How does a RT know when to raise your pressure

[less is more]

My RT looked at my smart card encore pro data and determined to raise my max pressure from 15 cm H2O to 17 cm H2O, what information is the RT looking at to make this adjustment. Is there any training manuals from Respironincs on when to adust pressure. I have a Respironics CPAP Auto M series. The RT would not share this information with me and I like to know why. Are there any RT on this forum who could answer this questioned. The only thing the RT stated was that my 90% Auto CPAP was at my max pressure on most days. A have a copy of the users manual but this offers not much help.

thanks...

[GumbyCT]

My RT looked at my smart card encore pro data and determined to raise my max pressure from 15 cm H2O to 17 cm H2O, what information is the RT looking at to make this adjustment. Is there any training manuals from Respironincs on when to adust pressure. I have a Respironics CPAP Auto M series. The RT would not share this information with me and I like to know why. Are there any RT on this forum who could answer this questioned. The only thing the RT stated was that my 90% Auto CPAP was at my max pressure on most days. A have a copy of the users manual but this offers not much help.

thanks...

There are some RT's on this forum. My understanding is the RT would need a doctors 'order' to change your pressure or said RT would be in violation of federal laws.

[cinco777]

You/we need to look at the EncorePro report created from your SmartCard data. Ask your RT for a copy of the EncorePro report. If the RT refuses, you are up the creek without a paddle.

To avoid a repeat of this "RT refuses to show you your sleep data report", I suggest that you acquire your own SmartCard reader (and SmartCard). Before you visit your RT - who didn't learn to share in kindergarten - use the MyCPAP card utility to save a copy of your smartcard data on your PC. If you have the funds, acquire your own copy of EncoreViewer or EncorePro (both are available on eBay) and create your own reports. Upload an image of your report (Daily Details) and members will interpret and offer guidance.

[2ndGenCPAPgal]

My RT looked at my smart card encore pro data and determined to raise my max pressure from 15 cm H2O to 17 cm H2O, what information is the RT looking at to make this adjustment. Is there any training manuals from Respironincs on when to adust pressure. I have a Respironics CPAP Auto M series. The RT would not share this information with me and I like to know why. Are there any RT on this forum who could answer this questioned. The only thing the RT stated was that my 90% Auto CPAP was at my max pressure on most days. A have a copy of the users manual but this offers not much help.

thanks...

I'm not an RT but I might be able to help fill in a few of the blanks.

As you probably know, your Auto machine detects events and adjusts the pressure within a preset range to respond to events. When your RT stated that your "90% Auto CPAP was at my max pressure on most days" they meant that most days, you spent 90% or more of the time at your max pressure. They may have also seen apneas/hypopneas that happened while you were at your max pressure. The machine would not have been able to respond to those events because it already reached its maximum allowed. By increasing the max, the machine may now be able to reach a pressure that will prevent those events from happening.

If your DME set up your machine to allow it, you might be able to get some of this info as averages from your LCD screen. If you can't view information about 90% pressure and AHI/Leak averages let us know and we can help you at least turn on that information. I just read cinco77's post and he also gives good advice about obtaining the report from your RT (your doc might also have a copy) and the software/card reader.

Resprionics probably doesn't give any "advice" on when to raise pressure because that is something that is typically left up to a doctor to prescribe. There is a clinician's manual that shows how to get to the clinician's menu and the settings within that menu (including pressure changes and the previously mentioned toggle for info on the LCD screen). If you register for the board I'm sure someone would be happy to send it to you by private message (we can't attach documents to posts).

[Hawthorne]

You probably have a Smart Card in your Remstar auto M Series machine.

As has been said, you need the Smart Card Reader and the Encore Pro or Encore Viewer software to "read", on your own computer, the data that the RT sees to determine if you need a change in pressure. If you had the software and card reader (Encore Viewer & Smart Card Reader available as a bundle from cpap.com) you could get that data on your computer.

You also need the Providers Setup Guide so that you can make your own changes in the light of what you see from the software. People on this forum can help you if you have these things.

You have to buy the software and reader, but if you PM me your email address, I can send you the Providers setup guide for your Remstar Auto M Series.

Making changes without the software data is not a good idea though so you need the software and reader as well as the Providers Setup Guide.

