cpap pressure setting

It is perfectly legal for you to buy the software in every state.

1. I was perfectly serious, the wink was over the politeness issue

2. Its absolutely true that DMEs are misleading if not downright lying.
Mine continues to tell me that he has given me the "exact machine and mask that my doctor ordered" And thats a lie. My doctor ordered "the machine and mask that best suited the patient", no particular machine or mask indicated. And the dme did not try several masks on me or several machines. Just had a machine on the table and told me he only had 1 mask that would fit me. Since then out of pocket I have gotten 2 more that fit me better. I keep reminding him of this and he backs down pretty quickly. Doesn't offer anything else, but at least fesses up to his deception.

Regarding a patient changing his/her own pressure without first getting permission from the doctor:

The first Guest wrote:

In almost any state, doing that without doctors orders is considered illegal

I understand that a doctor's order (a prescription) is required, in most cases, in order to legally purchase a machine. I also understand that most DMEs, RTs, etc. will refuse (and rightly so) to initially set - or later change - the pressure settings on a patient's machine unless the doctor has written orders for the initial pressure setting or the later pressure changes.

But, I'm a bit confused about this: Are you saying that it is actually on the lawbooks in some states that it is illegal for a patient to change the pressure settings on his own machine without first getting an order from the doctor permitting him to make a change in pressure?

I'm not asking if you think it's wise for a patient to do that without the doctor's "go-ahead". Nor am I talking about insurance companies wiggling out from under covering a patient who makes changes to his/her own treatment.

It's certainly better for the patient to consult with a good doctor before making any treatment changes. What I'm asking is only about the legality (not the "advisability"... only the "legality") of a patient making pressure changes to a machine he or she bought with a legal prescription.

In other words, are you saying there are actually laws in some states that specifically say there must be a physician's order before pressure changes can be made by anyone (the patient, for example) on a lawfully prescribed and purchased cpap machine...or...

Are you talking about existing laws that there must be a physician's order to purchase a CPAP machine in the first place..a prescription for the machine itself and for its initial pressure setting.

I realize that the initial pressure setting is part and parcel of the original Rx for the machine. To me, though, patients later choosing to change pressures on their own machines (whether that's a good idea for some patients to do, or not) is akin to patients on medications deciding on their own to:

A. cut back on their prescribed meds
B. increase their prescribed meds
C. take them on a different schedule than prescribed
etc.

Not wise in general for people to do without consulting their doctors first. But ... "illegal"?

What about other treatments/medicines prescribed by physicians? For example tablets for high blood pressure. If the prescription says two tablets a day, and the patient takes occasionally three tablets a day (just he/she feels so, by own decision) would the consequences be the same (insurance etc)? I think the difference is only SmartCard. Your pressure can be controlled by SmartCard, the number of tablets can not (yet). But legally the two cases are the same (imho).
Sandor

Quick List of Complications associated with giving yourself the wrong pressure:

CPAP is a prescription, and it I KNOW IT SEEMS REDICIULOUS, but there are truly complications and bad side effects to giving yourself the wrong pressure.

Too low of pressure: Apnea, hypopnea, feelings of suffocation, ripping the mask off at night and decreasing your overall changes of adjusting to the machine.

Too high of pressure: [ Your apnea will not be regulated correctly and this can also cause apnea, because the extra air will either escape out of your mouth, causing leak and leading to apnea, or will go into your stomach and cause the most uncomfortable stomach bloating you can imagine. Yu will not get therapeutic benefit if your pressure is too high, your symptoms will not improve and you will not be sleeping well, if your pressure is too high. If you have other conditions: CHF, emphysema, GERD (reflux) or other conditions, having too high of a pressure can complicate these conditions.

Please do not take this lightly, CPAP is pressure, not just air, and putting too much pressure inside of your body can and has been harmful. Would you take more medications than your doctor told you take without calling them - most people wouldn't.

Sorry for the lecture, I just don't want anyone to do something that can harmthemselves because they don't really undestand the possible problems. Be persistent with discussing the improvement or lack of improvement with your doctor, and find out your options through them.

Thanks for listening!
Joyce

Joyce, your cautions are good ones. Thanks for posting them. Consulting with a good doctor who (presumably) knows the person's entire health history is, indeed, the best course to follow....usually.

I'd still like to hear about the legality thing from the Guest.

neversleeps wrote:

Anonymous wrote:It really isn't a joke, we've had several patients increase their pressures themselves, only to forget about it when the DME or sleep docs come to download it. The doc sees that the pressure isn't what he ordered it at and then has his billers/insurance folks deal with telling your insurance co... ...and they deny your claims, stating that you could have caused damage by messing with your pressures while on CPAP, etc. The ins. companies have a hayday with cases like this!

You wrote, "...we've had several patients increase their pressures themselves..."
Question: Who is this 'we' to whom you are referring?

