Is the sleep disorders doctor actually a salesman? CPAP question.

All doctors who push devices and procedures are sleazy salesmen. Most doctors push these things and are thus sleazy salesmen. I hate doctors.

Probably. But I do feel better since I’ve been using the machine and family has commented on the improvements.

I have the machine because I was passing out asleep during the day and when I was driving . Just for like a second or so but I could have died or killed someone else if I didn’t get help . My health provider had a therapy company that sold me the machine and have been happy with the service ever since

CPAP masks are uncomfortable, to say the least. I think it would take a salesman to give this option any mileage at all.

All doctors get kickbacks for almost everything they sell us on, however that doesn't mean every treatment is bogus. I've been sleeping with a cpap for a little over two years now and though I was just as skeptical at first it has changed my life for the better and is completely worth those first few months of adjusting to sleeping with a mask over my nose. Previously I had insomnia, terrible body aches from stupid sleeping positions, and for most of my life could only sleep for about two hours at a stretch without waking up. This eventually turned into waking up actually gasping and my GP told me I'd feel better if my brain weren't so clouded each day by having nearly suffocated in my sleep all night, so I took the insurance referral and saw a sleep doctor. Took a nap test at home with diagnostic equipment (headset thing--insurance denied me an in-clinic sleep test) and it turned out I was ceasing to breathe some crazy number of times per hour, which scared me into trying CPAP even though I was positive I'd NEVER adjust.

At first it was the worst most annoying PITA of my life. I'd wake up and the mask would have been already flung across the bed with the machine still running. The first basic mask I used was a big one that went over mouth and nose because I was still mouth-breathing at night (oh shut up bitches yes I'm a mouth breather), but I didn't like the way it made my mouth taste in the morning so I switched to a nose mask and trained myself to nose-breathe at night, which wasn't hard because the air flow from the machine tends to clear congestion (ew oh well). The machine tracks how many hours you use the mask to make sure you're actually using the thing and insurance will stop paying for it if you don't but I found this helpful to motivate me to keep trying.

As soon as I'd worked up to sleeping in the mask every night I began noticing little miracles, such as being able to settle down and sleep in one position on my back instead of thrashing madly all night trying to be comfortable. I was very suddenly having markedly fewer body aches and before long I was sleeping through the night for 6-8 hours as I hadn't done since infancy. Bonus was ceasing to sleep on my stomach with face mashed into pillows so my wonky downward-growing eyelashes straightened out and I don't have to curl them to keep them out of my eyes! No more waking up gasping. Going through the whole process was an accomplishment, and I asked to change masks about three times (they usually let you have a free sample one of different models). You have to fill the tank with distilled water every night and keep the humidity of the air flow to your liking (so you don't dry the fuck out!) and wash your mask and the tank every other day or so, which you get used to, and change the little filter on the machine and the tubes every few months when they send you new ones. First year I had a lot of visits to the sleep clinic where they'd analyse my breathing "events" in the data and adjust the strength of the air flow until I wasn't having any breathing events, but once I'd gone through all that torture and annoyance I'm down to one visit to the clinic per year.

I'd really avoid checking into CPAP forums online btw. Those people are fucking cultists.

Go to a sleep doctor that doesn't also sell the machines. I've had a CPAP for a decade and my sleep doctor isn't affiliated with the medical equipment companies I use. Your doctor should just give you a script and that's it. You shouldn't need multiple sleep tests -- your machine should keep your AHI recorded and you supply it to your doctor ever six months or so. Only if there's a problem will you need another sleep test.

No idea why R5 had to go to the sleep center multiple times to titrate their pressure setting. It should be done in the first visit and then, as mentioned, your AHI will be monitored by the machine and your GP or sleep doc can make adjustments then.

If you don't want to wear it because it's uncomfortable then don't, but you're reducing your lifespan and continuing a series of serious health problems.

Might be better for you to accept your situation now and do what's best for you, instead of being pissy about it. You gotta grow up some time.

