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

SharkBait · Post by **SharkBait** » Mon Mar 09, 2009 7:41 am

mdbarthe wrote:I think I would have asked the threatening RT, "Do you know you can be arrested for practicing law without a license? Sounds to me like you're dispensing legal advice."

That, my friend, is an absolutely AWESOME reply...

roster · Post by **roster** » Mon Mar 09, 2009 7:48 am

blogginsjoe wrote:I am a CPAP user that is still on a trial. I have trialed a Resmed Vantage 8 Machine and am no using a Remstar A flex unit. My oximetry levels have dramatically improved since being on a machine but have still not reduced my AHI numbers below 10 on a continuous basis. Also, I have not been able to use the machine throughout the entire night. I have been on a trial for about 5 weeks. I use a Swift Lt II breathing device. I have met with my DME numerous times and discussed my condition. I have completed one hospital sleep- over which became a disaster as the night progress. The person in charge of the lab was less than cooperative in the sharing of information and assisting with the visit. Although it wasn't very successful for a variety of reasons, my doctor believed, from the information gathered, that I could very well have Central Apnea. This, in my studies, didn't seem to be able to be reduced by the Resmed A10 algorithm thus the change in machines. I have an appointment this week with my Dr. to review the printouts that we have taken over the past five weeks from both machines and hopefully we will be able to come up with a solution to this on-going problem. The question I have is whether a Bi-Level machine is an option for treatment of this condition?? I have again read a variety of theories in this regard. I believe that I’m experiencing apneas that are not being preceded by snores or flow limitations and thus and are not being addressed in a rapid enough manner to prevent them from occurring. It seems that an apnea followed by another sudden or runaway apnea needs a specific treatment that doesn’t seem appropriate using a Remstar A Flex machine or a Resmed Series 8 machine that is not able to provide Bi-level therapy. Not trying to self diagnose here but need some options to take to my Dr. so we’re speaking the same language when I meet with him later this coming week. Any suggestions???? Thank to all in advance for the support!!

How about first filling out your equipment profile (you will have to become a member) and giving us some more details like pressures, mask type, etc.

Post again in a new post. This thread is not the place to seek detailed advice.

roster · Post by **roster** » Mon Mar 09, 2009 7:49 am

dsm wrote:...........

NewsFlash
"A boston man died today in a shootout with FDA agents trying to arrest him for repeatedly adjusting his cpap'
The man, a Mr Airey Breeze, failed to put down his weapon and we had to open fire said the FDA investigator.
Unfortunately the weapon turned out to be an airhose that looked like a shotgun because of how he was holding
it said the unnamed Investigator. We have to weed these trouble makers out and what happens to them is all
their own fault! he added"

DSM

Good one DSM!

In a follow-up interview Deputy DuMmie said, "What tipped us off was the bumper sticker on the car in the drive that said, "You will take my hose from me, when you pry my cold dead fingers from it."

Gale Hawkins wrote:......... In many states there are laws on the books making some acts done in our bedrooms illegal I have read but I do not think adjusting our CPAP machines is own of them.

.........

What is done in the privacy of one's bedroom, between a consenting adult and a consenting data-capable CPAP machine, should be off-limits from the long arm of the law.

sleeplessinaz wrote:Are these the same people who believe that we are not allowed to cut the tags off of our matress and pillows????? LOL!!! ............
C

You guys are on a good roll.

wrote: ........ Are there risks? ........

Speaking about my case and many others I read on internet forums, the biggest risk seems to be not changing your settings because the sleep lab so often has them wrong.

Gale Hawkins wrote:...........

CPAP machines will become an over the OTC item.

Needs to be done soon. Obama wants to save health care costs, let's start selling them at WalMart and Best Buy.

Slinky · Post by **Slinky** » Mon Mar 09, 2009 8:03 am

sleepguide wrote: ... I know it's clear cut that the machines can't be sold without a RX. ...

I wouldn't go so far as to say that xPAPs can't be sold w/o a prescription .... we can buy anything our little ole hearts desire if we are innovative enough - and usually we don't have to be any too innovative. Yep, they can't LEGALLY be sold w/o a prescription - but - they are quite often. I've purchased two w/o ever presenting a prescription. (And since I do have a script here - somewhere - its the Seller who would be in trouble, not me. But I wouldn't rat on them.

Catnapper · Post by **Catnapper** » Mon Mar 09, 2009 8:37 am

I feel free to set the temperature on my water heater, and that certainly opens the possibility of a painful scald for someone, and could be dangerous. The furnace is another air blower that I adjust for my comfort, safety and health on a regular basis.

I can drink alcohol, overeat, and sit with smokers without being arrested. All of those things can be dangerous to my health. Heaven knows I drove while I was sleepy before I started cpap and was lucky enough not to harm anyone, but was not even stopped or warned.

You should see me swim! That looks dangerous! While I eventually get where I am going, you would think I am drowning the way I splash around. Yet I am allowed to get in the water, even the deep end of the pool.

I can see that an incorrect setting on my cpap could be disastrous. My initial setting was so high I could barely tolerate it, and as a result I could have stopped treatment and died of a variety of illnesses made worse by untreated sleep apnea. The high pressure also could have caused central apneas. The setting was done by an RT based on the results of titration where they recommended adding 2 cm to what they found "just in case" I needed more pressure. All of that was "legal".

I don't advocate breaking the law, but I do think misquoting the law is wrong if not illegal, especially when done by health professionals to unsuspecting and trusting patients.

Do laws protect us from ourselves? Perhaps that is the goal.

LoQ · Post by **LoQ** » Mon Mar 09, 2009 9:01 am

Do laws protect us from ourselves? Perhaps that is the goal.

