apap laws in texas

I just got back from my first follow-up visit with my sleep doc.

While going over my sleep study with me, the doc pointed out that I had no mixed apneas and very few centrals which only occurred during the CPAP titration period. My AHI of 102 consisted of almost all apneas with a few hypopneas at the begining and end of of my sleep cycle and before going onto CPCP for titration. He said the centrals were likely a response of my brain getting needed air into my lungs under CPAP and that in time they would likely disappear. With a minimum oxygen desaturation of 60%, he said I was the second worst case he has ever treated.

He said I would do fine under CPAP but understood my concerns regarding the potential use for APAP (ie. occasional night of alcohol consumption, losing weight, sleeping on side vs. back, etc.) and said he had no problem for me to switch out my CPAP for the APAP.

So the tech gives me the new machine and I get it home to start learning how to set all the settings. Seems that I am not allowed to make changes other than ramping and mask type ... not even to go back and forth between APAP and CPAP. So I called the tech and she says that by law only certified clinicians may set the settings on xPAP machines. Before I make a big fuss and start burning bridges with my sleep clinic:

1) Does anyone know if there is a federal or Texas state law prohibiting users from setting their own xPAP machines? … I suspect no, but please correct me if my suspicions are incorrect.

2) If I buy the software required for the S8 Vantage, will I have access to the settings on my APAP machine without needing the clinician's password?

Thanks,

- roberto

Give me a break!
Do they also have a law preventing a diabetic from administering/adjusting their own insulin injections?

Hello Roberto,

Answers.

1) The machine must be set to a prescribing physicians order. ANYONE who can do it is allowed to do it. No need to be a "certified clinician".

2) Yes, you can use the software to get in and make any needed changes within the doctor's order.

Beware of the "tech". The information passed on to you is not true. There are certainly no Texas or Federal laws supporting the techs statement.

No need to make a fuss. Be nice. Tell them to show you the law they reference. When they can't do it, simply ask them to allow access or you will have no choice but to get a provider who will allow you access, as your treatment is being compromised. The possibility of you returning the machine will get their attention and should put them into a helpful frame of mind.

There is no law, but if there is no prescription for the adjustments then they cant be done by the tech. Thats like you going into the pharmacy and asking for a higher dosage of pills. You can change it if you find out how to do so, but he company wont due to the fact it would then be liable.

You might ask your doctor to write you a prescription for titrating your own pressure. Mine was willing to do so, after a bit of discussion, and after I showed him how I could monitor my own therapy with the EncorePro and MyEncore software (Respironics machine).

Moogy

DreamStalker wrote:2) If I buy the software required for the S8 Vantage, will I have access to the settings on my APAP machine without needing the clinician's password?

It's not necessary to buy software in order to have access to the settings on any autopap. All the clinical settings can be seen and changed by pushing buttons on top of your machine. There is no password for the clinical set up menu on the machine. Nor is there any password for the software. There is, however, a specific sequence of a couple of buttons you have to push and hold down to access the clinical menu on the machine.

If you do go into the clinical menu on the machine, I'd suggest you not change anything the first time. Just walk through the clinical menu, writing down every word, every number, every symbol you see, so that you can go back to the original settings if you change something later and don't like it.

Thanks RG. I tried but still cannot figure out how to get in there. Here are my options:

Settling (aka – Ramping on CPAP) - I can only change in increments of 5 minutes using Up/Down Arrows.

Below that I can press Menu which leads to:

Used HRS: 00000 … only options are EXIT or Down arrow

Down Arrow leads to:

Usage:0000/0000 … only options are EXIT or Up/Down Arrows

Up Arrow leads to Used HRS and Down Arrow leads to:

Mask: Swift … only options are CHANGE, EXIT, or Up/Down Arrows

CHANGE leads to selection of masks (using up/down arrows) w/ option of APPLY or CANCEL either of which leads back to Mask: “whatever mask I selected”.

Up Arrow leads to Usage and Down Arrow leads to:

SW:SX3960202 … only options are Up Arrow or EXIT (which goes back to Settling like all other EXITs).

My guess is that the last menu item is the key but I tried holding it down and various other buttons at the same time … does nothing and only choice I have is to EXIT back out.

Any help breaking into the machine settings would be appreciated.

Thanks to everyone else too for your help and input ... I will call the sleep doc tomorrow and see what he can do to convince the tech to unlock the machine so I can get access.

- roberto

Roberto-

Please DON'T hold down the down and right buttons on your S8 Vantage. That would bring up the clinical menu and remember, you're just the patient, and the PROFESSIONALS know better what's best for us than we do. So, you won't EVER need to use the down key then to navigate to the settings menu, or the left key to change or apply settings or the right key to exit.

Glad I don't have to worry about ya!