I had a lot of luck on the cpap dot com forums as long as I avoided the handful of know-it-alls. But people show up with new diagnoses constantly and start whining "it's uncomfortable, do I really need it, is it a scam, I'm not fat and alcoholic like YOU people so *I* don't need a CPAP" etc. etc. and they understandably get tired of it, leading to crankiness. Just don't be an asshole on their forums and you'll be fine.

If your insurance is assisting with purchasing or renting a CPAP machine, be aware the device is able to transmit information about usage and if you don't use it, the insurance companies can tell and will ask for it back.

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I'm surprised at how many people appear to have sleep apnea.

Is it that more people are being diagnosed who would not have been in the past or that the machines are now paid by insurance in many cases?

R9 in my case I assume by now I would have simply passed away in my sleep and been attributed to "natural causes". Its a godsend too me and have had for 20 years.

Kickbacks are actually illegal in medicine. A doctor can go to prison and lose his/her license for engaging in them. If he is selling you the CPAP directly from his own office, it's not a kickback, it's a simple sale of medical equipment. A kickback would be if Doctor A referred a patient to Doctor B and as a "thank you" Doctor B gave Doctor A a cut of the profit from the referral.

I don't have the answer to that , r9. I'm just trying to figure out if I'm being scammed or not.

I appreciate r10 and r6, thank you.

The sleep study I attended was devoid of sleep. I recognize its importance, but damn that hurt.

These days doctors are doing anything they can to make money. I have become disgusted by most of the ones I deal with. Anything they can figure out to enable them to get a billing through, they're on it. Most of them are little more than blood suckers.

My apnea was severe enough that I needed a relatively high air flow that I was told I needed to work up to as I adjusted to treatment. I was also having trouble getting used to CPAP and was going in about every three months to talk to the doctor and try things such as melatonin (didn't help) and different strategies for combating mouth dryness. The clinic owned the machine for the first year and after that I'd paid enough for it so now it's mine, though I still use the clinic's services for the machine (through insurance) and they still collect data and will send me an email to schedule an appointment should I stop breathing in the night again. People are different, we can't all go in and boom it's all good on the first visit.

I was completely convinced it was a scam before diving in and trying cpap and I don't even snore anymore. I'd actually developed congestive heart failure due in part to sleep apnea, so yeah, it's worth it.

And yes kickbacks are illegal, how foolish of me to think the world so unfair, of COURSE no doctor would ever accept a kickback!

The Sleep Disorder Clinic is the biggest medical scam out there.

I went to one and the female Russian doctor was so obviously a quack peddling her expensive equipment....she looked at me for 10 seconds and murmured "oh, yes...small nostrils" and made her mind up I was an ideal candidate.

They gave me the At Home Test equipment and I ripped it off after 45 minutes because it was impossible to sleep with plastic crammed up my nose...I'm not sure how you accurately measure sleep patterns while wearing obtrusive equipment that makes it impossible to sleep.

R 14 and R15: Any doctor with half a brain would refuse a kickback if offered or proposed. If you distrust doctors so much, do us all a favor and remain at home praying to your magical healing crystal which I'm sure you gladly forked over several hundred in cash for, not thinking anything of it all while deigning people who went to school and training for upwards of 12 years, underwent constant evaluation (and paid a considerable sum of money to do so) only be called greedy and untrustworthy by the likes of you. You both must be a hit at parties. Your "bloodsucker" doctor likely has several hundred thousand dollars in student debt and is getting less and less reimbursement from your glorious private insurance -- if insurance decides to actually pay for the services rendered.

I knew I had sleep apnea when I was 14 and had seizures. They picked it up on the medical tests, but at the time (late 1980s) there was almost no treatment so they shrugged it off.

I have to think that the prevalence of sleep apnea is more about diagnosing it properly than anything else, but yes, as with ANY medical device, there are going to be salesmen trying to get you to buy something you don't need.

[quote]They gave me the At Home Test equipment and I ripped it off after 45 minutes because it was impossible to sleep with plastic crammed up my nose...I'm not sure how you accurately measure sleep patterns while wearing obtrusive equipment that makes it impossible to sleep.

