DME's Moving Toward Auto-Titration Machines For All??

[jnk]

I read alot about "taking control of your own therapy" and I would just like to comment about one aspect of this. Changing pressures on your CPAP or BiPAP equates to changing the prescription. Not even an RT is allowed to do this, only the physician. This includes setting the auto range as well. Would you change your blood pressure dosage, etc.? This is a dangerous area and I see many giving advise about pressures. Please verify with your physician before changing any pressures.

@ leejgbt: RTs are not allowed to make those changes, true. But I am not aware of any docs having trouble with the idea of educated patients with simple OSA restricting the range of their own autos when that increases comfort and lowers AHI. Pressure is not dangerous in the way insulin is, after all.

@ user: I, too, suggest your trying to get permission from your doc, if at all possible, before tweaking pressures to increase your own comfort and lower your own AHI for yourself as a patient with simple OSA. But you may not want to tell the DME RT about it--it sometimes make them cry and panic and obsess, and we don't want to worry them needlessly. After all, RTs have to be able to sleep at night too.

jeff

ps- @ carbonman: Sorry for the nicey-nice!

[cinco777]

leejgbt wrote

I read alot about "taking control of your own therapy" and I would just like to comment about one aspect of this. Changing pressures on your CPAP or BiPAP equates to changing the prescription. Not even an RT is allowed to do this, only the physician. This includes setting the auto range as well. Would you change your blood pressure dosage, etc.? This is a dangerous area and I see many giving advise about pressures. Please verify with your physician before changing any pressures.

Everyone is entitled to their opinion on this forum. I enjoy being exposed to views contrary to mine. When these views are supported with facts (not tradition, authority, dogma, unsupportable surveys, "because I say so", and a plethora of other nonsensical rationale), I've changed my thinking and become a convert to a different view/understanding than I held previously. Participating in this forum has changed my views, understanding, and approach to getting a restful sleep in a number of ways. However, one of my views continues to be strengthened as a result of forum participation and my own observations, investigations, research, and analyses. That view has to do with the question of whether users should change their CPAP pressure(s) or not. My view is that users who are unsuccessful in getting a restful sleep based on their prescribed machine pressure (from a Titration or a Sleep Dr.) and use this CPAPTalk forum to learn as much as they can about Sleep Apnea, including asking and weighing the answers they receive from experienced and knowledgeable forum users, are more than qualified to take control of their therapy, including tweaking their pressure(s). In my second week of my most recent CPAP journey, I attended a Sleep Clinic user's meeting. I was astonished that the Sleep Dr., in response to almost every problem raised, recommended a pressure increase, which his RT dutifully performed in a corner of the room. As anyone who has read even a little on this forum, a pressure change is not a snake oil solution. When a pressure change is supportable by observations and analyses, experienced and knowledgeable forum members sometimes recommend a change and provide the rationale for the suggested change. It is up to the user to decide whether to change their pressure, pressure range, ... This CPAPTalk process is why I am all for users becoming informed and taking control of their therapy.

[JimIllinois]

leejgbt :

I would agree with you if people were making random adjustments without information. That would be crazy.

But those of us with the data, and the ability to interpret it, and the advice of other cpap users with a lot of experience, can certainly come to educated conclusions.

A cpap is basically a technical treatment. There is not a lot of voodoo to it. The effects of various changes are well known, and no controlled substances are involved.

In those ways, it is very different from other prescriptions. I wouldn't adjust my blood pressure medication, because there are too many unknowns and interactions. Too much voodoo.

[rested gal]

leejgbt :

I would agree with you if people were making random adjustments without information. That would be crazy.

But those of us with the data, and the ability to interpret it, and the advice of other cpap users with a lot of experience, can certainly come to educated conclusions.

I agree, Jim.

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://ajrccm.atsjournals.org/cgi/reprint/167/5/716
As far as I know, those people were successfully titrating themselves using plain single pressure CPAP machines without the benefit of software or LCD data displays.

Link to a Powerpoint presentation by board certified pulmonolgist/sleep doctor (Dr. Barbara Phillips) at a meeting of the American Lung Association of the Central Coast - November 2004:
"Not Every Patient Needs to Go to the Sleep Lab"
http://www.alaccoast.org/pdf/Phillips_0830.pdf

[carbonman]

jeff ps- @ carbonman: Sorry for the nicey-nice!

Don't be sorry ...it's who you are.
Don't every change....unless you want to.

It's all fun and games, 'til someone releases the flying monkeys.

[GaryG]

It's all fun and games, 'til someone releases the flying monkeys.

You mean like this?

Still having fun tho.

[jnk]

. . . It's all fun and games, 'til someone releases the flying monkeys.

