Is It OK to Adjust My Own Pressure?

[AstralSurfer11]

The original machine my DME provider gave me was a brick. I paid out of pocket for a brand new Airsense 10 Autoset so I could use Sleepyhead. I took it in today to have clinician look at it. She said she programmed it to CPAP mode with a pressure of 8 which is what my 3rd titration showed to be ideal.

I just feel like I would be better off using Auto instead of CPAP. Not to mention I think it would be a very slow, drawn out process having to schedule appointments with the doctor and letting him tell me what to use. It's already been a long process using the original pressure he gave me at 12 and now saying 8. I'm just tired of wasting time. Should I just use CPAP with 8 pressure and track my results on Sleepyhead or just go right to Auto and if so what pressure ranges sound ideal?

Thank you all so much

[Wulfman...]

The sooner you take control of your own therapy, the sooner you'll see results.

https://sleep.tnet.com/home/files/resme ... -guide.pdf


Den

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[Pugsy]

If your previous machine was a brick and you have no idea what kind of results you were getting at that cm maybe start with the 8 and use it one night to see what you are working with. Gotta start with some data first to see if any adjustments are needed.
Then use those results to see if you want to try apap and will have an idea where to start.

Or use apap mode but with a real tight range close to what your RX is. Like maybe 8 to 10 range or something similar.
Since you have been using 8 cm for a while if you go changing things a lot you might find that big changes take more adjusting to and you might have some trouble sleeping. I would start with something close to what you had been using and then evaluated the data and make pressure decisions once you have some data in front of you.

[jtravel]

You definitely want to read everything you can about your treatment, machine and sleephead software.
Get the clinical manual for your machine so you can make adjustments as necessary based on your actual data from sleepyhead.
My Primary care DR and my insurance company(Cigina) totally let me down.
Lack of knowledge on the part of my primary care DR on how Cigna/Carecentrix operated meant multiple delays in my treatment.
I could not wait and purchased equipment on my own. I likely would have been dead if I had waited and played the insurance game.
Even after the insurance game played out I found it much less expensive to buy my own machine and masks from Cpap.com and Amazon for masks than going thru insurance.
Pretty sad as my yearly insurance premium and yearly deductible is pretty high. Even when the deductible is met my insurance only covers 80% of the cost.
I found my private insurance that I pay dearly for is totally useless when it comes to my Cpap treatment.

[JimW159]

I took it in today to have clinician look at it. She said she programmed it to CPAP mode with a pressure of 8 which is what my 3rd titration showed to be ideal.

I just feel like I would be better off using Auto instead of CPAP. It's already been a long process using the original pressure he gave me at 12 and now saying 8. I'm just tired of wasting time. Should I just use CPAP with 8 pressure and track my results on Sleepyhead or just go right to Auto and if so what pressure ranges sound ideal?

Regarding the results of the third titration: for "showed to be ideal," read instead "showed to be ideal on that date and under those circumstances." The whole premise of the AutoSet function is that it is constantly titrating your therapy. If, for what ever reason, you need less than 10 or more than 8 (as examples only) any fixed pressure you might have set is less than optimal. From my point of view, I would opt for a range that is slightly lower than the lowest titrated level as the range floor and slightly higher than the highest titrated value as the range's ceiling. Thus, if the lowest titration were 8, I would start at 7 (for example) and if 10 were the highest titration, I would set the ceiling at 12. Keeping in mind, if you never need anything outside the range, you will have never missed it. Also, if you never need above 10, it costs nothing to have the clearance overhead. By using SleepyHead with attention to detail, you will soon come to a better understanding of what events and circumstances trigger what demands on pressure adjustment by the machine. You will find a wealth of data in SH that will allow you to correlate the machines output to your needs. Just as an automobile's speedometer is not marked with the posted speed limit as the highest number, having a higher number marked provides some assurance that, if you need it, more speed is available. I recall reading an article in a car magazine some years ago where the writer had been doing a cross-country test drive that required the car be equipped with a fifth wheel and recorder to provide a calibrated track of the car's performance at any point during the car's operation. An unintended benefit of this was he was able to challenge a several hundred dollar speeding ticket by have irrefutable proof of how fast the car was going at the specific time the ticket referred to. SH does exactly the same thing: it provides a millisecond by millisecond track of your breathing behavior any time you are using your xPAP machine. You won't beat a speeding ticket, but you will be better able to optimize your therapy based on real data rather than the one dimension or time used.

