study.
Another pseudo-medical scam.
"Hug" pillow, sometimes a knee pillow. Earplugs for my wife.
2
@Aaron V.
Sorry to interrupt your rant, but that's not the way it works.
I had:
1. An appointment with the doctor to see if I qualified for a sleep study. I had had a recent hospitalization and during that my oxygenation levels declined (a lot) when I went to sleep, so I needed the study.
2. My sleep study, which they interrupted when my oxygen levels dropped, and put me on a nasal mask.
3. Met with the doctor afterward who discussed my results and told me I was lucky that I was still alive with no brain damage due to hypoxia because of the number of episodes of apnea I had during the study (and considering that this was happening at home as well). During this visit he arranged for me to get the CPAP machine at an independent medical supply company that specialized in respiratory supplies.
4. Got the machine at the medical supply company, where they showed me how to operate it, went over how to fit the mask, take care of the machine and the mask, and how and when to get supplies.
Both the doctor and the medical supply company monitor my results from the CPAP machine, and have let me know if I needed to change something. If I want a new type of mask (I just did get a new nasal mask that I like much better than the old one) I see the medical supply company, not the doctor or the sleep lab.
I only see the doctor once a year to verify that I am still using the machine and that it's helping so that insurance will pay for it.
10
As a veteran, I qualify for healthcare through the VA and I received my Bipap and accessories for free.
8
you say "Snoring and sleep apnea are on the same spectrum and are associated with Type 2 diabetes in adults. " in a paragraph which has two "associations" and two proven cause-effect results. Does putting these four hypotheses in the same paragraph imply truth to the unproven ones?
Care when reporting on medical items is important... I'm thinking of the anti-vaxers here... so please keep hypothesis and cause/effect reports apart.
As your reference states: "Well-designed studies are required to clarify the therapeutic effect of CPAP on diabetes. "
4
@Trying... I had a number of weird digestive issues before being diagnosed with sleep apnea, including blood test that indicated an elevated risk of becoming diabetic (I was "pre-prediabetic" according to my PCP) but also; gout, elevated liver enzymes etc... Once I started using a CPAP they all vanished. Now maybe this was because I was getting enough sleep, maybe it was because I was rested my body wasn't constantly craving carbohydrates, IDK. but I d do know that my blood work went from being typical of a 65 YO at 49 to typical of a 40 YO at 50, and I lost 60 lbs. I hate my CPAP, but it keeps me alive, so every night I curse it before strapping it on. It takes some time to get used to (3 mos for me) but if your are diagnosed, stick with it. It isn't any easy fix but it is better than dying.
4
A relative of a relative, routinely a poor sleeper, fell asleep at the wheel and killed an innocent. There are society-wide benefits from addressing widespread sleep deprivation more effectively. Great idea for docs to give out cpaps without the hated sleep studies required.
16
Can anyone here speak to the options for surgery? What are they, what are the pros/cons?
@botwin27
I was diagnosed with severe sleep apnea in 1995. I had the surgery UP3. It was painful. While recovering I had an aneurysm and nearly bled to death. After all that, I still had the apnea ... but I no longer snored. Also, now I frequently choke on food and water. I believe that such frequent complications and low success rate have made the surgery rare and used only as a last resort.
Initially a CPAP machine did not help me. It was eventually determined that I had a severely deviated septum. Surgery to fix it also didn't help alleviate or reduce my apnea, but it did allow me to benefit from a CPAP.
The CPAP changed my life. I had no idea how sleep deprived I had been. My job performance had suffered over the previous 5 years and I was very irritable. I couldn't sit at my desk without nodding off; it even happened in meetings. I had started having waking dreams.
Doctors warn about the risk of sleep apnea to the heart. They don't seem to recognize what the repeated lack of oxygen does to the brain. After the years of suffering from untreated apnea, I've experienced a permanent decline in my cognition and memory.
So particularly if your sleep apnea has been diagnosed as "severe," I advise you to stay with a CPAP.
10
Just read a comment, 'Medicare does not cover it...'
I'm out!
Age 69
See you in the next life and don't be late...
4
I’m not so sure that’s the case. I believe MEDICARE does cover the CPAP. I’d look into it before I gave up.
12
@Lost In America Medicare COVERS my cpap. You need to look into this - you will feel like a new person.
7
@Peter
MediCare definitely covers c-paps and bi-paps. Don’t hesitate.
10
I have slept with a bpap machine now for 20 years and always get a good nights sleep. Before my initial sleep study I was always groggy first thing in the morning and needed a nap in the afternoon. My wife first noticed that I would stop breathing during the night and then wake up with a big snort all night long. Sleep apnea will wear your heart out.
I am now using. Phillips Dreamstation, it’s totally silent as my wife can attest.
You owe it to yourself and your partner to get a sleep study and get diagnosed. I found a sleep support group that gave good advice and info. I never sleep without it my machine.
17
I tried a CPAP and could not tolerate it. But then the docs switched me to a BIPAP, essentially a "Smart" CPAP, and in a few days I was using it regularly. It is absolutely silent (which doesn't matter to me, but does to others). Now I use it every night, at least 80% of the night. Big difference. There are other versions too that are even more sophisticated than a BIPAP, but I have no experience with those. I recommend pushing your doc for a BIPAP right off the bat.
6
Thank you for this.
I’m a doctor with sleep apnea and the barriers to treatment are ridiculous. Examples: a simple at home sleep study, in which you wear self-applied monitors that transmit data to a computer for analysis, costs $2000. Once on CPAP, insurers won’t cover any of your ongoing expenses unless you agree to have all your sleep data online, something I find unnecessarily intrusive and actually pretty creepy. You can only replace disposables on the machine by purchasing an entire kit. If you want an additional machine for travel, or any change whatsoever, you have to go back to the sleep clinic for a new prescription. I could go on and on. If it weren’t so effective I would’ve ditched the treatment long ago in disgust over what is purely a money grab at every level.
49
@Riley2
As a CPAP user since 1995, I recall that it used to be a nightmare to jump through the successive hoops of doctors, insurance, sleep studies, and medical equipment providers. Back then it was a struggle just to get replacement equipment such as masks. And insurance wouldn't pay for a humidifier which is now standard equipment.
Over time I also discovered that my sleep doctors owned and were getting rich from the sleep centers that were charging my insurance thousands of dollars for a diagnosis. When I would get a required new sleep study every few years, they would charge my insurance for a new CPAP even if my current one was still in good condition.
But now days, I can get a prescription online for a replacement CPAP by purchasing an auto-CPAP that determines the pressure I need and removes the requirement for a new sleep study. I pay for the device myself at a cost less than the co-pay if I used my insurance.
Also ridiculous is that the FDA requires that only a licensed medical special can adjust the CPAP pressure settings. You can find out online how to access the "secret" settings for your CPAP. This is useful if you get a follow-up sleep study and receive a new machine. They may want to charge you to update the pressure setting of your old machine, or even try to force you to return it. But they should provide you with the new pressure numbers, and with online information you can update and have a working backup machine.
8
@Riley2 Now I'm wondering about your insurance company. I'm on Original Medicare plus a Medigap policy. I can order replacement components individually directly from the medical equipment provider.
I've had to buy my own travel CPAP, although perhaps [Medicare would cover it is that were going to be my only machine.]
3
@Riley2
IMO, most of “health care” is purely a money grab at every level!
4
I was diagnosed with OSA about 6 years ago, when my cardiologist required a sleep test before an ablation procedure for A-Fib. He said my A-fib was possibly the result of untreated OSA. My experiences with the CPAP are not unlike others responding to this article. I do not arise as refreshed as most users do, but I do sleep well, and do not have to get up to urinate for as long as 6 hours, instead of 2-3 hours. It seems I now sleep deeply enough that the urges do not wake me. That is a huge plus for me! I won’t leave home without it.
After my initial sleep test, Medicare has paid for all supplies, and the supply company
has been prompt with reminders about timely replacements. I am sorry for those folks whose insurance won’t step up, due to the exorbitant costs of the supplies charged to Medicare. Perhaps it is time for CPAP-using legislators to get involved to champion the cause of OSA sufferers.
7
Everyone talks about cost amounts as if they are a given.
You guys need to read the op-ed the other day here by a lady whose husband was hurt on a bicycle. She's a reporter here at the times, covering medical stuff, but even so the experience was an eye-opener regarding the price gouging that goes on.
Such as? How about $350 for a neck brace that was applied for 10 minutes, then removed and kept? A neck brace identical to one sold in the same hospital's pharmacy for $30?
But we'll never find a true and honest price for a CPAP machine -- medical machine makers have government protection to charge whatever they want, just like the rest of the medical industry in this country, all under the umbrella of this being "the best medical system in the world."
8
@Charles Trentelman
I have good insurance coverage though my employer. Nevertheless, I am careful to check the individual charges to my insurance company from my medical providers.
After one minor outpatient procedure, I checked my insurance account record online and found all sorts of false charges for tests, procedures, equipment, etc. that I didn't actually receive. The insurance company had already approved and paid for them.
So I called my insurance company to report this. The customer support representative I spoke with asked if I had been charged a copay for these items. I said no. She asked if I still needed the equipment. Again I said no. So then she says she doesn't understand why I'm calling. I explained to her that I assumed the insurance company would want to know about these questionable expenses. She took my information, but later when I checked my online account records, I noted that these charges were ever updated or removed.
1
@Charles Trentelman You can see the direct-to-consumer prices for CPAP machines by going to the various CPAP sellers online.
1
I've "fought" with my pulmonologist, my ophthalmologist, generalist, cardiologist over the fact that my BIPAP mask blows air through a tear duct into my right eye drying it out and making me unable to read for days at a time. I've tried eye drops at night and in the morning, eye gell at night. Nothing helps. I'm considering a nose plug for the right nostril if I can find one that blocks the passage to that tear duct but still allows me to breath through that nostril.
In short. It is a huge problem.
1
@Mad-As-Heaven-In
1. Get a different mask??
I wasn’t thrilled with the first one, so a month later they suggested I try others. I must have tried ten different types and sizes before I found a good combination. (I am cheating on Philips with a Resmed mask.)
2. Wear an eye mask?
Good luck!
1
@Mad-As-Heaven-In
Oral appliance therapy by a sleep trained dentist is a highly effective and increasingly popular alternative.
1
@Mad-As-Heaven-In Wearing a sleep eye mask might solve your problem. I wear a sleep eye mask on top of my CPAP full face mask. Even though the bottom edge of the sleep eye mask is above top edge of the full face CPAP mask (below my eyes), the sleep mask prevents any air from leaking and rushing over my face. I think the sleep eye mask traps some air or blocks flow which causes enough pressure to stop the leaking of air from the top of the CPAP mask. My sleep eye mask is just a sewn piece of double-layer flannel cotton with an elastic band but you can buy a sleep mask at any drugstore usually in the travel section (for use on airplanes). You could also try wearing a single eye mask such as used to treat lazy eye syndrome, those come in several sizes.
I knew I had sleep apnea for years because I'd wake up gasping for breath, with a terrible headache, but my doctor refused to refer me for a study> He said I can't have sleep apnea because I'm not overweight. I found out about dental appliances and had one made, but beware, they can change your bite. It does put pressure on your teeth all night. When I moved and changed doctors, my new doctor referred me for a sleep study. It was the most uncomfortable night of my life and I wasn't able to sleep until close to morning. As a result, I didn't have enough episodes for my insurance to justify paying for a machine. I told the doctor, forget insurance, I'll pay for the machine myself, if I can just get a night's sleep! so he gave me the Rx. I've been using my machine faithfully for 12 years now. I would not give it up for anything. It changed my life. For the first time, I could exercise and recover. I stopped having nightmares about not being able to breathe all night. I woke up rested in the morning and without feeling like I'd been wacked in the back of the head with a board. I don't get sick as much or as severely.
Being as any adverse affects from using a cpap machine are almost unheard of, I don't understand why they are so guarded and controlled. Yes, give them out to anyone who feels they may benefit! Let them try it.
10
@Mine2
Note that when I was diagnosed with "severe" sleep apnea 20 years ago, I was not overweight. Nor was I overweight during the previous 5-10 years that I suffered from apnea before being diagnosed.
I have gained enough weight over time that I am now overweight. My current doctor has repeatedly told me that losing weight may eliminate my apnea. I have explained to him that my apnea started long before I became overweight, but he won't listen.
5
Similar story here. I was very skinny when my OSA was diagnosed. My blood oxygen level was dropping into the danger zone every night and my heart beat was utterly erratic. In other words, sleep was killing me. And it had been going on for years. Most days I was a zombie.
Having a good CPAP machine with properly fitted nasal pillows saves my life every time I use it. I had to teach myself to sleep with my mouth closed and it only took a few nights. Today the situation is reversed, quite overweight but not waking up feeling as if I were drugged. I still awaken a bit tired, though there is no comparison between how it was and how it is.
Fortunately my insurance covers much of the costs. Reading others’ comments here make me realize how fortunate I am.
2
I've used a CPAP for more than 10 years. I've had Uvulopalatopharyngoplasty (UPPP) surgery ( very painful , expensive and useless!) I've even had Radiofrequency Volumetric Tissue Reduction (RFVTR). More pain, money and useless!
Only the CPAP machine works. Please if you suspect you have sleep apnea and you're having insurance issues just go buy a machine and live longer.
My newer CPAP is quiet and the new masks are much more comfortable. One side note: my 60 year old male attorney and I were having lunch. He looked terrible and confessed he's not sleeping well. I suggested a sleep study and possibly a CPAP machine. He called me weeks later and joyously shared that he has never slept better! It was an amazing transformation. It's not romantic at night but either is a heart attack!
18
@Mark
I haven't made my way through all of the comments yet, but from what I've read so far, it appears that everyone has had much the same experience with UPPP as me. I usually lunch alone because it's embarrassing to take a drink from a glass and have my coworkers see water shooting out my nose.
Also, since the surgery I've had trouble pronouncing words that begin with the letter "R." It's a big problem whenever I'm introduced to someone new since my name is Ray.
Don't ever believe that the uvula is a useless organ. That and my tonsils were removed with the UP3 surgery.
2
@Mark
I haven't made my way through all of the comments yet, but from what I've read so far, it appears that everyone has had much the same experience with UPPP as me. I usually lunch alone because it's embarrassing to take a drink from a glass and have coworkers see water drip out my nose.
Also, since the surgery I've had trouble pronouncing words that begin with the letter "R." It's a big problem whenever I'm introduced to someone new since my name is Ray.
Don't ever believe that the uvula is a useless organ. That and my tonsils were removed with the UP3 surgery.
One more thing about my UP3 surgery. Though it didn't stop my sleep apnea, I no longer snore.
2
@Mark
I haven't made my way through all of the comments yet, but from what I've read so far, it appears that everyone has had much the same experience with UPPP as me. I usually lunch alone because it's embarrassing to take a drink from a glass and have my coworkers see water shooting out my nose.
1
The home medical company and the insurance company are spying on you. What happens when you disagree with the data they collect? Who else can see it and to what end?
2
@Stella
HIPAA applies, so only pertinent information should be released and only to those taking care of you or paying for the therapy. They shouldn't get much more than number of days used, hours per day used, and whether or not it's effective. The data the doctors and medical supply companies get is mostly the same data you get from the phone app: Time of use, events/hr, mask fit issues, number of mask on & offs. There's probably some other data sent, like pressures, etc. so they can identify machine problems before they become critical.
I have a portable machine that I bought to use on trips, so my home machine record has gaps. If they argue about coverage, I will take in my portable and let the medical supply company read the data from there to prove I haven't missed any nights.
1
A CPAP machine is the 21st century equivalent of the iron lung. I've read that nearly 50 percent of people who are prescribed them stop using them permanently within a month or so. There has to be a better way than to spend the rest of your life tethered to this thing.
8
@David P.
A very effective alternative is available: oral appliance fitted by a sleep dentist. Much higher compliance rates make the treatment outcomes equal to CPAP therapy.
@Daniela My dentist discouraged me on oral device saying that it damages enamel.
Side sleeping, however long it may take to get used to it, is the best remedy.
Who gets asks “do you snore” by your doctor when you go in for a physical? And why not? If the machine is not invasive in any way why do we need to go through our medical crowd to rake off money - why can’t the marketers across the country just sell them at the drug store? Try it yourself and if you don’t like it you can stop using since you paid for it yourself. Not sure why it needs a diagnosis. I can buy off the counter allergy medication without being subjected to needles in my back for what I am allergic to. As well as I can buy orthotics for my tennis shoes without a prescription - can’t we just do this cheaper and quicker ourselves?
5
@Jan Whitener
They're not one size fits all. There are a variety of manufacturers and mask models that need to be fit properly; pressures need to be set correctly, and ramp-up times can be varied to accommodate the CPAP user.
You can't rely on an over the counter pill to solve all your allergy problems, and you can't rely on an OTC orthotic to solve all foot problems. Some things you really need to get professional advice and guidance before you start using something that might not be the correct solution to a problem.
2
In Sydney Australia, they sell machines and supplies over the counter in chain drug stores.
3
My wife and I use cpaps. Been using them so long they are a ritual that I actually can't sleep until I have donned it. Before cpap I would sometimes wake up suddenly gasping for breath, having been dreaming of drowning.
3
There are many other options to treat obstructive sleep apnea including oral appliances which are small convenient and easy to tolerate . As well as soft palate and skeletal surgeries for more permanent solutions so that you are not relying on an appliance for the rest of your life.
www.ussleepapnea.com
7
I agree on the idiocy of hospital sleep studies. A few years ago I went to a sleep specialist who prescribed a hospital study and I went to get one--as the article says, it is a fairly unpleasant experience. My insurer denied the claim; the doctor was unable to provide documentation that persuaded them. Fortunately, I could afford to pay out of pocket the hefty cost, but obviously many others can't. I got an oral appliance, which seems to work--had to have a home study to confirm that. As the article points out, the nuisance of getting the sleep study device and then returning it the next day (in my case, two 30 mile round trips in suburban NY) is not inconsiderable.
5
I have used a cpap machine since being diagnosed with severe obstructive sleep apnea about 5 years ago. My overnight study showed that I stopped breathing about 83 times an hour. I hadn't felt particularly tired during the day but I did sometimes wake up gasping for breath during the night. I thought it had to do with anxiety. My other obvious symptom was afib. Yes, I look ridiculous going to bed with the mask on. Yes, I have had to try different masks to find the one that is best for me. However, I now have no afib and take no medication. It is my understanding that you can die in your sleep from afib when your heart can't return to normal rhythm, so it was a no brainer decision for me. I don't go to sleep without it!
9
I would like input from anyone reading this who has first-hand experience with central sleep apnea. I have absolutely none of the symptoms of obstructive sleep apnea, but I do have border-line low blood oxygen which may be making my heart work harder than it should have to. I am especially interested in the diagnostic sleep study part of all this.
@Jennene Colky. I have that. After gall bladder surgery, that was supposed to be a day stay, I was in the intensive care unit when my blood oxygen level did not recover. After that, I saw a pulmonary specialist that ordered a sleep study. As a result, I was diagnosed with severe centralized sleep apnea. I use the CPAP which seems to help a lot, but I also have to advise the medical team if I need to be sedated that I suffer from Centralized Sleep Apnea, so they watch my sedation level. My biggest frustration level now is that I need a new machine, and they want me to have another sleep study, which was a horrible 2 night experience the first time. I use nose pad masks and had no problem with adjusting to them.
I've used a CPAP machine for up to four years. While it has improved my sleep quality, it hasn't cured me of insomnia. The mask took me up to one year to get used to. Even though I have great insurance, it still cost me $2500 out of pocket. I found out that rather than being owned outright, the machine was on a lease costing me more than $100 a month. I ditched it and purchased my own machine. Although it doesn't have the bells and whistles of the leased version, it's just as efficacious
3
@Edwin Baiye Actually, your insurance is not great if it cost you $2500 out of pocket as you stated. If I were you I would look into other insurance.
I've used a CPAP for a decade. My medical insurance covers 50% of its costs, but it is responsible for 50% of the conflict in my marriage. Getting consumables is a massive headache - you pay for shipping or have to drive 50 miles to get resupplied. After a dentist pointed out my teeth grinding, I think I'm going to switch to an oral appliance.
BTW I'm of normal weight.
I have wondered why a person couldn't just go buy a CPAP machine online if they wanted to. I don't see any harm in it. A spouse can usually easily tell if there is a problem. Heavy snoring followed by a long silent period followed by a gasp during sleep is pretty easy to tell. I don't think how much pressure matters very much. Just set the purchased machine to 8, which is moderate. If the user had problems, then take the sleep record the machine puts out to a sleep specialist. Oh, I am a longtime CPAP user and my spouse first diagnosed the problem.
16
@Ro Mason You can buy your own machines but the supplier will probably require a prescription written by a doctor. And, that may require the sleep study.
2
@Jack Get one used, clean it out well, probably only used for a few weeks. That way, no doctors involved, taking their cut.
1
My husband is 75 and retired. For many common reasons, including being on a diuretic, he gets up maybe three times a night. Though he has sleep apnea, he has for now abandoned the machine. We rationalize that his getting up and going to the bathroom restarts his circulation. It is a price he is willing to pay and I have my own room. We don't mind daytime naps and that's when intimacy can happen. So currently he is staying alive without the CPAP. Losing weight would not hurt either.
