Is changing cpap/bipap pressure yourself illegal?

[sleepapnea123]

Hi Guys,

Another newbie question from me. Is changing cpap/bippap pressure setting's yourself illegal? Do we need a Doctor's prescription in order to change pressure? Will it affect insurance compliance if I change my pressure myself?

The reason I am asking is In my last visit to the doctor, he recommended increasing my bipap pressure IPAP from 19 to 20. Since then my AHI which usually was around 5-8 jumped to around 14-15 range and I am felling pretty fatigued. I called them up to revert the pressure back to 19 and they said I have to come in for an appointment. The earliest they can set me up with one is 2 weeks later. They wont change the pressure over the phone. Does this mean I HAVE to wait till the appointment? Or can I simply change the pressure back to 19 so I am at least in a comfortable range, without affecting any Insurance rules/compliance?

[Wulfman...]

Hi Guys,

Another newbie question from me. Is changing cpap/bippap pressure setting's yourself illegal? NO Do we need a Doctor's prescription in order to change pressure? NO Will it affect insurance compliance if I change my pressure myself? NO

The reason I am asking is In my last visit to the doctor, he recommended increasing my bipap pressure IPAP from 19 to 20. Since then my AHI which usually was around 5-8 jumped to around 14-15 range and I am felling pretty fatigued. I called them up to revert the pressure back to 19 and they said I have to come in for an appointment. The earliest they can set me up with one is 2 weeks later. They wont change the pressure over the phone. Does this mean I HAVE to wait till the appointment? NO Or can I simply change the pressure back to 19 so I am at least in a comfortable range, without affecting any Insurance rules/compliance? YES

It's YOUR machine, it's YOUR therapy and YOU are the one who is sleeping with it every night.

Den

.

[Pugsy]

Your insurance company only cares about how many hours you use the machine each night for whatever period of time they care about. They are unlikely to even know what pressure you were using.

There are no cpap police that will come to your house in the middle of the night if you change the pressure yourself.
DMEs cannot change the pressure unless told to by a doctor because they are bound by some medical rules and regulations.

No one has ever shown where it is against the law for a patient to change his own pressure...especially when the doctor wants it done.

I would be concerned about that AHI though...what's the event category breakdown..with the prior pressure and the new too high pressure?

[sleepapnea123]

Thank you wulfman and Pugsy!! Thats a huge relief as I was dreading sleeping with the current pressure for 2 more weeks.

Pugsy, I know my AHI's are still not totally under control. I have been meaning to post my charts for some time now. I will have access to my SD card later today, so will upload my charts so you guys can have a look and help me out further.

[sleepapnea123]

Your insurance company only cares about how many hours you use the machine each night for whatever period of time they care about. They are unlikely to even know what pressure you were using.

There are no cpap police that will come to your house in the middle of the night if you change the pressure yourself.
DMEs cannot change the pressure unless told to by a doctor because they are bound by some medical rules and regulations.

No one has ever shown where it is against the law for a patient to change his own pressure...especially when the doctor wants it done.

I would be concerned about that AHI though...what's the event category breakdown..with the prior pressure and the new too high pressure?

Hi Pugsy,

I am attaching sleepyhead graphs, one for a typical night on Pressure 19 and one for pressure 20. Please let me know if more information is needed. I was thinking maybe instead of a flat bipap pressure I needed a range? Your help is really appreciated!!

[Pugsy]

Wow, some ugly reports.
I see at least one break in therapy on both reports...so at least one time where you turned the machine off and then back on again.
How many times do you normally remember waking up? Do you spend a lot of time laying in bed with the machine and mask on?

Finally...did you have any centrals in either your diagnostic sleep study and/or titration?

[SleepingUgly]

If you are arrested for changing your pressure, just invoke your 5th Amendment rights! Also, when you hear the police banging on your door, flush your Clinician's Manual!

OK, just a little levity. Seriously, depending on who your doctor is, you could alienate them and they might not want to work with you, whereas other doctors won't care a bit.

[sleepapnea123]

Wow, some ugly reports.
I see at least one break in therapy on both reports...so at least one time where you turned the machine off and then back on again.
How many times do you normally remember waking up? Do you spend a lot of time laying in bed with the machine and mask on?

Finally...did you have any centrals in either your diagnostic sleep study and/or titration?

I remember waking up atleast once each night, either for a restroom break or to clean/adjust mask.

I do spend around 15 minutes each night with Mask/Machine on to acclimatize while I watch tv or read.

In my titrations there were only one or two isolated centrals showing up, but nothing this consistent.

[sleepapnea123]

If you are arrested for changing your pressure, just invoke your 5th Amendment rights! Also, when you hear the police banging on your door, flush your Clinician's Manual!

OK, just a little levity. Seriously, depending on who your doctor is, you could alienate them and they might not want to work with you, whereas other doctors won't care a bit.

Humor is always needed. Yup I understand your point about alienating the docs, but recently I keep getting the feeling they are really only interested in scheduling as many appointments as possible.

[SleepyToo2]

Seeing reports like yours should actually make your sleep doc very happy. A good reason to have you back in for another sleep study, and help pay for his kids to go to college, or for his new car. (Pleased to see you had already worked that out in the time it took to write my post!) Seriously, start by investigating the leaks. Do you have the right mask fitted properly. Are you adjusting the mask at the bottom of the ramp and then falling asleep, or are you adjusting it at the maximum operating pressure? The maximum pressure will find leaks that you never knew existed at the bottom of the ramp.

Good luck.