[Sheriff Buford]

Do what Pugsy suggested and put a couple of nights under your belt. To me, changes in CPAP should be slow and gradual. Use your 95 percentile to work off of.
Sheriff

[Pugsy]

Be careful when using the 90/95% number to establish pressure needs. It isn't always the holy grail that people think it is.
It's just a number and the real definition is "at OR BELOW" that number and people tend to forget the "or below" part of the definition. It can be useful but a person needs to fully understand what it means first.
90/95% numbers are easily skewed and when easily skewed it makes them not always so reliable when someone is using a single night as a reference. 90/95% pressure numbers are best when evaluated long term....like 3 to 6 months. Not 3 to 6 nights.

[palerider]

I took it in today to have clinician look at it. She said she programmed it to CPAP mode with a pressure of 8 which is what my 3rd titration showed to be ideal.

Regarding the results of the third titration: for "showed to be ideal," read instead "showed to be ideal on that date and under those circumstances."

I couldn't agree more with this statement.

[JimW159]

I took it in today to have clinician look at it. She said she programmed it to CPAP mode with a pressure of 8 which is what my 3rd titration showed to be ideal.

Regarding the results of the third titration: for "showed to be ideal," read instead "showed to be ideal on that date and under those circumstances."

I couldn't agree more with this statement.

Welcome back. Many have been concerned that your voice was absent from this gathering of great minds. I hope you are feeling much better.

[MrGrumpy]

Its not generally thought of as a good thing to do. There are many sleep doctors who if you do that, they will get very mad and basically write you off as a patient. Its a legal issue for them, others its both a legal issue plus an ego issue (I am the sleep doctor, I order what pressure you are on).

If you change your pressure, many doctors are offended and take it personally.

Another bad thing about setting your own pressure is if you set your own pressure and it is wrong, say its actually too low, and you drive the next day and you are a little drowsy and have an accident that day, you just ffffked yourself. And its all recorded in that little computer in that machine, too.

On the other hand, to be a realist, Ive changed my pressure before because I had to. It was either change my pressure or stop using CPAP therapy. I chose using a pressure that gave me what I could tolerate, which was a lot less than what my sleep doc wanted me on.

So to be blunt about it, as long as you dont cause a wreck or something from doing it, nobody is going to come put you in jail or anything. Your sleep doc may, I say may, fire you or act hostile to you if you change it on your own, however. Or they might not, it all depends on you, the sleep doc, the situation. In other words nobody here can tell you for sure anything. Its one of those, "it depends" questions...

[AstralSurfer11]

I started with the 8 CPAP pressure they suggested. There were some points in the night I feel I could've used higher pressure. I had the latest titration on Thanksgiving but I haven't resumed using the machine until last night. I guess for the next few nights I can stick with 8 and then changed to a range of 7-9 auto. Then start looking at Sleepyhead and go from there.

What does 90-95% number mean?

[Pugsy]

Respironics uses 90% and ResMed uses 95%
both numbers have the definition of the number where the machine was at or below for 90/95% of the night.
Same definition for leak numbers...at or below.
People tend to overlook or forget the "or below" part of the definition and think that is where they were at for 90/95% of the night and it's simply not necessarily true.
Some people think it would be what a person would use if there were to use fixed cpap mode...and sometimes it might be and sometimes it might not be.

[Jasba64]

Your DME can only set your machine with the prescription from your doctor. Only your doctor can change your prescription. I took control of my machine after 10 horrible nights. Only you know how you feel and waiting for another study or doctors appointment can take weeks. I am much better off today than in the first month. By the way, I am only in month 3 and still don't sleep all night but I knew I needed more pressure. Good luck.

[Okie bipap]

Its not generally thought of as a good thing to do. There are many sleep doctors who if you do that, they will get very mad and basically write you off as a patient. Its a legal issue for them, others its both a legal issue plus an ego issue (I am the sleep doctor, I order what pressure you are on).

If you change your pressure, many doctors are offended and take it personally.

I don't actually see a doctor for my OSA, but a nurse practitioner who reports to the sleep doctor. She knows I change my pressure and said she prefers patients take an active part in controlling their OSA. We're the only ones that know how we feel. My current pressure is 5 cm less than I was originally prescribed and I am sleeping better at that pressure with less apneas than I had at the higher pressure.

[Guest]

Is It OK to Adjust My Own Pressure?

It's not only OK but pretty much expected in this forum. If your doc objects that is a signal to find another doc, period.

We're the only ones that know how we feel.

Absolutely.