2
@Leonie " We rationalize that his getting up and going to the bathroom restarts his circulation." Not a wise decision. Breathing correctly 3 times each night is not the same as breathing all night long. Your husband is putting his health in jeopardy. He would probably benefit from a sleep study, to show what kind of problems are resulting from not using the CPAP.
2
Though there are certainly exceptions, the vast majority of sleep apnea is caused or significantly exacerbated by obesity. Half of America didn't need CPAP masks one hundred years ago.
The first course of action for someone with airway obstruction should be weight loss if they are above ideal body weight. No it's not easy, but will not only help with OSA, it will also help avoid many other obesity related maladies like hypertension, type 2 diabetes, premature osteoarthritis, chronic back pain, etc., etc.. Handing out CPAP devices without addressing weight loss sidesteps the primary problem in most cases. A problem which costs nothing to address.
10
Sleep apnea was only recognized as a medical condition in the 1960s. And the CPAP device was invented in the 1980s. When I was diagnosed in 1995, I was not overweight. At that time, there were still relatively few doctors who treated it, and most people did not yet know about it. I have stories about the problems I had with airport security, especially after 9-11. Because of those hassles, I even once packed my CPAP in my suitcase instead of carrying it onboard. When I unpacked, I discovered that my CPAP had been disassembled by airport security, and no longer worked.
4
@CAF
I believe my weight gain was significantly exacerbated by sleep apnea.
The constant mind fog, lack of energy, and general depression associated with long term sleep deprivation is hardly likely to motivate a course of any action.
Finally getting treatment for my severe apnea (thank you ACA!) was a game changer for me. There is nothing like a good night's sleep and waking up clear eyed to produce the energy it takes to get motivated and moving again.
So, if you are suffering from sleep apnea and obesity, a CPAP may help you with both problems.
7
@Ray Gunn This is no longer a problem. TSA is required to allow the CPAP as an extra carry-on, as are the airlines. However, make sure you have two copies of a letter from your doctor confirming your need for the device... one copy should be with the machine, the other copy in your carry-on or in your wallet or pocket or purse. I have never had an issue with TSA and my CPAP. But if you are traveling a lot, get global traveler status or some other pre-check status, and there will be even less of an issue.
2
It can be hard to prove cost-efficacy in screening healthy populations, especially for low prevalence conditions or those in which false positives can lead to unnecessary risks and costs of treatment. But sleep apnea is highly prevalent, over-diagnosis and treatment may be costly and uncomfortable, for some, but it is not risky.
But it is easy to identify high risk individuals for sleep apnea: older patients, patients with cardio- cerebrovascular disease, patients with unremitting headaches, depression, or memory difficulty. The screening is easy, a few questions for the patient and bedpartner that any practitioner can ask in a few minutes. In my memory disorders clinic, I have incorporated these questions into the routine evaluation; it is amazing how many patients with sleep apnea we identify and how many improve with treatment. And to think we were missing the diagnosis before we started to ask routinely.
9
@MEM There is a standard screening questionnaire used by sleep doctors that asks how likely it would be for you to fall asleep in various situations. It results in a score, and that score can indicate sleep apnea as a possibility.
I was diagnosed with sleep apnea in 2014. I had a diagnostic sleep study which revealed apnea when I slept on my right side. I had to go back for a confirmation study and it was the worst night of sleep I'd ever had. Fortunately, the computer with my results crashed the next day so I had to do a repeat study. I had a great tech who fit me with a child's sized full face mask. That was the most restful night of sleep I've ever had. Since then, I've only slept without my cpap one night. After lots of trial and error, I finally found a mask that works well for me (Airtouch F20 full faced mask). I suspect many of the commentors who have had problems adjusting to their cpap are actually wearing the wrong mask. I was finally able to find a respiratory therapist who would listened to me when I described the problems I had with my various masks.
11
@Mellow Fred
You point out a big problem with sleep study providers. Apparently you were lucky to have experience a provider who presented you with a variety of different equipment options.
After my diagnosis, I was provided with a CPAP machine. I was not given a choice of machine or even told about the different models available. I was given one full face mask and two sizes of nasal masks to try on; again I was not told about the many different styles of masks that exist.
I suspect that my experience may be more common than yours.
Only later did I discover online the many CPAP models, varieties of masks, and optional equipment that exist. But the trouble with online supplies is that you can't try-on and test the hardware.
6
@Mellow Fred I had a CPAP machine but it was not doing the job. Then it was discovered that I had "complicated" sleep apnea. A special CPAP machine handles that. Apparently only one or two percent of people have that condition. Once I was given that special machine, I was able to get true relief and get some restful sleep. I was able to tell the difference because I started having dreams. I never had dreams before being properly treated, because I never got into that level of sleep where people dream.
3
I was diagnosed with sleep apnea about 2 years ago, although I was not experiencing daytime drowsiness or feelings of fatigue. I got a CPAP with just the nostril covering, not a full mask, and I absolutely hate using the machine. Contrary to what the article states about the silence of new machines, mine is not. It might start out very quietly, but I inevitably wake up at some point during the night or when morning is approaching, and find it impossible to fall back to sleep because of the machine's noise. I have tried using sound machines to mask the noise, but it is not sufficient. I even took the machine back to be checked out, and was told it was working fine.
I also have a cat, and contrary to what other cat owners, including the doctors, told me, my cat does, indeed, like to play with the hose!
Combine all that with the fact that unlike other sleep apnea sufferers I've heard from, I have never noticed any appreciable/positve difference in how I feel when using the CPAP, and you have a recipe for me not being very concientious about using it. I will typically get in the required amount of hours for "compliance", and then gratefully remove it and go back to a much more comfortable and enjoyable sleep.
7
@Paula Amols absolutely. The new APAPs start out quiet, but abruptly adjust pressure, often waking the patient or their partner. I'm about to ditch mine, but unlike you I did notice a large improvement when I originally started therapy (when I was single). I had severe apnea that reduced pulse ox to 81% with events every 30sec on average
@Paula Amols Have you tried wearing earplugs? There are several brands that work well for sleeping with, even on your side
1
@Paula Amols
See your medical supply company. If insurance covers things you can get new masks every 6 months. Talk to them about alternatives—there are lots of different masks and some of the newer ones are a lot more comfortable.
I was unaware I suffered from sleep apnea until my pulmonologist suggested a home test. It turned out I had a mild case, treatable with an oral device (MAD, or mandibular advancement device). The testing was all covered by Medicare. However, the device itself, a two part piece of molded plastic, cost what strikes me as an incredibly excessive amount, $2000! Fortunately, I was able to cover it as Medicare does not.
1
CPAP is covered by Medicare following a 30 trial period. Patient Use is monitored by the device and becomes the basis of an approval or denial of coverage.
@Vernon Rail
Medicare covers CPAP, but Richard is referring to MAD.
Medicare does cover MAD or oral appliance device for sleep apnea. An oral appliance must be made by a dentist with specialized training and, yes, many are Medicare providers. Check the American Academy of Dental Sleep Medicine website to find providers who are qualified. Most commercial insurance plans also cover oral appliances but many insurance companies won’t include dentists on their medical insurance panels so HMO plans are difficult.
1
All my nursing career, I’ve wondered how much Durable Medical Equipment goes unused ; and how that translates into cost ?
4
14 months ago I had a health emergency at my local YMCA. At the hospital, doctors found that I suffered from atrial fibrillation, which compelled me to undergo numerous tests, including a sleep study. Unbeknownst to me, sleep apnea is a potential trigger for AFIB. The study determined that I had OSA. For the better part of a year, I decided against using a CPAP machine for all the reasons mentioned in the article. Unfortunately, I continued to have to deal with recurrences of AFIB, which forced me to go to hospital ER’s to restore my normal heart rhythm. Life with AFIB forced me to rethink my resistance to trying CPAP. I now accept the inconvenience of CPAP in exchange for a chance to mitigate my AFIB. Sleep apnea is a real health risk, and we all need to come to grips with that reality.
11
From what Carroll and Frakt wrote it sounds like our for-profit health system is working the way it is supposed to work. It is generating profits. Hurdles have been effectively constructed to make patients jump through hoops leading to profits for the insurance companies and for the profit-oriented hospitals and clinics.
To keep our system working to generate profits we must do everything in our power to make sure that the next president and the next Congress do not start providing single-payer universal health care.
To get a system that delivers health care to those who need it, on the other hand, we might want to vote for candidates who support single-payer universal health care (which is very different from universal access to health insurance!).
19
@Benjamin ben-baruch Thank you for a wise comment. It is no wonder that life expectancy in the US is lower than other Western countries, especially Europe. Our health care system leaves a lot to be desired. We need a President and a Congress willing to fix this problem. A president can't do it alone. It requires Congressional support as well as the President's signature.
3
My research, after a sleep test showed I had a mild case of sleep apnea, indicated that a huge percentage of these machines are serving more as door stops than solving sleep apnea.
I think these door stop owners far out number these enthusiastic authors, who consequently at times sound to me like pitchmen. They also are grossly under estimating the inconvenience of using these machines.
A much better design is needed that is way leaner, much cheaper and more maintenance free.
15
@NDM So what is your alternative? The mandibular devices only work for a few. Most folks will not consider a tracheostomy, and we should only think of that when absolutely necessary (and I know two people who went that route, or die).
You make it sound as if there are easy alternatives, when in reality there are a handful and not all beneficial to everyone.
How many road deaths are caused by sleepiness brought on by sleep apnea is unknown but to get a Commercial Driver's License if there are signs of physical conditions that are strongly associated with SA, or if the history is strong, a sleep study is needed. I'd rather the guys and gals hammering down the roads in fully loaded 18 wheelers, or school bus drivers or commercial chauffeurs not run into me or a family member going the other way.
Many folks are embarrassed about having to use a machine or look like a SCUBA diver. After getting used to mine, it was absolute misery to have forgotten it and spent three nights traveling without the relief mine gives. And those who are in the same room or sleeping in the same bed can attest to the help it gives.
5
@NDM Agree they sound a bit like pitchmen. And the headline reads like they conqured the condition so I was expecting to learn about a new, non-cpap treatment.
They also left out the part where you still pay the $1000 out of pocket because you haven't met your insurance deductible. And the scammy medical supply company bills you "rent" for the machine but you are actually paying the full cost due to that deductible problem.
My husband was diagnosed and got the machine (rarely uses it anymore) and thinks I should be tested for apnea because I snore. But I don't want to buy another CPAP and am 90% sure I couldn't sleep with it anyway.
Definitley need improvements on all sides for people to be truly helped with this potentially-serious condition.
There is a simpler yet as effective solution to dealing with obstructive sleep apnea... sew onto the back side of a sleeveless undershirt a pocket just long enough to hold three tennis balls right over your mid-to-upper-spine. Bingo. You will not sleep on your back again. In a sleep lab test for me, the CPAP approach dealt positively with my condition. In a separate sleep lab test at the same place, the tennis ball approach was as effective as the CPAP machine. I've been using tennis balls for a dozen years... successfully. And, by the way, insurance coverage is not an issue.
2
@J. David Nelson, while I think that’s great for some people, it will not work for everyone. My sleep apnea exists whether I’m sleeping on my back or on my side.
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@J. David Nelson
I have obstructive sleep apnea and sleep with a CPAP device with the air pressure at maximum. Sleeping on my side without the CPAP device does not help, I still experience periods when I stop breathing. At no time do I wake up during an event. If I were alone I would never know I have sleep apnea. If alone and suspected apnea, I would not know the tennis balls solution was not working.
I consider your advice, although well meant, to be dangerous. If could lead those who need the CPAP device to not obtain it.
7
I am a side sleeper with apnea. I try very hard (four years in) to use my cpap.
Honestly, I despise it. While my sleep is incrementally better with it - I don’t wake up gasping.
It pulls my hair, the straps slide on my hair and the masks then leaks, and it has ruined my sex life - while my husband doesn’t mind the device - there is no opportunity for spontaneity - I have no interest while dressed like a cyborg. It is inconvenient, uncomfortable, depressing, and incompatible with my hobby of kayak camping and travel.
I hate hate this thing. I do comply and hope now that I am not caring for children, parent, and fulltime job to lose enough weight that I can get rid of this beast. With parents gone and kids fledging - maybe some personal care can fix it. Honestly though - I have complained of terrible sleep all my life - long before I my BMI passed even 22.
1
Rachel's husband writes:
A few years ago I had a nasty case of gout. In addition I had severe sleep apnea of both central and obstructive. They wanted me to take allopurinol for the gout. And my BP was getting high enough that my Primary Care Physician was muttering about taking BP meds. I was on statins for cholesterol. When I retired I started walking about 40 miles a week. As part of my goal was to lose weight I reduced my alcohol consumption from about 3 glasses of wine per day to a couple beers a couple days a week. I lost 50 pounds. This past August I raced up Pike's Peak fast enough to get the jacket. The gout went away. The apnea went away. My PCP took me off the statins as my cholesterol was low enough without them. My BP is about 110/60. It won't work for everybody but you won't know what works for you if you don't try. I absolutely hated the BiPAP machine I was on. It was the most intrusive damn thing imaginable. It seems like the default in American medicine is intervention.
9
My wife and I both have sleep apnea, despite having normal-range BMI and not being particularly old at all. I realized this because my wife complained about my snoring; my wife realized this not because her snoring was particularly bad, but because I noticed she sometimes sounded like she was struggling to breathe as she slept.
For both of us, CPAPs have been game-changers. Yes, they were awkward at first, but you soon get used to them. The benefits are overwhelming: we both are much more rested after using them than if we don’t.
For that reason alone, I urge people who might even suspect the mere possibility of sleep apnea to get it treated. The other health benefits — longer and healthier life — are icing on the cake.
17
I have used a CPAP for 15 years, and believe I would not be alive, given my other health conditions, had I not received one. One word of advice to prospective users: Get a CPAP only. Newer, and more expensive machines claim they can continuously adjust your airflow needs based upon data from their sensors. Don't believe it. These machines continually underestimate the amount of air pressure you need and leave you feeling like you are trying to breathe through a straw.
1
I have mild sleep apnea and I use an oral appliance, here to recommend it for those suffering who can’t wear the masks. It works well at opening the airways and also helps prevent migraine attacks for some people. To get fitted you need to see a dentist who does neuromuscular dentistry. Much easier to wear than the mask and very effective for mild/medium cases.
7
I did a sleep study many years ago, convinced I had apnea. Turned out I had restless leg syndrome. Taking medication is the only way I can sleep.
Some 10 years later, and with weight gain, I figure I now really do have apnea enough to treat. After 6 months and hundreds of dollars and testing multiple masks, I gave up. My favorite, the nasal pillow, wouldn't stay on my face (my hair is fine and the straps moved easily).
I know I need CPAP and want to give it another try, but not sure I can take going through all that again.
1
@Barbara
I also have fine hair. I use the Dreamwear by Phillips. Might be worth a try.
@Barbara I had a ACPA for 5 years and was unable to tolerate it. I would usually pull it off in my sleep after about an hour.
A friend provided me with a few masks to try and I found the Amara view mask to be life changing. This mask sits under your nose and was the first one I could tolerate.
Now I average a solid 6-7 hours of sleep and have never felt better.
Good luck finding a mask that works!
4
It can be difficult adjusting to using a CPAP machine.
I have a deviated septum and mild seasonal allergies, so I often have to use the mask. but I also use an advanced nasal pillow attachment. I also have a travel CPAP machine and a germicidal ozone cleaner. I keep my finger on the new product releases and consider each new mask or nasal pillow and will spend the money if I think it will offer more comfort. As the article says, it’s not cheap but, unlike with a lot of other prescriptions, one can manage many aspects of the therapy reasonably well.
It took me almost an entire year and some expense to adjust. There are some nights when I don’t use the machine, mostly when I am on the road and only one in five nights (usually when my nasal passages are most obstructed). At home, my wife (who has benefited mightily from my CPAP) will gently “remind” me to put it one.
As for the benefits, I can say that the headaches I used to get several times per week have disappeared and I do sleep better.
The largest benefit is being able to sleep in the same bed with my wife, it has really helped our relationship as I am no longer the cause of her sleep issues.
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@Peter Hansen
I'm only just starting to see other commenters who suffer from deviated septums. In my forties I had surgery to correct it, and couldn't believe that this is how you're supposed to be able to breathe through your nose (like a blind person who discovers sight).
The surgery didn't reduce my sleep apnea, but it made a huge difference with being able to use my CPAP.
It also greatly reduced my chronic sinus infections (which again I was unaware that I was experiencing something abnormal).
So unlike UPPP surgery which I don't recommend, I found my surgery for the deviated septum to be life altering even though it didn't help my sleep apnea.
2
I suffered for years before being properly diagnosed. Many years ago a doctor friend noted that I snored terribly, and recommend that I see an ENT specialist. That resulted in a surgery for a deviated septum.
Years later, I told my doctor I had developed frequent nocturia (nighttime urination). After a clinical exam, a urologist said my prostate was enlarged, and put me on medication. I had a severe allergic reaction when the pharmacy filled my prescription with a generic version of the same medication I had been taking.
Finally, daytime drowsiness was affecting my work, and I was reffered for a sleep study. It turns out nocturia is just as prevalent in sleep apnea patients as snoring. The CPAP has been a lifesaver. The writer is correct about the access to diagnosis,treatment and supplies. Even with good insurance, there are lots of out-of-pocket expenses.
When my machine's humidifier broke after more than four years of nightly use, I couldn't replace it under my insurance until five years had elapsed, and it would have been over $2,000. In the mean time, I was able to buy an external humidifier and some tubes online for about $160 to get me through. I have my new machine now, but really don't understand why my insurance would deny this life saving treatment until the 5-year mark was hit.
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@Robert
I too had surgery for a deviated septum. It didn't reduce my sleep apnea, but made it much easier to use a CPAP.
But what I want to comment here is that I found out in the last year that I can buy replacement parts for CPAP machines online, without a prescription, and for less than what my copay might be if I used my insurance. I bought a replacement humidifier for an old machine that I had stopped using, and so now I have an emergency backup.
If you have access to the prescription from your doctor, then you can even purchase a CPAP online possibly for less than your insurance copay. But a downside is that the pressure will be set according to to that prescription, which may no longer be ideal if it's been a long time since your last sleep study.
Also, supplies like filters, hoses, and masks may also be cheaper.
There are several online CPAP supply providers. Some supplies, such as filters, are even available on Amazon. Be sure to compare prices and check for sales. Hope you find this information helpful.
2
I was a skinny kid and always snored really loudly. And I had recurring nightmares that I was choking on gum for decades.
I wasn't diagnosed with sleep apnea until I was in my forties. I've been using CPAP for about 8 years now. I also had to have an in-clinic sleep study and then later an in-home study. Many doctors appointments and visits to the suppliers. it really is a convoluted process.
I wish I could say CPAP has changed my life. I struggle with the mask fit, and because I need a full face mask I'm getting wrinkles from it.
But I do feel better, less tired in the afternoon. For me I think the damage was already done before I got the machine. 40 years of low oxygen sleep have left me with a severely diminished memory.
7
@Chef G
So far you're the only other person I've read who suspects memory loss. My doctors are very concerned with the danger of sleep apnea to the heart, but have expressed no interest when I've told them about my diminished memory and cognition. I work as a scientist and can no longer follow along with mathematical equations and proofs that I used to be able to understand.
3
So good to see this article. I also believe that there are a lot of needless obstacles put in peoples' way to getting treated. My wife recorded me clearly apneic and struggling to breathe while sleeping in bed with an iPhone camera. Sleep study? Not necessary in my case and one of these big treatment obstacles. There was no way I was going to do CPAP without a fight. A dental appliance has made a world of difference for me. That being said, some of the oral appliances are junk. I finally got a dream TAP through my wonderful dentist and it was fairly smooth sailing after that -- even the appliances are far more expensive than they have to be. This is a significant public health problem that could be more easily and cheaply addressed.
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I have been using a Bipap for 2 months. Still getting used to it but no need for an afternoon nap. Uncomfortable, but.... Best option. I found a sleep study, and a follow-up was crucial to diagnosing and finding the correct pressure. I had 112 "events" per hour and little sleep. Now, about 3. I am too at National Jewish Health who did the study, diagnosing correctly, central versus obstructive is crucial. and then getting the correct pressure to treat it. Continuous use and weigh loss will, I hope, possibly result in no need. Lots of hard work but I am so blessed to have the option.
4
I was diagnosed with sleep apnea about 15 years ago. I had no problems adjusting to using the device and never forgo using the device. I can say I honestly think it saved my life. First my chronic migraines which I had suffered with for years became so infrequent I no longer take anything for headaches stronger than tylenol and can't recall the last time I had a true migraine. Secondly, as a long distance commuter I am convinced without nightly CPAP treatment I would long ago have run off the road to a sleep one does not awaken from. Don't let insurance companies or anyone or anything else prevent you from getting treatment. Its a modern miracle. Did I mention my life long struggle with insomnia has all but been vanquished? I do think the authors are rightly concerned about how difficult this life saving therapy can be to pay for and obtain. Its a racket, but so is anything related to health care in this country. Which in short is Just another reason to VOTE-Democrat.
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You failed to mention there are actually two types of sleep apnea. Obstructive and Central. Most people have and are familiar with Obstructive sleep apnea, where breathing is physically “obstructed”. In Central sleep apnea the brain doesn’t send the “signal” to breathe.
