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 that 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 fall 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 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.
8 thoughts on “A Sleep Specialist’s Hope: Over the Counter CPAP Therapy”
I have used a CPAP for almost 10 years now and think iy is great. I want to purchase a second CPAP for another location in another state but have been told I must have a perscription. Why is this necessary, I cant remember the original doctor I went to. It is a machine, why is this so difficult to purchase. ?
Hey Keith, I am very sorry to hear that you are having difficulty with purchasing a second CPAP machine. Per the FDA guidelines, we are required to have a valid prescription on file anytime you purchase a new machine, even if you already have one.
Please keep in mind that any medical doctor can write a prescription for you, it does not have to be a Sleep Specialist. If you have a doctor that is willing to write a prescription for you, we will be more than happy to request the prescription from your doctor on your behalf.
You can make this request by contacting our customer service department at: 1-800-356-5221.
Enjoy your day!
This article was very informative. I would like to receive further emails when available.
Hi Howard, I am very glad to hear that you found the article helpful. You can view all of our many articles by visiting cpap.com, scroll to the bottom of the page, under the heading assistance and resources, click sleep apnea blog.
Also, you can register to receive our company newsletter by going to cpap.com, scroll to the bottom of the page under the heading our company, click newsletter archive, subscribe, you will then be required to enter your e-mail address.
For further questions, or concerns feel free to reach us at: 1-800-356-5221, or firstname.lastname@example.org
Have a great day!
I have been using CPAP therapy since August 1997. I had been married for six years and my poor wife would be routinely awakened by either my snoring or me gasping or breath. I remember having dreams about drowning for most of my life, even as a small child. These would always result in me awakening in a panic and attributing it to a nightmare.
I don’t even take a nap without wearing my CPAP as I am fearful of dying in my sleep without it. I routinely remember the story of Reggie White who didn’t have his CPAP during a trip and died in his sleep in his hotel room.
My doctors have all heard my rant about the silliness of the need for a prescription to purchase a CPAP. They all have agreed that in my case a prescription would probably not be needed as I have studied this topic and have been using a CPAP for so long.
My other frustration is having to have a change to the prescription if the pressures need to be adjusted. But, thanks to Dr. Google and You Tubers I have been able to obtain the secrets behind adjusting my machines. I know what good sleep feels like and I know when my pressures are not correct.
I have encouraged many people to have a sleep study after hearing their snoring stories, usually from their spouse. I find it rather interesting that even after having a study and being told that they have sleep apnea too many either don’t continue with treatment to obtain a CPAP or receive one and then don’t use it.
My life has been made so much better since starting CPAP therapy now almost 22 years ago. I love being able to sleep and awake refreshed!
Hi Kevin, I am very happy to hear that your CPAP Therapy is going well for you. I wish you continued success with your therapy and thank you for encouraging others to have a sleep study as many folks really do not know the importance of learning that they have Sleep Apnea and the benefits of receiving the treatment that they need.
Have a great day!
I think there is an entire industry of stakeholders in the current system who will resist change to an OTC solution. A doctor needs to order a test. A sleep center needs to run an expensive study. The doctor writes a prescription for a machine that needs to be complex, because it will report data to the medical device supplier and the physician, reporting on compliance. So that an insurance company will pay for the expensive machine and supplies and services of the medical device supplier. Follow-up check ups are needed at regular intervals to continue eligibility for coverage. If the device fails, one needs to start all over with another sleep study.
Consider the alternative. A spouse or friend points out to you (or you self diagnose based on obvious symptoms) that you are not getting good sleep and you stop breathing during your sleep. The treatment solution is a device that produces a constant pressure delivery of air at fairly low (ergo safe) pressures. May include temperature and humidity control. Titration of the CPAP pressure could be determined by incremental adjustment by the user over a modest (still safe range). This is not a complex mechanical engineering problem. The expense comes from the electronic and communications components required for the monitoring and communications required of the prescription regulated treatment and the medical care coverage overhead for the doctor, CPAP supplier, insurance,, and billing. A fairly simple OTC device could be made for far less and marketed to anyone who felt they needed to try it. The results of treatment, if truly needed and if CPAP is the solution, are rapidly obvious to the patient and others. If the OTC device provides a benefit, it will continue to be used. If not it could be discarded (or recycled like other scrap metal/plastic devices without a major production.
Hello, I definitely, understand where you’re coming from. The process that you must go through to receive a Sleep Apnea diagnosis isn’t the most pleasant experience for most folks. Unfortunately, the requirement to obtain the prescription for your CPAP equipment and some supplies is the law.
Keep in mind that the Medical Supply companies such as CPAP.com, would like nothing more than to sell you a machine, or some other over-the-counter device that can diagnose and treat your Sleep Apnea.
The visit to your doctor, sleep study, medical supply company visit are all necessary steps to make certain you are getting the safe care and treatment you need and deserve without self-diagnosing, in turn causing unintentional self-harm.
I would encourage you, or anyone else who disagrees with the process in place for being diagnosed and treated for Sleep Apnea, to speak with your Congressman, or even reach out to your State Legislator, about what can be done to change the Federal Laws and/or process for being diagnosed and treated for Sleep Apnea.
If you would like to speak with me further, please feel free to call: 1-800-356-5221, ask for Carol, or you may e-mail: email@example.com, Attn: Carol.
We wish you the best!