Come on. Take it easy.

http://www.youtube.com/watch?v=rJbjJetU_1k

[Autopapdude]

I read alot about "taking control of your own therapy" and I would just like to comment about one aspect of this. Changing pressures on your CPAP or BiPAP equates to changing the prescription. Not even an RT is allowed to do this, only the physician. This includes setting the auto range as well. Would you change your blood pressure dosage, etc.? This is a dangerous area and I see many giving advise about pressures. Please verify with your physician before changing any pressures.

A prescription obtained during a sleep study is precisely that---one event in time. Given that Autopaps can provide a range of adjustment, and software can monitor the changes that these Autopaps register, it is quite feasible for an OSA patient to do a self-titration that is equal to or superior to that done on one 8 hour split session sleep study. After all, that involves 4 hours of diagnostic work to ascertain the level of sleep disturbance, and then 4 hours to find a pressure that will rectify that ON THAT GIVEN NIGHT. Most of us who have experience have data ranging for months or years of self-study (mot just ONE night). We have read articles, discussed topics, and used our follow-ups with physicians so as to fine tune our therapy. The Apap makes this possible, as the adjustable settings give a "safety net" so as to up the pressure so as to control events. It isn't an analog to blood pressure medicine--if we need increased pressure, Apaps have pressure settings up to 20CMH20. That should cover most people's safe zone (from 3-20CM) to enable fine tuning.

What is seeming irrelevant is the DME--you folks aren't giving us the help we need. You throw a low priced machine at us, with no choice. You give us a basic mask and a 10 minute fitting session (been there, done that 11 years ago). Then, when we need assistance, you're not available, or you don't return phone calls. Who does the better job of therapy management? The educated, informed patient, or the "brick and mortar" DME, who sells a M series for $2000, so as to get insurance reimbursement--and concurrently, driving up our insurance premiums with insane billings.

[carbonman]

. . . It's all fun and games, 'til someone releases the flying monkeys.

Come on. Take it easy.

http://www.youtube.com/watch?v=rJbjJetU_1k

OH, yea, The White Album ......I was at the front desk of life.... check'n out.

....would be checked out for the next few years.

You must have been the desk clerk.

Too COOL! .....don't you ever change.....you know me too well.

[roster]

I read alot about "taking control of your own therapy" and I would just like to comment about one aspect of this. Changing pressures on your CPAP or BiPAP equates to changing the prescription. Not even an RT is allowed to do this, only the physician. This includes setting the auto range as well. Would you change your blood pressure dosage, etc.? This is a dangerous area and I see many giving advise about pressures. Please verify with your physician before changing any pressures.

lee jbgt, That is nonsense.

My doctor also disagrees with you:

I referred a friend who has been on CPAP for a few years and is feeling poorly to my sleep doctor.

..........................

Then the doc said, "Before you leave, I want you to know that the study my sleep lab does for you will not be nearly as accurate as what Rooster does with his software (Encore Pro)."

Aha! This is what I have been saying. One quick night in the strange environment of a sleep lab with things glued and taped on your body and people watching you remotely with infrared cameras and listening to you with microphones and you will not sleep the same way you do at home.

I was glad to see my doctor admit what you guys taught me. If you want a good therapy you better get the software, get educated, and take charge of your own therapy.

...................

viewtopic.php?f=1&t=44379&p=396091#p396091

[old64mb]

Back to the original topic, I can actually confirm the opposite - Wellpoint now requires pre-approval for APAP. Absolutely stupid.

[rested gal]

As long as the cpap manufacturers make simple CPAP machines that are cheaper than autopaps for the DMEs to purchase, I seriously, seriously doubt that most DMEs will start giving out autopaps as first machines to the masses. Some will. But not the majority, imho.

"DME's Moving Toward Auto-Titration Machines For All??"
Some are. But not most DMEs. Not by a long shot. Just my opinion.

[GumbyCT]

Back to the original topic, I can actually confirm the opposite - Wellpoint now requires pre-approval for APAP. Absolutely stupid.

They get approval to make sure they will be paid even for cpap. It's ALL about the money, period.

[Slinky]

Its always struck my funny bone that one can only get an xPAP on order of a physician - and yet it is the sleep doctor who knows the LEAST about the xPAPs and their optional features and capabilities!!!! How basswards ackwards is that?

[old64mb]

Back to the original topic, I can actually confirm the opposite - Wellpoint now requires pre-approval for APAP. Absolutely stupid.

They get approval to make sure they will be paid even for cpap. It's ALL about the money, period.

Yes and no. Even the DMEs were puzzled over this one, since it requires intolerance at pressures over 10 cm and "mask counseling," which ultimately is going to be more expensive to the insurer than simply dispensing an APAP.

About the only way this would work is if there are two different reimbursement rates for CPAP versus APAP, and I don't see that happening any time soon. More that this particular insurance company doesn't understand sleep medicine economics, me thinks.