My 66 yo husband began to notice a swift cognitive decline a couple of years ago. He was having trouble remembering conversations and meetings he had yesterday. Very concerned, he saw his doctor who suggested both cognitive testing and a sleep study. He rejected the idea of the sleep apnea study at first because he is tall, very slim and doesn’t snore.
When the cognitive testing revealed he tested cognitively much worse than people much older than him, he agreed to the sleep study.
The sleep study revealed, on average he failed to breathe approximately 40 to 45 times an hour.
His diagnosis was a combination of both Obstructive and Central sleep apnea. He was fitted with a CPAP, and yes, it was uncomfortable at first, but now he actually has trouble sleeping without it! Additionally, he uses both a nasal pillow and a full face mask. He switches them for various reason, including seasonal allergy issues and comfort.
He now sleeps better at night, is much less tired during the day, has more energy and is way less “cranky” than before. But, most importantly, new cognitive testing reveals he is cognitively “younger” than his actual age, meaning he scored much better than most people his age.
19
I am a family physician who treats most patients on Medi-Cal. The difficulty in my situation is that once given the machine, there is no guidance as to when you should change the tube, filter, mask. The DME company has dispensed the machine and washed their hands. The sleep specialist has done the test and diagnosed the illness. But no one has told the patient or the family doctor how to trouble shoot the machine and when to change parts. My patients who are now ready to change their broken machines need to have another sleep study in order to get a new CPAP machine which is ludicrous. Their OSA hasn't gone away. Why are we wasting money on a repeat sleep study? The system is so poorly controlled that it's not only what this article describes but the multiple steps that come after make it hard for patients to treat their OSA.
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@KK
They should not need a new machine.
Tubes, Masks, Supplies... do not require prescription.
Tubes, masks, and filters often require a prescription in order for insurance to cover the cost. I’m on my third machine in nearly 20 years. Machines have gotten easier to use and quieter in the time I’ve been using a CPAP. It helped me greatly to work in getting the right mask with a therapist who also has sleep apnea. That was luck of the draw but experience does make a difference.
And as an aside, having a relatively short neck ups the odds of having sleep apnea.
1
I too suffered from sleep apnea. It was necessary for me to have nose and throat surgery because the CPSAP didn't work for me. A few years later it had gotten even worse. My sleep study showed that I awoke 22 time a minute. Needless to say, I was totally exhausted. I had to have a sleeping endoscope that showed the epiglottis fell over my trachea when I fell asleep. A CPAP would have pushed it down so was again not an option. To assume a CPAP machine is an automatic solution is not a good idea. I had to have more extensive surgery which worked well. Sleep Apnea is not a joke. Severe snoring should be investigated by specialized sleep study doctors. Your life can be threatened by this disorder. Take it seriously.
8
To actually "beat" sleep apnea, it would seem you would get rid of it. And in fact, you can - get off all the carbs. If people just ate a reasonable portion of carbs in their day instead of the steady stream that most consume, the incidence of metabolic disorder (obesity, diabetes, cancer, heart disease, dementia and sleep apnea) would plummet.
And of course, a very important part of all those carbs is SUGAR.
The amount of plain sugar most people eat is appalling. In 50 years we will be seeing candy as tantamount to smoking.
When will we stop thinking treatment is the end goal and think about prevention?
8
@NEKVT
I know several thin athletic people who have sleep apnea so there is more complexity to this issue than obesity.
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@NEKVT
My husband and are are trim; he has a terrible case and I have a mild case. Quite a few people I know who suffer from SA are within a healthy weight range.
2
I've worn the CPAP mask for almost 20 years and I'm resigned to never enjoying sleep for the rest of my life. I do sleep better and longer and don't wake up gasping for air, and if I don't wear the mask I snore like a wild animal and I wake up painfully thirsty from mouth to throat and downwards. But even though the machines have gotten quieter and the masks more comfortable, it's a drag having that mask on your face - at least for me (apparently the two authors here don't mind it). My physician told me that many men just can't deal with it and he's very impressed I just do it without question every night. There's a small chip I bring to visits and he gets great data. If you have sleep apnea you have no choice but to do everything you can to manage it, the health costs are too high not to wear the unpleasant head gear.
4
Thank goodness CPAP machines exist. I'm really grateful and hopeful about solutions that provide dramatic increases in the quality of life. I am frustrated, however, that they are not available for me. I'm a young professional with employer-provided healthcare and it would still be a few thousand dollars for me to get treatment (including the prerequisite sleep study) for my sleep apnea issues. I hope someday these machines can become common and accessible. I cannot imagine the huge difference they would make in my life.
4
@aeb
I don't know if this will help, but don't necessarily accept the cost that a sleep center may quote you, without independently checking with your insurance company. Even if you have a high deductible plan, your insurance company may have sleep centers where they've negotiated the price. If so, by going through your insurance company, you should get the same discounted price. It's not uncommon for the accepted price less than half the original price.
FYI - You may find the exact opposite situation for medical equipment. Once you have a prescription from your sleep study, you may be able to purchase a CPAP device much cheaper -- even from the same medical supplier -- by not going through your insurance company. I don't know why this is ... but this is just the crazy way our healthcare system works.
2
Another complication is that there's another kind of apnea, central apnea, where the airway is clear, but the brain just doesn't send the signal to breathe.
It's more common here in the higher elevation in Colorado (breathing during sleep is regulated by CO2 levels in the blood and all gases are thinner up here). I'm asymptomatic near sea level.
Central apnea requires a different kind of machine called an ASV: CPAPs don't help and can even make it worse.
My specialist was initially skeptical about my claims that it felt like I wasn't even *trying* to breathe, but after repeated (and adamant) complaints that the CPAP wasn't helping, an in-lab study confirmed central apnea and a second study confirmed that an ASV made a difference. This meant two copays, sadly, but they were worth it.
For the last year or two, I've worn an all-night pulse-oximeter, so I have definitive data that the machine is working. Before the machine, I would spend a total of 5 to 30 minutes below 90% O2 saturation every night, with dozens of drops of 4% or more. Since the machine, I *very* rarely drop below 90% or even 93% and often have only a handful of 4% drops.
In the first couple of weeks, I'd often wake up to discover I'd taken the mask off or a strap had come loose, and those are the only nights I've seen bad O2 stats, but this is occurring less frequently now that I've had the ASV a couple of months.
Sadly, when my deductible resets, the monthly rental will be costly.
8
Hear hear. Great idea to just give out the machines for use. Pulmonologists or ENT physicians could easily do this. Cardiologist give out Holter Monitors all the time.
2
@Tony
Not such a good idea. After extensive study, I was found to have my epiglottis falling over my trachea. A CPAP would have made it worse and might have killed me. They can be awesome machines for most people but it is a mistake to assume it is for everyone without doing the required studies. It is not a one size fits all solution.
Warning: if you get a diagnosis that you have sleep apnea- even mild sleep apnea (aka; “snoring”), and then later try to get a life insurance policy, it will be more expensive.
Get the policy first, CPAP later.
13
Get an adjustable bed that raises your head about 15-20 degrees or an inexpensive mattress wedge that does the same thing. I gave up on CPAP because no mask I tried (full face, nose only, mouth only) made it impossible to be comfortable as a so-called "side sleeper." Further , the machine(s) I tried were so noisy that even with a white noise machine running I was always aware of the sound of my breathing through the machine. At a certain point, the combination of sound level from the white noise machine and the CPAP machine became louder than a TV left on. I ended up watching TV instead of sleeping. For many CPAP failures, a BIPAP machine (which allows exhalation with less effort) is the better solution but is almost impossible to get approved by insurance or Medicare. If you have to submit to a sleep test as part of the process for getting a CPAP approved, have the sleep lab also test part of the night with your head elevated and compare the results against the CPAP. You and your doctor might be pleasantly surprised.
3
@Billy The Kid
I put phone books under the legs at the head of my bed. I'm a side-sleeper too, but the wedge bends my back sideways. The phone books or wood blocks elevate the bed, but keep your sleeping surface even. I use a Quattro Air full face mask, which stays in place nicely and doesn't interfere with sleeping on my side. I have an APAP machine which eases up when I exhale. It is totally quiet, no need for white noise. (Made by Philips Resperonics.) Have your doctor write MUST BE Bipap or Apap on the prescription. I've had the same machine for over six years with no problems.
Hope you can try it again. It really makes a big difference!
1
I just took Sleep Tests and found I stop about 15 times an hour. I am trying to get a CPAP for the home but it is taking weeks to have the thing delivered. I didn't know I had it but apparently it will help with a lot of trouble. My advice; get the sleep test, and if Apnea confirmed get the damn machine. CPAP...
The airway is blocked because of the relaxation of the muscle during REM...good report BTW .
Simple, factual, without the medical hysterics!!!
1
I'm a Canadian who lives in Belgium at the moment with Belgian public health insurance. My CPAP costs me 7 euros a month, the tests to get one a total of 80 Euros. Insurance paid over a 1000 Euros. I'm monitored every six months at a cost of 25 euros. Belgium is not bankrupt, by a long shot.
Public health insurance works, America. Get real. You are getting screwed.
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@Angstrom Unit I'm an expat working and living in Belgium at the moment with private insurance. Expats working in Belgium are not allowed to sign up for public health insurance - which is fine with me. My first visit to a sleep specialist cost me 70 euros. The specialist, even without conducting a sleep study decided that I would pay 50 euros per month to rent out the CPAP device. He claimed he didn't know me well hence the 50 euros per month. I refused. In other words, unless you are using public health insurance, Belgium, or the vaunted EU health system, is no different from USA, in overcharging patients. And, don't get me started on trying to schedule medical appointments in Belgium - it is far worse than a visit to the DMV in USA.
2
@Angstrom Unit I got a sleep test and all CPAP supplies under Medicare. Eventually I stopped using the machine became using it disturbed my sleep more than the Apnea.
Why does every CPAP/OSA article omit this simple fact, and one that probably explains the millions of undiagnosed OSA sufferers: you don't have to be overweight to have sleep apnea! (But it helps!)
Since I was diagnosed and got my CPAP, friends have come out of the woodwork, of all sizes and ages, to sing the benefits of a real night's sleep.
I'll be honest, I found wearing the mask humiliating at first, worried about how my wife and kids would view having a dad that looked like a pale Darth Vader heading to bed. Well, they got used to it before I did, and my wife loves the silence.
And me - I got my afternoons back. No more dozing every day at 2pm at my desk, and napping on the weekends (unless I really want to!).
25
CPAP dried my eyes as my optometrist told me. Side sleeping is the best remedy as it opens airway. Then once in a while I find myself on my back that causes the airway closure. To open the airway while on my back I learned to find the angle in turning my head sideways. To reach this conclusion, I went through a few chin straps; none of which worked. Then used Dr.Dakota Snore No More sold on Amazon for several years. Dr. Dakota was the most effective device of all; but the long term use developed a little neck problem, that put this device in the drawer several months ago.
Today, I use a thick hug pillow and a thin knee pillow to assist position to sleep on my side. If I wake up on my side in the morning, the sleep was perfect. Occasionally, I find myself on my back during the sleep. If I am too tired to turn on the side, I turn my head sideways to stretch out my throat. This is helpful to prevent my tongue to block the airway. My mouth is often closed and moist on awakening.
First; Side sleep. Use knee pillow and hug pillow.
Second; When side position fails during sleep, turn your head sideways to open the airway.
CPAPs are money making machines for the industries. How much doctors get for kickbacks? I tried it for three months; and despised it. There are better ways.
4
@hiker
They can also be life saving machines. It may not have worked well for you, but they are for others. Don't discourage people from seeking help for a chronic and life threatening ailment.
3
@ExPatMX ExPatMX, you are not only twisting my words but are discouraging people to try better methods than CPAP.
You may be a doctor or in the CPAP industry. Or are you one of those who would swallow whatever the pills your doctor may gives you?
For some people who absolutely cannot sleep on their side, they may try sleeping in the head raised position such as in a recliner.
For those who don't even try what can be the best for them, there is this awful machine, CPAP. It's your choice.
A friend of mine who uses CPAP every night often complains how badly he slept last night. He doesn't try anything else. That's his choice.
ExPatMX seems not to have tried anything else either. But the world is full of people like ExPatMX.
That sells CPAP.
Once again, an ounce of prevention is worth a pound of cure. We just don't follow that axiom in our for profit medical world. Sleep apnea is no joke. Obviously not breathing will have terrible effects on your health over time. Light sleepers usually cannot use CPAP machines. There are other options. In Brazil studies have shown that certain tongue exercises can reduce sleep apnea by up to 40%. Sleep apnea oral devices, those made by a dentist, also are an option, but are prohibitively expensive for many. They should not be. We should be making all sleep apnea devices affordable, even surgery for those who prefer it. The long term effects of sleep apnea are much more expensive than all of these cures.
7
@Mark
For some people, surgery is not an preference, it is a necessity.
1
To be added to the benefits....
Not mentioned here or in the top comments...sleep apnea can affect blood pressure. After starting with a CPAP machine my blood pressure dropped 10-15 points almost immediately lowering it into a normal range.
It was a complete surprise that a doctor's visit a week after starting the CPAP uncovered. I insisted the nurse take the reading again. Nice!
7
This article is excellent and provides important health information, but it could have highlighted another medical option: dental devices akin to top and bottom retainers that open the air passages and are fit by licensed sleep dentistry specialists. I, as well as a number of friends and family members, have used one for years after I was unable to get used to a CPAP (although admittedly one of the older models). The darn thing works; it’s changed my life. I understand some patients have trouble adjusting to the oral appliances (known as mandibular advancement devices) due to discomfort, jaw pain, etc., but it’s an option worth exploring, in my experience.
7
The bit of info I'd really like to know is whether snoring frequency and loudness is correlated with sleep apnea -- if you get your snoring taken care of, have you in effect addressed the risk of sleep apnea as well?
2
I have been using a CPAP machine for about 10 years and have benefited enormously. Recently my grown daughter was told during an emergency hospital stay that she has serious sleep apnea that is contributing to heart and lung issues that will shorten her life unless she gets a sleep study and some sort of intervention. This is not a surprise to either of us. The problem is that she has no insurance even though she is working. Is anyone aware of any programs that might assist her in getting the help she most desperately needs to address her sleep apnea?
7
I have had good luck buying gently used machine
at this website:
https://mytranscend.com/
They are much cheaper becasue 1) they are used, and 2) you are paying cash/direct without insurance. It may be worth buying one on spec for your daughter. They will help you adjust it over the phone, good luck.
1
I think CPAP is a boondoggle for the medical device industry. I wish this article looked into how many companies are producing how many machines at what profit margins. I have owned two of them, both of them frustrated me and, if anything, added to the stress of my life. I stopped using them some years ago. Now, I make sure I keep my weight down. I exercise regularly. I sleep only on my side, and I use a smart phone app at my bedside that records my sleep movements and snoring during the night. From this, I can more or less tell how well I sleep. I am satisfied that my original diagnosis was overstated. I think there are other strategies one can try before becoming dependent on expensive technology.
6
@Cookie I think you are in the minority. These devices as are as easy as a operating a toaster oven. There's absolutely nothing complicated about them. I suggest you get a better modern one and give it another try. If an iPhone can cost over a $1000 with all the market penetration they have a CPAP device can cost as much or more considering the amount of research and development that goes into it. Besides they don't sell billions of them so the prices will not go down as fast. I have health insurance and paid $0 out of pocket to get it. It is covered by Medicare as well. Good luck,
7
@Cookie I can understand and share some of your concern. I tried a number of hacks before getting an ASV (I have central, not obstructive apnea), but the all-night pulse oximeter I've worn for more than a year shows definitively that my hacks didn't work consistently and that the ASV does.
@Cookie I can understand and share some of your concern. I tried a number of hacks before getting an ASV (I have central, not obstructive apnea), but the all-night pulse oximeter I've worn for more than a year shows definitively that my hacks didn't work consistently and that the ASV does.
I should also say that my mom succumbed to complications of afib resulting from sleep apnea, as did a friend.
3
I decided to seek out a sleep study mostly for night terrors that had been plaguing me, but I also mentioned that my snoring had been the subject of family jokes for years. Sure enough, I have obstructive sleep apnea. I have been using the CPAP machine since April. It is an adjustment, but well worth it. I don't feel like falling asleep every afternoon, and I can sit on the sofa to watch TV or a movie without immediately dozing off.
6
I've had a BiPAP machine for over 10 years now, and it has helped tremendously. I had also developed AFIB (irregular heart rhythm) which might have been triggered by my sleep apnea. Since being on BiPAP therapy, my AFIB has gradually decreased in severity until now it really only shows up on an EKG. So the sleep therapy is saving my heart, in addition to helping me live life with a lot more energy.
My secret source of supplies while traveling: Truck stops. A lot of truckers have sleep apnea. Many of them are living up to their commitment to drive safely by getting treatment. You can't get the machines, but you can often find masks and hoses for sale.
7
Have been using a CPAP for last 30 years and will not even take a nap without it. Saved my life. On my fourth machine - quietest yet. Plus have a back-up, battery-powered travel machine in case of power failures which occur a few times a year in the foothills of the Cascades. If your spouse complains about your snoring GET IT TESTED! Can avoid heart and stroke issues.
35
Getting a replacement CPAP machine when the old one begins to fail after 10 years can be daunting. Insurance would not pay with a new sleep study, although I use the machine religiously. I solved the problem by buying a second hand, reconditioned machine. No prescription required, much less money. Works great. Very happy.
9
@Bernard Fensterwald Glad you were able to find a replacement. I am truly surprised that your insurer wouldn't replace the old unit, they have a life expectancy of 5-7 years. Did you talk with your prescribing doctor about it failing? When mine started acting up, I made an appointment with the doctor, he wrote a new prescription and send it directly to my CPAP provider. Within a week I had a new machine.
From reading these comments, I guess I have been very lucky with my health insurance coverage and my CPAP provider. No problems in getting the unit or getting supplies.
3
Diagnosed 19 years ago and have been on CPAP therapy ever since. I'm on my second home machine and purchased a portable unit for travelling.
While awakening feeling refreshed is a dream of mine (I don't remember the last time it happened) I no longer fall asleep in the middle of the afternoon at my desk.
The most difficult part of it is getting a mask that fits (Good luck with that! That group could use some training.) and then getting an HME provider who can deliver the products when you need them and at a reasonable price. I've given up on the latter and now order from Amazon. So long as the manufacturer doesn't discontinue this mask (they did that with the last one after about 12 years) I'm good.
For such a crippling condition, the medical field does a generally lousy job of helping care for people who suffer with it.
14
@Brian I'm very new to this, having just gotten diagnosed late summer. I did not know I could order supplies from Amazon. Thanks for that. I have battled the supply company who fails to tell me how much they'll deduct from my checking account and when, because, yeah, the insurance company isn't covering this. I'm 100% behind you and the authors - the medical field is even pushier than ever about getting diagnosed (intrusively so), but then is lousy at providing care. Thanks.
3
Obstructive sleep apnea runs in my family and I was diagnosed at the age of 41. I've been using a CPAP machine for about 18 months and it has changed my life! I'm very fortunate to be among those easily treated by CPAP. I love the authors suggestion of giving the machines out more liberally rather than doing the dance of multiple tests and diagnoses. I have really good insurance, but the process of being diagnosed and treated was still agonizingly long and frustrating. OSA is a life-threatening condition and causes many other physical problems that are much more difficult and expensive to treat. Quick, accessible treatment is a no-brainer.
10
This becomes an even larger problem when diagnosed, as I am, with Upper Airway Resistance Syndrome (UARS). My AHI Index is *just* below the threshold for 'sleep apnea' (around 4.3) so as far as insurance is concerned, I'm 'fine.' I've spent $15,000+ out of pocket so far on mandibular adjustment devices, CPAP and BiPAP and AutoBiPAP machines, as well as countless blood tests, dietary supplements, etc. To be titrated for UARS is very difficult and, again, is a condition insurance refuses to even recognize. At this point, I've been miserable for 11 years and don't see that changing anytime soon.
I recently went to get a replacement mask and hose because mine were leaking. I was standing in the store where I got my machine with my machine and the broken parts and was told they could not sell me replacements because my prescription had expired. Fortunately, duct tape. My CPAP wasn't badly broken, but I could have died. It's still duct taped together but now I have to order parts online which might not fit or get them shipped from the store that cared more about a form than whether or not I lived.
6
@Bob Soon after I got my CPAP, I managed to tear the hose and had to use the duct tape solution. Since then, I have always kept a spare hose and mask in case of a problem. I get replacement supplies every 6 months; I instill the new ones, clean and store the just replaced pieces and chuck out the older pieces. Luckily, I haven't managed to tear a hose since that first one.
2
@Bob
Your PCP can write the prescription. It's not like a hose is a controlled substance.
2
I was diagnosed with severe sleep apnea after being chronically exhausted for 4 years at the age of 22. I would fall asleep at work, in strange places, and while driving, but for years doctors insisted it was a byproduct of depression - I couldn't possibly have sleep apnea because I was too young and not overweight.
When I finally got my CPAP, I found it impossible to even get to sleep with it on. The feeling of having straps around my head made me incredibly anxious and the noise the machine made made it impossible for my partner to fall asleep either. Once you have the CPAP machine, though, the companies that make them will do ANYTHING to keep you on it, no matter how miserable they make you or how much they actually help your apneas.
After much finagling with doctors and insurance, I finally got an implant to stimulate my hypoglossal nerve (which ended up also being shockingly expensive, even with insurance) but I am finally getting good sleep. Make no mistake though, this condition is incredibly expensive and exhausting to deal with, especially when you are already so tired!
