11 ms·

If We Told You That, We Would Have to Shoot You

262 points by ubasu 14y ago

powera 14y ago
Definitely sounds like a bit of a racket. There doesn't seem to be any reason to need all these studies to get diagnosed here. However, if you go too far the other way, you end up with Kevin Trudeau and other scam artists selling you snake oil to cure whatever ails you. There are reasons why people can't just say anything will cure any medical ailment.
- steamer25 14y ago
  > too far the other way You're obviously allowing for nuance but it seems like many people have the argument that, "unless we put all our eggs in the single basket of a central 'impartial/trustworthy/infallible' evaluation and enforcement agency such as the FDA, people will get taken advantage of".
munin 14y ago
"If this situation existed anywhere else where we paid tens of thousands of dollars, people would be outraged." oh you mean like your iphone? or how about your android? or the software that runs your television? or how about your car? you're locked out of software products all the time and (almost) no one is outraged. the people who care diligently go to work to jailbreak the device and everyone else enjoys something that "just works"...
- jamesaguilar 14y ago
  If you paid tens of thousands of dollars for your Android phone, you might want to check out the better prices available at http://www.google.com/nexus/ http://www.google.com/nexus/. Also, to answer your real question and not the hyperbole: you aren't locked out of your iphone or Android with anything like the security of the device he's describing. No one cares about installing software on their TV -- mine doesn't even have an obvious port by which this could be accomplished -- and cars share the same liability structure as medical devices, probably. Plus many of them are actually quite easily programmable.
  - TeHCrAzY 14y ago
    My TV has a USB port for firmware updates ;)
  - DanBC 14y ago
    Except there are laws specifically designed to stop people jailbreaking some devices. See WIPO treaty and the DMCA as examples.
TamDenholm 14y ago
While this sort of policy has its place, like for stopping people overriding their morphine machine to skip its limit, I honestly don't see the problem for things like this, primarily diagnostic based equipment. I wonder if there might be a market for open source medical hardware with open source software to go with it. This could provide people with a very inexpensive option to look after themselves and also by perhaps uploading their data anonymously to an open database, help others too in diagnosing their problems too. Obviously you when you get into things like this people get a bit scared because the medical industry is proprietary by nature which makes it scary because you don't want to mess with something you are told to go to a professional about, I think ubiuiquity might solve the problem. The more information out there, the more people are educated and the less scared they are.
- jreeve 14y ago
  One of the common jokes between my wife and I is to setup a "home surgery kit" for some point in some horrible dystopian future. However, we were thinking it out and were moved to wonder why there isn't more straightforward "how-tos" as far as medicine is concerned: how-to relocate joints, how-to suture, how-to collect appropriate equipment, how-to operate in a sane and sanitary manner. This is, of course as lay people... for all we know all the information is available to whoever is willing to look for it and take the risks involved with amateur medicine. However, I wonder if what trained people think about the ethics of making professional medical techniques and equipment available to lay folks.
  - EvilTerran 14y ago
    Some books in the "survival guide" genre cover things like setting broken bones, basic stitches, biro tracheotomy, etc. I did once come across a "how to amputate your own leg" in a mountaineering magazine, but I'm pretty sure it was satirical: http://bubl.ac.uk/org/tacit/tac/tac50/advertis.htm http://bubl.ac.uk/org/tacit/tac/tac50/advertis.htm
    - arethuza 14y ago
      A Soviet doctor had to remove his own appendix in 1961 - he was stuck in a base in Antartica during the winter: http://www.theatlantic.com/technology/archive/2011/03/antarctica-1961-a-soviet-surgeon-has-to-remove-his-own-appendix/72445/ http://www.theatlantic.com/technology/archive/2011/03/antarc...
TamDenholm 14y ago
I think open source medical hardware is an industry ripe for exploding, which is helped by 3D printers becoming more common and affordable. Need a new prosthetic leg? Let's print you a specifically custom fit one for next to nothing compared with getting one made the traditional way.
- Torn 14y ago
  How do you propose modelling and tailoring a custom leg attachment for "next to nothing"?
  - brohee 14y ago
    Imprint in Play-Doh, 3D scan, 3D print?
snitko 14y ago
I think this is a perfect opportunity for businesses from other countries to step in. Say, some company in a less regulated country starts selling ones. Would it be actually cheaper to hop on a plain and get yourself one, instead of taking a couple of $2000 sleep studies? I bet it would. To generalize, basically any kind of business could profit from less regulation. You just have to find the market big and desperate enough to travel far for that.
- underwater 14y ago
  The government would quickly outlaw that behaviour if it became popular. For your own safety, of course.
  - snitko 14y ago
    The government is, actually, extremely slow. I don't remember exactly how it was, but I think there's only one state in US in which it is illegal to have plans to smoke weed in Netherlands. But even that has taken years to implement. My guess is that the market must not be too big, so as to stay reasonably under the radar, and not too small, so the businesses in another country can be profitable.
    - guard-of-terra 14y ago
      "illegal to have plans to smoke weed in Netherlands" Thinkcrime?
- ttt_ 14y ago
  >> To generalize, basically any kind of business could profit from less regulation. I think the point is made that the health-care business is doing quite well. Now how about the actual patient? Would you say he would benefit from more or less regulation? Seems to me that competition on this front would only be between the companies that can manage to better extort patients. I say more regulation works best in the health-care area. Authority is called for to oversee practices and audit business decisions to make sure that the patient is first priority and profit second. Taking an example from Brazil. A while ago the private health insurances were regulated into not enforcing grace periods of users who had already gone through them and were migrating from a different plan from the same or another insurer. Isn't that perfectly valid policy that focuses on the patient for what they really need (health-care)? Would unregulated business agree to this on their own?
spullara 14y ago
I blame lawyers more than doctors for this situation we've gotten ourselves into.
mtraven 14y ago
Here's a start: http://www.kickstarter.com/projects/1342192419/pulse-sensor-an-open-source-heart-rate-sensor-that http://www.kickstarter.com/projects/1342192419/pulse-sensor-... CPAPs aren't exactly super hi-tech either, and since they are fairly noninvasive as medical tech goes I can easily imagine some people experimenting with homebrews...
- masonhensley 14y ago
  Link to buy now because the kickstarter is over... $20 http://pulsesensor.myshopify.com/ http://pulsesensor.myshopify.com/
- ars 14y ago
  CPAP can be dangerous actually. First if the power goes out the person can suffocate. The masks have small holes in them for this reason (basically a permanent leak). A MUCH MUCH more dangerous hazard is re-breathing. In a properly designed machine if it fails (power outage or mechanical) it will have a strong resistance to air flow - this lets the small holes take over. But if air flow is not blocked then the person will breath the same air over and over in the tube (the same air will flow back and forth) and will eventually asphyxiate. Another hazard is if the pressure goes up too high, this can cause injuries. The fact that you are not even aware of these hazards is probably a good reason not to try building one. And there may be more hazards I have not thought of.