I'm still trying to find out what caused this rumor in the first place. So far, it seems to be just that RTs are telling patients it's illegal. Even the OP doesn't have any link where the practice is said to be illegal. His only reference describes a CPAP machine as an "dangerous medical device." I have asked him twice to explain how that connects to illegality in some way, but he has ignored both requests.

We may be debating a non-issue here. All we have are some RTs' assertions that practice is illegal. I can't find anything to relate that back to, and certainly no laws. Is it more than rumor?

Meanwhile, RTs might want to clean their own noses. According to their own Code of Ethics, they should avoid conduct that creates a conflict of interest. That is expanded upon here:

Conflict of interest has been defined by Thompson1 as “a set of conditions in which professional judgment concerning a primary interest (such as patient’s welfare or the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain.)”

By associating themselves with the business end of DMEs, I think lots of them are advocating more for the financial interest of the DME than the health of the patient. They won't help patients with equipment bought elsewhere, for example.

Under no circumstances should any respiratory care practitioner engage in any activity which compromises the motive for the provision of any therapy procedures, the advice or counsel given patients and/or families, or in any manner profit from referral arrangements with home care providers or others within the healthcare environment.

I'd say the motives of RTs who do this have certainly been compromised.

LoQ · Post by **LoQ** » Mon Mar 09, 2009 9:18 am

I don't think this is a dumb question. Under the current logic (that says it is 'illegal' for a patient to adjust their own settings), wouldn't it also be illegal for an autoPAP to adjust settings? Well, maybe the doctor ordered a range of settings, so therefore it isn't illegal for the machine to choose and adjust settings within that range.

And now we have this truth, that anyone whose doctor has prescribed an auto range can set his machine for auto within that range or straight PAP for any number between the high and the low of that range. After all, all of those settings have been "prescribed" by the doctor. If not, then the autoPAP is doing something illegal.

So get your doctor to write you a script for auto for something like 4-20, and you can pretty much do what you want within that range.

Gale Hawkins · Post by **Gale Hawkins** » Mon Mar 09, 2009 9:34 am

LoQ wrote:I don't think this is a dumb question. Under the current logic (that says it is 'illegal' for a patient to adjust their own settings), wouldn't it also be illegal for an autoPAP to adjust settings? Well, maybe the doctor ordered a range of settings, so therefore it isn't illegal for the machine to choose and adjust settings within that range.

And now we have this truth, that anyone whose doctor has prescribed an auto range can set his machine for auto within that range or straight PAP for any number between the high and the low of that range. After all, all of those settings have been "prescribed" by the doctor. If not, then the autoPAP is doing something illegal.

So get your doctor to write you a script for auto for something like 4-20, and you can pretty much do what you want within that range.

Machines are smarter than people so it is OK for them to Rx the settings without Dr. review.

On the OTC statement sounds bold but when you look at the stuff sold that way to you have to agree a Auto set 4/20 could no more harm than some of it. I bet few kids have died from a CPAP OD.

LinkC · Post by **LinkC** » Mon Mar 09, 2009 9:38 am

LoQ wrote: anyone whose doctor has prescribed an auto range can set his machine for auto within that range or straight PAP for any number between the high and the low of that range.

Nope! If the Dr prescribed "auto" as you stated, that doesn't allow for setting it to "straight PAP" at ANY fixed pressure. Auto means auto.

LoQ · Post by **LoQ** » Mon Mar 09, 2009 9:43 am

LinkC wrote: Nope! If the Dr prescribed "auto" as you stated, that doesn't allow for setting it to "straight PAP" at ANY fixed pressure.

Sure, it does. Even in auto mode, the machine operates as "straight PAP" at various pressures throughout the night. An auto machine is really just a straight PAP machine that has a sequence of settings rather than one single setting all night long.

LinkC · Post by **LinkC** » Mon Mar 09, 2009 9:49 am

Playing devil's advocate...

Suppose my Dr prescribed Oxycontin at a dosage of 1 per day. I find I feel much better when I take 2 every 4 hours. Is it OK for me to make that dosage change? Is it illegal?

By the logic expressed so far on this topic, it would be perfectly fine for me to addict myself.

(Let me be clear that, once I have an auto machine, I fully expect to make setting changes contrary to my prescription. But let's not pretend it's "OK"...)

LinkC · Post by **LinkC** » Mon Mar 09, 2009 10:01 am

LoQ wrote:has a sequence of settings rather than one single setting all night long.

Yes. Which makes the two modes....um...DIFFERENT.

If your 'script specifies "auto mode", then straight "CPAP mode" isn't what the Dr ordered, no matter how you twist it.

Paul56 · Post by **Paul56** » Mon Mar 09, 2009 10:20 am

Lets ask this question in reverse...

Is it illegal for a DME to set the pressure on the provided machine incorrectly?

I've had this happen. Dammed if I was going to drive all the way back to the DME to have then set it correctly... I set it correctly myself.

Who knows... perhaps my cell mate will be the DME.

LinkC · Post by **LinkC** » Mon Mar 09, 2009 10:23 am

Paul56 wrote:Is it illegal for a DME to set the pressure on the provided machine incorrectly?

I would HOPE so. Whether oversight or intentional, a mistake like that SHOULD cost them their DuMmiE license!

roster · Post by **roster** » Mon Mar 09, 2009 10:29 am

Paul56 wrote: ..........
Who knows... perhaps my cell mate will be the DME.

DMEs should only be put in cells with CPAP patients who have bad cases of aerophagia.

Machine	Mask	Humidifier

Additional Comments: 11-14 cmH2O

Machine	Mask	Humidifier

Additional Comments: 11-14 cmH2O

Machine	Mask	Humidifier

Additional Comments: 11-14 cmH2O

Machine	Mask	Humidifier

Additional Comments: 11-14 cmH2O

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

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