Is it Illegal to Change Settings on One's CPAP Machine?

Alabama State Statutes Title 24, Section 22-1-8
Penalty for patient violation of changing cpap pressures law.
Any person who violates any of the changing cpap pressure laws, except those for which a pressure is prescribed, shall be guilty of a 5th degree misdemeanor.

First Offence: Three days on public display with cpap mask in stockade.
Second Offence: Public hanging by the neck with cpap hose.

(Code 1907, §7058; Code 1923, §4360; Code 1940, T. 22, §104.)

My biggest fear is that you get checked for "compliance". And "compliance" is defined as so many hours per day at your prescribed levels.

This "compliance" will be used like smoking or drinking are used as considerations for expensive medical procedures or where availability of resources are scarce such as transplants or new procedures.

I mean its quite likely that if the government became more deeply involved in medical care, they will require compliance and defer to the sleep disorder industry to determine what that is.

Its more likely the government will go the other way due to .... you guessed it! ... MONEY ..... cheaper to have us monitoring and adjusting our therapy w/input from our physicians as w/diabetics.

ChrisC wrote:

nobody wrote:The mask should have been one one of the guys in the line.

Fixed - how's this?

I love the facial expressions; the third guy from the left looks like he is sleeping and could really use a sleep study, the short chubby officer has a ***t-eating grin
on his face thinking "that Hitler what sense of humor, he really cracks me up".

It is not illegal for a patient to change his or her own rx, its just stupid. As fay as an RT changeing the rx without an order it probably is, especially in WV which has licensure for RTs. The law expressly forbids RT's from changing MD prescriptions without an RX. About teaching or showing someone how to change the Rx, well its an ethical issue, if you believe as I do that MDs are best able to judge the need to change a RX then it would be unethical foe me to show you how to do it. For some of us its a safety issue. Its not always about money

I agreee that RTs should not change a setting without a prescription because they are under a state's registration that cannot prescribe or change a prescription. But if they see something not exactly right with the prescription they have a right & duty to question the prescription.

Trusting a doctor to make the prescription decision all of the time may be suitable for those who have a great provider that is always right or someone who cant or wont take responsibility for their own health. But for those of us who have been messed up by the medical profession and have some common sense many times it may help not hurt if the consumer becomes proactive in their health.

rjjay wrote:It is not illegal for a patient to change his or her own rx, its just stupid. As fay as an RT changeing the rx without an order it probably is, especially in WV which has licensure for RTs. The law expressly forbids RT's from changing MD prescriptions without an RX. About teaching or showing someone how to change the Rx, well its an ethical issue, if you believe as I do that MDs are best able to judge the need to change a RX then it would be unethical foe me to show you how to do it. For some of us its a safety issue. Its not always about money

Under the current medical system most of what you say is really about liability and protecting both the doctor and the RT against problems down the line.

The real problem is that the current system of prescription is ineffective and even detrimental to our health. As Slinky suggested earlier in this thread, it should be more like diabetic prescriptions. Diabetics who have to take insulin have to be able to figure out on the fly exactly how much they need and when. They can't wait months or weeks or wait for someone else to give them a shot in a doctor's office when they need it at the unlikely hour of 4:00am. The 'law' needs to change.

I posit that xPAP users can't wait either. We need to be taught from the beginning exactly how to titrate. We need to all start with a data capable auto that can detect central as well as obstructive apneas. We need to all be taught how to read and interpret our own data, know what to expect and how to change our own settings. Once we know from therapeutic data feedback that we're using the machine properly - by checking our own data, we should be able to choose any future replacement machine depending on our determined needs. Not because it's the cheapest machine that a DME can provide within the parameters of the insurance provider's purchasing limits.

RT's need to have legislated something along the lines of a "good samaritan" legal defense against liability when it comes to teaching people how to read - and change - their own pressure. Sleep Doctors and sleep techs should be legislated similarly. If not, the technical aspects of self-dosing with diabetes have been figured out, why not follow that model?

A first user's machine capable of at least detecting centrals would be a good way to isolate the smaller number of people who have more complex apneas that need further sleep study. Machines that don't record much data should be relegated only to those who are already familiar with their settings and need a small, quiet machine for travel or as a backup. Dataless machines should be for advanced users - not noobies.

rjjay wrote: ......... if you believe as I do that MDs are best able to judge the need to change a RX ........

You are free to believe whatever the hell you want to, but plenty of people here know by hard experience that an educated patient with the right equipment can optimize their pressure better than a covey of MDs with sleep labs.

Your market is changing and you are falling further behind everyday. Open your eyes for your own good.