  - shrike 14y ago
    All masks come equipped with an anti asphyxia valve. They are a very simple flap that fails open in the case of a power outage or other failure, a (C|A)PAP mask cannot asphyxiate you. [1] https://encrypted.google.com/search?hl=en&q=anti%20asphyxia%20valve https://encrypted.google.com/search?hl=en&q=anti%20asphy...
    - ars 14y ago
      Only full face masks do. The nasal ones don't. Technically you could breath through your mouth if there was a problem, but some people have issues keeping themself from breathing through their mouth, so they use a chip strap to prevent it. And then this hazard comes into play. And you entirely missed my point. The masks are safe because someone thought of the hazard and designed against it. If you are making things homebrew you better make sure you are aware of all the hazards.
ezyang 14y ago
Suppose you have a system, but for legal liability reasons you cannot have this system be open to users (say it's a medical system, and having untrained people fuck around with it messes with certification.) However, you make it reasonably easy for users to override any interlocks (i.e. put in no protection). A user finds out about the override, hacks their device, misprograms it, and dies. Is the company that manufactured this device legally liable for this death? If they knew that it was easy to override the safety interlocks, are they then liable? How about if there was demonstrable evidence that the knew about the specific override? What if they, in an informal capacity, spread information about how to do the override? Here is a parallel situation: same company makes a device, and has locked it down so hard that it's not possible to actually get anything done with it. Nurses and other trained practitioners know that "the usual way of business" is to override some of the safeguards, because, of course, that's the only one anyone ever gets any work done. However, the company disclaims all legal liability in the case that someone does such a modification. Are they allowed to disclaim that? It's complicated.
- sirrocco 14y ago
  No it's not. At the doctor's office you should be told: "Don't fuck around with the machine. If you need to change the settings, come to me and I'll change it. You also have this hand-book of how to override, but if you do you might die." It's simple. You were warned.
  - wickedchicken 14y ago
    > It's simple. You were warned. laws don't work like that
    - chao- 14y ago
      Not to nitpick, because I agree, but I think it's a more accurate to say "litigation doesn't work like that" or "lawyers don't work like that". I was under the impression that it's less a specific law which spells out the liability, but rather a patchwork of regulation and court cases that leave a company with so much uncertainty that the only intelligent choice is to cover your ass any-which-way that you can. My impression (and it is merely that) comes from today's earlier discussion on liability, regulations and compliance: http://news.ycombinator.com/item?id=3889512 http://news.ycombinator.com/item?id=3889512
neilk 14y ago
My experience wasn't nearly as bad as the OP's - one at-home sleep study, a tester CPAP machine for a week, and a prescription to get my own CPAP soon after. (My health provider/insurer was Kaiser, which is more integrated, so perhaps they have less incentive to milk it.) It was, however, strange to need a prescription to buy a machine. The prescription includes the settings, so when it arrives, it's already tailored to your needs. Even so, the machines I was given were relatively easy to understand -- I even fiddled with the settings a bit and found what was more comfortable. The machine I bought for myself is a DeVibliss, and part of its appeal is that comes with software to read its data. It is proprietary and Windows only, but likely hackable since we have readouts of what the data means. I haven't gotten around to figuring that out. Medical techs take a really dim view of patients fiddling with settings. I know they did when I asked them all kinds of questions. Their assumption, which is probably verified for them daily, is that patients have no idea what they're doing, and conceding authority is to invite disaster. Hackers may trust themselves to figure something out, but let's be serious -- we can be aggressive because it's just data. We forget all the times we hose the filesystem, corrupt the database, have catastrophic memory leaks, and so on. Medicine is not as forgiving as computing. Still, with CPAP, it's probably very difficult to cause yourself injury. Maybe a more open policy would be appropriate.
- X-Istence 14y ago
  As a hacker and someone that has a few things that I take medicine for I ask a lot of questions, and do a lot of research. My doctors always find it interesting when I can pull up full charts and graphs of data that they simply have written down, mine will generally be more accurate and has contained data points that they didn't have due to being measurements I took at certain times of day (blood pressure), and it has helped them give me the medicine I require. Not all patients are dumb, and while it has taken me a while to get my doctor to realise this, she has started realising that maybe there is something more to it and that it will be beneficial to both of us. I understand the CYA policy, and I understand that for most patients that is the best way to go about it, but for those of us who are outliers I think it may be beneficial because we may have more time to look at the data and find significant data (and then get them verified by a doctor) than some other people. It is in my own personal best interest to be as healthy as possible and if I can do that by knowing more about what is going on with my body, then all the better!
ars 14y ago
These guys can help: http://www.apneaboard.com/ http://www.apneaboard.com/ They have info on adjusting lots of models of machine. And there is nothing actually illegal about doing so for yourself. You don't really need a sleep study with an APAP machine since it does it automatically. So what you do is find a friendly doctor to write a prescription, then go to http://cpap.com/ http://cpap.com/ and buy your own machine. Legally any doctor can do this, you don't need a specialist. Some are willing to prescribe based on symptoms without needed a sleep study. And by buying the machine yourself you can research it to pick the best one instead of what the medical supply house picks for you. These laws are incredibly annoying, but there are ways around it - while staying legal! I remember once seeing a bottle of sterile water (for a humidifier) that said "By prescription only. Only for use by, or under the advice of, a Doctor." Apparently by writing that they can charge more money for it, and insurance will pay for it. But if it's over the counter (remember we are talking about water here) insurance won't pay.
Eliezer 14y ago
I tried to schedule a sleep study, was told it would be a month, tried to price a sleep study somewhere else, was told it would be over $2000... ...gave up and bought an automatic CPAP machine off Craigslist for $650 from someone who knew how to access doctor mode (hold down button X for 10 seconds after turning the power on), set it to adjust automatically... ...and stopped after a month because the mask was preventing me from sleeping well, but at least I didn't spend more than $650.
- ars 14y ago
  Try a different mask. There are a huge number of types, and different people like different ones. Nasal, dental, full face, nasal prong, nasal pillow. And the straps attach in many different ways as well.
  - Tichy 14y ago
    Maybe had he done the sleep study they would have fitted the right mask to begin with :-)
    - dsr_ 14y ago
      Probably not. The sleep study measures the number of events per hour and your blood oxygenation, and in the followup (which can be in the same night, at no extra cost) discovers the necessary pressure. It doesn't check for mask comfort or fit. (Should it? Probably.)
- oz 14y ago
  Instrumental rationality FTW, right? :)