People with OSA are cash cows to CPAP manufacturers, and doctors still have a lot of misconceptions about who can and can't have sleep apnea. The entire sleep medicine industry is a mess, and CPAP is not a one-size-fits-all solution.
8
@Paige A good sleep apnea specialist will make sure you are set up with a machine and mask that work for you. My machine is so quiet you would not know if it's on or not. Same with my mask; some are more noisy and uncomfortable than others. There are also a couple online forums that are very helpful to people who don't have enough support from their own sleep clinic.
3
@Paige
I had my implant activated about 6 weeks ago and the results have been incredible! As another writer noted, the re-appearance of dreams is the most surprising. Yes, it was shockingly expensive and required months of relentless negotiating, but I haven't felt this well in years!
2
After years of living far away from my family, I came home and spent a night in the same room with my elderly mother.
I discovered that she clearly had severe apnea...but her doctor had been giving her Ambien for a couple of years by then, never considering that her obesity and age and recessive chin indicated a possible apnea diagnosis. The Ambien messed her up...eventually she began falling out of bed at night, leading to a nursing home. And the years of apnea contributed to subsequent strokes.
I believe she would have had several more healthy years of life had she gotten proper treatment.
Beware of Ambien...it has very serious side effects. And do treat sleep apnea!
22
@Wocky My mother snored horribly and took a heavy duty sleeping pill every night. Still, she frequently took naps and fell asleep while watching TV. She had her first heart attack at 52 and died of one at age 74. I am convinced she had sleep apnea which put extra strain on her heart. I do have it. I am used to my CPAP and do not find it noisy or difficult to use as I am able to deal with it using only the nose pillow. I have had no problems getting insurance coverage.
2
I have been using. cPAP for the last mine months and my sleep has not improved. I still wake up tired aven when I use my CPAP. I have had 2 sleep studies to see what the.problem is with no positive results. I use my CPAP machine everyday hoping that my sleep will improve, but so far no luck. I am envious of people that get better sleep and I am still looking for the day that I can get a good night's sleep.
6
@ACPAP USEr Read the comments, there are a number of good ideas. Perhaps you have the version of Sleep Apnea that doesn't respond to CPAP usage, someone mentions that in the comments. Another mentions ASV. You should go back to your doctor and explain that the CPAP isn't working and perhaps one of these other conditions is what you are experiencing.
Good luck.
2
I have a CPAP, but the real issue is that I also have a deviated septum and other issues in my nose that prevent all the air from the CPAP from penetrating. And yes, the process to get supplies is maddening and expensive, despite the meager assistance called "insurance" that pays very little of the cost.
3
I’ve used a CPAP/BIPAP for over 20 years, I find sleeping without my machine very difficult and never restful. I’m on my 3rd machine, and they keep improving, getting smaller & quieter. I come from a long line of thick people with short necks; over the years my weight has varied, but my snoring and apnea episodes remain consistent without the machine. I will be eternally grateful for my GP who sent me for my first sleep study, and to all the technicians who continue to make sure the machine and masks function as they should; these folks have improved my life more than I can say. One side benefit of being treated for apnea not mentioned by the authors is that the respiratory problems which used to plague me (frequent colds, coughs, sore throats) rarely occur any more, and I can sleep without medication during allergy season as my machine filters out most of the particles which irritate my sinuses. So my two cents: try it, it may not only improve your sleep, it may improve almost all facets of your life.
11
If you are diagnosed with OSA find out if it is positional: My father (not overweight) was diagnosed with OSA several years ago. He couldn’t tolerate the cpap machine - the feeling of the air pressure kept him awake - and the dental appliance made for him caused TMJ. So we let it go - he was in early 90s and in good general health. About a year ago he suddenly began having memory problems likely caused by the OSA. Back to the sleep lab to confirm OSA. Then another session in the lab to figure out what air pressure in the machine would work - we were told machines had improved and are more comfortable. The second session was a total failure as he didn’t sleep at all in the lab again cause the air pressure kept him awake. At that point I closely examined his test results and noted that he only had OSA episodes when lying on his back - POSITIONAL OSA. In fact the test write up suggested positional equipment as a possible treatment. The sleep doc never mentioned to us until I raised it. The fix is a simple harness (cost $100) he wears with blow up bubbles positioned on his back that prevents him from rolling on to his back while sleeping. I was totally outraged that we put him thought the testing plus the cost and time. Medicare was paying for all the tests and equipment which made me wonder whether the low tech low cost fix wasn’t suggested.
6
@A Person It can be very hard for people to change their sleeping position and to many, being told to just not sleep on their backs is a cop-out, but glad it worked for your father.
@A Person An even cheaper option is to sew a tennis ball into the back of the pajama top or t-shirt to keep the person off their backs. Sorry to hear your Dad went through all of that for what should have been an easy fix.
I have had sleep apnea for 15 years or more and I would be in a world of hurt without the CPAP machine. That said, I do think there is something sinister about the CPAP machine industry. Yes a sleep study is required to establish the amount of pressure to which the machine should be set, but just buying supplies is way more cumbersome than it needs to be. Like moving to a new town and going into a medical supply store and being told "you can just walk in and buy supplies, you need to have an appointment". Just wanting to buy a new mask or tubing and being told I have to have a sleep study that's less the a year old. Crazy.
6
@Contrarian Today's machines are very good at adjusting the pressure themselves and instructions are available online to adjust the machines, as well. One knows when they are not getting enough air or getting too much.
@Contrarian you can purchase new masks and tubing online through sites like cpap.com. No wait and no hassle from the rude folks at the medical supply store.
1
Odd that the article glosses over the success and much lower cost of oral appliances (called mandibular advancement devices) for sleep apnea. 50% or more CPAP stopped using the CPAP machine after a year or less because it can be intrusive, uncomfortable, claustrophobic, and difficult to use and maintain. And yet health insurers generally require a trial of CPAP and demonstrated failure before they will approve fitting of an oral appliance which is easily tolerated and does not require special cleaning nor replacement supplied every month.
6
@Waldo
The success rate for oral appliances is actually not high, plus they alter your bite significantly. But if it works for you, great.
I was diagnosed with sleep apnea over 20 years ago. Before my diagnosis and subsequent treatment I was constantly tired and totaled my car after nodding off behind the wheel. I was very lucky to escape further injury. I have been sleeping with cpap ever since and I can't sleep without it. After about 10 years my machine was replaced and the process seamless.
Last year, my machine broke and for the first time in years I had to face a night without cpap. As I could not sleep without the machine, I considered this a medical emergency of sorts. Yet I could not get my current insurance, or doctors to move on getting me a replacement with any expediency. In order to solve the problem, I turned to Craig's List where I purchased an unused machine for a hundred bucks. Meanwhile, I got parts on line and repaired my old machine, so I have a back up. There is something wrong with a system values process over a persons health.
32
I have used the cpap but it bothers my sleep. I still had to get up 2X a night to use the bathroom. Sleep meds help me but I keep my ceiling fan running and it seems to give me enough air to keep my passage open. It is more comfortable than the small nasal cover with the machine. I don't feel sleepy during the day. Perhaps the couple of drinks before dinner help.
@steve Alcohol usually makes sleep apnea worse.
1
@steve Almost everything you say here makes no sense at all!
1. You "still had to get up" to use the bathroom? Well, duh! What about between those trips?
2. Running a ceiling fan keeps your airway open? I don't think so...that sounds ridiculous.
3. Sleep meds? NOT! Yes, you will sleep, but you STILL will have apnea...with all the associated health risks
4. A couple of drinks helps? TONS of data shows that alcohol causes sleep disturbances.
You sound entirely like someone who is bound and determined NOT to use a CPAP machine. Good luck as your weight increases, glucose levels rise, hypertension and kidney disease hit you, and you end up old and sick.
3
I use an oral device fitted and prescribed by a dentist specializing in apnea and TMJ disorders. It’s been life/changing and minimally invasive. It’s extremely easy to travel with. Many sleep specialists do not discuss this as an option with patients but it’s definitely worth considering. Also, Medicare paid for the whole thing.
9
@Joyce McKinney
Me too!! Dental appliance can work wonders. Also for someone of any age or weight who has a recessive chin.
1
I have sleep apnea, and the hassle to get it diagnose was inexcusable. I had a TIA stroke, and my doctor told me one of the possible causes was sleep apnea. I knew I had sleep apnea because I snored like a freight train and frequently woke up gasping for breath. I told my primary care physician. She got me an appointment with the sleep clinic that was several months in the future. Based on a worthless one-page survey sheet that took two minutes to fill out and a couple of months to analyze, they scheduled me for a sleep over several months in the future. Based on that data, they diagnosed me with sleep apnea, which I already knew, and scheduled me for a fitting for a CPAP machine. That appointment was a few months in the future and was scheduled for a Sunday. I finally got my CPAP machine. Total time it took was over a year. All this for something I already knew I had, and the doctors knew that it had at least contributed to a stroke. I could have died waiting for the CPAP, and the doctors knew it. Yet, the process hasn't changed, and they apparently don't even care that the process is deeply flawed.
58
I have been using a mask for about four years to treat a pronounced sleep apnea I seem to have inherited and, by all accounts, have likely had for my entire adult life, even when I was young and skinny. My father almost certainly had sleep apea, snoring loudly and with arrested breathing despite not being overweight, and two of my three brothers also use CPAPs. I use a full-face mask at a prescribed pressure of 14psi, so my apnea seems to be fairly pronounced.
That being said, the treatment has been a disappointment. I do not find myself more refreshed in the morning than I did before starting treatment, possibly due to the fact I also experience wee hours insomnia that the mask seems to aggravate, though I have no problem falling asleep initially.
But my biggest complaint is how the mask is a barrier to the kind of quiet intimacy I enjoyed with my partner prior while falling asleep when I did not have the mask. Cuddling, spooning and most definitely, small kisses are impossible with the mask and something it seems I must resign myself to not enjoying again in this lifetime, unless surgical options become more affordable.
9
@A2Sparty
Have you looked into a dental appliance? If you are young and thin-ish, it could be the conformation of your jaw that is at fault...
I was diagnosed with sleep apnea about five years ago. I found the process of getting the right mask cumbersome; the apnea specialists didn't work on Saturdays, so I would have to take time off from work to drive back and forth to their place of business. You get 30 days to find the right mask, and I didnt before the time ran out. They sold me a machine that was almost obsolete, it was on a 2G network, So within a year or two it wouldn't transmit data anymore to the distributor. i had a chronic cough, and the combination of the cough and the mask made me gag. so frustrating. I know it would help me, but a few months ago I boxed it all up and put it away. I think I'm sleeping better now, haha
2
There are a few medical devices that can keep you alive. A CPAP machine is one. It also makes you feel great again. It stops all sorts of accidents.
To all you great inventors, thank you.
14
More awareness is important and thank you NYT for publishing this article.
11
@Dr John
Yes, enormously helpful.
1
I see there are lots of people who are glowing about their experiences with a CPAP. Seems nobody wants to mention the other aspects of the experience. Was referred to a sleep ‘doctor’. My problem was periods of vivid dreams and waking up with a headache. Explained my symptoms to this ‘doctor’ with the standard response “You need a sleep test.” I did the home sleep test procedure. The test showed zero sleep apnea and zero snoring. The ‘doctor’ said I need to wear a CPAP anyway??? Tried the CPAP for two nights and experienced a severe panic as if I was being smothered. Returned the machine to the vendor. That is when the veneer came off this experience. Despite returning the machine, the vendor’s field service manager then repeatedly called me about buying more CPAP supplies. I also received many mailers extolling the benefits of buying CPAP supplies. I blocked their phone calls and returned their mailers to the sender. Have been to 3 sleep ‘doctors’ & I am convinced they are so financially tied to a particular machine vendor (because they get kickbacks from the machine vendors? Or some other lucrative financial arrangement? maybe.) they are more interested in hooking you up to the money stream rather than trying to help solve your problem. The CPAP is the new miracle money machine – it brings great rewards to everybody in this chain but mostly the doctors and the equipment vendors.
21
At first I thought it was a lot of blah blah, the next-gen "TMJ" - something everybody "got."
I was exhausted all day. My wife would pound me awake throughout the night because of my snoring. Then, she thought I was dead, because I stopped breathing.
My GP sent me to a pulmonary guy, who ordered a sleep study. I did the overnight bit, wired up. It was fine, like a night on the road at a Marriott Courtyard.
Turns out, I was waking up many many times per hour, desperate for air. No wonder I was exhausted all day long.
I got fitted for a Philips Res Med unit, with a lightweight nasal "Wisp" attachment. It was calibrated just for me. I was shown how to use it.
We call it my "Sleep Machine." I sleep like a blanking rock every night. I wake up with new energy and I'm more productive than ever. I was wrong, this time, about medical diseases du jour. I had sleep apnea. It could have led to bad things. Thanks, Doc. I'm telling you, this thing works great.
89
I don't understand why you don't explain how much easier oral appliances are to use than CPAP machines. These are not quack medicine, they are fitted by real dentists and do actually work. Mine is a very lightweight device, a lot like the retainers I wore in high school. I pop it in at bedtime, and out in the morning. It fits in the palm of my hand, requires no electricity or maintenance (other than cleaning with denture tablets), and will last about 10 years. It's very effective in eliminating snoring and apnea, costs less than a CPAP machine, and is much easier to use.
9
@Catherine I'm glad you have had success with your oral appliance. Unfortunately, not everyone does. I have one that I use when I go camping and it helps somewhat it is nowhere as effective as the CPAP for me. I still wake up somewhat groggy when using the oral appliance. I've talked with others who are in the same boat, the oral appliance is better than nothing but it isn't always a total solution.
I gather the intent of the authors was to encourage people to get checked out to see if they have a problem and make a case that the medical community and insurers have made it much more difficult to get treatment than it needs to be.
2
@Catherine They can be hard on the jaw and change your bite. I wore one for 2 years and my bite has never been the same. But they are worth a try, they do work great for some people.
3
@Catherine
I had the same experience. Your sleep physician can recommend a sleep dentist.
2
I just had a sleep study done because I have the lucky combo of severe snoring (ergo disturbed sleep) with severe tinnitus (ergo further disturbed sleep).
I don't have sleep apnea, thank goodness, but I still can't sleep.
One thing I found fascinating is that my doctors were too polite to tell mento exercise far, far more. Lack of physical exertion is the elephant in my bedroom.
Gotta run...
3
I was diagnosed with sleep apnea about four or five years ago. I was 65, in excellent shape, not fat, none of the typical things that come to mind when you (or at least I) thought of sleep apnea. I did an at home sleep study, felt it was worthless, until the doc said I stopped breathing for a full minute! While my poor wife had complained about my snoring for years, it wasn't until I got an Ipad and put an app on it that measures your snoring that I started to take that seriously. When the doctor told me that I had stopped breathing for a minute, that did it for me.
I got the machine and it changed my life! I even have a portable for the car, in case I need to spend the night somewhere. I got used to it right away, although like many, I am on the hunt constantly for the perfect mask. Still looking! I have tried the nose masks, the half masks, the cloth masks and the full masks (which I keep going back to).
But other than that, I feel it has saved my life, my sleep and probably my marriage. As a group of fellows told me when discussing this - 6 hours on a cpap machine is akin to 8 regular hours sleep. And, after 5 years of never missing a night, it appears to be true.
14
All CPAP treatment - sleep lab visit, diagnosis & prescription, device, mask, filters - are covered my German insurance while the patient pays an approx. 40 dollar annual additional compulsory fee.
17
It is unclear to me why the need for a sleep study. In my own instance, I wake up with a dry mouth and plugged nostrils. There is little doubt in my mind that I suffer from sleep apnea. I will discuss this with my Doc, but if need be, I will just purchase my own CPAP.
6
I am alarmed that the discussion is the symptomatic treatment of sleep apnea with cpap, which has been shown to improve energy levels but not lower occurrence of hypertension, heart attacks, or diabetes. Shouldn’t the discussion be how do we avoid or cure sleep apnea?
For the majority of people this is a disease of excess weight often coupled with sedative usage (alcohol, benadryl, ambien, etc.). We are facing a pandemic of obesity related illnesses and we appear unwilling to speak clearly about it. CPAP is a bandaid, significant weight loss through calorie restriction can be a cure.
2
@Joe I initially thought that it was limited only to people with weight problems, until I was diagnossed 15 years ago. I weighed 140 lbs at 5,10 and a half. Agree that the US is facing a pandemic of obesity, CPAP however saves lives.
8
@Joe My sister and I both suffer from sleep apnea and neither of us are overweight.
1
I use a CPAP machine since the beginning of October, after being diagnosed with severe sleep apnea (originally, I went because I was a loud snorer). My doctor was worried that it could affect my heart. It is the most dramatic result I have experienced of a medical intervention of any kind, period. After the first night (yes, the first night), I woke up rested and refreshed. My wife tells me that my snoring is gone and my sleep apnea has been reduced to almost nothing. I do not know how typical my results are, but I wish I had gone to the doctor decades ago.
Also, I was afraid I would find the mask and the tubing impossible to sleep with. My mask covers only my nose and is very gentle on the face. The tubing is easy to set and does not get in the way.
If you are always fatigued and you are told you snore and/ or stop breathing in your sleep, you owe it to yourself to go through these tests to see if a CPAP machine can help you. Not only can it save your life, it will help you live better.
14
@José - :) I dated a guy for a year once who used a CPAP machine. It was like sleeping next to Darth Vader. I didn't get a decent night sleep the entire year and had lots of night time seizures. We quit dating and the seizures stopped once I caught up on my sleep:) I'm not gonna ask my doctor if CPAP is right for me.
Thank you for raising awareness of this condition. My CPAP machine has saved my life--I used to fall asleep driving my car and motorcycle. Once I put the mask on and take three deep breaths, the machine starts and I quickly fall asleep for a good night's sleep. This has changed my life the better and i never travel with out it. Once again many thanks for raising awareness of the condition and how easily it can be effectively treated.
8
My Dad (87) was referred to a sleep study clinic in February after constant complaining about poor balance and memory. Study showed he stopped breathing multiple times/minute. He was given a CPAP with mask. After a month of complaining, we went to a less intrusive version. He tried for another two months and then told me "return". He understood the consequences would be 1) another stroke (he has had 2) 2) poor balance 3) poor short term memory. #2 and 3 have declined rapidly. I wish he would have stuck with it but at 87 he said "no". So here we are...
2
I have Afib, and my wife, an anesthesiologist, beats herself up for not detecting my sleep apnea earlier. She says that it is one of the causes of my Afib. I have had my machine for over ten years and it has changed my life. I had no trouble adjusting to wearing the mask and the only issue I have is I’m unable to sleep on my back but to my wife’s amazement I can still sleep on my stomach. Another benefit, with the deeper sleep using the mask, I no longer get up during the night to use the restroom and can sleep a good 8 hours without getting up.
10
@Jacksonian Democrat You know, I had a conversation with my dad not even 40 minutes ago about his episodes of irregular heartbeats that only happen when he's sleeping. He's had all sorts of heart studies done and no one tells him that anything is wrong, only that it's cardiac arrhythmia and, "here, take this pill, and if it happens again, go to the ER." I asked him about his sleeping habits and snoring, and I immediately thought of sleep apnea. This article and your comment is timely. Thank you!
3
I was diagnosed with sleep apnea last year. I saw a sleep specialist, took home some testing equipment and it was clear that my morning headaches and foggy brain were the result of stopping breathing and heavy snoring.
So, I was given a home CPAP machine (Resmed Airsense) and, while I didn't get on with the facial mask, I've been using the nasal pillow to great effect ever since.
The only issue is ensuring the nasal mask stays put; sometimes it slips off, or becomes slightly displaced and that can wake me up.
And, not wishing to gloat or anything, albeit, this may swiftly become a lament, all of my appointments and equipment were supplied by the UK National Health Service.
Cost to me?
Zero.
Socialised medicine, what an idea!
109
Me too. Resisted the CPAP machine, finally badgered into getting it. First night used it 4 hours, second night all night- I have the nose holes ones. Use it regularly and after awhile found I really missed it if I did not use it (like on a trip). My sleep statistics are much better than they were. Small ones available for travel too.
try it if you need it, it may be easier than you think. mine have been largely covered by insurance.
5
I was diagnosed with moderate sleep apnea. I opted to try the SomnoMed dental appliance. It's a one time purchase with for the oral device and works great! It requires no maintenance and only one follow up so the long term savings is a huge advantage. I highly recommend this device for people who are not comfortable with the CPAP.
6
@suzanne Do you know if your moderate sleep apnea has been resolved with this device?
2
My spouse, my child (he's the most CPAPA-compliant pediatric sleep apnea case the Mayo Clinic has ever seen), and I all have apnea, all treated with CPAP. Sleep deprivation is torture for a reason, and it's especially awful if it's a grade schooler who cannot sleep. My son had his tonsils and adenoids removed, which helped, but it still wasn't enough. With CPAP, he gets the amount of sleep appropriate for a kid his age, and his parents can sleep, too. It's hard to imagine life without it once the treatment is started.
As my spouse says, "Sleeping is the best, and CPAP makes it even better."
13
I have been a psychotherapist for 25 years. For people who need it, the single most effective and speedy treatment for depression and low energy is the CPAP machine. Within weeks patients with depressions that had been slow to respond to medication and psychotherapy were feeling brighter and more energetic. Certainly there are many causes of depression, but if sleep disruption is one of your symptoms, please get evaluated. It can change your life.