[Pugsy]

Well I am pretty sure that the Thurs the 21st ugly stuff at around 4:50 is likely awake clear airway events being flagged...that cluster is too soon after your turning the machine back on for you to be likely asleep. The other cluster of CAs close to getting up time likely are also probably awake stuff but you have so much stuff going all over the place that it is hard to put all the blame on awake event scoring...so I don't know how much might be real and worrisome.

So...hm...what to do. Is your doctor okay with your playing around with things? Are you okay with playing around with things?
I don't want to create additional stress here for you.

Man, I don't know where to start with this one....Play darts and fix a chart and throw a dart and try something?
I assume that these are pretty typical nights for you and you aren't hiding some nice normal nights but instead chose to offer the work of the aliens at your house.

So here's what we see on these two nights...too many obstructive apneas and in straight bilevel mode we are told about flow limitations which would kinda be nice to see in this situation.
I am going to come up with an idea or two but bear with me...Right now I am going to treat the centrals as if they aren't the real deal centrals in the sense that you would be needing a different bilevel machine. For right now let's pretend those clear airway events are sleep stage transition or Sleep Wake Junk (SWJ) or just plain ordinary awake centrals getting flagged while awake.. In the back of my mind I know they might be the real deal but if you had these numbers during the titration study a big red flag should have gone up and there would be more than a slight mention. So I know what they might be but maybe they are just arousal centrals due to excessive obstructive apneas causing arousals and along with the arousal we get to have more sleep onset chances and thus more chances for sleep onset centrals...follow my misguided logic???or have I confused you.

So for right now I would think we need to try to fix what we can fix with this machine and hope by fixing those OAs we reduce the arousals and maybe arousal centrals.

General rule of thumb for bilevel machines....EPAP for obstructive apneas and IPap for hyponeas.

How about an experiment and concentrate on EPAP and yes, change to auto mode but we won't give it a wide range.
14 EPAP is not sufficient to hold the airway open and prevent the collapse of the airway...that's why so many OAs.
I propose change to auto mode...15.5 EPAP and PS of 4..with max IPAP being 20. Let's see if the machine wants to go up or stay low instead of forcing IPAP up automatically in straight bilevel mode.. It's a modest adjustment mainly to see if the machine is even going to want to raise IPAP very much. The machine won't respond to centrals anyway...any response is going to be related to the normal precursors to events....snores and flow limitations. This is just a test...test to give us an idea what the machine would do if it could do its auto adjusting thing. You likely will need even more EPAP but lets start slow and low just in case we get lucky and besides...its easier to get used to.

I am hoping that with better effective EPAP the obstructives won't become full blown events and as such maybe trigger an arousal and the arousal triggers the sleep onset or sleep stage transition central. So hoping to reduce the centrals by reducing the arousals (all the while hoping the centrals are associated with arousals) ...it pure speculation on my part but it is painfully obvious that this way now is not working.

So try to fix what we see needs fixing and pray the other stuff disappears or is reduced if we can fix the easy stuff.
Do you follow my weird logic here? I have no idea if it will work but I can't see any reason not to try if you are up for it.
It's not really all that different from the existing settings anyway. Just a little tweaking and fine tuning and let the machine do its job so we can see what it wants to do.

So If it were me...auto mode.. EPAP minim 15 or 15.5....PS of 4 and maxi IPAP at 20. When you start off the night you will see EPAP 15 and IPAP of 17 depending on which EPAP you choose...because while awake the default PS is 2 cm but once you go to sleep the machine will start evaluating the comings and goings of the snores and flow limitations to try to figure out what it wants to do...let's see what it wants to do. The highest the pressure would go would be that max IPAP of 20 and EPAP will only be able to come up a little because we are using a tight range.

Up to you if you feel like trying it on your own.

[sleepapnea123]

Thanks Pugsy!!

I am definitely up for trying different things. I will try with Epap 15, Ipap Max 20 and Ps of 4 tonight and keep you updated on how it went. I sort of get the logic of what you said . Good night for now.

[sleepapnea123]

Hi Pugsy,

I tried out the settings last night and had a decent night. My AHI was around 9.1 with very few centrals. Just a quick note, In the setup menu, when I went to set PS support as 4, it had two options Min PS and Max PS, I set both to 4, but am not sure if that's what you meant. EPAP was 15, and Max Ipap was 20.

[Pugsy]

Well at least the clear airway (central) events decreased.
I forgot your PS has a minimum and maximum. That's new to the 60 series.
Interested that it seems to allow the PS to stay fixed now...when you have minimum equal to maximum.
My machine doesn't offer that choice..and thus my PS will roam between 2 cm and 4 cm.....this seems to mimic ResMed's way of doing thing. Interesting. Not a problem though.

Are you sure IPAP max was set to 20?.....the graph shows reaching 25 cm...
After ramp it shows EPAP being around 18 and up and not 15 and up.
Can you confirm in your machine settings that you had 15 EPAP and max IPAP of 20?
I don't know if the machine is set differently than I expected or SleepyHead is having a little bug in the software.

Do you have EncoreBasic software? I think I would like to see that report if at all possible.

Actually...I am thrilled that the centrals essentially went away. That's a huge relief.

[ughwhatname]

If you are arrested for changing your pressure, just invoke your 5th Amendment rights! Also, when you hear the police banging on your door, flush your Clinician's Manual!

OK, just a little levity. Seriously, depending on who your doctor is, you could alienate them and they might not want to work with you, whereas other doctors won't care a bit.

Or, like my doctor, he/she could be thrilled that you are taking charge of your care, and call you a Rock Star!