Daniel_Newby 14y ago
This isn't about FDA regulations[1] or tort law[2]. It's about the American medical system being a corrupt racket. 1. The FDA will approve nearly anything. For example, very flexible user-managed insulin pumps. 2. A jury of retards will convict if the plaintiff is sufficiently pathetic. Assuming you have reasonably good intentions and reasonably clear documentation, tort liability is just a roll of the dice.
antihero 14y ago
Are there exercises you can do to improve the muscle tone in your neck?
- archangel_one 14y ago
  Seems to me like a sensible option would be to try losing weight, since sleep apnea is strongly linked to obesity. And yeah, he says it's his muscles that are the problem, but it seems rather convenient to blame that when he admits he's overweight and suffering from this complaint where that's known to be a huge factor. I guess you could say that a hidden silver lining of the medical industry taking so long to fix his problem is that it'd give him time to explore that alternative...
  - antihero 14y ago
    Aye, becoming healthy is a better start than drugs or equipment to help you breathe.
- brent5000 14y ago
  I've heard that learning to play the didgeridoo will strengthen these muscles. Just google didgeridoo and sleep apnea and you will get several results. I have no idea if it works, but it sounds like more fun that wearing one of those machines.
swombat 14y ago
The most valuable hack I've discovered and used when dealing with the health system (and bear in mind this is in the UK, where the main problem is not cost, but time) is to be great friends with a GP. I always discuss health issues with him before going to the doc, so there are no surprises afterwards, and I know exactly what to say to expedite the process. It turns out that there are various magic phrases you can use to speed up the outcome, guarantee a referral, etc. If you're friends with a doctor, they'll tell you those phrases. It probably won't help with all the waste in the process, though. And it definitely won't help with closed hardware.
- asmosoinio 14y ago
  "GP"?
  - usaar333 14y ago
    http://en.wikipedia.org/wiki/General_practitioner http://en.wikipedia.org/wiki/General_practitioner
    - andybak 14y ago
      I got a peculiar sense of satisfaction about seeing someone (presumably US) having to ask to have an acronym or bit of country-specific jargon explained. My brain is now full of terms that only exist in the States that get bandied around in discussions as if everyone knows what they mean.
      - lukejduncan 14y ago
        We actually use the term GP in the US
      - nollidge 14y ago
        This is hardly unique to the States.
- nollidge 14y ago
Derbasti 14y ago
Very simply, the medical system can extract as much money from the patient as they want. The worse the illness, the more the patient will pay. Because the alternative is death. Health care is not a matter of supply and demand, it is a matter of life and death. Patients will give you the shirt off their back to avoid death. It's just not fair. That is why strong government regulation for health care is a good idea. These things run far more smoothly in countries with a public health care system. There, doctors typically get a fixed amount of money for each kind of illness. Hence, their incentive is to diagnose an illness as swiftly as possible and get the patients out the door. This has its own set of downsides, but at least the patient gets help rather more quickly and with less hassle.
- Dove 14y ago
  That is why strong government regulation for health care is a good idea. Government has the power to protect anyone from anyone else. Ideally, it should use that power to protect weak people from the powerful corporations, as you propose. Practically, it tends to use that power to protect powerful corporations from slightly less powerful competitors.
- codehotter 14y ago
  I have no idea whether to be for against government regulation in health care because it's a complicated issue and I am nowhere near an expert. But I would like to ask you if you think the same logic applies to food. Can the food industry extract as much money from me as they want? I will give you the shirt off my back in order to avoid starvation. If no, what is the magic happening in the food industry? Could similar magic apply in health care?
  - jablan 14y ago
    There's a big difference here. Basically, anyone can grow food, while not many people can make their own antibiotics or CPAP machines in their backyards.
    - deleted 14y ago
      [deleted]
arvidj 14y ago
Of course, doctors should just give the patient whatever he asks for. What does all those years of medical school matter, this guys runs a blog and he has done research before going to the doctor!
DanBC 14y ago
The system does sound incredibly frustrating. It definitely needs some fixing. But some of what the author mentions are sensible and reasonable restrictions. > I can't breathe at night -- it's not being fat, although I am, it's that for some reason the muscle tone in my neck sucks. How does he know? Losing weight is effective for many people with OSA. NICE[2] have guidance for OSA and CPAP which specifically mentions obesity and the need for lifestyle changes before CPAP is used. (http://publications.nice.org.uk/continuous-positive-airway-pressure-for-the-treatment-of-obstructive-sleep-apnoeahypopnoea-ta139 http://publications.nice.org.uk/continuous-positive-airway-p...) > You'd think sticking a mask on your face would be fairly simple to learn The mask has to push air down an obstructed airway. Obviously it has to fit correctly. As for masks being easy to fit - see almost any facemask and check for the nose strips.[1] > So I went to the doc and told him my problem. Told him I needed a CPAP Imagine you're a doctor. You pay millions for liability insurance. Some guy turns up and self diagnoses his illness. Do you accept that diagnosis? Or do you follow recommended procedure for that illness? (I accept that the recommended procedure is broken because of insurance). > My wife and I have been observing the symptoms for years, we're done the research, and now it is time for action. See, for example, Morgellons or Chronic Fatigue or Myalgic Encephalitis or MMR vaccinations where people have spent years doing the research and have arrived at very wrong conclusions and want useless, or harmful, medical interventions. [1] correct: (http://www.molnlycke.com/us/Surgical-Products/Product-Selector---Surgical-Division/Tabs/Products/Face-Mask---Extra-Comfort/?activeTab=1 http://www.molnlycke.com/us/Surgical-Products/Product-Select...) {stupid image, sorry) incorrect: (http://www.sciencephoto.com/media/101522/enlarge http://www.sciencephoto.com/media/101522/enlarge) [2] NICE is the organisation in the UK that assesses cost effectiveness of treatment options. It's important not to waste money on ineffective treatments; it's important to use a cheap treatment if it's as effective as an expensive treatment.
- tripzilch 14y ago
  > it's not being fat, although I am, it's that for some reason the muscle tone in my neck sucks hehe, jeez, I really wonder why "for some reason" the muscle tone in his neck sucks ... that said, having to repeatedly pay $2k for sleep studies that tell you nothing new before you get any treatment is really crappy. even if the first type of treatment should be a dietician and a personal trainer, not a fancy machine. and even then, if you have a fancy machine that is doing important health related tasks for you (possibly you're even trusting it with your life), I don't think there should be any question whatsoever about the user of said machine being allowed to know exactly how this machine works. as for liability, just have people sign off on the liability if they make any modifications or change settings to the machine since the last checkup by a medical expert, if you make modifications it becomes your own responsibility, that only makes sense.
pepijndevos 14y ago
Would it be possible to reverse-engineer such a device? I have been messing with some stepper motor drivers, that had at least a few pages of spanish or incorrect documentation, or a very simple circuit, however, I wonder what you do when there is no documentation. How do you learn reverse-engeneering?