I am also married to a man who now uses a CPAP. He didn't always. I was myself evaluated for a sleep disorder which it turns out I did not have, but the physician commented that I slept so deeply and restfully at the hospital, with electrodes all over my head, that he wondered about my home life. "Do you live in a dangerous neighborhood, like, with a lot of gunfire?" When I told him my husband had a sleep disorder but did not like to wear the mask, he advised that either my husband wear the mask or I sleep in another room. That solved the reluctance problem. I find the quite susurration of his machine to be quite soothing.
29
I was diagnosed with obstructive sleep apnea earlier this year. Even with insurance, the amount of steps, waiting for appointments, and red tape involved in obtaining treatment can be daunting. Since I already wear a night guard I opted for an oral appliance, which is less obtrusive than the CPAP; however, it is extraordinarily expensive (I was quoted a price of a little over $4000, if my insurance hadn't covered it) and if you grind your teeth like me, it will rearrange your dentition. But I now dream again and have been able to cut my high blood pressure in half. With better rest regular exercise isn't so daunting, and I've also managed to lose 20 pounds. My doctor assures me that, being female, if I manage to lose the rest of the weight, the condition could resolve itself. Treatment isn't always as simple as getting a CPAP, but IT IS WORTH IT, given the health consequences of leaving the condition untreated.
12
@Lhong
My appliance cost me a thousand dollars after insurance paid. But the dentist has my mold and will not have to redo that step in the future unless my teeth change (but of course any new caps would be a change).
I am fortunate in that I am a patient of the Veteran's Administration that both provided the sleep study and the CPAP at no cost to me. The VA is also very responsive to requests for replacement parts for the CPAP. For those who are veterans and have not registered with the VA, consider it. It was only through a friend's insistence that I do so that I became enrolled. Do it on-line. Oh yes, the CPAP was difficult to get accustomed to, but it has become part of my life now.
10
I would also add to the barriers to adoption the maintenance recommendations that CPAP machine suppliers promote, like daily washing of parts, etc. I finally ignored those recommendations and only occasionally wash the nose mask but virtually never do anything else without adverse effect, making life so much simpler.
4
As a physician with sleep apnea, I would recommend rinsing and drying humidification chamber and wiping off mask daily. The takes a minute or less. Thoroughly cleaning both and the tubing with a mild detergent (such as unscented liquid dish soap) weekly is a good idea.
8
@David Hurwitz I take my reservoir, tube and mask in the shower with me. It only takes a couple minutes to rinse or wash them out and it can be done daily.
1
@Bill Same here! I wash the nasal pillow daily and that's it. I use distilled water, filtered air blows over it. Why would it be in any more need of cleaning than the distilled water still sitting in the jug? My experience is, it doesn't. The heated tube stays dry; if I "washed" it, I'd be introducing more germs than just leaving it alone. From reading the cpap talk forum, I think most of us ignore all those washing instructions.
3
You are so right. I've been on CPAP therapy for nearly 10 years. When I went on Medicare, the equipment firm I had to use was so inexperienced at dealing with Medicare that it took me six months to get a new mask. In the meantime, my old one was falling apart. So for six months, I didn't get the optimum benefit from the CPAP machine. The ins and outs of dealing with insurance shouldn't endanger your heart and your brain.
10
OSA, according to the American Heart Association, is also associated with high blood pressure, arrhythmia, stroke and heart failure. My husband, a life-long snorer, found this out after developing chronic heart disease in his early forties and almost dying. Every patient in his cardiologist’s practice is prescribed a CPAP machine. Universal screening could potentially save many lives!
I also use a CPAP; I was diagnosed after heaving years of nightmares that I was choking on something. Knowing that I could be protecting myself against heart disease or a stroke is worth any money or effort using the machine takes.
12
I am one of those success stories I was diagnosed with sleep apnea July 2018 at which time I was 64 years old. I got a kick in the pants to do something about it after reading a NY Times article in July that year about the problem. When I read the symptoms I saw myself. I found a sleep doc who had me tested at a lab. Yes, it's uncomfortable for one night but well worth the data they can harvest, by the end of August, I had my machine. I went with the 'Resmed air sense' and have never looked back. My life has improved greatly. Now I'm nearing 66 and I have more energy today than I did when I was younger. Insurance is a pain, I ended up paying over $2000.00 for the CPAP machine and the 2 nights at the labs plus co-pays to my Doctor. But it was worth every dime because of how I feel today. I encourage everyone to get tested.
7
@Edward Stern I developed severe depression and anxiety as a result of misdiagnosed sleep apnea, along with the other symptoms. Took 4 tests over 2 years to finally get properly diagnosed. My life was ruined during that time. Finally I got a proper diagnosis and treatment in the form of an oral appliance which saved my life. I started showing symptoms at 42 years old. Without treatment I'd be dead by 50. I feel much healthier now than a few years ago
5
@Edward Stern
My diagnosis was around 15 years ago and my condition was so poor that they put the CPAP on me two hours into the sleep study. [I was tipped off by an article in the WSJ.]
Within six months I had lost 50 pounds with no conscious dieting or exercise, although I had given up the 2pm candy bar and cola required to keep me from nodding off at my desk. Currently, my weight is 100 pounds lighter than at my peak.
2
My husband and I both have CPAP machines and love them. We use them every night and take them on trips even packing them in our carry-on luggage. Yes, the first few nights were adjustments but well worth the effort.
I never fell asleep in the daytime but would be so tired at work, I wanted to cry. The CPAP fixed that! It also cured my snoring.
My husband’s neurologist advised him to have a sleep study. He was diagnosed with OSA and now uses a CPAP too.
I agree with the authors’ comments on the difficulties of obtaining a correct diagnosis and hassle over supplies.
7
CPAP treatment gave me my life back 9 years ago. The company that did the sleep study were no help when I complained about the size small mask, but I found an online supplier and ordered a size petite instead, and that was perfect. I've bought different kinds of masks over the years and now use one with just a thin strip of rubber under my nose and the hose exiting on top of my head. There are still annoyances: my mouth gets sooo dry, and the strap tends to slide up the back of my head, but they are worth it for the relief. Don't give up - try different masks, ease into using it by wearing it for a few minutes at a time while watching TV, for example. I have not used a doctor since my initial diagnosis and rely on an online supplier for my replacement products.
7
@Wonderdog Try a chin strap to hold your mouth closed. I have less mouth dryness that way.
1
My dentist recommended dry mouth mouthwash and a dry mouth pill that sticks to your gums while you sleep and has melted by morning. The pills can be used during the day if you wish. A good dentist or pharmacist should know about them.
One unexpected side-effect and result of effective sleep apnea therapy is the return of vivid dreams. The "best" sleep is REM sleep, which corresponds to the time when the unconscious person is dreaming.
No REM sleep? No dreams!
I hadn't really dreamt in years but it hadn't occurred to me that I was supposed to. I chalked it up to getting older.
With the CPAP I now enjoy wonderful colorful imaginative dreams in which I am naturally, the star protagonist. Not right away, but soon after CPAP.
I made other choices as well - cutting out red meat; switching from coffee to tea; wearing compression hose. But the re-appearance of dreams has been the most satisfying and dramatic.
Ever older person needs to be asked whether they snore and whether they dream.
10
Let’s also add to the expense the device that sterilizes the mask and line - a literal lifesaver. One can not even come close to controlling fungi and other nasties getting an express trip to your lungs without this added out of pocket expense.
5
@Linda hoquist It was recommended that I clean my machine weekly with a vinegar water solution. It's cheap and it works. Just soak all components in the solution for a while, rinse, then replace. And change the filter weekly as well.
5
@Linda hoquist
I use soap and hot water for both my mask and line. Seem to work just fine. Unless you are experiencing unusual circumstances, there is no need to purchase a sterilization device.
8
@Linda hoquist : A multitude of published studies have studied this question and come to a very different conclusion from you. The results of the expensive machines (such as ultrasound baths) that claim to clean and sterilize the mask and line are indistinguishable from a simple water/vinegar bath followed by hand-washing with dish soap.
The devices that allegedly clean and sterilize CPAP equipment epitomize the worst excesses of a consumer-product approach to health care that emphasis manufacturer profit over consumer cost and outcome.
17
I fell asleep at the wheel of my car on the Los Angeles Freeway system while downtown during morning rush hour and drifted from the number 4 lane and crossed over the number 1 lane and was less than 1 second from hitting the median. The noise of the uneven, not so smooth, surface woke me up and the adrenalin pumping saved my life. Fortunately I was headed east against rush hour traffic.
(I had nodded off a few months before with 3 others in the car but is was for a couple of seconds.)
My sleep study results were horrendous and was fitted for a CPAP machine and mask 23 years ago. I am alive today to tell that story because my doctor was wise enough to send me to be tested.
I've missed 2 nights in the last 23 years, one was that I forgot my plug set in a European country and one due to no electricity from a hurricane (that has been solved with a battery operated generator that is recharged when the electricity is working.)
There is no excuse for not using a CPAP if you are prescribed for one. None.
31
My husband just couldn’t use the machine but he was referred to a specialist dentist who fitted him with the mouth appliance. It was very expensive and we paid out of pocket but it is nothing short of a miracle! We both sleep much better. Don’t give up - there are alternatives to the masks.
9
@Darla I was lucky enough to have the oral appliance covered, but had to wait over a year to get the proper diagnostis for the coverage. If I'd have known how much it would improve my health I would have just paid the $3.5k out of pocket, it's been that good for me. Tried a cpap machine waiting for my appliance to be manufactured. Had a very difficult time with it, but turns out I didn't need it, the appliance works better for me! Saved my life!
4
I've been on CPAP therapy for 20+ years. Even after significant weight loss, I needed my CPAP machine. Having good insurance has made a huge difference as I've never experienced "sticker shock" from diagnosis or treatment. Testing certainly has changed over the years. My first sleep study was in Massachusetts General Hospital, in a hospital bed. My second study was actually in a hotel room, near MGH that had been adapted for sleep studies. My my recent study was in a sleep facility configured to look like a hotel.
I am on my third CPAP machine (Resmed). It's six years old and never misses a beat. These machines are remarkably reliable and quiet. Worth every penny IMHO.
Over my 20+ years of CPAP usage, I've missed about 7 nights of therapy due to "user error." I was 3 hours from home when I realized I had left the machine on my bed, all packed and ready to go. That was a rough long weekend. Some years later, I brought my machine but left the "hard to replace" power cord at home. Another rough weekend.
Getting new supplies is a breeze. I get a robo-call about once a month from my insurance-supported CPAP supply company and I select the supplies I need. I do have a copay but new supplies are important so I just do it.
FWIW, I am a nasal pillow user so, I also wear a chinstrap to help keep my mouth shut while using my CPAP.
Bottom line, I am a huge fan of CPAP therapy and feel very bad for those with sleep apnea who cannot benefit from its benefits.
6
I was diagnosed with Moderate OSA about 18 months ago. Prior to that I was experiencing severe nightmares frequently which entailed claustrophobic situations and terrified wake-ups. Thought I was having psychological problems; GP referred me to the local hospital sleep clinic and I learned what my problem was. [Live in Canada so haven't experienced any of the pecuniary adversities of folks further south. Universal health care rocks; y'all should try it sometime]. I am 69 years old, never been overweight, always kept fit so never thought I was an apnea candidate. My downfall appears to be a significant spine scoliosis which over time jiggered the configuration of my windbox [not the exact words of the diagnosis, just my way of explaining things]. I had a tough time getting used to the CPAP, or "that damned contraption" as I lovingly call it. My sleep tech told me to "persevere" and so I have. If a tennis ball could fix me up I'd pitch my CPAP in a minute but I expect I'm stuck with it. Getting about six hours of quality sleep now, numbers are good and don't have anymore nightmares. My wife calls me dicknose but it beats brain damage.
16
@David
Very similar problem than yours, the nightmares or waking up in the middle of the night feeling that my end was next, were quite common. I'm, like you, not overweight, and I never felt sleepy or tired. However, I went to a specialist and they monitored me throughout my sleep with scary results. Now I use the CPAP machine with great improvement in my sleep.
I was surprised how easy it was to get used to the mask and the over-pressure.
Here the machine is paid by our public health system, a very simple procedure.
6
Poorly fitting masks can make these devices practically non-usable. Is there anyone out there making CPAP masks from molds? I am this close to starting that business myself after watching my mom struggle. She can't sleep on either side because of a bad hip replacement and another painful condition, and has to tape her mouth closed every night to try to stop her gums drying out any further. The wait to get appointments and exchange masks is so American - meaning needlessly expensive, risky and stupid.
10
@Kathy I’m on Medicare so it pays for most things. However, if you want to try a different mask, forget it. You get a certain amount of supplies according to a schedule and to deviate is criminal. Presently, I use two different nasal masks and pillows. Just had to buy new pillows on Amazon to keep up to date.
Ali I have struggled and have had little knowledgeable support from real experts. Quite frankly it’s been my own perseverance that’s kept me in the game.
2
@Kathy - I use a soft collar at night (from CVS) to keep my mouth closed and the CPAP works well that way. A chin strap did not work for me.
1
Hey-You can likely just buy your mom the masks online. We buy parts for my husbands directly from the supplier.
Good luck.
1
After untold years of me slapping, tickling, shoving, poking and shoving my dear husband every time he snored so loudly that he woke me; my DH agreed to go in for a sleep study. He found out that he had severe sleep apnea.
He's cycled through several generations of CPAP machines and has a travel one that is quite small and convenient to use.
Not only has the CPAP saved his life, it's saved our marriage.
10
I am in my 40s and have had sleep apnea for most of my life. As a mouth breather, it is much harder to use cpap devices. I have received some benefit but I am far from where I should be.
Sleep studies at hospitals are horrible experiences. They connect countless wires to your body, making it very difficult to sleep. In this age of wireless technology, one would think they could attach the nodes and have them give wireless feedback.
Like many others, I have used my machine on and off. I have ignored the problem for extended periods of time. The equipment providers are a nightmare to deal with, though it has gotten a lot better. I see a well-regarded sleep specialist at a major research hospital and I still feel like he is often just guessing when trying to figure out how to best treat me, and then I have to wait months to get a follow-up appointment.
9
@NYC BD - As I told someone else, I use a soft collar at night to insure my mouth stays closed.
@NYC BD My sleep study was done at home, with a sophisticated device that sat on my forehead. It measured pulse rate, O2 levels, as well as brain waves (so they said), and listened for snoring. I didn't sleep incredibly well, but it sounds a lot better than being at a facility.
5
Several years ago, I had sleep apnea and gastroesophageal reflux disease (GERD). I changed some habits. I stopped eating after 6 or 7 p.m. and ate my main meals early in the day. I also chose my food more carefully. I began going to a "stretch and tone" class, and, perhaps more importantly, I placed the head of my bed on blocks and raised it by about 3 inches. I now have no GERD, and as an additional benefit, my snoring (if it still exists) does not deprive me of sleep. When I travel, I use extra pillows.
8
it's worth knowing, and the authors should have disclosed, that the "non-adherence" rate in a recent JoO meta analysis of CPAP studies was around 35%, and no behavioral intervention reduced it. so about one third of people with sleep apnea can't benefit from the prosthesis.
i use a sleep tracking app each night and have learned ways, such as going to bed earlier and not eating before bed, that reduce the time i spend snoring -- from about 1 hour on average to around 10 minutes.
7
I knew I snored but it took me years before I went for a sleep study and was diagnosed. I was not more than 10 lbs overweight but my dad had it so not surprising. I inherited an exaggeration of his receded chin and especially as I got older, everything was relaxing and softening there, causing OSA. I started using CPAP at about the same time I started having hot flashes of perimenopause. The first few nights I would throw the mask across the room yelling that I could deal with one or the other but not both. Nevertheless I persisted and got used to it. Now I can't sleep without CPAP. It's not a perfect system and definitely requires an adjustment period but I do feel much more energetic than I did before despite being ten years older!
My biggest frustration is that the medical supply companies are horrible. They can't get orders straight, they charge exorbitant amounts for small pieces of plastic. I can get the same brand names supplies for a small fraction of the cost they charge online, a fact my insurance company must love as they then don't have to pay. We need to make this more accessible to more people.
34
I have been using a CPAP machine for two years. It is not quite the miracle for me that some have experienced, but it has made a significant difference. Once my sleep was a bit better, my energy and concentration increased, so my exercise and other activities increased, and I have been on a slow virtuous cycle to better health.
And as for the costs: sleep test completely covered by Canadian public health (except for the parking overnight at the clinic), and my CPAP was covered 75% by the Ministry of Health. The other 25% was covered by my workplace private insurance. I paid only the $15 or so for the parking.
20
At my wife's insistence I asked my doctor about snoring and referred me to a somnologist for interview, which went just fine until he asked if I ever woke up after thrashing, kicking or swinging my fists. I was mortified. It had gone on for years and I decided I had some unconscious hatred towards my wife. That was enough to get a sleep study and eventually a CPAP. It turns out I would stop breathing several times a night for almost a minute, my brain scan activity would go crazy - when you are asleep and can't breathe it creates violent dreams where you literally fight for breath.
After about two months of adapting to my new routine, two things happened: First, violent dreams subsided and I stopped physically acting them out. Second, my need for daily naps - sometimes two a day also ceased. I have used my CPAP nightly for about 5 years and its benefit is obvious.
I tell this story for those who may have similar symptoms. For me, it may have saved my marriage, my job, and maybe my life.
238
@Plumberb The article was informative, but your response offers real and genuine compassion--empathy with the desire to help. I sent it to a loved one who is in debt for $1,000 for a sleep study he had over two years ago, the results of which pointed to many instances of breathing stoppage and wild brain activity. He never followed up with a doctor or got a machine and still suffers nightly (and daily). Thank you for sharing your story, as it just might help someone in a big way.
14
@Plumberb Sounds like REM sleep disorder, not sleep apnea, though you can have both. The CPAP can help with the sleep disorder. Melatonin does too.
Most doctors, including sleep doctors are not familiar with REM sleep disorder. It can be a precursor to Parkinson's and other "delights".
My sleep doctor, who studied at Stanford (the premier program) with the professor who "discovered" the condition, didn't diagnose it when I told him 3 times over a year that I was waking up screaming and now, sometimes thrashing.
2
@Plumberb Your comment about violent dreams is fascinating, as I have both sleep apnea and many violent dreams that I have assumed are symptoms of PTSD. I kicked my husband during sleep and often wake up with my hands in fists. I will be asking my doctor about this.
1
Oh, dear. I've been using a CPAP for more than a year now, and while it has alleviated the fear that I could easily die in my sleep, it does not make it easier to fall or to stay asleep.
Too often I lie awake past midnight, and/or wake up well before dawn. It can take 2-3 hours for me to fall into deep, dream sleep, and then I sleep until almost afternoon. If I were still part of the workforce, I would have to operate on only a few hours of sleep.
I do appreciate the CPAP. I do not have breathing problems in sleep. But I still have problems in achieving sleep. The CPAP doesn't cure that.
11
@ Try sleep gummies by Olly for a natural send off. Works for me and even gets me back to sleep after getting up during the night. No drugs. Using a CPAP has been a bear for me but I’ve been persistent. Support is awful.
I used to feel sleepy while driving. I had read about sleep apnea so I talked with my ENT sleep specialist who arranged a home test for me for two weeks with instruments to measure sleeping oxygen levels in my blood and breathing information. After getting the test results he recommended a CPAP machine which I have been using for last seven months. The machine records inhalation breaks per hour and the amount of time the machine is used for. It transmits the information to the insurance agency when in use. Minimum recommended use time is four hours each night. The insurance company pays for its use if the machine is used for four hours every night.
Minimal instructions were provided and no measurement were taken when I was given the CPAP machine. After three trials with different nose air fits I have learned that the air fits suggested by the manufacturers do not perform properly. I have small stature so I was sent a small size Airfit N20 based on outer dimensions of my nose. It restricted airflow through my nose and made me uncomfortable. I tried the medium size air fit which was slightly better. Now I am using the large size air fit. It is comfortable because it allows more airflow through my nose. On the other hand it has forced me to sleep on my back because it slips and leaks air if I sleep on my sides.
Looking at the overall experience I am satisfied with the results. I sleep better and get up refreshed.
1
I have been using a CPAP since 2012 and have slept well since then. Before diagnosis, I never suspected sleep apnea; my wife threatened divorce because I snored all night...who me? One of the best things I've ever done==I sleep like a baby, every night. The machine is costly (around a thou), but 80% covered by Medicare. It's worth it. I'm on my second machine (wore out the other one). It takes some getting used to, but it is not impossible. How people live before this device? Who invented it? Better living through medical science.
9
My partner told me I was snoring. I'd wake myself up gasping. I went to an ENT. He told me that skinny women (5'3" 123 lbs) were not candidates for sleep apnea. I heard a piece on NPR about oral appliances and asked my dentist, who cited a study (Swedish, I think) that showed that skinny women were likely to show apnea or pre-apnea. He fitted me for an appliance, which I've been using ever since. It fits over both upper and lower teeth and creates an underbite, which helps to open up the airway. If I hadn't already had an appliance on my upper teeth for bruxism (grinding my teeth), my insurance would have paid at least a part of the cost. But it was worth every dollar. I'm not snoring and I sleep much better.
