Content provided, in part, from Dr. Barbara Phillips, a board-certified sleep specialist with 36 years of experience in the field. She talks about the challenges she sees with current Sleep Apnea diagnosis and treatment, as well as her hopes for the future in those areas. The views and opinions expressed in this article are not necessarily the views of CPAP.com.
Could CPAP Without a Prescription One Day Be Possible?
Is it possible to live in a world which largely eliminates prescription requirements for CPAP machines? Dr. Barbara Phillips seems to think so. We interviewed Dr. Phillips for this article, to get her perspective regarding Sleep Apnea treatment. Her opinion about whether or not treatment should require a prescription may surprise some of you. Before we take a deep dive into some of the science behind Sleep Apnea, let’s start with a question. Why does CPAP therapy require a prescription? In our world, many of the things that require a prescription are dangerous if overused or misused. Prescription drugs, certain implanted medical devices, certain foods, and supplements can all result in injury or death if misused.
But what about a CPAP machine? Could a person hurt themselves with a CPAP machine? Here’s Dr. Phillips’ take:
“The only way you can really hurt yourself with CPAP is if you have heart failure. People with heart failure should be cautious about CPAP and should start CPAP only after evaluation and prescription from an expert in sleep medicine.”
In the eyes of Dr. Phillips, the health crisis of Sleep Apnea is a rapidly growing problem, responsible for many deaths. For example, auto accidents come to mind as an immediate consequence of Sleep Apnea. Dr. Philips believes one of the guiding principles of public health is that, if you have a common condition and you have an effective treatment that is reasonably safe, you remove every barrier that you can between that patient and that treatment. Since Dr. Phillips considers CPAP therapy to be relatively safe, she thinks it should be more accessible, and that means deregulating CPAP usage by not requiring a prescription. This would reduce the number of traffic fatalities, and help improve public health overall.
In a perfect world, would there be any cases where we would still need to regulate CPAP therapy using prescriptions? Dr. Philips thinks that anyone who has a condition like COPD, Emphysema, or Heart Failure in addition to Sleep Apnea would need to be under a doctor’s care, and would need to have prescriptions regulate CPAP treatment in those cases. With the added risks involved with those conditions, it’s important to make sure everything is going well to avoid situations where a person could potentially hurt themselves.
What is Sleep Apnea? It’s Not Entirely Clear.
During our interview, Dr. Phillips was quick to mention a startling observation about her years of practicing medicine.
“During 36 years of practicing medicine, the definition of “hypopnea” has changed six times. The same raw data, from the same night, from the same patient can and is scored very differently in different laboratories by different technicians and clinicians.”
Since measuring hypopneas is part of making an accurate diagnosis, it’s important to understand what one is. Since the definition keeps changing, there are no long-term studies of Sleep Apnea that can evaluate treatment. The bottom line is we still don’t know who benefits from CPAP treatment and who doesn’t. And with different sleep labs measuring sleep study results in different ways, it leaves a lot of room for interpretation of not only the diagnosis but also the severity of Sleep Apnea. Dr. Phillips has this to say about the diagnostic criteria:
“The American Academy of Sleep Medicine, which sets itself up as an accrediting body of sleep centers, requires a definition of hypopnea that does not include oxygen falling. So it’s much easier to diagnose somebody with Sleep Apnea using the AASM criteria than the Centers for Medicare and Medicaid services, otherwise known as CMS, which does require an oxygen fall for a hypopnea to be counted.”
Dr. Phillips thinks that a better way to monitor Sleep Apnea is by looking at the level of oxygen in a person’s system during the night and using that to measure Sleep Apnea severity. The AHI system of measuring the severity of Sleep Apnea falls short and doesn’t take into account blood oxygen levels, which Dr. Phillips deems more important than the number of blockages.
Science shows, a doctor can predict heart failure based on the number of minutes a person spends with blood oxygen levels below 90%. When a person falls asleep, the soft tissues of the mouth and throat relax and collapse the airway. This creates a blockage and prevents air from reaching the lungs. As that happens, a person’s blood oxygen levels crash, and it becomes harder to breathe.
CPAP therapy blows gently pressurized air into the airway and keeps the throat open so that air can pass through the airway and reach the lungs. An open airway raises the blood oxygen levels, reducing the risk for certain cardiac conditions like heart failure, high blood pressure, and so much more.
Home Sleep Studies vs. Sleep Studies in a Sleep Lab: Which One is Better?
As our interview wrapped up, we asked Dr. Phillips about whether or not a home sleep study was better than a sleep study done in a lab. Because home sleep studies are less expensive and easier to do, a home sleep study is yet another way the medical community can remove a barrier to treatment. Dr. Phillips believes there are already too many barriers to successful therapy, and home sleep studies are a great way to cut through the red tape and get people back on the road to success. We asked Dr. Phillips if there were any negatives to home sleep studies. She mentioned a few.
- Data Loss is More Common in Home Sleep Studies
- You Can’t Titrate in a Home Sleep Study
What is titration? CPAP titration is only done in a sleep lab, and it’s a way of measuring and calibrating the correct pressure for CPAP therapy. Dr. Phillips describes it as: “CPAP titration is needed mostly for two groups of people: For people with heart failure or profound hypoxemia (people whose oxygen levels falls very low, usually because they have other lung diseases).”
So, again, when CPAP gets complicated with other serious conditions, you’ll need to have your sleep study done in a lab. “It all boils down to choosing which patients you assign home sleep studies carefully and considering their circumstances. I think we are always going to need to do sleep studies in the laboratory for some patients, but I do not believe it should be the standard.”
For More About Dr. Phillips
Dr. Barbara Phillips practices at the University of Kentucky College of Medicine
She is the former president of CHEST, and organization of Sleep Specialists
Dr. Phillips is a board-certified in internal medicine, pulmonary medicine, and sleep medicine and is a former chair of the Sleep Institute and the National Sleep Foundation. She has served on the Boards of the American Lung Association, the American Academy of Sleep Medicine, and the American Board of Sleep Medicine. Phillips received a Sleep Academic Award from the National Institutes of Health and was presented with the College Medalist Award at CHEST 2013.
Her research focuses on the effects of Sleep Apnea on performance and outcomes, genetic risk factors for Sleep Apnea, non-pharmacologic treatment of Sleep Apnea, and sleep in aging.
David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.