- pmjordan 14y ago
  For USB devices, where you have access to both the device and some proprietary software that can drive it, this isn't so difficult: you can intercept the USB commands quite easily, then it's a matter of spotting patterns for each activity. For intercepting the USB traffic, you have a few options: - software USB Snooping; this hooks into your OS's USB subsystem and intercepts data. The Linux USB debug stuff works well for this, I've had less luck on Windows. - using a virtual machine and forwarding it the USB device. I've had success with this for intercepting the USB traffic for a device with only proprietary Windows drivers, but where snooping in Windows directly failed. Boot up in Linux, set up a Windows virtual machine, forward the USB device to the VM, install the Windows drivers in the VM and use Linux' USB debug interface. - Hardware USB snooping devices. You physically insert them between your USB device and the PC, and they log the data flowing through. Obviously, this is a bit more expensive, but will basically always work.
gosub 14y ago
The "True Hacker™" way: step1, reverse engineer the pulse ox usb protocol, step2, build a DIY CPAP machine, step3, release everything as open source/open schematics.
vinc 14y ago
I wrote a small program named Oximon a few months ago to extract data from CMS-50x pulse oximeters and generate Gnuplot graphs. I use it to detect REM sleep and it does the job with a nice accuracy so maybe it could help someone suffering from sleep apnea as well: https://github.com/vinc/oximon https://github.com/vinc/oximon
VBprogrammer 14y ago
A lot of his complaints remind me of a situation I'm sure everyone here is familiar with: Client / Non-technical Manager: I looked it up on the interwebs and we should use [MongoDB / Node.js / Java / C++ ...] for [Completely inappropriate problem space]. You: But that technology doesn't fit our problem space and / or we have no domain knowledge of that technology. Client: The interwebs said it was the fastest hipster technology around it would be stupid not to use it. You just want to charge your extortionate rates analyzing the problem just to come to the same conclusion. You: ....What?! I'm not saying there isn't anything wrong with the medical profession, and the US seem to have fostered a special brand of messed up in there healthcare system but suggesting that the doctor should just agree with the patients own diagnosis, or worse the the patient should just self medicate, seems like a crazy thing to advocate.
- ScottBurson 14y ago
  I think it's more complicated than that. Sometimes the patient is forced to become the expert on his/her condition. Doctors don't always have the expertise, and the system doesn't encourage them to spend the time required to understand truly difficult cases. Yes, I'm sure patients sometimes get weird ideas in their heads, but doctors are far from perfect as well. I think patients should definitely study the literature and bounce what they find off their doctor. Ideally the doctor is both open to new ideas and capable of ruling out the obviously silly ones. Of course I have to qualify that by adding that occasionally, the obviously silly idea turns out to be right.
- georgieporgie 14y ago
  I used to agree with you. But I've seen too many doctors who are either outright bad, or who don't recognize the limits of their knowledge. I've been told many things that were directly contrary to the reality of the situation. I've been prescribed drugs which exacerbated my condition, only to read up on them on the Internet and -- within hours -- see how they'd obviously prescribed the wrong drug based on the symptoms I had described. In my current opinion, doctors are far too convinced of their own infallibility and supposedly immense knowledge. I believe that if you're a rational, intelligent person who actively seeks out reliable knowledge, you can in fact have far greater insight into your specific problem than any doctor can hope to reasonably attain. I used to think it was crazy that in various other countries you can visit the pharmacist, describe your condition, and likely walk out with the drug you wanted. Now I'm convinced this is a perfectly acceptable solution, at least for me.
jdietrich 14y ago
Frankly, this is an example of everything that's wrong with healthcare in the US and much of the developed world. The textbook OSA patient is a middle-aged man with a short, thick neck. OP is a middle-aged man with a short, thick neck. I'll bet dollars to doughnuts that OP is also hypertensive. In such a presentation, there is a very simple initial prescription - lose weight, drink less alcohol, quit smoking, get some exercise, see me in six months. In nearly all cases these simple lifestyle changes cure the OSA, yield a huge array of other health benefits and cost nothing. CPAP is only indicated if either the patient still has symptoms after reducing their neck circumference, or is somehow unable to lose weight. The only thing that went wrong in OP's case is that his primary physician yielded to demand for a quick fix, rather than making the correct prescribing decision. OP would rather sleep on a respirator than improve his lifestyle. I'm not blaming him, it's a cultural problem, but it's one that will kill us all and lumber us with an impossible burden of healthcare costs. Consider this: The leading cause of limb loss in the developed world is type 2 diabetes. Mull that thought over for a moment, let it percolate. Most cases of type 2 diabetes are preventable through simple lifestyle changes. Most cases of dysvascular amputation can be prevented by better management of blood glucose levels. People are having their feet cut off because they are unable to appropriately manage their most basic physical needs. That thought is what disturbs my sleep.
- naner 14y ago
  Considering that he wasn't getting restful sleep, wouldn't it be best to give him the CPAP and tell him to change his lifestyle? If I was in his situation and the doc told me that he would not give me a CPAP and that I needed to eat better I'd tell him where he could shove it...
- mynegation 14y ago
  Sometimes, like in this case, quick fix is sorely needed to even get started with long fix. If you are sleep deprived and have hypertension, there is just not enough energy to do exercise or seek or cook healthy food. As for the weight - I can only offer anecdotal evidence: OP's problems are likely aggravated by weight, but it may well be that there is a muscle problem as well. My BMI (weight in kg divided by height in meters squared) during different periods of my life hovers around 25 - just between healthy and overweight. According to my wife, once my BMI is below 25 I stop having episodes of snoring at night and the more my BMI goes over 25 the more snoring I do.
tibbon 14y ago
For everyone hyper-focused on him being overweight- that sometimes isn't the only problem (or the problem at all). I'm relatively thin/average build, and was having troubles sleeping, breathing and I was snoring a ton. I complained to my GP about this, and he prescribed some nasal spray which didn't help at all. Went to an ENT and of course had to have a sleep study. The entire time I was telling them, I think my tonsils are fucking huge and I have sleep apnea due to it. Only after seeing two doctors and having an $800 sleep study did they agree and I was able to get my tonsils removed. Afterward they wanted to do another sleep study to find if it fixed it; I said no thanks. Sometimes- just sometimes the patient actually knows what they need. Now I have a new GP, who is much more helpful in providing what I actually need without random expensive tests.
sbierwagen 14y ago
This site smells like a SEO scam. Look in the "related sites" sidebar: lots of links to common search keywords like "treating neuropathy in feet" and "facebook login help", in a small, light gray text.
steamer25 14y ago
Does anybody know what the medical risks of a non-OSA sufferer using an APAP/CPAP are?
- steamer25 14y ago
  Let me Google that for myself: http://www.nhlbi.nih.gov/health//dci/Diseases/cpap/cpap_risks.html http://www.nhlbi.nih.gov/health//dci/Diseases/cpap/cpap_risk...