8
I was driving a tour bus when I began to notice I was getting darn sleepy around 2 PM in the afternoons. My wife commented that I snored loud. I went in for a 'sleep-study'. That was over 15 yrs ago.
CPAP saved my life. Period. I gladly wear that CPAP mask when going to sleep. Otherwise....I would be dead. Simple as that. No complaints about CPAP technology. After all, I could just easily be dead if there were no CPAP gear. You will not hear me complain about wearing a mask. I AM ALIVE!!!!!
172
@Stephen Douglas And so are your passengers.
5
@Stephen Douglas Thanks for stepping up to get help, I know many who are in denial and their spouses sleep on the couch because of the snoring.
I sympathize with this article in most ways. I would fall asleep, just sitting on the couch talking to my wife. It took a bit of time to adjust to the CPAP, but now, it's like curling up with a nice warm blanket on a cold night. The sleep study showed all kinds of ugly things happening, including some heart glitches until I started using it. It has saved my life. I can understand that there are hypochondriacs out there who don't really need it, but that's what the sleep studies are for. There really isn't a reason for insurance companies to refuse to pay for these things. Do they refuse to pay for cardiac pacemakers? How about insulin pumps? Supplemental oxygen? How about some common sense!
33
>>This article is helpful though it doesn't mention misdiagnosis such as in cases of sleep paralysis. Maybe sleep disorders call for second opinions.
Most effective treatment for marginal sleep apnea is to lose weight
5
@Bill True, but losing weight can be enormously frustrating. I think better to go to work immediately on sleep; being better rested may help with establishing regular, healthy eating habits, key to weight control, with or without bariatric surgery.
19
@Bill Even as a marginal issue, it is not solely an obese person's problem, which is one reason why it often doesn't get properly diagnosed.
11
@Bill For some people. Not everyone with sleep apnea is overweight. Not everyone who is overweight can just stop being overweight.
14
sleep on your stomach and avoid the mask
1
That doesn’t work for all people. My husband was not over weight and snored in any and all sleep positions.
5
My husband has been using a CPAP machine for nearly ten years and it saved his life as I was close to smothering him with a pillow. Prior to getting his sleep apnea diagnosed and treated he was almost continually ill and was chronically sleepy. He is now rarely ill and has much more energy and his professional productivity has skyrocketed. Our only complaint with the CPAP industry. On several occasions my husband has forgotten his machine. cord, or some other piece of the system. Supply companies are only open Monday through Friday, nine to five. If you don't realize that you forgot to pack your mask until Friday night at 10pm you are SOL until Monday. We have had many miserable, sleepless nights and have had to resort to duct taping jerry-rigged equipement from Home Depot in order to survive the weekend. CPAP devices and CPAP supplies need to be available from any 24 hour pharmacy and ought not require a prescription. Regulations on the medical device industry needs to be re-evaluated entirely starting with the whole sleep apnea industrial complex.
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@Happlegate - Killer opening sentence, literally. You had me laughing out loud.
Cheers,
Jeff Pucillo
3
@Happlegate AGREED. I once traveled to Europe for work and forgot to pack the seal for my CPAP. My employer has an emergency medical service that will do everything from get you an emergency dentist to refilling prescriptions you forgot at home and probably emergency surgery if you needed it. But they COULD NOT figure out how to get me a CPAP seal and the machine can't work without it (even though they kept telling me it would). Finally on the day before I departed I found an online store that would have shipped it to me overnight. By then I had gone two weeks without sleep which certainly didn't help the jet lag at all. It is appalling that a necessary treatment is so difficult to obtain, and insurance restrictions make it very hard to get backup supplies to keep in emergency kits etc.
5
@Happlegate Order online from Amazon. Most supplies are available there and will arrive in one or two days.
The durable medical equipment industry is a racket.
3
Yeah, here's the thing about those costs...they don't cost that much. Yet, that's what the Dr. will charge you. I can find you a machine for well under $1000 in under 5 minutes. But, you have to have a prescription to get one. What needs to happen is more push back from patients. My husband was a health benefits trustee for ASEA/AFSCME for several yrs. and I got him to wield his power and push back against an outrageous 'sleep doctor' who is located in another state and has offices in 2 cities in our state. Having a trustee, who works for thousands of public sector employees, state that they will file a complaint with the board got that Dr's. attention. Pointing out that the same machine he was billing us for [over $1500] could be purchased for half that from a reputable source online, also got his attention. He adjusted the charges accordingly. I get real tired of hearing people diss the internet. It's a damned library at your fingertips, people. Learn how to use it!
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@Brooke This is good news. I'll try this next time. Thanks for the post!
2
It seems to me that everybody I talk to has been diagnosed with sleep apnea. Sounds like the disease of the week.
12
I'm a woman with OSA (yes, we are largely left out of all the articles and marketing materials consistently - my first trip to an overnight sleep clinic, I was the only woman in a waiting room of fat old men snoring at 6 pm waiting for admission!)
I now have a machine and full mask and while I don't love it, after a few months it makes a huge difference. As an expat, I hate that I basically rent the machine so I have to go through this all again wherever I move to next. It took a few months but the machine works. I had to pay extra ( I pay about 40% of my salary in health insurance and tax in Germany) for anything above the bare minimum so it was a few extra hundred euros.
6
As a long-time CPAP user, I can testify to its efficacy. It is, however, a "medieval" solution that works: Inflate the entire head to keep the nasal and throat tissues from collapsing. This was never exceedingly onerous for me, but another thing to do at bedtime and another bag to include when traveling. Perhaps as more people come to need treatment, researchers will find better solutions.
The ridiculous scam perpetrated by the sleep-doctor / medical-hardware-supplier complex is the requirement to get regular prescriptions from the doctor in order to purchase masks, chin straps, and the sophisticated air-supply devices. The online prices for these pieces of hardware are far less than what the user (or insurance) must pay. But the online suppliers refuse to deal with insurance companies.
So the sleep doctors get to bill for regular visits to get the prescriptions, and the hardware suppliers get to charge inflated (pun intended) prices for the goods. How did we users (or taxpayers if user is a Medicare patient) come to get bilked coming and going?
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@Leading Edge Boomer I don’t have a sleep doctor. My primary care doc has handled all.
I can't believe only one or two people have mentioned that sleep apnea often occurs only in those who sleep on their back. You can think you are a side sleeper, but you may often roll over onto your back in sleep and not realize you have done so. I found that the cushions (found on Amazon) that you strap to your back have forced me to sleep on my side, and that seems to have worked. The tennis ball sewn into the back of a t-shirt is a variation on this simple and rather inexpensive solution. And it IS a simple solution compared to most alternatives, doesn't involve insurance, several visits to doctors, etc. etc.
9
@Tania
I'm happy that's worked for you but it's not true that side sleeping prevents apnea in everyone. I am most comfortable sleeping on my side and spend most of the night there but even with my CPAP running I sometimes wake myself up with a snore while on my side.
8
@Tania this is not true, in the group I am in, most of us sleep on our sides
3
@Tania I also thought I was exclusively a side sleeper but my sleep test showed that I'm on my back 40% of the night, and that was when I had my apnea level above normal. I read a study showing that long term compliance with those tennis balls and back straps is about 6%. I knew I'd be part of the 94% so I found another product called Night Shift which looks and sounds medieval -- a strap around the neck with a little device that makes a sound when you roll onto your back, prompting you to stay on your side. Did another sleep study and my AHI is normal! Way more effective for back sleepers than a tennis ball.
2
My specialist in Switzerland pointed me towards a Swiss firm https://www.velumount.ch/en offering a very simple device that has cured my issues immediately. While it may not work for everyone and a medical exam should be done first, this device may help many sufferers. It comprises a plastic-coated slimline wire frame that fits behind the uvula together with a nose clip to expand the nasal passages. The device stops the upper airways descending, so stopping the snoring. It takes a little training to get used to placing something so far behind in the mouth and to not have a gag reaction, but now I place it in a second and have a peaceful night thereafter. Something like this must exist in other countries.
6
My husband developed sleep apnea at a young age--he was overweight and had other medical problems. One of the other cardiologists in his cardiology group recommended that he see a lung specialist (the the only one to do so, after several years under the care of multiple doctors), which he did--this in about 1990.) In those days the patient spent a night at a local hospital and was diagnosed, followed by a second night there a week later to make proper adjustments. My husband was not a cranky patient and cooperated fully with the new reality. He lost some weight; after about 5 years he realized somehow that he didn't still need the machine and went on comfortably with his life without it.
3
I would like to point out that as a Kaiser Permanente patient, I had the sleep study and CPAP (a BIPAP) machine for no cost, no copay, and no fuss, after it was determined that I needed them. And I get supplies at no cost. Admittedly, being a retired KP physician and Medicare Advantage patient helps, but as I understand it, costs for most Kaiser patients are low, and there definitely is no insurer second-guessing physician orders. However, no insurer will cover a small travel machine and that’s definitely at the patient’s expense.
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@David Hurwitz Yes, Doctor--Thank God for Kaiser. If socialized medicine ever comes to this country, it will look a lot like the Kaiser plan. Hurrah!
4
@David Hurwitz My husband on Kaiser Senior Advantage had two sleep studies, one to confirm his central sleep apnea and one for CPAP adjustment, for which there were no copays. The CPAP machine cost $129 and mask cushions and filters for a year were $30.
4
I have never found it difficult to use either pillow, half-face or full-face masks. Yet when I told my cardiologist, who first diagnosed my SA ,or later, my pulmonologist that neither machine helped and that they actually exacerbated the SA problem, they accused me of not wearing or not wanting to wear a mask. This was patently not true but neither of these specialists would accept this. I have a doctorate in a medical field, yet my observations of my own body were totally discounted.
20
I was diagnosed with sleep apnea several years ago by the VA. Testing was an overnight in the nearby VA hospital. Sleeping on my side was fine on my back very high incidence of interrupted breathing. VA provided a CPAP machine and all accessories. The VA monitors my usage though a wireless internet connection. My only cost has been the trip to the VA hospital, the distilled water and the small amount of electrical power used. Thanks again VA!
5
Glad you submitted your comment Dan. Veterans are very fortunate to have testing and treatment through VA. It’s a costly condition. Some Veterans are now getting a surgical procedure to remove excess tissue from throat to reduce or eliminate symptoms. Is this being done in the civilian world too?
@Nancy Laude
I'm not military. I had a UPPP (the surgery you refer to) maybe 20 years ago and never looked back. During the trial to see if I could adapt to CPAP, the CPAP mask always ended up on the floor because I'm extremely claustrophobic. The procedure was done at Kaiser Permanente in the SF Bay area. It was not extremely costly.
1
I am a law student in the Twin Cities. I come from a family of sleep apnea (SA) and I was recently diagnosed and now use CPAP and it works great. My background is my father, sister, brother, and grandmother (my mother’s mother) all have SA. I am a heavy dude and so it would seem from genetic and physical factors that I have SA, pretty straight forward right? No, because of the insurance hurdles. From the first conversation where my general practitioner said “you probably have SA” to the day I got my machine was 3 months. The number of hoops and meetings and “preauthorization” periods was just horrible, all for something that we all knew I had. During my sleep study they only needed an hour to determine I have SA and they got me on a CPAP. To make matters worse I get my health insurance through my mothers job (university of Wisconsin school system) so there really aren’t healthcare options in the Cities so all of the testing and 30 minute appointments each required 5 hours of round trip driving. The machine is fantastic and I describe it like having jet fuel for my brain. I was maybe operating at 40% and I have become a much more active person with the extra rest. From dating, exercise, life planning, extra curricular activities, to improved schoolwork my life has been transformed by the treatment. I wish they could have just given me the machine for the thing they knew I had and saved me 3 more months without the valuable treatment.
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It is not clear that humans *ever* evolved over 300,000 years to sleep lying down absolutely FLAT, or even close to. Sleeping in a comfortable more UPRIGHT position might also help the quality of sleep for many of us. A rather "simple" but important consideration.
8
The main point of this article is important: nowadays, with extremely smart CPAP machines, routine use of overnight sleep studies is like swatting a gnat with a sledgehammer. The machines produce copious data detailing numbers of apnea events per hour, leaks, etc.
The specter of an overnight study in a facility undoubtedly inhibits many from getting proper diagnosis. Also, these studies are technology- and labor-intensive, and therefore very costly.
For any apnea skeptics: as a result of going on CPAP several years ago, not only am I far more alert (though never as much as I once was), but the air pressure eliminated a long and stubborn case of GERD (acid reflux) that left me constantly hoarse, as well as the persistent sinus infections which are often associated with GERD.
I only wish the sleep community could agree on a more euphonious term than the ugly and awkward "CPAP." In the medical community, continuous negative pressure is CNP, so how about just "CPP" for us?
7
@LD Rabbit A CPAP machine cannot distinguish between obstructive sleep apnea and central sleep apnea. A sleep study can. The two conditions require different treatments apart from CPAP.
6
@LD Rabbit many of us have had at home studies which were equally effective. I was DX with 20 episodes an hour, am now less than 2 (usually under 1)
I was looking up about what it takes to get a CPAP. It seems one can't purchase one without a prescription. Wondering if the science behind needing a prescription is solid i.e. why can't machines automatically adjust the pressure. The pressure range is quite narrow well within the capabilities of most machines built in recent years.
Would appreciate if someone can comment if one can get a CPAP machine without prescription ?
@Ramesh Machines can adjust the pressure I start at 6 cm. of water and average 10 to 12 at night.
@Ramesh
Try eBay.
2
@Ramesh I purchased my last machine from eBay. I was diagnosed in 2005, with effective pressure set at 10.5. It's easy to reset the prior user settings, thanks to the internet.
My primary care physician is kind enough to provide me with a written Rx for masks every couple of years.
I would see a physician for your effective setting, though. Your lungs deserve it.
If a CPAP doesn't work for you, don't give up--try a BIPAP. In the beginning (19 years ago) I struggled for eight months with a CPAP: the high continuous pressure made it hard to breathe normally and fall asleep; it also tended to wake me up several times at night; I always had excessive flatulence the next morning. I was only able to use the CPAP 3-4 nights/week. Finally, I asked my doctor for a BIPAP, which required yet another sleep study. A BIPAP works like a CPAP, except it has two different levels of air pressure--a higher pressure when you're breathing in, a lower pressure when you're breathing out. The machine automatically adjusts the pressure with each breath you take. You don't have to "fight" the continuous high pressure of a CPAP while breathing out. Breathing is truly effortless, and enough pressure is maintained to keep your airway open while you sleep. I use my BIPAP with built in humidifier and with nasal pillows each night and during naps. It's the same size as a CPAP and travels everywhere with me. BIPAPs cost more so insurance doesn't like them. But the BIPAPs I've had all lasted at least 6 years. Even if I had to pay the full price out of pocket, I'd still do it to get consistently good sleep each night. It's easy to get frustrated with the sleep therapy racket, as pointed out in the article, but don't throw the baby out with the bathwater--once you get dialed in to a machine/mask combination that works for you, the rewards are priceless.
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@timdix2 Thanks for mentioning this. I also experience the extreme morning bloating and flatulence associated with high pressures of CPAP. I wonder why my doctor never suggested BiPAP. I will ask her at my next visit!
3
@timdix2 I use a CPAP and had a lot of problems with leakage. The airflow seemed to be tremendous. I had my doctor lower the pressure from 11 to 6. New world.
2
The medical profession will give up "sleep studies"? Visits to "sleep specialists"? Prescriptions for grossly overpriced machines? Hah! That'll be the day!
I have had some experience with these infernal machines--where's Jony Ive when we need him? They are cumbersome, ugly, downright scary. And did I mention--crazy-expensive?
3
@richard cheverton But they work.
2
@Dick Watson Yeah, it's a nuisance, but I must use it .. like glasses. Hate those, too.
1
I had a sleep test and was diagnosed with sleep apnea. After they put the CPAP mask on me I had a horrific nightmare and vowed not to use a CPAP machine. [ A majority of "users" stop using their machine after only 3 months.]
I went online and found, on the British Journal of Medicine website, a study done between University of Zürich and Zürich Hospital. They had a musician who played the didgeridoo teach their sleep apnea patients how to blow and make sounds/music. The blowing strengthens the muscles in the throat that otherwise collapse during sleep.
They stopped the study after 3 weeks due to it being very successful with the overwhelming majority of the patients.
I purchased a plastic didgeridoo [painted to look like a real Australian wood one] and have been using it ever since. It cost me around $35. And for traveling I purchased a small box one that is based on the same principles. They both work for me.
I also have friends who practice a form of yoga breathing to strengthen the same muscles.
Perhaps these more natural remedies might be helpful for folks to try first instead of forking over big $$$s for a machine.
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@denverhi I had heard this about the didgeridoo a while back and forgot about it, thanks for the reminder. I'll look into it further, it's worth a try. I appreciate what CPAP has done for me but I'd prefer to not have to use it at all.
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@denverhi Very interesting. Do you know if a patient using this technique ever gets to the point where the throat muscles are strong enough not to continue playing the didgeridoo?
3
@denverhi
Thank you so very much for this interesting info. I always try natural remedies first, and since my diagnosis is mild sleep apnea, perhaps the didgeridoo combined with some yoga breath work will work for me and allow me to avoid the horrid CPap or dental appliance the doc recommended.
3
I was diagnosed with sleep apnea and found a relatively simple, unobtrusive, and inexpensive solution: a t-shirt with a pocket in the back. The pocket is in the center and holds a tennis ball. For many people, snoring and sleep apnea occur when sleeping on one's back. The tennis ball forces me to sleep on my side. No more sleep apnea.
6
Sleep apnea is very common in post polio survivors. A nite time sleep device can greatly reduce Post polio fatigue.
3
I would like someone — physician, researcher? — to explain why it is that human beings have been sleeping for centuries and millennia without need for CPAP? I ask this sincerely — it seems extremely unlikely, even in a statistical sense, that ‘suddenly’ we have tens of thousands of people with a new ‘disorder.’ I in no way make light of those who are suffering; I simply would like someone to address why/how this is now such a common problem.
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@kathpsyche: good question. my very fit and athletic father snored like a freight train as did his father who died of a 'heart attack at age 62 in 1963. My father died of a 'heart attack' at age 59 in 1979. I am nowhere near as fit as my dad at age 67. I was diagnosed with OSA around 2008 when it almost caused my heart to give out. I also snored heavily. I now use CPAP. I was told by my pulmonologist that OSA was initially "discovered" and labeled as "disease" in the medical literature only as recently as the early to mid 1980's. I have no proof that mankind has 'suddenly' developed OSA- like many other ailments, medical science continues to grow and understand more things. Another example is Alzheimer's. Back when my grandmother died they just said she was old and "senile" but now we understand it's a degenerative brain disease. So, as we live longer, i think we are going to continue to discover the variety of the different ways we all die, and some ways to delay that from happening at an earlier point in time.
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@kathpsyche They used to just die young.
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@kathpsyche There are many common ailments that we haven't evolved past yet. Low back pain, sickle cell, lactose intolerance. You can probably think of many more.
4
My sleep disorder took nearly ten years to be accurately diagnosed. As a fit female, I didn't fit the stereotypical profile (overweight and/or obese; sedentary; male and middle-age or older).
I was lucky to have support from my internal medicine doctor and a neurologist-owned sleep center that persevered through the hoops of my employer-sponsored insurance company denials. I was surprised by the sleep technician's reports of fit, pre-and post-menopause women, and even teenagers, all with healthy weights and lifestyles, who were found to have OSA after undergoing comprehensive in-center overnight studies.
This year, Psychology Today reported on study-based findings that upend the stereotypical overweight male profile: https://www.psychologytoday.com/us/blog/sleep-newzzz/201906/new-findings-sleep-apnea-in-women
A European study this year also linked apnea to increased cancer prevalence in females: https://erj.ersjournals.com/content/53/6/1900091
My path to diagnosis was daunting enough to make many sufferers give up. The continuing care and costs (as others have noted) are problematic as well. But my wakefulness at night, and snoring and sleepiness by day, no longer are. I'm grateful I have the time, coverage, and resources to afford and manage this. Our hit-or-miss "healthcare" system excludes many who can't and don't.
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@Jann Alexander
Thank you for supplying the info sources, much appreciated.
This is a nice overview but there is one glaring oversight. As many as 50% of those properly diagnosed with sleep apnea do not use the masks because they fit poorly. CPAP masks are almost universally sold in just 3 or 4 sizes. Can you imagine the failure rate of comfortable shoe fitting if shoes were only sold as sm, med and large for everyone?!?!?! If the fit is poor the masks leak and are just plain uncomfortable and interfere with the sleep that they are supposed to help. Is it any surprise that patients refuse to use them?
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@Alan This was indeed my problem. I was kept awake more as I tried to keep the mask fitted. The sleep doctor gave me the alternative of nocturnal oxygen and sleeping on my side. Medicare covers nocturnal oxygen if you wear overnight a finger monitor that measures your pulse rate and oxygen concentration and the latter goes below 89% for a defined period. I actually bought one of these recording finger monitors online for about $30 and had fun reading the graphs on the computer and identifying the "events". Using it on my wife revealed she too needs nocturnal oxygen. Medicare covers a machine for each of us at home and a machine delivered to your locations as you travel. This is a real nuisance however, so we bought two small portable oxygen concentrators (expensive) that fit into a small suitcase along with cords, power supplies, cosmetics, and medicines. The total weighs only about ten pounds, so I, at 82 years, can readily put it into the overhead bins on airplanes. The concentrator senses when you start to breath in and releases a short burst of oxygen that averages over time to 2 l/m. The sleep doctor writes a prescription for this particular type of device. It was not covered by medicare, so we used the prescription and ordered the concentrators online. They always pass through DHS screening in the USA and abroad.