It's not impossible, you drama queen. People with all sorts of disorders sleep with a CPAP mask, oral (tooth) devices, or oxygen cannula all the time.

A CPAP uses air to stent the airway open. It's just ridiculous nonsense to act like you can't measure sleep patterns when wearing oxygen or a CPAP mask or an oral device while sleeping. It's done all the time.

Same, R13. The first sleep study I went to was done poorly and I was actually injured -- the sleep tech was a newbie and wasn't supposed to be left unmonitored during the test, so my insurance company went after them, and HARD. Heard they closed down their sleep study for several months and I wondered if it was because of the newbie screwing up so many of our tests.

The second sleep clinic I went to was much better. I only got about two hours of sleep but it was enough for them to figure a good pressure, which my doctor then raised after reading a few weeks worth of my AHI readouts.

Now that I see the person up thread had a CPAP from the sleep clinic I realize why they went back in multiple times.

It’s total bollocks. I was referred twice for a sleep study. Both times during the pre-study “counselling” I was told that I’d be getting a CPAP machine. Wait, what? How do you know the outcome of the study before it’s been done?

I’m not overweight, I don’t snore. You have no clue what the underlying issue is - but you can make assumptions and tell me I’m getting a CPAP?

So I left both times and never went back. The second time, I reported the clinic for insurance fraud.

OP here, in regard to r21, I understand the feeling.

Trying to understand if there is a Stranger Danger component of unknown CPAP doctors.

It's confusing. I know I have apnea, but these people, who are these people? I've rarely been skeptical.

[quote] Is the sleep disorders doctor actually a salesman?

Clearly OP isn't getting enough oxygen to his brain, stop worrying if you are being sold and use the CPAC.

Sleep apnea is a real disorder that can kill you. If you have the diagnosis, do what your doctor recommends. Or get a second opinion/sleep test if you're prone to think your doctor is trying to 'sell' you a machine. My CPAP doc charges a LOT, no need to get kickbacks. (Thanks for paying most of it, Humana.)

I’m a primary care doctor and don’t get kickbacks for anything, besides the odd lunch here and there. We suggest cpaps because most people feel so much better on them.

My HMO does not cover durable medical equipment, but the sleep doctor tried to sell me (and a group of other apnea patients) a $1k APAP machine - because CPAPs are so passé! I definitely got the vibe I was at a multi-level marketing pitch, and opted to try less invasive ways to diminish my snoring, such as getting fit and eating better, since my apnea is mild and reversible.

When you have Sleep apnea, you wake 10s if not 100s of times a night. Your airflow is interrupted and so your body wakes up, to breathe. The wakings are of very short duration, you don't even know you are waking up.

The sleep study is looking at the frequency of your awakings. That's why you're tired/falling asleep during the day- you have not actually had a full nights sleep. So, your heart isn't resting like it needs to.

Being overweight, having a short neck may be factors, but they are not the only factors. If you are struggling with a cpap device, talk to a cpap technician.

OP here again, thanks and so forth.

To the hot doc at r25, I know you guys are on the level, and doing your best for your patients.

My inquiry is about the sales pitch I got at the sleep clinic. It's just strange, at least to me.

Thanks, r27, appreciated.

My HMO has a 20% co-pay for CPAP machines, but since they have to pay the other 80%, I doubt they'd recommend it unless it were medically necessary. So I never even considered that there were kickbacks or scamming involved.

I have a question for the sleep doctors: once a patient starts using a CPAP, what happens if it malfunctions or breaks down during the night? I’m wondering if these patients are at a higher risk of dying than those who never used CPAP because their bodies have “adapted” to getting an artificial air flow. Is it possible that their brains might not signal them to “wake up” if they stop breathing and don’t have a machine to detect it?

[quote]My HMO has a 20% co-pay for CPAP machines, but since they have to pay the other 80%, I doubt they'd recommend it unless it were medically necessary. So I never even considered that there were kickbacks or scamming involved.