262 points by ubasu 14y ago

Definitely sounds like a bit of a racket. There doesn't seem to be any reason to need all these studies to get diagnosed here. However, if you go too far the other way, you end up with Kevin Trudeau and other scam artists selling you snake oil to cure whatever ails you. There are reasons why people can't just say anything will cure any medical ailment.

steamer25 14y ago
> too far the other way You're obviously allowing for nuance but it seems like many people have the argument that, "unless we put all our eggs in the single basket of a central 'impartial/trustworthy/infallible' evaluation and enforcement agency such as the FDA, people will get taken advantage of".

munin 14y ago

"If this situation existed anywhere else where we paid tens of thousands of dollars, people would be outraged." oh you mean like your iphone? or how about your android? or the software that runs your television? or how about your car? you're locked out of software products all the time and (almost) no one is outraged. the people who care diligently go to work to jailbreak the device and everyone else enjoys something that "just works"...

jamesaguilar 14y ago
If you paid tens of thousands of dollars for your Android phone, you might want to check out the better prices available at http://www.google.com/nexus/ http://www.google.com/nexus/. Also, to answer your real question and not the hyperbole: you aren't locked out of your iphone or Android with anything like the security of the device he's describing. No one cares about installing software on their TV -- mine doesn't even have an obvious port by which this could be accomplished -- and cars share the same liability structure as medical devices, probably. Plus many of them are actually quite easily programmable.
- TeHCrAzY 14y ago
  My TV has a USB port for firmware updates ;)
- DanBC 14y ago
  Except there are laws specifically designed to stop people jailbreaking some devices. See WIPO treaty and the DMCA as examples.

TamDenholm 14y ago

While this sort of policy has its place, like for stopping people overriding their morphine machine to skip its limit, I honestly don't see the problem for things like this, primarily diagnostic based equipment. I wonder if there might be a market for open source medical hardware with open source software to go with it. This could provide people with a very inexpensive option to look after themselves and also by perhaps uploading their data anonymously to an open database, help others too in diagnosing their problems too. Obviously you when you get into things like this people get a bit scared because the medical industry is proprietary by nature which makes it scary because you don't want to mess with something you are told to go to a professional about, I think ubiuiquity might solve the problem. The more information out there, the more people are educated and the less scared they are.

jreeve 14y ago
One of the common jokes between my wife and I is to setup a "home surgery kit" for some point in some horrible dystopian future. However, we were thinking it out and were moved to wonder why there isn't more straightforward "how-tos" as far as medicine is concerned: how-to relocate joints, how-to suture, how-to collect appropriate equipment, how-to operate in a sane and sanitary manner. This is, of course as lay people... for all we know all the information is available to whoever is willing to look for it and take the risks involved with amateur medicine. However, I wonder if what trained people think about the ethics of making professional medical techniques and equipment available to lay folks.
- EvilTerran 14y ago
  Some books in the "survival guide" genre cover things like setting broken bones, basic stitches, biro tracheotomy, etc. I did once come across a "how to amputate your own leg" in a mountaineering magazine, but I'm pretty sure it was satirical: http://bubl.ac.uk/org/tacit/tac/tac50/advertis.htm http://bubl.ac.uk/org/tacit/tac/tac50/advertis.htm
  - arethuza 14y ago
    A Soviet doctor had to remove his own appendix in 1961 - he was stuck in a base in Antartica during the winter: http://www.theatlantic.com/technology/archive/2011/03/antarctica-1961-a-soviet-surgeon-has-to-remove-his-own-appendix/72445/ http://www.theatlantic.com/technology/archive/2011/03/antarc...

TamDenholm 14y ago

I think open source medical hardware is an industry ripe for exploding, which is helped by 3D printers becoming more common and affordable. Need a new prosthetic leg? Let's print you a specifically custom fit one for next to nothing compared with getting one made the traditional way.

Torn 14y ago
How do you propose modelling and tailoring a custom leg attachment for "next to nothing"?
- brohee 14y ago
  Imprint in Play-Doh, 3D scan, 3D print?

snitko 14y ago

I think this is a perfect opportunity for businesses from other countries to step in. Say, some company in a less regulated country starts selling ones. Would it be actually cheaper to hop on a plain and get yourself one, instead of taking a couple of $2000 sleep studies? I bet it would. To generalize, basically any kind of business could profit from less regulation. You just have to find the market big and desperate enough to travel far for that.

underwater 14y ago
The government would quickly outlaw that behaviour if it became popular. For your own safety, of course.
- snitko 14y ago
  The government is, actually, extremely slow. I don't remember exactly how it was, but I think there's only one state in US in which it is illegal to have plans to smoke weed in Netherlands. But even that has taken years to implement. My guess is that the market must not be too big, so as to stay reasonably under the radar, and not too small, so the businesses in another country can be profitable.
  - guard-of-terra 14y ago
    "illegal to have plans to smoke weed in Netherlands" Thinkcrime?
ttt_ 14y ago
>> To generalize, basically any kind of business could profit from less regulation. I think the point is made that the health-care business is doing quite well. Now how about the actual patient? Would you say he would benefit from more or less regulation? Seems to me that competition on this front would only be between the companies that can manage to better extort patients. I say more regulation works best in the health-care area. Authority is called for to oversee practices and audit business decisions to make sure that the patient is first priority and profit second. Taking an example from Brazil. A while ago the private health insurances were regulated into not enforcing grace periods of users who had already gone through them and were migrating from a different plan from the same or another insurer. Isn't that perfectly valid policy that focuses on the patient for what they really need (health-care)? Would unregulated business agree to this on their own?

spullara 14y ago

I blame lawyers more than doctors for this situation we've gotten ourselves into.

mtraven 14y ago

Here's a start: http://www.kickstarter.com/projects/1342192419/pulse-sensor-an-open-source-heart-rate-sensor-that http://www.kickstarter.com/projects/1342192419/pulse-sensor-... CPAPs aren't exactly super hi-tech either, and since they are fairly noninvasive as medical tech goes I can easily imagine some people experimenting with homebrews...

