Story from the local Sleep Doc's office.

wahooker · Post by **wahooker** » Wed Aug 30, 2006 8:45 am

This actually happened a few months back... but it was before I started reading here.

I went in for a 4 month compliance check. (Gotta check in with my parole officer I guess!)

The RT tested the machine, and said that it was blowing out more air than it should. So she changed the setting to read one number lower.

As she was giving it back to me, she said that she also disabled c-flex because the doctor had not specifically prescribed it. I told her I did NOT want cflex disabled, because it made it a lot easier to breathe, and I couldn't exhale well in the sleep study (when there was no c-flex on the machine).

Anyway, for the next 3 days, I'm getting horrible headaches every morning.

Had to take another half day off work to talk to the RT, the lead RT, and then finally the doctor to get cflex turned back on. The doctor said he couldn't understand why on earth the tech would have turned it off in the first place.

I really ought to buy one of those pressure gauges to make sure she wasn't wrong about the pressure also.

Wulfman · Post by **Wulfman** » Wed Aug 30, 2006 8:56 am

Send a bill to the RT and your doctor for your time off. See if it'll get their attention. That kind of "excellent service" is uncalled for and a big reason so many people find their way to these forums.....regardless of the "BS" ResMed tries to feed us. CPAP.COM has some inexpensive manometers that will tell you if your pressure is correct. Those machines that don't have an automatic altitude adjustment have manual settings for altitude.

Best wishes,

Den

communilink · Post by **communilink** » Wed Aug 30, 2006 1:06 pm

Wulfman,

If you check with a meter and it is off, how do you correct the settings? Also, if you are on an Auto, and your pressure is set for -3/+3 of your 90%, does it really matter if you pressure is not accurate to the meter?

Guest · Post by **Guest** » Wed Aug 30, 2006 1:22 pm

In the RTs defense - they did exactly the right thing, unfortunately.

If the prescription does not specifically call for cflex, it is absolutely out of thier hands as to leave it on or not. They must turn cflex off.

It is sad, but due to our massively litigious society, those sorts of laws have had to be passed to protect people who were "just trying to help out".

It's stupid, but true. Thanks to everyone wanting to jump up and call the cops or sue someone everytime one little thing doesn't go thier way, there is no longer any choice for someone like an RT to make an informed decision about a machine setting that a doctor didn't include on a prescription.

Wulfman · Post by **Wulfman** » Wed Aug 30, 2006 2:37 pm

communilink wrote:Wulfman,

If you check with a meter and it is off, how do you correct the settings? Also, if you are on an Auto, and your pressure is set for -3/+3 of your 90%, does it really matter if you pressure is not accurate to the meter?

If the internal altitude setting is correct for that location, then the only other way to correct the pressure would be to either raise or lower the "indicated" pressure until it corresponds with the manometer.
I think all Autos are self adjusting, but I would imagine that calibrating an Auto would have to be done by setting it to the fixed pressures of the range you wanted to use and checking it that way. Then, if it was off at the fixed pressure, you would have to adjust your pressure range (up or down) to compensate for any discrepancies.

I've never done it, but I would presume that's the way it would happen. Then, if it WAS off, there's also the option to send it back to the factory and have it re-calibrated.

Guest,

I'm afraid you're correct in your statements, too. It's interesting that the doctor in that case couldn't understand why it was turned off, too. It still gets back to the patient's comfort and compliance issues. Why didn't the RT just pick up the phone and call the doctor's office? Like the amount of relief in any C-Flex setting is going to make a huge difference when compared to how they came up with the titration number from a few hours of one night's lousy sleep in a sleep lab.

Den

wahooker · Post by **wahooker** » Wed Aug 30, 2006 2:52 pm

The RT didn't even need to Call the Doctor. THey just needed to walk across the hall into the Doctor's office. (THe RT was on staff there at the office.)

Wulfman · Post by **Wulfman** » Wed Aug 30, 2006 3:36 pm

wahooker wrote:The RT didn't even need to Call the Doctor. THey just needed to walk across the hall into the Doctor's office. (THe RT was on staff there at the office.)

SHEESH!!! < SMACKS FOREHEAD >

Den

Snoredog · Post by **Snoredog** » Wed Aug 30, 2006 4:07 pm

your story is a perfect example why I took control over my own therapy years ago. Knowing what I know now, I would never let a RT touch my machine precription or no prescription.

they could have made a simple log into your chart that the machine had xxx hours on it for insurance compliance and accomplished the same thing.

that machine is so easy to program, just hold down the two arrow keys while plugging in the machine power wait for beeps, change mode from cpap to cfle using the up/down keys set pressure back to where it was if you were sleeping fine.

wahooker · Post by **wahooker** » Wed Aug 30, 2006 8:03 pm

I have, thanks to some use of the search function here.

MaskedMechanic · Post by **MaskedMechanic** » Thu Aug 31, 2006 5:53 pm

Anonymous wrote:

If the prescription does not specifically call for cflex, it is absolutely out of thier hands as to leave it on or not. They must turn cflex off".

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, Prescription

This is not true. The same thing was said about using a cpap machines ramp when ramp first came out. If the physician does not specify the details, there is freedom within that order to do what is needed within the scope of the order. Therefore, for example, a physician's order for CPAP @ 8cm can be used with no ramp or 20 minutes ramp with or without c-flex or EPR with no issues what so ever.

KansasRT · Post by **KansasRT** » Fri Sep 01, 2006 7:29 am

That is not neccessarily true either. It is a case by case basis. There are some Doctors that will give RT's freedom with ramp and Cflex/EPR, but some will not. You have to develop a relationship with the DR to be able to have that freedom. I am sure that alot of people in the medical field have gotten in a lot of trouble for assuming that there is "freedom within the order" to set equipment. I know that adding or removing CFlex/EPR or changing someone's ramp is not going to hurt them and depending on their physician I will change settings, but there are some Doctors who will not accept changes like that.

Mask

Additional Comments: AHI 105 per hour before CPAP - 6-28-06 AHI Index after CPAP - .1 per hour 7-5-06