The RT at my DME called my doctor and tried to explain to him why his prescription was wrong. Gather up enough guts to do that yourself sometimes.

rjjay wrote:It is not illegal for a patient to change his or her own rx, its just stupid.

Well, I guess there's a lot of stupid people on this forum. I shudder to think where we'd be if we followed the sleep doc's recommendation to "just set the auto from 5-20 and let it find the right pressure for you". At least our Internist was honest and said he didn't know much about OSA therapy except that it makes his patients better. When we went for a 3month followup with the sleep Dr to establish compliance, and brought him some reports, he was quite impressed with hubby's numbers and the setting changes I made to a narrow range of 11-15cms with daily help from this forum. When I told him I was now thinking of changing to cpap set at 12cms, he said "great, you're doing fine".

What I will add is, I have gone online and learned how to adjust my machine.

I own a Phillips system one unit that my humidifier decided to quit. I bought a Respironics M series BIPAP, an '08 model and very noisy in my quiet bedroom. I bought the machine used for $225 including the humidifier, and they gave me a 30 day return policy. On day 2 I went back to complain about the noise. The tech looked at it, in his shop, I was present and he could find nothing wrong. I said I will try it for a couple more nights. I ended up using my old machine, no humidifier, dry throat and all. The end of the story is my supplier told me I was out $225 because they were not going to give me my money back.

So I decided to try to make my new machine work. I went online to find out how to adjust my settings. My problem with the noise is on the exhale. Also my inhale seemed much stronger than my old machine, even thought the number was the same. So I worked on the settings today and I think I can sleep tonight. Settings are much different than my old machine. My old machine is 19.0 for inhale and 15.0 for exhale. Because the noise was on exhale, I have lowered the setting to 5, near ramp start pressure. My new inhale setting is 12. BUT- i will be able to sleep. As long as 12 keeps my passage open, I am a happy camper.

Ummm I wonder if you've given the right info here... you presented your previous no's in such a way as to make me think you had an ASV machine for central (or mixed) apnea, and you apparently think the higher no. is 'the' one that does the work of intercepting apneas, but that's not the case with machines designed to treat the much more common obstructive apnea. In those cases the lower no. is the one that counts and the upper setting is often left quite high... the lower (or minimum pressure one) is not very comfortable or therapeutic at 5 and most need to bump that at least a couple of cms. Are you sure you have (either) central or obstructive apnea and that the machine you now have (vs what might have been a very diff. one) is the right one for you?

allen081644 wrote: have lowered the setting to 5, near ramp start pressure. My new inhale setting is 12. BUT- i will be able to sleep. As long as 12 keeps my passage open, I am a happy camper.

That's not how it works, it's the *LOWER* number that keeps your airway open, and a PS of 7 is very likely to hyperventilate you and lead to a bunch of centrals.

allen081644 wrote:learned how to adjust my machine

You would do well to start a new thread and let experienced members do a comprehensive review of your situation. Frankly, you appear to be fumbling around and may be using suboptimal machine settings. Get help here and get things right.

I concur. Please get your issue into your own, current thread, so you can be helped.
The experts here are awesome.

I remember from my sleep study when they were working on my titration pressures in the 7's were causing centrals to occur. Once they got past 9 they stopped completely but it took 11 to treat my apnea when I was on my side... I needed 13.5 to treat when I was on my back - more or less... That was way back when I was using CPAP only with no auto. I fought for years and years to get an auto and finally got one after the 4th doctor and going on my own for 3 years.

My current machine is set to start at 11 with no ramp and will sometimes clime as high as 19 in the middle of the night. My suspicion is when I'm in REM. Which is when my apnea was the most dangerous and my de-sats were going into the 50's with out treatment.


The lower number as others have said is the more important number. It's your foundation were you start to maintain a open airway. The second higher number is your glass ceiling if you will. You lower it or rase it depending on how much added pressure you need through out the night or from day to day. Some people like me leave it at the machine max... others have found that they have other problems if their machine goes that high so they'll lower it a little to try and reduce unwanted issues.



PS: on a side note --- I would like to see a setup were if a thread hasn't been replied to for more then 2 years it can't be replied to any more. You could create a new thread that links to the old one if people want to read through it because it contained pertinent info but you would be required to start your own current thread. Not sure how you would go about doing this but it's a thought. This would help make sure that really old threads like "The Great Pillow Exchange" that receive regular replies would always stay active but the truly dead posts that have been long forgotten couldn't be dug up by new people who sometimes post followups or "Me toos" that would be better served by starting a new dedicated post to their issue.