masonhensley 14y ago
Link to buy now because the kickstarter is over... $20 http://pulsesensor.myshopify.com/ http://pulsesensor.myshopify.com/
ars 14y ago
CPAP can be dangerous actually. First if the power goes out the person can suffocate. The masks have small holes in them for this reason (basically a permanent leak). A MUCH MUCH more dangerous hazard is re-breathing. In a properly designed machine if it fails (power outage or mechanical) it will have a strong resistance to air flow - this lets the small holes take over. But if air flow is not blocked then the person will breath the same air over and over in the tube (the same air will flow back and forth) and will eventually asphyxiate. Another hazard is if the pressure goes up too high, this can cause injuries. The fact that you are not even aware of these hazards is probably a good reason not to try building one. And there may be more hazards I have not thought of.
- shrike 14y ago
  All masks come equipped with an anti asphyxia valve. They are a very simple flap that fails open in the case of a power outage or other failure, a (C|A)PAP mask cannot asphyxiate you. [1] https://encrypted.google.com/search?hl=en&q=anti%20asphyxia%20valve https://encrypted.google.com/search?hl=en&q=anti%20asphy...
  - ars 14y ago
    Only full face masks do. The nasal ones don't. Technically you could breath through your mouth if there was a problem, but some people have issues keeping themself from breathing through their mouth, so they use a chip strap to prevent it. And then this hazard comes into play. And you entirely missed my point. The masks are safe because someone thought of the hazard and designed against it. If you are making things homebrew you better make sure you are aware of all the hazards.

ezyang 14y ago

Suppose you have a system, but for legal liability reasons you cannot have this system be open to users (say it's a medical system, and having untrained people fuck around with it messes with certification.) However, you make it reasonably easy for users to override any interlocks (i.e. put in no protection). A user finds out about the override, hacks their device, misprograms it, and dies. Is the company that manufactured this device legally liable for this death? If they knew that it was easy to override the safety interlocks, are they then liable? How about if there was demonstrable evidence that the knew about the specific override? What if they, in an informal capacity, spread information about how to do the override? Here is a parallel situation: same company makes a device, and has locked it down so hard that it's not possible to actually get anything done with it. Nurses and other trained practitioners know that "the usual way of business" is to override some of the safeguards, because, of course, that's the only one anyone ever gets any work done. However, the company disclaims all legal liability in the case that someone does such a modification. Are they allowed to disclaim that? It's complicated.

sirrocco 14y ago
No it's not. At the doctor's office you should be told: "Don't fuck around with the machine. If you need to change the settings, come to me and I'll change it. You also have this hand-book of how to override, but if you do you might die." It's simple. You were warned.
- wickedchicken 14y ago
  > It's simple. You were warned. laws don't work like that
  - chao- 14y ago
    Not to nitpick, because I agree, but I think it's a more accurate to say "litigation doesn't work like that" or "lawyers don't work like that". I was under the impression that it's less a specific law which spells out the liability, but rather a patchwork of regulation and court cases that leave a company with so much uncertainty that the only intelligent choice is to cover your ass any-which-way that you can. My impression (and it is merely that) comes from today's earlier discussion on liability, regulations and compliance: http://news.ycombinator.com/item?id=3889512 http://news.ycombinator.com/item?id=3889512

neilk 14y ago

My experience wasn't nearly as bad as the OP's - one at-home sleep study, a tester CPAP machine for a week, and a prescription to get my own CPAP soon after. (My health provider/insurer was Kaiser, which is more integrated, so perhaps they have less incentive to milk it.) It was, however, strange to need a prescription to buy a machine. The prescription includes the settings, so when it arrives, it's already tailored to your needs. Even so, the machines I was given were relatively easy to understand -- I even fiddled with the settings a bit and found what was more comfortable. The machine I bought for myself is a DeVibliss, and part of its appeal is that comes with software to read its data. It is proprietary and Windows only, but likely hackable since we have readouts of what the data means. I haven't gotten around to figuring that out. Medical techs take a really dim view of patients fiddling with settings. I know they did when I asked them all kinds of questions. Their assumption, which is probably verified for them daily, is that patients have no idea what they're doing, and conceding authority is to invite disaster. Hackers may trust themselves to figure something out, but let's be serious -- we can be aggressive because it's just data. We forget all the times we hose the filesystem, corrupt the database, have catastrophic memory leaks, and so on. Medicine is not as forgiving as computing. Still, with CPAP, it's probably very difficult to cause yourself injury. Maybe a more open policy would be appropriate.

X-Istence 14y ago
As a hacker and someone that has a few things that I take medicine for I ask a lot of questions, and do a lot of research. My doctors always find it interesting when I can pull up full charts and graphs of data that they simply have written down, mine will generally be more accurate and has contained data points that they didn't have due to being measurements I took at certain times of day (blood pressure), and it has helped them give me the medicine I require. Not all patients are dumb, and while it has taken me a while to get my doctor to realise this, she has started realising that maybe there is something more to it and that it will be beneficial to both of us. I understand the CYA policy, and I understand that for most patients that is the best way to go about it, but for those of us who are outliers I think it may be beneficial because we may have more time to look at the data and find significant data (and then get them verified by a doctor) than some other people. It is in my own personal best interest to be as healthy as possible and if I can do that by knowing more about what is going on with my body, then all the better!

ars 14y ago

These guys can help: http://www.apneaboard.com/ http://www.apneaboard.com/ They have info on adjusting lots of models of machine. And there is nothing actually illegal about doing so for yourself. You don't really need a sleep study with an APAP machine since it does it automatically. So what you do is find a friendly doctor to write a prescription, then go to http://cpap.com/ http://cpap.com/ and buy your own machine. Legally any doctor can do this, you don't need a specialist. Some are willing to prescribe based on symptoms without needed a sleep study. And by buying the machine yourself you can research it to pick the best one instead of what the medical supply house picks for you. These laws are incredibly annoying, but there are ways around it - while staying legal! I remember once seeing a bottle of sterile water (for a humidifier) that said "By prescription only. Only for use by, or under the advice of, a Doctor." Apparently by writing that they can charge more money for it, and insurance will pay for it. But if it's over the counter (remember we are talking about water here) insurance won't pay.

Eliezer 14y ago

I tried to schedule a sleep study, was told it would be a month, tried to price a sleep study somewhere else, was told it would be over $2000... ...gave up and bought an automatic CPAP machine off Craigslist for $650 from someone who knew how to access doctor mode (hold down button X for 10 seconds after turning the power on), set it to adjust automatically... ...and stopped after a month because the mask was preventing me from sleeping well, but at least I didn't spend more than $650.

ars 14y ago
Try a different mask. There are a huge number of types, and different people like different ones. Nasal, dental, full face, nasal prong, nasal pillow. And the straps attach in many different ways as well.
- Tichy 14y ago
  Maybe had he done the sleep study they would have fitted the right mask to begin with :-)
  - dsr_ 14y ago
    Probably not. The sleep study measures the number of events per hour and your blood oxygenation, and in the followup (which can be in the same night, at no extra cost) discovers the necessary pressure. It doesn't check for mask comfort or fit. (Should it? Probably.)
oz 14y ago
Instrumental rationality FTW, right? :)

Daniel_Newby 14y ago

This isn't about FDA regulations[1] or tort law[2]. It's about the American medical system being a corrupt racket. 1. The FDA will approve nearly anything. For example, very flexible user-managed insulin pumps. 2. A jury of retards will convict if the plaintiff is sufficiently pathetic. Assuming you have reasonably good intentions and reasonably clear documentation, tort liability is just a roll of the dice.