STILL AWAITING A REPLY... APPARENTLY 'ANONYMOUS' PREFERS TO REMAIN ANONYMOUS. Gee, I'm shocked....

rested gal wrote:Regarding a patient changing his/her own pressure without first getting permission from the doctor:

The first Guest wrote:

In almost any state, doing that without doctors orders is considered illegal

I understand that a doctor's order (a prescription) is required, in most cases, in order to legally purchase a machine. I also understand that most DMEs, RTs, etc. will refuse (and rightly so) to initially set - or later change - the pressure settings on a patient's machine unless the doctor has written orders for the initial pressure setting or the later pressure changes.

But, I'm a bit confused about this: Are you saying that it is actually on the lawbooks in some states that it is illegal for a patient to change the pressure settings on his own machine without first getting an order from the doctor permitting him to make a change in pressure?

I'm not asking if you think it's wise for a patient to do that without the doctor's "go-ahead". Nor am I talking about insurance companies wiggling out from under covering a patient who makes changes to his/her own treatment.

It's certainly better for the patient to consult with a good doctor before making any treatment changes. What I'm asking is only about the legality (not the "advisability"... only the "legality") of a patient making pressure changes to a machine he or she bought with a legal prescription.

In other words, are you saying there are actually laws in some states that specifically say there must be a physician's order before pressure changes can be made by anyone (the patient, for example) on a lawfully prescribed and purchased cpap machine...or...

Are you talking about existing laws that there must be a physician's order to purchase a CPAP machine in the first place..a prescription for the machine itself and for its initial pressure setting.

I realize that the initial pressure setting is part and parcel of the original Rx for the machine. To me, though, patients later choosing to change pressures on their own machines (whether that's a good idea for some patients to do, or not) is akin to patients on medications deciding on their own to:

A. cut back on their prescribed meds
B. increase their prescribed meds
C. take them on a different schedule than prescribed
etc.

Not wise in general for people to do without consulting their doctors first. But ... "illegal"?

STILL AWAITING A REPLY FROM 'GUEST', (who is clearly not a doctor, lawyer or DME, because they would all immediately know the answer to the question rested gal asked).

rested gal wrote:

The doc sees that the pressure isn't what he ordered it at and then has his billers/insurance folks deal with telling your insurance co. that you aren't following doctors orders

Is that a scenario you have first hand knowledge that a doctor actually did to a patient who changed his/her own pressure without asking for permission?

Or is that simply what you think some doctor might do? If any doctor really did do such a thing rather than discuss it with his patient, it would be a terribly unfeeling, uncaring, egotistical doctor, imho.

STILL AWAITING A REPLY FROM 'GUEST'. While waiting for Guest's reply, I spoke with: my sleep doc, my internist, my sister (nurse at major Minneapolis hospital) who spoke with 3 more doctors regarding this comment by 'GUEST'. Their combined responses were:
1) "You've got to be kidding."
2) "I have never done anything like that, I don't know of any doctor who has ever done that, and I don't know of any doctor who ever WOULD do that.
3) "That's ludicrous."
and lastly,
4) "You really think a doc tells the billing department to contact the insurance company to tell them a patient isn't 'following doctor's orders'? That's a good one!"

Ok, ok, ok, ok, lots of good questions.

1) RT's, RN's, CNA's, PT, etc etc etc are only allowed to follow a doctor's prescription. They can only do what a doctor tells them to do (via prescription). Their lisence only allows them to practice under a doctors order. This year an RT in my area was fired to giving advise to a CPAP patient that went beyond the scope of his license, now he has a mark on his license and has to face a board of judges that will determine if it's ok forhim to keep his license. Mind you he paid x dollars for his education and spent x years obtain his degree and x years in his profession. And now it can be taken away. So, that's one reason we make such a big deal about it.

2) I don't know of any cases where a patient has changed his pressure and the insurance has denied it as a result. However, the the manufacture's guide does state "Your warranty is voice if you "tamper" with your device" and usually the financial agreement you sign with the DME company states the agreement is void if you tamper with your device. In other words, there aren't laws like there are for RT's and RN's, but there are lots of good reasons not to do it
.
On an unrelated note, there have been cases where patient's have tried to sue DME companies because of harm that came to them from a medical device called an apnea monitor (for infants). In some case when they downloaded the informatin from the device it has shown at times it was the fault of the family/patient for tampering with or not using the device correctly. I've never heard of a CPAP case like this, but other devices it has happened. Most xPAP do record these days and it would show if a pressure change was made.

I'm glad there are not laws preventing people from doing what they want. I'm actually a firm believer in allowing people to do what they want (wear a seat belt or don't). But I think you should always do your research before you make a decision so that there is no harm that comes from lack of education.

thanks for listening,
Joyce

Sorry it took me so long to get back to your questions. I've been at work all day and hadn't been able to get back to check this yet. I figured that I might get some rises out of people for writing that comment. I first want to say that I love my job and I love the new people that I meet when they come in for a setup. Helping people is my passion! I was not trying to be rude, as some of you may have taken it. I am simply trying to raise the awareness that although you may feel like the doctor is wasting your time or not responding quickly enough to your needs, s/he is simply trying to make the best decisions regarding yours and many, many other patients health. Don't get me wrong, I don't always agree with their decisions or like the week that it takes for them to respond to one of my patient's questions, but I have to remember that most of them are looking out for their patient's best interest.