You are lucky then. My HMO’s coverage of sex re-assignment surgery but not CPAP machines really makes me question the necessity of them, however.

I would like to know what r25 had for lunch this week.

Was it sushi? I love sushi.

This question is a passing inquiry. I don't sleep well, people. Zzz.

^OP.

R32, you are so right. The heart attacks, strokes, diabetes, and shortened life span associated with sleep apnea are myths the medical community invented.

So glad that you, a person of no medical training and no understanding of health insurance, can see through this evil.

R31, every CPAP mask I've seen has a little flapper valve which allows you to breathe more or less normally if the machine fails. I experienced a short power failure a while back, woke up, no damage done, and simply waited a bit for the power to come back on. I considered buying a computer type UPS after that, which might keep things running for short outages, but haven't felt any urgency about it.

Doctors ARE salesmen.

R22 Oh I really feel for you OP. You're right to be skeptical of most doctors but I don't know if you have much of a choice in this situation since not getting enough oxygen is serious. The problem is that even if you have a decent doctor they'll still recommend the solution that requires least effort on your part because most don't believe that their patients are willing to do the work for a different solution. It's not that they're getting kickbacks it's just that they honestly believe this is the best and easiest way.

Has your doctor explained to you why you have sleep apnea? Is it obesity, is it that your jaw has developed incorrectly? Or do you simply always have your tongue in the wrong resting position? Or another issue with your tongue? These are all issues that have different more difficult solutions. Your doctor also should tell you about other lifestyle factors that make a difference but I can't say that if you change the other issues that you can avoid a cpap machine.

Still checking tongue position is something you can do yourself and it's worth knowing about.

R38 I should have said that I don't have breathing issues but my parents and my partner do. My mom developed hers later in life when she started breathing through her mouth while sleeping, while my dad has always had jaw issues. My partner had a posture issue that was recognised early.

[quote]So glad that you, a person of no medical training and no understanding of health insurance, can see through this evil.

R35 If CPAP machines really prevent heart attacks, etc., why is it that many insureres don’t cover them, while they cover other treatments for the same conditions?

I think their actuaries are credible, since they make 6 figure salaries doing nothing but cost-benefit analysis rather than trying to sell unnessary devices to sleep apnea sufferers who probably should be put on a weight-loss plan or have treatment for nasal obstructions instead of being hooked up to a noisy, expensive medical device every single night - for the rest of their lives.

OP just take a deep breath. Literally. I knew I had sleep issues because I (used to) snore like a mother fucker. My first sleep doc wasn’t a scammer but you’d wait over an hour after your appointment to finally see him, his office had horrible follow through etc - since I didn’t WANT to sleep with a machine anyway I just stopped going.

Five more years of waking up feeling like I’d been hit by a truck and not feeling remotely awake till after lunch later I knew I had to put on my big boy pants and finally deal with it. My new sleep doc was great - had another sleep study - I was right in the border of moderate / severe - 40 apnea episodes an hour - no wonder Infelt like crap.

I’m not overweight but have a wide tongue, a slightly smaller than ideal jaw, I’m fairly muscular with a thick neck and I had a congenital deviated septum - so I always breathed through my mouth. (And my uvula is very stretched out from decades of snoring)

Not only did I get the Cpap, I got nasal surgery and the oral appliance. I can use either the appliance or the CPAP - both get me to about 2 episodes per hour - so if you are dead set against the machine tell your doc you want to see a sleep dentist. It did take me a few weeks to get used to sleeping with the full mask (although the surgery has allowed me to not breathe through my mouth anymore).

I was a bit surprised at the weird claustrophobic feeling I’d wake up with at first since that had never been an issue before - but I kept at it & like others I adapted. It did take about 3 months of using the machine every night for me to really feel different - but it suddenly happened and I was dramatic - ine morning I woke up refreshed and not the least bit groggy - it is kind of amazing I’ve felt like crap in the mornings since college.