antihero 14y ago

Are there exercises you can do to improve the muscle tone in your neck?

archangel_one 14y ago
Seems to me like a sensible option would be to try losing weight, since sleep apnea is strongly linked to obesity. And yeah, he says it's his muscles that are the problem, but it seems rather convenient to blame that when he admits he's overweight and suffering from this complaint where that's known to be a huge factor. I guess you could say that a hidden silver lining of the medical industry taking so long to fix his problem is that it'd give him time to explore that alternative...
- antihero 14y ago
  Aye, becoming healthy is a better start than drugs or equipment to help you breathe.
brent5000 14y ago
I've heard that learning to play the didgeridoo will strengthen these muscles. Just google didgeridoo and sleep apnea and you will get several results. I have no idea if it works, but it sounds like more fun that wearing one of those machines.

swombat 14y ago

The most valuable hack I've discovered and used when dealing with the health system (and bear in mind this is in the UK, where the main problem is not cost, but time) is to be great friends with a GP. I always discuss health issues with him before going to the doc, so there are no surprises afterwards, and I know exactly what to say to expedite the process. It turns out that there are various magic phrases you can use to speed up the outcome, guarantee a referral, etc. If you're friends with a doctor, they'll tell you those phrases. It probably won't help with all the waste in the process, though. And it definitely won't help with closed hardware.

asmosoinio 14y ago
"GP"?
- usaar333 14y ago
  http://en.wikipedia.org/wiki/General_practitioner http://en.wikipedia.org/wiki/General_practitioner
  - andybak 14y ago
    I got a peculiar sense of satisfaction about seeing someone (presumably US) having to ask to have an acronym or bit of country-specific jargon explained. My brain is now full of terms that only exist in the States that get bandied around in discussions as if everyone knows what they mean.
    - lukejduncan 14y ago
      We actually use the term GP in the US
    - nollidge 14y ago
      This is hardly unique to the States.
nollidge 14y ago

Derbasti 14y ago

Very simply, the medical system can extract as much money from the patient as they want. The worse the illness, the more the patient will pay. Because the alternative is death. Health care is not a matter of supply and demand, it is a matter of life and death. Patients will give you the shirt off their back to avoid death. It's just not fair. That is why strong government regulation for health care is a good idea. These things run far more smoothly in countries with a public health care system. There, doctors typically get a fixed amount of money for each kind of illness. Hence, their incentive is to diagnose an illness as swiftly as possible and get the patients out the door. This has its own set of downsides, but at least the patient gets help rather more quickly and with less hassle.

Dove 14y ago
That is why strong government regulation for health care is a good idea. Government has the power to protect anyone from anyone else. Ideally, it should use that power to protect weak people from the powerful corporations, as you propose. Practically, it tends to use that power to protect powerful corporations from slightly less powerful competitors.
codehotter 14y ago
I have no idea whether to be for against government regulation in health care because it's a complicated issue and I am nowhere near an expert. But I would like to ask you if you think the same logic applies to food. Can the food industry extract as much money from me as they want? I will give you the shirt off my back in order to avoid starvation. If no, what is the magic happening in the food industry? Could similar magic apply in health care?
- jablan 14y ago
  There's a big difference here. Basically, anyone can grow food, while not many people can make their own antibiotics or CPAP machines in their backyards.
  - deleted 14y ago
    [deleted]

arvidj 14y ago

Of course, doctors should just give the patient whatever he asks for. What does all those years of medical school matter, this guys runs a blog and he has done research before going to the doctor!

DanBC 14y ago

The system does sound incredibly frustrating. It definitely needs some fixing. But some of what the author mentions are sensible and reasonable restrictions. > I can't breathe at night -- it's not being fat, although I am, it's that for some reason the muscle tone in my neck sucks. How does he know? Losing weight is effective for many people with OSA. NICE[2] have guidance for OSA and CPAP which specifically mentions obesity and the need for lifestyle changes before CPAP is used. (http://publications.nice.org.uk/continuous-positive-airway-pressure-for-the-treatment-of-obstructive-sleep-apnoeahypopnoea-ta139 http://publications.nice.org.uk/continuous-positive-airway-p...) > You'd think sticking a mask on your face would be fairly simple to learn The mask has to push air down an obstructed airway. Obviously it has to fit correctly. As for masks being easy to fit - see almost any facemask and check for the nose strips.[1] > So I went to the doc and told him my problem. Told him I needed a CPAP Imagine you're a doctor. You pay millions for liability insurance. Some guy turns up and self diagnoses his illness. Do you accept that diagnosis? Or do you follow recommended procedure for that illness? (I accept that the recommended procedure is broken because of insurance). > My wife and I have been observing the symptoms for years, we're done the research, and now it is time for action. See, for example, Morgellons or Chronic Fatigue or Myalgic Encephalitis or MMR vaccinations where people have spent years doing the research and have arrived at very wrong conclusions and want useless, or harmful, medical interventions. [1] correct: (http://www.molnlycke.com/us/Surgical-Products/Product-Selector---Surgical-Division/Tabs/Products/Face-Mask---Extra-Comfort/?activeTab=1 http://www.molnlycke.com/us/Surgical-Products/Product-Select...) {stupid image, sorry) incorrect: (http://www.sciencephoto.com/media/101522/enlarge http://www.sciencephoto.com/media/101522/enlarge) [2] NICE is the organisation in the UK that assesses cost effectiveness of treatment options. It's important not to waste money on ineffective treatments; it's important to use a cheap treatment if it's as effective as an expensive treatment.

tripzilch 14y ago
> it's not being fat, although I am, it's that for some reason the muscle tone in my neck sucks hehe, jeez, I really wonder why "for some reason" the muscle tone in his neck sucks ... that said, having to repeatedly pay $2k for sleep studies that tell you nothing new before you get any treatment is really crappy. even if the first type of treatment should be a dietician and a personal trainer, not a fancy machine. and even then, if you have a fancy machine that is doing important health related tasks for you (possibly you're even trusting it with your life), I don't think there should be any question whatsoever about the user of said machine being allowed to know exactly how this machine works. as for liability, just have people sign off on the liability if they make any modifications or change settings to the machine since the last checkup by a medical expert, if you make modifications it becomes your own responsibility, that only makes sense.

pepijndevos 14y ago

Would it be possible to reverse-engineer such a device? I have been messing with some stepper motor drivers, that had at least a few pages of spanish or incorrect documentation, or a very simple circuit, however, I wonder what you do when there is no documentation. How do you learn reverse-engeneering?

