Assessing Clinical Menu on CPAP / BIPAP Units

[resp1962]

There is a good reason why there is a clinical menu included in CPAP / BIPAP units. It is for QUALIFIED clinicians who have been formally trained in the delivery of pressure. Those of you who are not clinicians and feel you know what you are doing are flirting with trouble. When you had you first formal sleep study, ( Some did not and bought their machine on the "black Market") a specific pressure was prescribed to eliminate your apneas / hypopneas. If the pressure is changed without being examined by the M.D., the result could be fatal. Let me explain why. If you have COPD / Emphysema with Blebs and you increase your pressure yourself, you could easily rupture the bleb and die. If you feel you are getting too much pressure and decide to decrease it then you are not being treated for your apnea. It is important to call your doctor with pressure issues instead of self treating. I wear CPAP myself and understand the challenges it brings but decreasing, or even increasing the set pressures are not the answer. I only posted this because I see alot of posts claiming someone has discovered the clinical menu and made changes. The only changes you should make are in the patient menu and relate to ramp time, C-Flex, A-Flex, etc... which doesn't compromise therapy.

[GumbyCT]

There is a good reason why there is a clinical menu included in CPAP / BIPAP units. It is for QUALIFIED clinicians who have been formally trained in the delivery of pressure. Those of you who are not clinicians and feel you know what you are doing are flirting with trouble. When you had you first formal sleep study, ( Some did not and bought their machine on the "black Market") a specific pressure was prescribed to eliminate your apneas / hypopneas. If the pressure is changed without being examined by the M.D., the result could be fatal. Let me explain why. If you have COPD / Emphysema with Blebs and you increase your pressure yourself, you could easily rupture the bleb and die. If you feel you are getting too much pressure and decide to decrease it then you are not being treated for your apnea. It is important to call your doctor with pressure issues instead of self treating. I wear CPAP myself and understand the challenges it brings but decreasing, or even increasing the set pressures are not the answer. I only posted this because I see alot of posts claiming someone has discovered the clinical menu and made changes. The only changes you should make are in the patient menu and relate to ramp time, C-Flex, A-Flex, etc... which doesn't compromise therapy.

You can deliver my pressure. I need it today, please. All my trained pressure people were OFF yesterday, I was told to wait until Mon.

Now I will wait for CM to deliver the popcorn. I was wondering what I was gonna do today.

[drj130]

There is a good reason why there is a clinical menu included in CPAP / BIPAP units. It is for QUALIFIED clinicians who have been formally trained in the delivery of pressure.

Yeah, let me run down to the corner and see the local DME for pressure changes.

As a Soldier stationed in Germany, I have to go through hell to get anything for my machine. I see everyone posting about getting too much in supplies, being able to call up their insurance company and complain about problems and then getting them fixed, about being able to switch DMEs. Because I am a Soldier, I have to go through the people that Tri-Care WANTS me to go through. I have so many freaking channels that I have to deal with just to get supplies it isn't funny. I have had my machine for over a year and a half, deployed with it to Afghanistan, and everything that I was using until just the other day was either from when I first got the machine or I paid for out of my own pocket with NO hope of getting paid back. The ONLY reason that I was able to last so long on what I had was that there were people out there who sent me masks and filters at no charge. The only reason that I am doing well with my treatment is that I have taken charge of my care. Is my doctor aware of this, YES. Is he upset that I've made changes, NO. He is happy that I have what I need to ensure that I'm getting the best treatment that I can get and that I have taken charge. I've seen this person once in the whole time that I've been on it.

I will keep monitoring MY treatment and making the needed adjustments as I see fit to ensure that I live as long as I can.

David

[resp1962]

Dear drj130,

I did not mention anything in my post stating that people should not use different masks, hoses, and filters. I said it is dangerous for non-clinical to change pressures in the clinical menu of their machines. I respect you as a patient, a soldier and for defending our country. I realize that going to the doctor is not easy for you. If you have pressure issues with your machine and can contact me with pressure or supply issues, I will help in getting them to you.

[Slinky]

Ah, Resp1962, welcome to the forum and thanks for your input - but - while you can ENCOURAGE us to rely on our doctors and RRTs, "please" don't hand us the horsepuckies about changing our therapy settings ourselves. Most of us in this forum found our way here BECAUSE our sleep professionals either let us down or just plain screwed us.

I have COPD. I have a history of a spontaneous pneumothorax in the past - yet I had a sleep doctor script me a loaner APAP set at 4-20 and w/no humidifier to boot. And, yes, he was and is aware of my SP history.

Shortly after getting a new mask my cat grabbed it while I was making the bed and I dropped it and the elbow broke as well as the cat's claw put a small puncture in the cushion. The DME provider's RRT told me they didn't carry extra cushions or elbows and I would just have to wait until I was due for a new mask!!!

Needless to say, that DME provider is no longer MY local DME provider nor is that sleep doctor MY sleep doctor anymore. But it takes TIME to get an appointment w/a new sleep doctor. FORTUNATELY, I had the members of cpaptalk to bail me out.

So - we appreciate your sharing your advice and support w/us - but please be sure it is support and advice and not propaganda.

And I would suggest that you allow PMs and invite members who would like some assistance to PM you for advice. Posting your e-mail addy in a public forum isn't all the great an idea.