I do currently use the oral appliance more than the Cpap - but once that changes my bite I go back to the Cpap for a few weeks and my bite resets. No solution is perfect but any of them are better than living with apnea. Good luck.

R40, because different medical insurances negotiate with medical providers over procedures and appliances. Maybe one insurance company pays for procedure x, but another ins. company doesn't cover procedure x. Each ins company has negotiated something different. Also, ins A wants you to exhaust all your remedies before they give you a prescription for y, ins Company B has a less restrictive exhaustion policy. Again, negotiatied by ins company, medical provider, employer.

It's possible that CPAP machines are both effective (for some people) and lucrative for doctors to sell.

Prescription eyeglasses seem similar. Very expensive. Easy to find a doctor who will do a free or low-cost eye exam if you buy your glasses there.

This is anectdotal, but someone I know said that the CPAP machine was helpful to his sleep.

My primary physician referred me to a sleep doctor who saw 10 patients at once. It felt like a sales meeting, and he pushed us on buying (renting?) a top-of-the-line APAP machine. CPAP was not even an option. My plan does not cover medical devices, so I was shit-out-of-luck.

This is probably the largest HMO in the U.S., and they have their own medical device sales branch - it’s not a third party, so the same company that insures me would be getting my out-of-pocket cash. Shady!

This practice - when an insurer/physician up-sells a non-covered medical treatment that would otherwise be covered if there were a lower cost alternative, is known as “balance billing,” which is supposedly outlawed in the U.S.

R44 - Go to a different sleep Doc. Is there another one who is in Network in your plan? It should be like a regular Dr appointment not an Amway meeting.

R45 - I’d have to get another referral from my PP, I guess, and hope for the best. It was two meetings: one before and one after we self-administered our sleep tests. It was creepy and (I felt) unprofessional for the doc to reveal our results in front of each other! (Isn’t that HIPAA violation?)

I felt especially bad for the patients with severe apnea upon hearing the “bad news” in front of a group of strangers, instead of getting a private call from the physician. But peer-pressure and public humiliation is an effective sales tool, I guess. I, for one, was extremely embarassed when I had to say “no” to buying a machine in front of the other patients.

Sleep apnea is a real and serious condition that has been linked to other life threatening ailments. Those machines are life saving. Even if you use it stop snoring, it's worth it. I was snoring like a freight train and would stop breathing. The sleep study discovered all this. Now I don't fall asleep in the middle of the day or get drowsy when I'm driving. If you have an insurance plan that doesn't cover these machines, then you have a shit insurance plan.

Don't play games with your health because the doctor seems shady. Go find another doctor.

A number of you have said you did self administered sleep tests - which is new to me - I have had sleep studies done at two different facilities. Are you gents in more rural areas where there are no available sleep labs?

I got mine from a medical supply company, not directly from my doctor. He just wrote me a prescription for one. But the medical supply company informed me the units cost about $2500 out of pocket if you were to buy them outright (without insurance). For me, the nasal mask (not the one that goes up your nose, but just covers it) worked the best. With the nose & mouth mask I kept breaking the seal whenever I would lay on my side or on my stomach.

They take some getting used to at first. I felt like I was suffocating when I initially started using it, but once I learned to adjust my breathing patterns, it was alright.

R48 I’m in a big metro area. I met with the sleep doc at a hospital, but to cut costs (I assume) they only offered the at-home testing. They loaned me a machine to take home (with a mask and oxygen/pulse sensors) that was preset to record my sleep.

I assume to cut costs and maximize income, they try to sell APAP machines that cost over a grand and are not covered by the insurance group the sleep doctor belongs to. They are one of those “non-profit” orgs whose CEO makes over 10 million per year.

I used to use the full-face mask (which took some getting used to, but I eventually did), but then I switched to the nasal pillows, which are more comfortable and allow you to sleep on your side. But lately I've been getting these sores on the my nostrils -- very painful. I can't figure out what's causing them. I use a saline nasal gel but it doesn't help much. Anyone else have this issue?

[quote]I’m not overweight but have a wide tongue,

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