[rested gal]

Did RT say anything about your leak rate?

If it were me, I'd ask the RT for a printout of specifically the "Full Details" report from the Smart Card download she did.

Not just the Summary report.

And not just the Trend report.

The FULL DETAILS report.

The entire "Full Details" report printed out from that download should be at least 5 pages long, probably close to ten pages long.

Once I got that report in my hands, I wouldn't bother looking at pages 1 through 3 at all, or the last page. I'd begin looking at the graphs that start on page 4. Those Daily Details graphs are all I ever look at. And I don't even look at everything on them.

Here's a topic that has a screenshot of the only part of the report from Encore Pro or Encore Viewer I look at (begins on page 4 of a downloaded report):
viewtopic.php?p=417959#p417959

My understanding is the RT would need a doctors 'order' to change your pressure or said RT would be in violation of federal laws.

That's my understanding too, but I'll bet there are quite a few doctors who have told the DME or RT they can adjust the pressure some at their own discretion...which would be legal for them to do if the doctor had already told them that was ok. The RT might have called the doctor's office immediately after doing the download.

Is there any training manuals from Respironincs on when to adust pressure.

Not that I know of. There is a titration protocol guide Respironics wrote for sleep labs to use when titrating with a BiPAP Auto SV machine, but that's not the kind of machine you have.

The only thing the RT stated was that my 90% Auto CPAP was at my max pressure on most days.

That would be reason enough for me to want to raise the maximum pressure setting. But, I'd want to be SURE that leaks have been well under control all along, before I took that 90% number as gospel. Massive leaks can skew what pressure gets used....or at least does on my own reports if I have an occasional unusually leaky night. That's why I'd want to see the Daily Details leak info in a Full Details report of the download -- to get a better look at the leak situation, if any.

[lessismore]

Thanks please sendme the guide for the REMSTAR to way2manythings2@yahoo.com, does the machine store info on the display for more than one night.

[LinkC]

The card stores "compliance data" (hrs/days of use) for several months. There must be a max but I've never reached it.

The "detailed data" is stored for 7 days, then begins to roll off due to lack of memory space. The machine's display only shows the current session and averages. (And it doesn't begin to show ALL the details.)

So, at any given upload you will get tons of compliance data and only the last 7 days of detailed data from the card.

[rjjayrt]

As a RT i would look at the amount of time you were at max pressure and your AHI. As a matter of practice most sleep docs want to keep your machine set max pressure 2 to 3cm above your actual max pressure.

[lessismore]

So if my 90% auto cpap pressure is at 15 cm H2O for most nights and my max pressure is at 15 cm H2O you would raise the pressure to 17 cm H2O

[JohnBFisher]

So if my 90% auto cpap pressure is at 15 cm H2O for most nights and my max pressure is at 15 cm H2O you would raise the pressure to 17 cm H2O

Exactly. See my description of how the average and 90th percentile numbers help the RT and DR to understand your pressure requirements:

viewtopic/t46950/DME-was-PISSED.html

If your machine says the 90th percentile pressure is 15cm H2O and your max pressure is 15cm H2O, then you have no room to go any higher if you need it. Setting the machine to 17 or 18 will allow the machine to go above 15 if needed. Essentially, the 15 would be a "false ceiling". By setting the pressure there and then often ending up at that value, the machine is limited in how high it can go, though you might need a slightly higher pressure.

Hope that helps explain how a little bit of statistics can provide a good bit of insight into your therapy needs.

[Autopapdude]

How does an RT know when to raise your pressure? coin flip, perhaps? or prehaps "eenie, meanie, minie, moe?"

[LinkC]

you spent 90% or more of the time at your max pressure.

I'm sure you MEANT to say "at OR BELOW"...

[less is more]

Yes at or below 15 cm H2O for 90% of the time, and the other 10% is at or above and since the maximum is at 15cm H2O I spent at least 10% of that night at 15 cm H2O. The event repeated for 14 nights out of 23 nights.

[DoriC]

Did RT say anything about your leak rate?

On my husband's reports, only when he's having leaks then his 90% is usually at his max.

Link, thanks for that correction. I thought I was going to have to unlearn everything I thought I finally knew.

you spent 90% or more of the time at your max pressure.

I'm sure you MEANT to say "at OR BELOW"...