[flash 2]

Slinky is right. I came here because of bad dme, and sleep, pulmonologist, dentist and allergist that couldn't agree on the right pressure. Sleep study was useful but it wasn't the end all. I found my doc now listens to me and lets me tell him what's going on. Most of the sleep docs I saw were actually poorly versed in dealing with my situation besides taking forever to see. I am more than happy to follow a doc who is accurate, timely and thorough. I'd like the sun, moon and starts too. Besides, I went to school with most of these folks, I know I'm more intelligent than many of them. It's not that hard to understand or learn.

[robysue]

The only changes you should make are in the patient menu and relate to ramp time, C-Flex, A-Flex, etc... which doesn't compromise therapy.

And then of course there are plenty of folks whose machines were set up in such a way that they, the patient had no access to C-Flex, A-Flex, ramp, etc. that don't affect treatment. To set the time correctly on my machine you need the clinicians menu. The way mine was set up originally, the EPR (Resmed's A-Flex) was set to 3 and unchangable by me.

Just cause we know about the clinician's menu doesn't necessary we muck around with the pressure settings willy-nilly.

[GumbyCT]

The only changes you should make are in the patient menu and relate to ramp time, C-Flex, A-Flex, etc... which doesn't compromise therapy.

Just cause we know about the clinician's menu doesn't necessary we muck around with the pressure settings willy-nilly.

Speak for yourself....IF I can't go dial wingin what will I do during the time period I am NOT sleeping? Seems like a waste of time not to be changing something, eh?

[toddlorensinclair]

The only changes you should make are in the patient menu and relate to ramp time, C-Flex, A-Flex, etc... which doesn't compromise therapy.

And then of course there are plenty of folks whose machines were set up in such a way that they, the patient had no access to C-Flex, A-Flex, ramp, etc. that don't affect treatment. To set the time correctly on my machine you need the clinicians menu. The way mine was set up originally, the EPR (Resmed's A-Flex) was set to 3 and unchangable by me.

Just cause we know about the clinician's menu doesn't necessary we muck around with the pressure settings willy-nilly.

I agree with Robysue ... there are several items on the clinicians menu that are useful ... including detailed information. I can't see changing a pressure setting ... but I can see turning off c-flex which isn't in the user menu on my unit. If you're having a problem adjusting to the unit turning off the c-flex and trying it that way is one way to eliminate a cause.

[brazospearl]

resp1962, honey, bless your heart! While we completely appreciate that you have our best interests in mind, your credibility is a bit tarnished since, despite your formal training and expertise, you don't seem to know that your statements were not accurate. Since most of us don't live in Utopia, where all the sleep medical professionals are helpful, accessible, affordable, and know all the nuances of every aspect of successful therapy, we've decided to take matters into our own hands. You're so sweet to be concerned, but if I accidently die by increasing my pressure nobody on this board is responsible. My health, my therapy, my decisions, my responsibility.

[Willtry]

I too am new to this forum.
The one thing I can say with out contradiction is that the people on this forum support you.
The basic and most important form of support supplied here is MORAL support.
It is not easy to start therapy and learn to sleep with a piece of plastic strapped to your head it is very daunting.
The people here encourage you to keep at it, they encourage your to follow guide lines, they educate you about how what when and where with out pre-justice on what colour race or creed.
They give you more details about what is happening and why, they do not ask for anything just give and give which is more than a lot of money hungry GP's and other medical support do.

If you where to add up the total years of Knowledge accumulated from experience on this forum it will exceed the total number of hours most GP’s receive on the condition.

That is all I wish to say.

Life is like a box of chocolates you never know what you will get.

[Janknitz]

There's been an especially lively discussion about this on Sleep Guide.com and I agree with the conclusion--if you don't have something like Emphysema with blebs or other such risk factors, about the only way a regular CPAP or Auto machine can hurt you is if it's thrown at your head.

And maybe you should learn to spell A-C-C-E-S-S-I-N-G before you go preaching to people about whether or not it's OK to do it. I don't think even people with very serious lung disease can be hurt by "assessing" anything.

[linagee]

I could easily create an algorithm to do what a sleep doctor does to titrate to the right pressure for the minimum amount of AHIs. (In fact, they already have that. It's called an APAP. APAPs fail at analyzing multi-day data though.) As for the risks of killing yourself with too much pressure, yes there is that risk. A doctor is covered by insurance to protect from the risks he takes. But everything in life has risk and the doctor does not know *that* much more than a well educated CPAP patient using an APAP. BTW, when they titrate you, they put you at unknown pressures without knowing if it will kill you or not. They don't have some magical device in sleep labs that brings people back to life if they give you too much pressure. There is risk there.

May you all sleep well with low AHI,
linagee

[DaveMunson]

QUALIFIED

In order to have people trust what you say, you need to come across more helpful. Your message was not put out well. I hope you stick around enough to learn why we do what we do. It will make you a better professional. As you look at the different stories of why anyone would struggle and change their pressure, well, it may surprise you. It's educational. I would not preach, if I were you, here, without learning more.

[GumbyCT]

QUALIFIED

In order to have people trust what you say, you need to come across more helpful. Your message was not put out well.

I could be out in the weeds again (or still) but I think instead of kicking the door in and telling a group of people (who have been extremely successful) they are doing things all wrong and you are here to save the day - that an introduction of yourself would fare better.

How have we managed for so long with out you?

See also the quotes Slinky "Flies and Honey" lectures -
search.php?keywords=flies+honey&terms=a ... mit=Search

JMMO - Just MY Meaningless Opinion