Good luck with the new S8 Vantage. Its a GREAT auto-titrating CPAP.

Chuck

There's a "secret keypress series" on all the machines. On Respironics machines it's "hold down left and right arrow while plugging power in". I don't know how to get into it on the Evil Empire (Resmed) machines. I'm sure someone here does though!

I always thought Federal law took presidence since they are an FDA approved device. But you know what they say don't mess with Texas...

I have no idea how you would enter the setup mode on your machine.

I have been lurking on this board for the past 4 weeks and saw DreamStalker's posting about accessing the Clinician Menus on the S8 Vantage.

I acquired an S8 Vantage about 3 weeks ago and tried to convince the clinician to give me the manual...he refused. I told him I would get it one way or another...and I did. After much internet searching to no available, I found one for purchase on EBAY for $5.95.

To save you the trouble of buying the manual, you can access the Clinician Menu by performing the following:

Simultaneously press and hold the RIGHT KEY AND DOWN ARROW KEY until the menu changes to "CLINICIAN MENU WELCOME".

NOTE: THE FOLLOWING MAY NOT BELONG IN THIS FORUM, BUT HOPEFULLY YOU WILL FIND IT HELPFUL:

I should point out that I really liked the machine, but convinced my DME to swap the machine out for a RemStar M Series Auto CPAP instead for the following reasons:

* While it is probably minor, the ResMed S8 Vantage owner's and clinician manuals clearly state that Auto CPAP mode is ONLY to be used with a RESMED mask. I believe this is because the unit utilizes mask leak factors in determining correct pressures. I suppose it is possible to closely match the pressure of a non-Resmed mask to that of an existing Resmed mask...but it is a nearly impossible to do an exact match. I was concerned about getting incorrect data.

* The humidifier on the RemStar M Series machine so far seems to be FAR superior to that of the Resmed S8 Vantage.

* The RemStar machine is SIGNIFICANTLY quieter than the ResMed.

* This board...as well as others seem to know a lot more about the RemStar machines...particularly when it comes to software. I, like most other on this forum, want to know everything I can about my "therapy" and its benefits. I have already purchased the RemStar software, and time will tell how it works.

The disadvantages I have noticed with the RemStar:

* You MUST have the software to obtain any daily information off the Remstar. It only provides 7 and 30 day averages on the display.

* Access to the Clinician mode is only by unplugging the machine and plugging it back in.

* In general, the "user aspects" of the ResMed are in my opinion FAR superior to the Remstar (as has been reported by other users).

* For me personally, the Resmed seems to operate at lower pressures than the RemStar...this, however, is likely a mask related issue but I have noticed that the RemStar seems to operate at the Max APAP setting more often than the ResMed.

I hope the above helps.

2Curious

Pull over GoofyUT,

Let me see your Professional license and ID. The law in Texas requires anyone removing a xpap from a box to have a minimum of 6 years of box cutter 101.
I flunked the course. That is why I am....


DME Police

I agree it is insulting and absurd not to be able for the patient to change the settings. You can purchase the clinician manual on Ebay for the resmed S8 vantage auto CPAP.

I have changed from CPAP to Auto titration many times.

Thanks Chuck. I'll try not to mess up the "professional" certified clinician's settings since they probably know what is best for my health. Nice to know you are looking out for me.

Snoredog - thanks for the picture of that funny looking ResMed face of smell no evil, see no left-eyed evil.

Curious2 - thanks for the comparison info between ResMed and RemStar.

All of you thanks and keep an eye out for that secret DME police.

- roberto

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, DME

Amazing. This group is truly amazing. I had my sleep study about 3 weeks ago. Got the data from the doc, (I asked for apap, but the doc kinda waffled around it, saying it didn't do anything. But I had read many of the posts, and halfway argued my case. and got the script for a cpap w/ c-flex and he told me to talk to the dme about the apap. So I called the insurance to make sure everything got there, and low and behold script was CPAP only. So I called dr. office again, and explained to the nurse what had happened. Basically said he told me it would be for atleast c-flex, and said to talk to the DME for apap. Well, the nurse hooked me up. The APAP script was called in (which i verified the next day) and I was on my 2 week wait for the machine. (i know, but that's what it takes with the insurance I have (hey, I can't complain. I've had Lasic, and this study for basically free)).
So today I go to pick up the machine, and how about that, the APAP is on the paperwork, but the technican was saying something about all this not being right. I told her that they called in the APAP... Long story short, I ended up with the APAP. Oh, RESMED Auto w/ CFlex. Comfort Gel mask. (which I used in the study, and it worked fine for me)

So I get home, and how about that. The APAP "feature" is disabled.

Oh well, I guess I"ll have to live with what the doc ordered.

Thanks everyone for the posts. They were very helpful.