16
@Alan here are now a greater variety of masks available. They have different straps and various combinations of face/nasal coverage.
You can usually go back to the medical device provider and have them re-fit your current mask or identify another type of mask which works better for you. Most (not all) give you a certain period to try it and if it doesn't work come back for a different fitting.
And you can purchase replacement parts online
6
Not only is diagnosis and treatment of sleep apnea unnecessarily difficult but all too many sleep specialists do not engage in follow-up once the diagnosis is confirmed and CPAP is prescribed. Poor compliance with treatment occurs in about 50% of patients and the die is usually cast within the first week. In addition, many patients have other sleep disorders that need to be addressed before they can adapt to CPAP. Unfortunately, sleep specialists are overwhelmingly pulmonary docs who have subspecialized in sleep medicine and all too often are largely focused on sleep apnea and other sleep related breathing disorders. This can result in less than needed regard for other sleep disorders and failure of CPAP use. When I was training docs in sleep medicine most were indeed pulmonary fellows. The first thing I would say to them is: "There's more to sleep than breathing."
10
A large percentage of people discontinue CPAP. I use the nasal pillow. It was initially very hard to use as the air would escape through the mouth. Finally found a hypoallergenic cloth tape to seal the mouth, but then the air would blow up my cheeks and wake me. So I bought an ace bandage, anchored it by my ponytail and wrapped it around my cheeks to stop them from inflating. It took a lot of frustration and ingenuity to figure out what worked, but have now been using the CPAP for many years. But, truth be told, I still often take a daytime nap, sitting up on my couch, which reduces the apnea, for a delicious snooze without the infernal machine :)
1
@Mm I began using the CPAP machine in 2012, and have been using the nose pillows for the whole time. Shortly after I began with the CPAP I decided to have my dentist set me up with Invisalyn to correct crowding in my lower teeth. Once you end the Invisalyn treatment you must wear your last aligners as a retainer to prevent the teeth from moving over time. I found that my duty to wear the aligners overnight played right into my success with the CPAP machine. That is to say, with the aligners in place I instinctively keep my jaw closed/teeth together. Thus avoiding the phenomenon you experience - the air escaping thru the mouth. If you happen to be someone who grinds their teeth at night and you want to have a custom night guard made for you - it just might prove to work like my aligners do... they influence me to keep my mouth closed at night.
1
Get corrective surgery if you can. The mask alone at the end of the day is not a great solution. In summer 2016, my aunt was prescribed new medications that caused her to be drowsy and sleepy. Fell asleep without the mask one afternoon, then died in here sleep. Unfortunately, I also had another good friend die of sleep apnea that same year. He was a D3 college football player who could bench press nearly 400 lbs...I've been cautious of sleeping on my back ever since. EVERYONE should get tested...it can definitely save your life.
2
As a sleep specialist who began sleep medicine practice 40 years ago I well remember the days before CPAP came on the scene when the only treatment we had to offer was to bypass the throat via a tracheostomy. Unsurprisingly, trach's worked quite well but fairly few patients would agree to have one. CPAP was introduced in the US in 1985. The first machines were the size on an office wastebasket, had a fan belt, were very noisy and weight 22 pounds. Modern machines are very lightweight and almost soundless. One of the things I emphasize when introducing the idea of CPAP to apnea patients is to point out that there are only 2 treatments in all of medicine that always work if you use them and can not cause any serious time. CPAP is one ot them, the other is: glasses.
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@sleepdoc As a glasses wearer and a CPAP machine user, I would advise you to stop telling that to your patients. A CPAP machine most certainly does not always work if you use it (or rather, it only always works if the circumstances are perfect, which is utterly meaningless inasmuch as anything always works if the circumstances are perfect).
If glasses were a CPAP machine, a glasses wearer might suddenly realize that for the last six hours of his life, when he had been counting on (for the sake of, you know, his health) being able to see clearly, his glasses had not even been on his face because, unbeknownst to him, he had inexplicably removed them (perhaps the way they worked -- refracting light rays -- put uncomfortable pressure on his eyes? perhaps a piece of dust got underneath them and he unwittingly removed them to address the itch and then never replaced them?). So instead of being able to see clearly, he had been going about his day with his usual blurred vision, which meant that he had accidentally signed a contract promising to give up his firstborn child, or that he drove his car into a tree or something. Because that's what would happen if glasses wearers suddenly ripped off their glasses without noticing.
I like to think that if glasses were that unreliable, people might come up with a better solution to addressing poor eyesight. CPAP is better than nothing but is not a good solution.
2
@Chris
Chris..I am 67, rail thin and got a DX of OSA..I hated the masks..did some research..bought a cheap didgeridoo..learned to play it..no more apnea...give your throat some exercise..Docs know most people will not do this..that is..play a drone instrument...but it works...keep your old mask just for a periodic check on the chip to see you are not still having apnea
2
@Chris try a cloth mask. Latex is terrible!
I had a sleep study done earlier this year. Turned out my apnea was off the charts. I've been using a CPAP ever since. It's been a life-changer. I no longer have the urge to fall asleep during the day. I think and function better. I wake up feeling like I actually got some rest. I use the nasal gel pillows and my husband observed a few nights after I started that I no longer snore and rarely sleep with my mouth open.
They absolutely should be more accessible, more user-friendly and easier to afford. Also, at-home sleep studies like the one I have need to be more widely available.
37
When my doctor suggested I do a study, without any explanation of what that meant, I assumed a study is done over a long period of time, and because I was in and out of town, I assumed I could not do that. If I had been told that by "study" they meant eight consecutive hours I would have been treated a year before I was treated, by which time the problem had led to A-fib. My issue was central sleep apnea, not obstructive. It requires a more expensive, bi-pap machine.
2
I've been on CPAP for a month, on an Airsense 10. I've tried the full face mask, the nasal under-nose (N30i), and the nasal pillows (P30i). Only the pillows are working well for me, although even with a chin strap, I wake up with a dry mouth.
I accept that the machine will collect data and report it back to the doctor and insurance company. That's the price of getting reimbursed. But I called the doctor to request a pressure adjustment. I was surprised when they called back and said they had adjusted it remotely.
If the machines can be controlled remotely, what's to stop a hacker from cutting it off during the night, or making other changes? I do not like someone having the ability to control something inside my house.
25
@SO I used to have the problem of waking with a dry mouth. It caused my use of the CPAP to be less efficient than it should have been. I’d wake up feeling like an army had been marching in my mouth and take off the CPAP. A chin strap didn’t help.
Then, at my last annual review, the great nurse practitioner that I was meeting with suggested using “Cover-Roll Stretch” by BSN Medical - purchased on Amazon for about $6 - 2 in. X 10 yds. I use about a 4” length each night to tape my mouth shut. No more breathing out of my mouth.
What a WONDERFUL suggestion! I sleep longer on the CPAP and no longer have the dry mouth.
I can’t speak highly enough about the Meadowbrook Clinic Pulmonary Department at Methodist Hospital in Minneapolis.
In addition to diagnosing my sleep apnea, they discovered I also suffered from a bit of narcolepsy.
My life has been SO MUCH better since I went in for that sleep study.
1
My husband was snoring a lot and was not getting sleep, so at the suggestion of his doctor, he went to see a sleep specialist. The specialist prescribed a machine and we had not trouble getting one, and our insurance "covered" it. My husband had so much trouble with it, he didn't use it. First, they sent the wrong mask, which took over two months to straighten that out with the supplier of the machine. And in the meantime, by changing his diet, my husband's snoring got markedly better. We should have returned the machine then, but we were hesitant, because it had already been several months, and that's when the bills started coming. We talked and talked with the insurance company and the supplier to no avail, and here's the bottom line: you have to use the machine for the insurance company to cover it. While I was on the phone, I couldn't get a straight answer from either the insurance company of the supplier about why we were getting all these bills until months later. I realize some people need it and are helped with it, but the whole system seemed to us like a tightly run, money-making racket. We finally returned the machine and my husband and I swore never to deal with any of the sleep people again.
16
@Yuko purchasing the CPAP online is an option for those who can afford it and don't want insurance company monitoring their use
1
All you have shared is fine and helpful to many I assume. But you have ignored those people like myself who have been using CPAPs for years without significant, sometimes no improvements in their sleep. The alternative remedies you have mentioned (plus behavioral & and cognitive health approaches not mentioned) may be helpful to some,but for others they bring no relief or make the situation worse. My experience with consulting 4 different sleep doctors over the past nearly 10 years is that they appear to be stymied and have nothing further to offer. It seems we need a great deal more applied research though any results may come to late for those of us stuck with the unimpressive state of the art for sleep apena.
28
@Michael Hey I have had SA for over 2 decades and have used both CPAP and BIPAP machines. Neither were successful, and, in every instance exacerbated the problem by delaying the restarting of breathing when I stopped breathing. I produce a lot of mucous and when it builds up and I stop breathing, the positive pressure compacts it and I have trouble initiating breathing (this is my dx, and has not been confirmed medically). Alternatively, pulmonologists have also suggested that I may have central SA, which I am told is not amenable to positive pressure machines.The method I use to relieve the tachycardia accompanying episodes of SA is to hold my breath until my heart rate decreases. This takes a relatively short time and is 100% successful. I am over 80 and not overweight.
3
@voyageurx Central sleep apnea is also treated with CPAP/BiPAP. https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/symptoms-causes/syc-20352109
1
I have central sleep apnea, and use an “adaptive servo ventilator” which is another kind of respiratory device, It continuously monitors my breathing and adjusts in and out pressure to keep me breathing. It has been a great help to me. I no longer have morning headaches and foggy thinking. I’m surprised that you haven’t been tested with one.
2
I have my sleep study on December 17th. I'm so curious about what the results will be. My PCP referred me because I'm experiencing cognitive decline & she wanted to rule out sleep apnea as a possible contributor. Yes--she is a very wise woman & I'm so grateful for her help & grateful for all the tips here in the comments.
4
I've been using a CPAP since 2008 for my sleep apnea and absolutely swear by it for all of the reasons listed - better sleep, much less tired during the day, ancillary health benefits to heart etc. My father had a major stroke in his 50's AND undiagnosed severe sleep apnea which probably contributed to his stroke.
A very significant side benefit relates to the fact that the air that you breathe from a CPAP besides being pressurized is also FILTERED. During allergy season, this means that during sleep you are breathing air free from allergens, under pressure - so your air pathways are clear; I usually wake up completely clear and no longer need the various inhalers/antihistamines that I used to require during allergy season. I suspect the CPAP would also help if you live in an area where the air is not that clear (think smog or downwind of forest fires)
19
@John T
I have sleep apnea and I hate the CPAP machine. Sometimes the pressure jumps up and blows in my face for no discernable reason, and I have to reboot it, which of course requires me to move around. Insurance-coverage rules require me to use it at least 4 hours a night ( they monitor it) ; it's gotten to the point that I usually wake up after 4 hours and take off the mask, which makes it a lot easier to sleep. Isn't the CPAP supposed to HELP me sleep?
5
@Charlesbalpha I've been using CPAP machines for 20 years and have never had a problem like that. If I were you, I'd contact the CPAP supplier and your prescribing doctor and solve the problem. Be persistent. It's worth it.
13
@Charlesbalpha
Try an oral appliance from a dentist who handled the devices. I couldn't use a CPAP machine because it just filled my GI tract with air. I love the oral appliance -- it's easy to use and care for, and largely invisible. I don't understand why more doctors don't recommend them (or why they were largely left out of this article) -- may simply be a function of how much money is invested in CPAP machines by the medical-industrial complex.
7
I may well be the longest studied case of OSA in the United States, having been diagnosed in 1975 (when it was still called "Pickwickian Syndrome") and the only treatment method was a tracheotomy tube. I had been misdiagnosed for the previous 13 years while my condition deteriorated significantly. Over the years, I have had 9 operations to deal with this deadly serious condition before the CPAP machine was invented.
I have now been using a CPAP (continuous positive air pressure) or a Bi-PAP (Bi-level positive air pressure) machine for more than 20 years. It has been a life-saver for me.
Please, PLEASE. If you or a loved one suffers from this affliction, do NOT delay getting it properly diagnosed and treated. Don't worry if you think it will look weird; you'll be fast asleep. ASLEEP! With DREAMS! With ENERGY DURING THE DAY!
Your heart will thank you. Your lungs will thank you. Your co-workers will thank you. Your car passengers will thank you. Your bed mate will thank you.
A more rest-filled life awaits.
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@Dochoch
Totally agree. Annoying, but a life changer, maybe even a life saver.
10
@Dochoch
I am a champion sleeper. I sleep through the night, have dreams, all that good stuff. I sleep on my side or stomach, and tend to breathe more through my mouth than my nose. For me, sleeping is not a problem.
The real problem is that I snore, which doesn't bother me but does disturb the sleep of my spouse.
Will CPAP help stop my snoring?
5
@Mon Ray Get thee to a dentist who specializes in sleep medicine for an oral appliance, a mandibular advancement device, to be specific.
I use one for treatment of sleep apnea, and when I started sleeping through the night after years of undiagnosed sleep apnea, it felt like a rebirth. (Truly. I had been concerned that I had early onset Alzheimer's because of the cognitive decline I had experienced prior to treatment.)
20
You should learn how to adjust the pressure yourself. I turn mine up when I have a stuffy nose and back down when better. If it is to high you will never sleep.
3
@Carl
My trainer won't trust me to judge the pressure setting. It's locked in.
I've used a CPAP for many years. When it was first prescribed I was given a mask which I found to be unusable. I couldn't breathe with it on. I just put the machine in a closet. Some months later a colleague mentioned using a CPAP and I told him about my experience. He said that he'd gotten nasal pillows rather than a mask and it worked fine for him.
I returned to the doctor and reported this. He gave me a new prescription for a mask with nasal pillows. I got it, slept through the entire night beginning the first day I used it, and now have been using it, and replacements for about fifteen years.
I never would have known of the option of something other than a mask if my colleague hadn't mentioned it. The initial sleep center I went to (at a major research hospital) certainly never discussed this.
There are a wide variety of masks and headgear and anyone diagnosed with sleep apnea should press the prescriber and equipment provider to let you try alternative configurations to see what actually works for you.
95
@AudenHoggart " . . . press the prescriber and equipment provider to let you try alternative configurations to see what actually works for you."
Absolutely. I've been using CPAPs and Bi-PAPs for 20 years and am on my fourth or fifth machine now (they wear out and lose pressure) and third supplier. There came a time when a mask manufacturer discontinued the model that I liked, but I had a good supplier who gave me some different masks to try out, and I tried them all until I found one that was just right - a nasal pillow. The equipment just keeps getting better and better, but you have to persist and get what works for you. My local sleep doc and his staff have always been very helpful in recommending equipment suppliers.
5
I have used a CPAP machine for over 5 years. Recently I got a new machine with auto titrate instead of constant pressure. That is good since I have lost over 60 lbs so far and still losing. My pressures change throughout the night adjusting to just what I need. They are low at the start and ramp up as I fall deeper into sleep. I like this better. With this type machine I do not see how you could be hurt by it. It was a boom to me because as I lose weight the pressures I need have changed.
11
@Anthony Thank you for sharing this information & congratulations on your weight loss!
6
@Anthony The Ramp-Up and Auto-Titrate are two different features. Ramp-up brings the pressure up over a period of time, or after you fall asleep. Auto-Titrate is supposed to work within a range of pressures, to set the minimum needed to prevent apnea events.
I turned off the ramp-up. I felt that the lower pressures were suffocating me. I wanted more air. I also asked the doctor to adjust the lower range of the auto-titrate for the same reason.
In my experience, the single biggest innovation that addresses mask comfort and leakage is the memory foam liner. If more people tried this, adherence to using a CPAP machine would skyrocket.
1
@Anna Crivici yeah i've heard this, definitely wasn't offered it
The amazing thing about CPAP pressures is that if you don't have a bizarre type of sleep apnea, there isn't any danger in self-changing the pressure, which actually works a lot better over time than trusting the one-time test which often gets it wrong.
CPAP would have been completely useless to me had I not self-changed the pressures (after confirming no problems to raising the pressure as needed with my sleep doctor.)
After that, it worked great. I actually now feel that the whole 2nd sleep study to find your ideal pressure is a total scam - it's close to $1000 in the pocket of the sleep doctor, but the results are a one-time snapshot, usually when you are not even acclimated to the CPAP machine/pressure (meaning it'll wake you up at the correct pressure until you get used to it) so the study is of low value compared to self adjusting in small increments over time until your sleep is notably improved.
I still wonder why CPAP machines are designed so the user can't self-adjust the pressures as needed if there is not a major health problem from doing so. Obviously, if you're making big changes, you should probably consult with your sleep doctor, but you probably did that when he prescribed you the machine.
18
@agarose2000
try the auto-CPAP machine. it self adjusts... initially and I think begins to average your trend...in terms of pressure. starts low and then increases until it reaches the level you need. I agree I wonder if the second night in the sleep clinic is necessary. better to spend that money on a machine that is self adjusting and can be adjusted by the user.
4
@agarose2000 It must have been some time ago that you got on CPAP. Other than Medicare no insurance company pays for a night in the lab any more for routine diagnosis or treatment with CPAP since a home study is as or almost as good at diagnosing sleep apnea and the (relatively) new auto-set machines obviate the need for in-lab titration. You likely will need a home study to get new equipment since insurance does not want to pay for something you don't need and therefore demand that the diagnosis be reconfirmed. You must be fairly technically adept since the methods of changing the pressure are typically hidden from the patient (for the obvious good reason that CPAP is a prescription device and it is a bad idea to let patients decide the dose of any prescription).
2
@agarose2000
My Family DR signed a patient choice box on my prescription form for CPAP.com and apparently it is a lifetime designation. I have been able to order various masks and even a self-adjusting pressure CPAP machine under this lifetime doc.
I have to use my FSA medical savings card to pay for this instead of charging the Durable Medical Equipment charge against my medical insurance.
2
While I agree that getting a diagnosis took time, I found the home sleep study to be easy (I have never even been able to wear an eye mask to sleep so thought surely I would not be able to even tolerate the test) and the process of obtaining my machine easy. I picked it up at the medical supply store, they fitted me and I have not been back since. Since I am on medicare my supplies are shipped to me and I do no paperwork. As for cleaning and maintenance, it takes me 10" once a week to clean the tubing and mask and changing the filter once a month takes me 1". While I sympathize with those people who have trouble finding a mask or nasal mask/pillow to fit, I have no sympathy for those grumbling about how time consuming and difficult maintaining a CPAP is. Give me a break. For me, a good nights sleep is worth the 15" a week I have to spend on cleaning my machine.
That being said, I do think the machines are overpriced and you can avoid monitoring if you want to pay out of pocket for everything. A friend gave my sister a machine and she uses it and buys her own supplies and no one monitors her.
6
@Kris Bennett Actually the staff person who fitted me for a CPAP later told me that people buy them on Craig's list then for a modest fee go in to the medical supplier to get it set up.
1
It wouldn't surprise me if -- years down the road -- you find CPAP machines on Amazon like one sees many medical devices there to buy now. Another comment says you can currently buy them online.
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@K Henderson
Unfortunately, Amazon doesn't do a good job in screening its resellers. I am the director of a sleep clinic in Seattle - we had a number of CPAP machines stolen from our inventory several years ago - many of these machines showed up on Amazon several months after the theft (we were able to match up the serial numbers). It's better to buy from a reputable online CPAP supply store; there are many of them.
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Yup, the process has been a time-wasting nightmare. The gatekeeping is needless and the whole system is rigged against anyone with a demanding work schedule. I, too, had all the un-needed appointments (across months due to the unavailability of scheduling) and have ultimately received very little of value from my sleep center, save the formal prescription. I travel for work, so I had to self-purchase the travel machine that isn't covered by insurance, and my provider is so inept that I've also supplied myself with 4 different masks by now to look for the perfect fit. Better in-person support and less hurdles would help a lot of people, but there is a lot of anecdotal info on the internet and there is also an online store that will sell you a prescription along with the machine (the route I went at first so I could get one). When I can tolerate the mask, my life is changed massively by sleeping better, so it is worthwhile in the end. But the encounter with yet another trumped-up medical system rip-off is infuriating.
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Several years ago, my wife encouraged me to have my (obvious) sleep apnea treated. I dutifully went to the doctor and explained (based upon my wife's observations) that when I slept on my back (my preferred position), I suffered from sleep apnea, but if I slept on my side (particularly with a pillow wedged against my back to prevent me from turning onto my back, I was fine. So at the cost of several thousand dollars to my insurance company, I participated in the requisite sleep study. Afterwards, I was told . . . I suffered from sleep apnea when I slept on my back, but I was fine when I slept on my side. And rather than being prescribed a CPAP machine, I was instructed . . . to sleep on my side and wedge a pillow in my back to prevent me from rolling onto my back. Good to know. Sarcasm aside, I am fine with this, notwithstanding the excellent article, precisely because of the equally excellent comments by ALB regarding the reality of CPAP use. To be clear, I have friends (and spouses of such friends) who consider their CPAP machines an absolute godsend, but ALB's comments provide useful information that the authors gloss over.