I am not a doctor, but am an RT working for a DME and my job is specializing in CPAP/Bipap setups and mask fittings. To reference the question about a specific law...Indiana has such a law that pertains to patients changing their parameters without orders or without direction from a state licensed respiratory therapist. Secondly, I do know of a doctor who had his billing person call the insurance company and let them know that the patient wasn't being compliant with his ordered settings. The doctor's have to cover their butt when things like this happen. In this day and age, lawsuits are always happening. When people don't do their research and find out the potential complications of what can seem harmless, they can make mistakes and damage their health. I understand the logistics behind wanting to take matters in your own hands when the therapy that everyone said would make you feel great doesn't, but I have also seen first hand the irreversible damage that overexpanding your lungs can do to a person. That patient's ins company was still in the rental phase and the doctor dropped him as his patient, citing non-compliance. The patient went to a different sleep doc, only to be turned away because of the lack of compliance from the previous doc. Had the patient already owned the device, that would be one thing, but he didn't. Eventually he got his primary doctor to furnish a script so that he could purchase one online.

I would hate for someone to damage their lungs so badly, that they ended up ventilator dependant and stuck in an ICU for months. All because they thought that turning up their CPAP a "little" would be okay. Most people are shaking their heads right now saying, 'A little bit won't hurt me', but everyone's body is different and everyone's airway muscles have their own compliance issues. One person who might say that 14cwp isn't very much pressure for them, might pass that along to someone who's airway is already damaged by 20 years of continued smoking. That person might turn their CPAP from 8 to 14cwp because so-and-so said that it wasn't very much pressure for them, and end up with a pneumothorax that leads to hospitalization or even death. I know that sounds far fetched, but the reality is that it could happen.

Sorry to have caused such a ruckus! Happy Sleeping![/i]

"Your warranty is voice if you "tamper" with your device"

I think they mean tamper as in take it apart. Adjusting the pressure is a normal operation. Like adjusting the 'settimg' on a toaster or washing machine.



:twis ted:

Thank you, Joyce. I so appreciate your honesty and you have cleared up a lot of misinformation! I am very curious to know what advice the RT in your area gave to a CPAP patient that was beyond the scope of his license and got him fired.

Here's what I know to be true:

1) It is not illegal to change the setting on your own cpap or apap or bipap machine. If anyone should find a law stating it is, please reference the source so we may all look it up.

2) Physicians find the idea laughable that anyone should think they tattle on patients to anyone for not following doctors orders. If anyone should know of a case where it happened, please reference the source so we may all look it up.

3) No one here is aware of any case where insurance was denied because pressure was changed by a CPAP patient.

4) It is too bad that dishonest parents tried to sue their DME company because of harm caused to their baby when they tampered with/or did not properly use the apnea monitor (commonly used for SIDS). (Why didn't the alarm sound? Did they have it hooked up correctly? Did they have it turned on? Did they forget to use it one night?)

5) The purchase agreements on many items, including toasters, T.V.s, thermostats and Cpap machines, warn that if the device is tampered with, the warranty is voided. (Tampered with does not include changing a setting.)

5) Thank goodness people are seeking the wisdom and experience of other CPAP users on this board, and are conducting self-titration studies and examining the software data results before making any adjustments to their pressure settings.

6) Since many on this board have indicated their sleep docs/DMEs don't ever check their downloads, it's a good thing we are able to do it ourselves so we can make adjustments in an informed manner and not arbitrarily.

7) Beware of scare tactics and lies used by 'Anonymous' and 'Guest'.

the machine is not designed for pressure, it is measured in volume. CFM doesn't mean that you will have a lot of pressure when you turn it up. Try this experiment, take a balloon and put it over the end of the hose, don't be scared to crank it up. Take your finget over the end of the hose, there is hardly any pressure. I think I have a valve stem that might fit the end of the hose and I have a low pressure tire gauge. So tomorrow after I get home from work I will see how much pressure my machine has. I doubt if it even comes close to 5 psi. By the way, my DR said that I needed 7 cfm on my side but 15 on my back. I have my machine set at 11-12 and since doing that, my energy level has shot thru the roof. I don't have to worry about ins. I have non. So going to the DR just to increase the machine is not an option.

Toby

The pressure on the CPAP is measured in cwp (centimeters of water pressure). To get an accurate reading, you would need a water manometer. The Indiana website for that code is http://www.in.gov/legislative/ic/title25/ar34.5

Chapter 2 has the information on who (in this state) can change ordered parameters and under who's direction. Chapter 3 has the possible charge of a Class B Misdemenor.

I'm REALLY not trying to judge here. Heck, I would probably do the same thing myself if I needed to. I just know that people who are informed and educated about all aspects of their care are better patients.