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Comment by _qua | Hacker News Reader

As someone who treats people with CPAP, it’s absurd how many people get them and then don’t use them hardly at all. Yes there’s an adaptation period where you need to get used to using it, but you do need to use it for it to do anything. It doesn’t seem crazy for insurance to want to not keep paying for something that is sitting under a pile of clothes in the corner.

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I don't know. I feel like the compliance checks are more expensive than the machines at this point. They retail for around $/€ 500. I suspect that sleep centres (or whoever hands out CPAP devices to patients where you are) get significant volume discounts. Say they last for 5 years. That's a near zero cost.

Of course, someone is upcharging somewhere, but that's hardly the patient's fault.

I went through this with my provider and insurer, Aetna.

They had me rent the machine for 30 or 60 days. The machine had a cell modem that reported data to medresair, the manufacturer, and my sleep clinic checked that. A nurse called me twice to check in, sent the something to the insurer and after 60 days submitted a new claim.

It was actually one of the most efficient processes I’ve ever had with my insurance.

Like everything in the US health system, experiences vary depending on provider and payer.

I tried to use a CPAP machine for a while. I honestly could never figure out how I was supposed to breathe with it. At all. It seemed to be physically impossible. I'd try for a while each night, then get frustrated and stop so I could get some sleep. Completely useless to me.

Fortunately I was able to just return it, but if I hadn't been able to, why should that mean insurance wouldn't cover it? I was prescribed this device and it didn't work for me.

Insurers don't want to pay for unnecessary treatments, including equipment. Maybe your provider could have done a better job selecting the right mask or settings for the CPAP? Maybe they could have trained you in their office?

I'm not saying the surveillance and payment-held-hostage model is the best, but it does at least attempt to provide some useful incentives.

I'm sorry to hear you had that problem, you're not alone. I hope you found some alternative treatment that works for you! It's possible to succeed with CPAP even if it's hard at first, too, with various adjustments. I hope you've found a way to get a good night's sleep.

CPAP makes breathing harder than normal. It's antiquated technology, superseded by something called bilevel-CPAP (BiPAP) which has the quality that it makes breathing actually _easier_. It's slightly more expensive than plain CPAP so insurance and doctors withhold it from the patients and try to keep it a secret.

CPAP is NOT "antiquated technology." It has different indications from BPAP. Some people tolerate one better than the other. We are not "keeping one a secret."

How do you feel about the new surgical options like Inspire Sleep as an alternative for people who can’t tolerate CPAP?

It's a lot more involved than CPAP. You need to have a low enough BMI to qualify which excludes a not insignificant proportion of apnea patients. You need to have predominately obstructive sleep apnea since the device can't treat central apneas (where you just stop attempting to breathe). You need to be fit enough to tolerate surgery. You usually need to have an induced sleep study where you get put to sleep with propofol while someone uses a nasal endoscope to watch what part of your airway becomes occluded when you sleep to see if it's even something that can be treated with the device. And then even after all that the device essentially zaps your tongue to make it move and open your airway and for some people they find this intolerable, and the device needs to be turned off. After all that I think it's effective in about 50% of people.

So given all of that, I think it's better to work on trying different masks and other strategies for getting used to the mask before considering the implant.

Thank you for your detailed reply! I have no issues tolerating CPAP, so I’m not the target audience here. I’ve been seeing it advertised pretty heavily as of late and was curious about what the gotchas were.

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