pmjordan 14y ago
For USB devices, where you have access to both the device and some proprietary software that can drive it, this isn't so difficult: you can intercept the USB commands quite easily, then it's a matter of spotting patterns for each activity. For intercepting the USB traffic, you have a few options: - software USB Snooping; this hooks into your OS's USB subsystem and intercepts data. The Linux USB debug stuff works well for this, I've had less luck on Windows. - using a virtual machine and forwarding it the USB device. I've had success with this for intercepting the USB traffic for a device with only proprietary Windows drivers, but where snooping in Windows directly failed. Boot up in Linux, set up a Windows virtual machine, forward the USB device to the VM, install the Windows drivers in the VM and use Linux' USB debug interface. - Hardware USB snooping devices. You physically insert them between your USB device and the PC, and they log the data flowing through. Obviously, this is a bit more expensive, but will basically always work.

gosub 14y ago

The "True Hacker™" way: step1, reverse engineer the pulse ox usb protocol, step2, build a DIY CPAP machine, step3, release everything as open source/open schematics.

vinc 14y ago

I wrote a small program named Oximon a few months ago to extract data from CMS-50x pulse oximeters and generate Gnuplot graphs. I use it to detect REM sleep and it does the job with a nice accuracy so maybe it could help someone suffering from sleep apnea as well: https://github.com/vinc/oximon https://github.com/vinc/oximon

VBprogrammer 14y ago

A lot of his complaints remind me of a situation I'm sure everyone here is familiar with: Client / Non-technical Manager: I looked it up on the interwebs and we should use [MongoDB / Node.js / Java / C++ ...] for [Completely inappropriate problem space]. You: But that technology doesn't fit our problem space and / or we have no domain knowledge of that technology. Client: The interwebs said it was the fastest hipster technology around it would be stupid not to use it. You just want to charge your extortionate rates analyzing the problem just to come to the same conclusion. You: ....What?! I'm not saying there isn't anything wrong with the medical profession, and the US seem to have fostered a special brand of messed up in there healthcare system but suggesting that the doctor should just agree with the patients own diagnosis, or worse the the patient should just self medicate, seems like a crazy thing to advocate.

ScottBurson 14y ago
I think it's more complicated than that. Sometimes the patient is forced to become the expert on his/her condition. Doctors don't always have the expertise, and the system doesn't encourage them to spend the time required to understand truly difficult cases. Yes, I'm sure patients sometimes get weird ideas in their heads, but doctors are far from perfect as well. I think patients should definitely study the literature and bounce what they find off their doctor. Ideally the doctor is both open to new ideas and capable of ruling out the obviously silly ones. Of course I have to qualify that by adding that occasionally, the obviously silly idea turns out to be right.
georgieporgie 14y ago
I used to agree with you. But I've seen too many doctors who are either outright bad, or who don't recognize the limits of their knowledge. I've been told many things that were directly contrary to the reality of the situation. I've been prescribed drugs which exacerbated my condition, only to read up on them on the Internet and -- within hours -- see how they'd obviously prescribed the wrong drug based on the symptoms I had described. In my current opinion, doctors are far too convinced of their own infallibility and supposedly immense knowledge. I believe that if you're a rational, intelligent person who actively seeks out reliable knowledge, you can in fact have far greater insight into your specific problem than any doctor can hope to reasonably attain. I used to think it was crazy that in various other countries you can visit the pharmacist, describe your condition, and likely walk out with the drug you wanted. Now I'm convinced this is a perfectly acceptable solution, at least for me.

jdietrich 14y ago

Frankly, this is an example of everything that's wrong with healthcare in the US and much of the developed world. The textbook OSA patient is a middle-aged man with a short, thick neck. OP is a middle-aged man with a short, thick neck. I'll bet dollars to doughnuts that OP is also hypertensive. In such a presentation, there is a very simple initial prescription - lose weight, drink less alcohol, quit smoking, get some exercise, see me in six months. In nearly all cases these simple lifestyle changes cure the OSA, yield a huge array of other health benefits and cost nothing. CPAP is only indicated if either the patient still has symptoms after reducing their neck circumference, or is somehow unable to lose weight. The only thing that went wrong in OP's case is that his primary physician yielded to demand for a quick fix, rather than making the correct prescribing decision. OP would rather sleep on a respirator than improve his lifestyle. I'm not blaming him, it's a cultural problem, but it's one that will kill us all and lumber us with an impossible burden of healthcare costs. Consider this: The leading cause of limb loss in the developed world is type 2 diabetes. Mull that thought over for a moment, let it percolate. Most cases of type 2 diabetes are preventable through simple lifestyle changes. Most cases of dysvascular amputation can be prevented by better management of blood glucose levels. People are having their feet cut off because they are unable to appropriately manage their most basic physical needs. That thought is what disturbs my sleep.

naner 14y ago
Considering that he wasn't getting restful sleep, wouldn't it be best to give him the CPAP and tell him to change his lifestyle? If I was in his situation and the doc told me that he would not give me a CPAP and that I needed to eat better I'd tell him where he could shove it...
mynegation 14y ago
Sometimes, like in this case, quick fix is sorely needed to even get started with long fix. If you are sleep deprived and have hypertension, there is just not enough energy to do exercise or seek or cook healthy food. As for the weight - I can only offer anecdotal evidence: OP's problems are likely aggravated by weight, but it may well be that there is a muscle problem as well. My BMI (weight in kg divided by height in meters squared) during different periods of my life hovers around 25 - just between healthy and overweight. According to my wife, once my BMI is below 25 I stop having episodes of snoring at night and the more my BMI goes over 25 the more snoring I do.

tibbon 14y ago

For everyone hyper-focused on him being overweight- that sometimes isn't the only problem (or the problem at all). I'm relatively thin/average build, and was having troubles sleeping, breathing and I was snoring a ton. I complained to my GP about this, and he prescribed some nasal spray which didn't help at all. Went to an ENT and of course had to have a sleep study. The entire time I was telling them, I think my tonsils are fucking huge and I have sleep apnea due to it. Only after seeing two doctors and having an $800 sleep study did they agree and I was able to get my tonsils removed. Afterward they wanted to do another sleep study to find if it fixed it; I said no thanks. Sometimes- just sometimes the patient actually knows what they need. Now I have a new GP, who is much more helpful in providing what I actually need without random expensive tests.

sbierwagen 14y ago

This site smells like a SEO scam. Look in the "related sites" sidebar: lots of links to common search keywords like "treating neuropathy in feet" and "facebook login help", in a small, light gray text.

steamer25 14y ago

Does anybody know what the medical risks of a non-OSA sufferer using an APAP/CPAP are?

steamer25 14y ago
Let me Google that for myself: http://www.nhlbi.nih.gov/health//dci/Diseases/cpap/cpap_risks.html http://www.nhlbi.nih.gov/health//dci/Diseases/cpap/cpap_risk...