6
Julio
Because of your post, I am going to be retested to determine which sleeping position is causing my mild sleep apnea. When I did the home overnight test, I slept on my back, as always. Was not tested side, vs back vs. stomach. Thank you. Perhaps there will be a simple solution for me too.
@Julio
Another option for the rolling over is sew or have someone sew, a pocket on the back of your pajamas or T-shirt and put a tennis ball in it. My husband would always remove the pillow in his sleep, but the tennis ball worked great.
I am three years into CPAP-ery and am yet to be satisfied. I have tried full face masks and I am currently using nasal masks but still have far too much leakage. There is no question but that CPAP is necessary in my life but I still seek the right mask.
This Friday, I am going to get a nasal cushion mask to try.
I currently last wearing the mask for about three hours before I have to remove it to be comfortable enough to sleep, albeit disturbed.
is there a solution? Sure, I just haven't found it yet. Oh yes, I am 83 and suffer Type 2 diabetes.
3
@Steve I have a Respironics Dreamware mask. They call it full face, but it actually covers the mouth and fits under the nose. I have had fewer leaking issues with this one. I have probably been through 8 different masks in the 6 years since my diagnosis.
3
@Steve Maybe you need to change providers. I use a provider in Maryland called Bay State Medical and have been extremely pleased with them. When I first started using the device, they tried about 4 or 5 different styles of masks to ensure I got a good fit. My son also uses them but he likes a different mask than I do. I suggest contacting them and see if they can help you. Getting a good mask that is comfortable and doesn't leak makes all the difference in the world. Good luck.
6
@RJB You are correct. Bay State Med is my provider and they are very helpful. In fact, I am going to their office for a fitting this Friday.
1
As in incorrigible stomach-sleeper, my attempt to use a CPAP was doomed to failure. Not possible while tethered to this machine.
I opted for an alternative treatment recommended for those diagnosed with "mild to moderate" sleep apnea: something called a "mandibular advance device," a custom-fitted, adjustable oral device designed to gently place the mandible (lower jaw) in a forward position, thereby inhibiting the tongue from falling backwards so as to maintain an open, or more open, airway.
This strategy probably isn't as effective as the CPAP, it is pricey, but it did improve the quality of my sleep by better than half.
But if you typically sleep on your back, well, by all means, the CPAP would be the best solution,
1
@Charles Sager It's good you found something that works for you, but I want to respectfully challenge the assertion that stomach sleepers can't use a CPAP machine. I do. Granted, I have to turn my head to the side on the pillow, but I was doing that before (I don't know if any of us truly sleep face-down in the pillow). The lightweight nasal-pillows mask I use stays in place surprisingly well.
10
@Charles Sager i used a mouth device for 20 yrs. helped a lot at first, not comfortable, and a lot of dry mouth and flem in the morning. recently realized it was doing the trick. go the hoe sleep test and now a Cpap machine. life changing. and my wife sleeps better too as no snoring etc from me.
@Charles Sager A solution which works for many stomach-sleepers is a cloth mask, such as Élan. For those who tend to roll over in their sleep, the hose should be routed up over the top of the head by attaching it to a
strap that goes across from ear to ear.
When I was diagnosed with sleep apnea, I had to deal with a "durable medical equipment" suppler to obtain a CPAP machine. These people are crooks! They came to my house once to drop off a machine that they claimed cost $6,000 (for which they billed my insurance company) and every month they billed my insurance company for servicing the unit, although I never saw them after the initial delivery. The machine did not work correctly, but they would not respond to calls for help. Then I found the exact same machine for sale online for $700. It turned out that I didn't have sleep apnea at all and the whole thing was an insurance scam.
24
I can't tolerate the CPAP machine. I have severe sleep apnea, but the options available to me aren't great. On the nights when I get good restful sleep, the difference in me the next day is amazing.
We need more options for those of us who suffer from this problem. Also, I don't wish to be tracked by any machine or app. All of this is my business. My insurance company isn't allowed to spy on me.
22
@Pamela L. I had severe sleep apnea and used CPAP for many years. Then I had a lower facelift, not realizing it changed my apnea score from severe to mild. I continued to use CPAP set for severe apnea for several years, until I qualified for Medicare and needed another sleep study. Now I use an oral appliance which is 100% better than CPAP. You may want to consider a lower facelift as an option.
4
@Pamela L. Pamela - Look into getting an oral appliance. Although these are known to be somewhat less effective than CPAP, I've used one for a couple years and it has certainly provided me with a modicum of relief. My recommendation would be to find a DDS who specializes in these devices, that is, you need someone who is not going to simply hand you a "boil and bite" solution.
2
As this is a non-invasive device, why do you need a prescription at all?
I am allowed to acetaminophen myself to death with OTC meds without a regulatory qualm - they even sell 500 pill packs - and that kills about 150 people a year and lands about 70,000 in the ER with severe liver damage. So why the hooha about a C-PAP machine. Let people buy one if they think it will do them good.
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@David Rose It has specific pressure settings that are set based on the information gathered by a sleep study. Too little pressure and it won't work, too much pressure and it can hurt your lungs.
16
@Steve It should not be too difficult to add a sensor to the device which would adjust pressure based on usage data. Not going to happen because the medical industrial complex would not make as much money.
10
@Steve The latest machines, APAPs (Automatic Positive Airway Pressure) automatically adjust pressure. They are far better than using a months' or years' old sleep study to manually establish a pressure setting. They change the pressure setting, minute by minute, for what your breathing requires.
11
i did the sleep test at home, and a week later they brought me a resmed cpap machine to my house. works great. quite. medicare pay for most of it. no appointments etc.
6
I just cannot wear the mask for more than an hour or so. As soon as it gets to full pressure it starts to leak and that wakes me up.
5
@Thomas Me too.
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@Thomas I have had mine for a year and never have gotten a proper fit. The last sleep test they blamed my short beard. It’s a horrible system if you’re a mouth breather, the full face mask is a nightmare. Oh I also usually wake up with an incredibly cramped painful stomach full of excessive air. Aerophagia!
3
@Thomas Tell your provider and tell them that you want to try out different masks. There are numerous different types and styles. Also, I found that masks tend to leak as they get older, the foam starts to loose its elasticity. I agree the leaking sound can be very annoying. Your provider should be providing replacement masks or nasal pillows on a regular basis. If they aren't ask them why not? Good luck.
4
There is a new treatment for sleep apnea which the Times, in several articles, has failed to mention. It involves the implanting of a lead to the hypoglossal nerve, which, which charged, drives the tongue forward and opens the airway. It's called "Inspire," and can be checked on the internet. It's expensive, and involves surgery, but it works for those who can't tolerate the CPAP mask. The VA Medical branch is pushing it, which is where I got mine, free, after 24 years of the failure of the mask.
6
The authors' description of using a CPAP machine is so adorable.
Let me tell it like it is: Remember that scene in the movie "Alien" where the succubus alien leaps out of its egg, blasts through the astronaut's helmet and attaches itself to the astronaut's face while winding its tail around his neck? Well, that's what it feels like to me when I use a full face mask (which I must, because the "nose pillows" and other less- intrusive masks don't work). My adult daughter tried my mask once so she could see what I was complaining about, and she practically jumped out of her skin when the air pressure kicked in.
Also, using a CPAP comes with a nearly endless "to do" list: cleaning the components of the machine (reservoir, tubing, mask, headgear) on a regular basis; dealing with suppliers to order the parts on a set schedule; making sure all the right paperwork gets to the insurance company so the costs get covered; changing the air filter regularly; seeing the doctor once a year (for insurance coverage purposes), etc.
And then there's the issue of travel. I travel continuously, including overseas, and having to take the CPAP with me has created many additional problems due to luggage restrictions on foreign air carriers. In fact, someone should write an article titled "Travels With My CPAP."
But notwithstanding the downsides, my CPAP has restored my ability to get a decent night's sleep -- and if I can stand to have that thing on my face every night, so can anyone.
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@ALB "if I can stand to have that thing on my face every night, so can anyone"
Sorry, not true.
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@ALB Wow! You might want to consider changing your medical insurer if you can. Everything is covered by my insurer and I don't have any paperwork to fill out. My device provider emails me every 6 months regarding supplies; it takes about 2 minutes to complete and submit and within a week I get everything i need for the next 6 months. I don't know about foreign air carries but on domestic flight, CPAP equipment is not supposed to be counted against your baggage limit.
Get a So-Clean or something similar to clean the unit. Yeah, the weekly washing ritual got to be a major pain in the butt. It takes about a minute or two to connect the unit to the So-Clean and ends the washing ritual. You probably can't take it with while traveling overseas but at home it will make your life a lot more simpler.
2
@ALB
I have traveled with my machine,and as it is a medically necessary device I am never charged. I have a copy of my prescription and a letter confirming this. I show it to the airline and no problem. This is covered under the ADA I put my machine in a carry on with a pillow to protect it
2
There is a strong association between sleep apnea and AFib (irregular heartbeats).
8
@Catherine This how I came into CPAP-world, through a
Afib-related brain-diaphraigm mismatch called CSA (contructive sleep apnea) The reports produced by my CPAP machine can distinguish between CSA and OSA (obstructive sleep apnea) "events"(when you stop breathing)
It's not all bad news. I've used a CPAP since 2001. While I've had to tweak mask selection I've found the treatment effective.
Adaptation was not difficult in my case. Also, my insurance has covered the machine and all supplies from the start. I haven't spent a cent on it. The insurance, incidentally, is Medicare primary. The secondary insurance is through the NY State Empire plan for current and retired NYS employees.
6
My wife is thin and needed a CPAP machine after her sleep study at a major hospital in NYC showed that she stopped breathing 52 times an hour. It took us 4 times to find the right mask for her .
After all the time in the sleep study we found the real culprit after the Obstructive Sleep Apnea was discovered and treated ,it is the CPAP suppliers ,inefficient ,impossible to get them to call you back for help and vastly becoming a monopoly with few choices remaining for help or to reorder the filters ,this very fine article did not mention the replacement filters and other parts that need frequent maintenance and yes the new machines spy on you to avoid this spend the money yourself on the equipment where you own it not rent it.
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I have been using a CPAP for almost 2 years. The initial cost was over $1000 for my portion: 2 appointments with sleep doctor, sleep study at home, rental of machine until I proved I was using it by paying a monthly monitoring fee. Since I travel often, I also need a travel size, the standard home size can be taken on flights, but it's bulky. Insurance considers a travel CPAP a luxury and will not cover, that cost me an additional $800 for a total outlay of $1800. This is such a financial racket on the part of "sleep doctors" and DME companies, I wish I had a job that allowed me to print money. We should have option of initial rental from a walk-in clinic (think CVS) with 2 weeks of monitoring. No physician appointments or co-pays.
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@Pat Baker Medicare seems quite lenient on the allowed time-interval between replacement of the CPAP paraphenalia (besides the air pump), and the agressive DME phone calls reminding me that "It's time to replace your headgear, mask, etc" are irritating.
1
@blcowhig
The wonderful automated system I was suppose to use for supplies only works if the humans input the proper name and phone number. Hours of frustration with automated systems that don't work (do they ever?) led me to order directly from the local store. They hate me because they have to pay a human to provide my horribly expensive products rather than a bot. Would love to know what Medicare pays collectively for this. We could maybe invade a whole nuther wrong country with all the money. A 14 inch hose is billed at about $70, and the technician who fitted me says I should "always order all the supplies you can get every three months".
Six months into using it and still no better waking performance. Have missed only 4 nights use. Not too uncomfortable, but think the only beneficiary is the med supplier.
The worn nose pillows are great cat toys.
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@Pat Baker Forget about the insurance. Upload your prescription to an online company such as cpap.com, and then buy what you want, when you want. I used to travel 48 weeks a year for business. I kept one machine at home, and another at the hotels that I traveled to week after week.
1
I was diagnosed with severe Sleep Apnea about 18 months ago. I had a couple of overnight sleep studies, lab tests, pulmonary function tests, X-Rays and a couple of appointments with a Respirologist. I use the nasal pillow CPAP machine and get tubing replacement every 6 months and a yearly check-up with the specialist. I have never paid one cent out of pocket - Canadian healthcare is terrific, some issues yes but generally excellent. I sleep better than I have for years, rarely wake in the night and no longer feel tired during the day.
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@Pam Same here. I am having the best sleep in my life with the CPAP - so worth it. Most nights I am asleep within 15 minutes of putting the mask on and sleep like a log. I now look forward to hitting the bed. I had sleep apnea for years and finally when my wife started sleeping in the guest bedroom to get away from my snoring, I clued in. I was diagnosed with severe sleep apnea. My blood pressure has dropped and I even lost a little weight.
4
@Pam OHIP doesn't pay the whole amount for the cpap. I had to pay $150 as a down payment for the "loan" of the machine while I was trying it out and there would have been at least another $350 had I not given up and returned it. (OHIP pays 75%, so that means $2000!). How did you get it for free?
@Pam
I'd move up there in a minute if you'd take me.I'm in an online international support group one of the great things about the internet and social media) for a rare condition, and the people who have faced the worst delays and costs are in the US. The only way I got to see a neurologist in less than 3 months was that my husband wasseeing one and she was willing to piggy back me onto his appointments at first.
1
I couldn't believe this article does not mention the strong association between obesity and sleep apnea, just a passing reference to the linked association with Type 2 diabetes. But then again one of the authors has written a book titled "...How to Why to Eat Sinfully"
God forbid we point out the obvious that poor life style habits, too much food and lack of exercise/strength training are at the root of so many medical issues, and just keep on prescribing expensive medications and equipment as the "cure". No wonder our insurance costs keep rising.
15
@FamousFam
Many patients are thin and still have sleep apnea due to neurological issues or genetically small airways. A part of assessment is evaluation of the 'mallampati class' which is a determination of airway size.
Because low oxygen during sleep at night suppresses the pituitary and hypothalamus, this can cause obesity due to derangements in both sex and stress hormones. It is not unusual for many of my obese patients to experience weight loss with initiating CPAP. So it becomes a chicken or the egg issue with sleep apnea and obesity. Obesity causes sleep apnea, but sleep apnea certainly causes obesity.
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@FamousFamGod forbid" we blame the victim. Or so most do criticize in response to this. However, such critics are wrong. Is there a chronic disease that does not have as causal factors; lack of exercise, eating habits mostly too much, failure to use preventive and curative measures. You hit the nail on the head: the lack of attending one's health is a causal factor for many of the failures of the "health/sickness" system. We need to mind our own health, nature supplied the best advice: listen to yourself, exercise, eat better with weight control, get a night of good sleep, keep up with friends...live long and prosper!
8
@FamousFam This is BS! You have no clue what you are talking about. I was diagnosed with sleep apnea while I was in the military. At that time, I exercised on a daily basis, my body fat was under 20% (for my age I was allowed up to 26%) and could run 2 miles in under 14 minutes. So don't give me that I had sleep apnea because I was fat and physically unfit.
Have you ever considered that sleep apnea is causing the person to be obese?
23
CPAP use is not a one time fix since machine pressure levels and masks need to re-evlutated over time. Someone may begin with a mask over only their nose and later need a full face mask. Effective pressure levels change also. I was told weight loss would help. It did not after losing 50 pounds. Some people have difficulty in finding a mask that fits properly with no air leaks reducing air pressure. It is baffling why a prescription is needed to replace supplies, such as masks, when someone has been diagnosed with sleep apnea and used a CPAP successfully for years. Life would be more simple if sleepers could replace supplies off the shelf.
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@carolcat
The devil is the CPAP suppliers monopoly ,off the shelf replacement in selected pharamcies parts would be most welcome, In NYC I could not find a walk in brick and mortar store for CPAP replacement parts ,only the web or phone good luck with that!
47
@carolcat - so true. It is an ongoing monitoring need besides the medicare requirement for sleep studies when needing a new CPAP is throwing away money.
2
@carolcat I buy supplies online without a prescription (CPAPxchange).
4
I've been using CPAP therapy for over 22 years, with only two nights without it (for unplanned/emergency reasons). I can teach pulmonary specialists (who've become the specialists assigned to this) a thing or two or three.
The gatekeeping for this is partly a racket that's rationalized as a risk management system. And each time I get a new CPAP (every five years or so), I see how the racket is getting deeper.
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@Karl
Do tell what you can teach Kari. I am hopeful you can to some extent but seem to have limited empirical experience in the context of your presentation.
I had a surgical intervention some 20 years ago (UPPP, however, there a number of procedures on the continuum of patient presentation symptoms) and it has worked to this point.
I had the surgery because I could not tolerate the CPAP equipment at the time. I understand it has much better delivery systems at this time.
I will soon undergo a sleep study again due to my recent diagnosis of myasthenia gravis, a neuromuscular condition that weakens the voluntary muscles.
The sleep study along with a medication may quell the MG effect, however, a failure of the voluntary muscles some 40 years resulted in a permanent apnea.
6
Folks in the health field hide behind white coats and the image of doing good, while they squeeze their patients (i.e. customers) for every penny. And they would challenge someone with sleep apnea to avoid covering the costs and risk, instead, a bad accident, for example.
They have no shame. Not a speck.
7
My wife and I were both diagnosed with sleep apnea in our 50s. in the morning.We were both prescribed cpap machines and had no trouble adjusting to them. In fact my wife has trouble even taking a nap without it she's gotten so accustomed. What I like about it is that I can bury my head in pillows and blankets and still breathe since the air gets pumped in externally. We both sleep better because of it and generally feel more refreshed in the morning. There are many mask options available so it shouldn't be difficult to find an option that works for you. The treatment has made a big difference in the quality of our lives.
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I tend to have trouble falling asleep, but recently discovered that pulling the covers up over my head helps a lot. And my bipap delivers fresh, cool air to just my nose and mouth.
I was diagnosed with severe apnea last year, and have been using a cpap device successfully in the sense that I now wake up only 1-3 times per hour, earning good scores from the sleep quality algorithm. However, it is difficult to say that I feel better, feeling drowsy and lightheaded during the day. I continue with the device because it is better for my internal organs to prevent falling blood oxygen levels at night, and because my state can lift your drivers license if you do not. But in terms of feeling refreshed the device has been a huge disappointment.
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@Robert Hall
Anyone who wakes up one to three times per hour isn't having rem sleep. Consult your doctor again.
19
As "men of medicine," I'd imagine that this article's two authors ought be more focused on the cause of sleep apnea, rather than its treatment. Here you go:
In adults, the most common cause of obstructive sleep apnea is excess weight and obesity, which is associated with soft tissue of the mouth and throat.
Physicians--or whatever you are--heal thy selves.
13
@Greg Gerner, excessive weight is not an exclusive cause. In my early 20s, when I was 130 lbs and 5'10", I had a 19 " neck. Both my parents' ancestors had huge necks, and all the problems of sleep apnea plagued me for decades -- and likely caused many a family member's health issues. CPAP works for me. I was also fortunate to have a sleep specialist (my third over 20 years) who taught me to make pressure adjustments on my own.
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@Ed Mannix
Indeed, and at least in the case of one of the doctors, we're talking a comparative model of midlife fitness. My apnea started (and long undiagnosed) in childhood, and continued even in times of my life when I was too thin for my frame. The neurologist who diagnosed me said I was not a candidate for surgery because the unusual length of my neck (genetic) meant I would always remain vulnerable to the condition. There's no neck shortening.
15
@Greg Gerner What are your sources for this broad-brush statement?
I was diagnosed with sleep apnea while I was in the military. At that time, I exercised on a daily basis, my body fat was under 20% (for my age I was allowed up to 26%) and could run 2 miles in under 14 minutes. So don't give me that I had sleep apnea because I was fat and physically unfit.
I too would haven been interested on an article on the causes of sleep apnea. But I believe the authors intent was to focus on those who are undiagnosed or untreated and to have them seek out treatment and that the treatment isn't as bad as some critics have made it out to be.
12
I was at my cardiologist for an appointment, and my doctor said, I had bags under my eyes, I also complained of being tired and taking naps during the day. Said I should be tested for sleep apnea. It took a year before I got the cpap machine. Delays in my doctor prescribing, and promptly submitting, only after months of delay and prodding, I did get the machine. I took to it with no problems. Started with the air pillows, moved to a full mask because of breathing with my mouth open during sleep I was diagnosed with over 200 episodes per night. With the equipment it fluctuates between 4 and 11 per hour. I do feel better, but still take naps. I do wonder why I still have interruptions in breathing, and why do they fluctuate. All said, if you are diagnosed with sleep apnea, it is worth the trouble to treat it.
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@Steve Talk to your CPAP provider. If your equipment fits properly you shouldn't be having 4 to 11 apneas per hour. The larger the mask the more opportunity for leaks. When I first started using my CPAP, I was given a nasal pillow which just covered my nose and an soft elastic strap that went around the back of my head and under my jaw to keep my mouth closed. I found out that I didn't need the strap after a couple of weeks. See if your CPAP provider offers something similar. I used to be in the 200+ apneas per night range and now I'm done to 1 or less per night.
Good luck.
11
@RJB There are two types of apnea. One is obstructive, which is typically treated with CPAP or oral appliances. I use the later, because I could not sleep with CPAP.
The second type is central sleep apnea, which occurs when your brain basically forgets to breath. CPAP will not fix central sleep apnea, even with a properly fitted mask.
3
@Steve Get a chin strap for use with the Nasal pillows. Less cumbersome than the face mask.
I'm so used to m CPAP machine that I can fall asleep in minutes.