cpap pressure setting

some of us who have cpap except this and don't want to go back to the doctor to be charged for turning up the pressure some!!! we just want to go about our lives and live!! we promise not to adjust to blow our brains out lmao

Self protectionism and professional pettiness coupled with self importance and factual ignorance tend to rain supreme in the medical arena. Like others have said, adjusting settings is not tampering with the device under any circumstances; settings are adjustable by design. The laws seem to protect the end user from self proclaimed “experts” making unnecessary and improper adjustments; nothing concerning the end user themselves. I can just imagine the statements made by that RT whose license is in jeopardy; could it have been stuff like: “this PAP machine could blow up your lungs if mistreated”? I am surprised that a DME has not been sued for not passing on the complete instruction set for a PAP machine; likewise, I suspect that we will see a class action settlement or federal ruling that mandates full instructional disclosure in the near future.

How can a consumer make a reasonable inspection of their prescribed PAP setting if they cannot access the menu that displays their pressure setting (S8 Compact)? How do I know if the DME bimbo pushed the right buttons during setup? It’s like getting your pills without a label and the pharmacist stating “trust me; you can’t be trusted with the knowledge of what’s inside”. If I am not mistaken the FDA and FTC have very specific rules and laws that are likely being violated by manufacturers requesting setup documentation being pulled before dispensing PAPs. Why are advertised non therapeutic comfort and connivance features controls hidden away on these hidden clinic menus?

As a point of interest, about 70 cm H2O = 1 psi, and I can blow more than 1 psi into a pressure gauge; infant monitors register up to 100 cmH2O. If changing your pressures is illegal, does that mean all the APAPs are outlaw robots lurking in the shadows just waiting to accost the unsuspecting? Maybe that’s the real reason the Drs. don’t like the APAPs; they ARE looking out for our best interest and not just trying to put their kids through college on our dollar. The internet lists numerous studies that compare different methods of setting PAP pressure; sleep study titration, neck size algorithm, and BMI based arbitrary pressures, and as I understand most conclude there was no significant difference in outcome. Also, there are many studies that show that most overnight studies are not necessary and not worth the cost, inconvenience, and delays in treatment when APAP and oximetry can be deployed at home. Just use Google, Yahoo, or the search engine of your choice to educate yourself. And while you’re at it, note that there does not seem to be any real standard accepted for a titration endpoint; it is a lab dependant assessment.

The facts seem to me that the manufactures are catering to the DMEs and Drs. to keep them necessary for trivial functions and associated charges. Of course the DMEs deserve such ridiculous profits from their PAP sales because of all those secret code setting changes that they provide during the PAP’s lifetime. How else could they justify their pricing policies without using the word gouge?

If you really want to rattle their cages, just organize a complaint filing campaign with the FDA and FTC concerning the manufacturer’s improper handling of instructions. Include hidden control of function and performance of advertised features and the inability to verify and calibrate or adjust settings. Also, the fact that you are usually tied to the specific DME of purchase for these “services” likely infringes on your right to chose and is a captivating factor for future supply purchases. In any case, the current manner of sales and distribution of PAPs is not in the consumer’s best interest, nor in the least reasonable restrictive manner. Dr, sleep lab, and DME relationships seem areas of high suspicion for unethical behavior and market manipulation.

If your Dr reports to your insurance company and tells on you, just plead ignorance and blame the DME; you didn’t have any instructions on how that pressure change could even be done, could it have happened by accident when you picked the machine up? Then contact the local medical board and file a complaint against your Dr for defamation and violations against medical ethics; check with your lawyer, you both can likely collect on this deal. And I have never heard of an insurance company denying a medical condition based on a persons poor judgment. If this was common then everyone told to loose weight or quit smoking by their Dr would loose their coverage for any condition that could be associated with these activities. Likewise, the concept that doing something illegal that contributes to your medical condition would give the insurance companies an out for providing coverage is silly, just think of all the auto accident injuries that would not be covered by insurance because a person broke a traffic law.

Remember, information is only as reliable as the source; including this! Even well meaning statements made in ignorance are still made in ignorance. I am not claiming to be an expert, nor do I claim to play one in real life or on the internet. And every profession has its bottom tier of performers; unfortunately, neurology seems to have sleep medicine for a large number of those who just scraped through school but managed to pass the boards. It appears that the gems in this field are few and far between; many seem to be in the field to simply collect the green.

Saw this two posts up...

kevin4gal@aol.com
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Talk about an identity crisis!

That happens when an AOL user doesn't log in......or posts as a guest.

Den

neversleeps wrote:

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).

i am a sleep tech and we have a dme site here and i set pt's up with machines and it is against the law for you to mess with the machines nuff said?

I have read alot about it being illegal to change pressure settings on cpap. I have not yet seen the actual law in writing. As some of you may know, I have done all of this cpap stuff on my own since day one. My insurance would not cover a sleep study. The sleep doctor that I saw only once was kind enough to fax a prescription to cpap.com. The original settings on my apap were 5-10. After a year, I have settled on 10-14 to keep my ahi under 5. I adjusted my pressure alot until I found what was best for me. The next person that tells me that I cannot change my pressure can come to my house and raise my teenagers because I will be in my bedroom napping.

t e wrote:i am a sleep tech and we have a dme site here and i set pt's up with machines and it is against the law for you to mess with the machines nuff said?

Eleena wrote:I have read alot about it being illegal to change pressure settings on cpap. I have not yet seen the actual law in writing. As some of you may know, I have done all of this cpap stuff on my own since day one. My insurance would not cover a sleep study. The sleep doctor that I saw only once was kind enough to fax a prescription to cpap.com. The original settings on my apap were 5-10. After a year, I have settled on 10-14 to keep my ahi under 5. I adjusted my pressure alot until I found what was best for me. The next person that tells me that I cannot change my pressure can come to my house and raise my teenagers because I will be in my bedroom napping.

Well put, Eleena.
These morons have been showing up here for over three years claiming "it's against the law" to change settings on our machines. Oddly, though, NONE of them has been able to specify any "law" to that effect. THEY are not able to set pressures on the machines without a doctors order, but when it comes to what WE do with our own machines.......that's up to our own discretion.

Den

Wulfman wrote:THEY are not able to set pressures on the machines without a doctors order, but when it comes to what WE do with our own machines.......that's up to our own discretion.

Right. "They" are constrained by their own states' license laws applying to their particular profession.

"We", the actual cpap users, are not hindered legally (haven't yet seen any of "them" produce a link to a law in any state saying otherwise) from changing our own machine settings if we choose to do so.

Guest wrote:Just so you know....you should really contact your doctor before doing that. In almost any state, doing that without doctors orders is considered illegal and your insurance company can deny all claims regarding treatment of OSA and any complications/symptoms that you have that are anywhere near that in relation. Just an FYI

Dear guest,

If we had to wait to rely on a doctor or dme, we'd be in worse condition or would have just given up a whole lot sooner. If the doctor wants us to see them regarding pressure changes or abnormal readings or whatever, let them treat us like we exist after we leave the sleep lab. They should be educating everyone diagnosed and following up with doctor appt after one month, 3 months, and 6 or 8 months.

They think we are like dumb sheep and can't figure out our treatment isn't working and that we are getting frustrated with all their secrecy. We need to know what is going on with our bodies and how to take part in our treatment now, not a year from diagnosis. I for one, am fed up with lack of support and education before treatment starts and right after and for the year between next sleep study. They should be ashamed at how they treat us. No wonder so many people don't bother with treatment.

This site is the only place I know where I can expect others to understand and to let me know what has worked for them. No one has told me what to do. Any suggestions are only that, suggestions. We understand they are not medical professionals and if we decided to change anything, it is done at our own risk. The site does Not promote giving medical advice and we are just sharing what we learn as fellow cpapers.

The reason support groups work is that everyone knows where the other is coming from and understands their frustrations and have an attitude of encouragement and support for each other. Most (not all) medical professionals don't live with the condition so don't really understand the need for education, support, and wanting the best for each other.

I can understand if you are a naive medical person and are genuinely concerned and therefore post your warnings. If you really want to help, try this. Work on getting more education and ongoing support for the full first year for diagnosed persons and educate the medical profession on the need to treat their clients/patients as responsible adults who want the best health for themselves and are willing to invest everything into taking care of their health. If they make mistakes, maybe it's because the ones who should have educated them beforehand and invested a 3-4 doctor followups in the first year, just didn't thhink it was necessary. They are failing in their responsibilities.


I don't like to be so blunt but I am so fed up and if it weren't for this site, I would have given up before the first month was up.


I hope you never have to experience what we do in order to understand our frustrations.


Please try to understand the real need here. It is for the medical profession to wake up! Treat us like we matter.


Anne

I VERY QUICKLY learned that I had to take control of my husbands treatment and with the tremendous help of this forum I'm learning every day. When we got our APAP(thanks to you all) we went to see our sleep dr(first visit) who read the sleep study report with titrated pressure of 13, so he arbitrarily picked a setting off the top of his head of 8-18(5 below and 5 above), ramp at 5 with no rhyme or reason. Mike was struggling at this setting and I began to educate myself here. We saw dr yesterday for a followup and I boldly(and fearfully) told him that I had learned to change the settings to 10-15,ramp 8, with AHI between 4.7 &2.4. We just found a memory foam pillow and that seemed to lower the AHI the last few nights with less leakage. The pressure has raised to 14 (it was between 10.7 & 11.4)and I'll be asking you about changing the settings after a few more nights. Anyway getting back to the Dr, he looked at me, smiled, and said "good work". So we found another friend in the medical community to help us on this journey along with the "pros" here. Thank you.

does anyone know how to change a devilbiss model 9001d thanks

Here is a link that may be useful for those with a Respironics machine:

http://www.wikihow.com/Adjust-Pressure- ... AP-Machine

My pressure was at 6.0, but it feels too low, so I adjusted it conservatively to 6.2.

What I recommend that anyone do, adjust it, then put it on and breath. If you feel the pressure is filling your lungs too much, too strongly, lower i; test again.

There is a danger with increasing the pressure on one of these machines; essentially, it can cause a reaction (I forget the medical term) where you actually stop breathing while your lungs continue to get air forced into them. So, beware.

In the directions above (from the URL) it doesn't account fully for the S8 (which I have). There are two settings that contain the CPAP pressure - it's not clear to me what those are, so I set them both to be the same (as they already were before)... in my case from 6.0 to 6.2.

Also, the pressure will be different based on the brand/type of mask you have, length of tubing, etc. There are settings for those, too.

Thanks Forestgump. I've been looking for the procedure to allow access to setup my backup RemStar Auto Bi-PAP.

How do you adjust the pressure on the Puritan Bennett Sandman Intro?

Thanks for your help