Why it IS illegal - sort of - to change your pressure.

SleepingUgly wrote:
But doesn't a "prescription" technically have to be written or oral, accompanied by a DEA number?

While each doc must have a DEA number, it is only required on scripts for controlled substances...........
a minor point of distinction..............

Doctor's orders... is there really such a thing?


follow doctor's orders..

I would must prefer that term had never become associated with a physician....

in the military, sure...


but I think doctor's can order a test like a big mac, but giving patients "orders" just implies something less than a collaborating relationship..


Doctors advise patients.. I like that sound of that.....

What I see in this thread is an OP that lays out a series of facts in a neutral way followed by several posts attacking the poster without any reference to the content of the post.

I think it does a disservice to this community when every poster who is perceived as deviating from the accepted way of thinking is insulted and attacked. If you disagree with what somebody is saying, can't you address the points they make instead of calling them names?

This site is great in many ways. I've seen a great deal of support for other users that are clearly in pain. I don't understand why experts get such a different treatment in this forum.

I am a CPAP user and not an expert in medical or legal fields. However, I'm very interested in learning more from all sides - both from other users and from experts. I've watched at least three other posters that claimed to be experts be chased away from this forum by the vitriol that spews forth every time that someone posts something that doesn't unequivocally support a patient's doing whatever they want to with their machines. I think it's a shame that we don't get to hear both sides of the story here.

SleepingUgly wrote: Sounds to me like someone who is HOPING to be able to connect with some people at the level he intended his original post, but that he has seen enough here to realize that there are always those who succumb to the base impulse to call everyone who states anything remotely counter to their opinion a "troll", and to insult their intelligence, education, masculinity/femininity/appearance, etc. (OK, I'm ready to be called an ugly troll now! Have at it!)

Meant in the kindest, light hearted of ways - I agree with you. But I don't think you are a troll

And I certainly don't think XJ was doing anything more than trying to explain how someone could interpret that changing a cpap pressure is/was against the law. He never said that he agreed with it or that we should never do it.

I thought his communication skills were outstanding but clearly some don't agree with that thought either.

XJ, I enjoyed reading your post(s) very much. I'm not in the legal or medical field, but I thought what you wrote to start this thread contained well reasoned, well organized, beautifully articulated points. A pleasure to read and think about.

xj220c wrote:I came into this forum because it seemed people here were interested in open discussion about CPAP and the circumstances surrounding their therapy.

I am. I'm very interested in open discussions about all things "CPAP." I hope you'll continue posting on this forum, XJ.

Well said, Laurie and cwied. I wholeheartedly agree:

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Laurie1041 wrote: I really enjoyed the original post. I did not find it inflammatory nor offensive in the least. IMHO, it was only an exercise in starting up a discussion. As I review each post, I find it interesting that some people "respond" and some people "react". Coming from a purely psychosocial model, it is my understanding that our reactions and responses are largely shaped by whether or not we feel there is a threat to self - in this case, I can only imagine that it relates to perceptions revolving personal choice and freedom, along with the need to have power over our health.

In reviewing the original post, I cannot find one instance where the poster said, "Don't change the settings of your own machine or else. . ." I read about a bunch of laws, regulations, and rules and a personal interpretation based upon the poster's experience of reading case law, statutes, etc. Not once did my hackles rise up and my panties get in a bunch while reading the original post.

To me, it was merely academic and an interesting way in which to get people talking and sharing. Any communication, whether written or spoken will most certainly breakdown when people become disrespectful, argumentative, punitive, or shaming. I see no need for any of us to stoop to this level.

_____________________________

cwied wrote: What I see in this thread is an OP that lays out a series of facts in a neutral way followed by several posts attacking the poster without any reference to the content of the post.

I think it does a disservice to this community when every poster who is perceived as deviating from the accepted way of thinking is insulted and attacked. If you disagree with what somebody is saying, can't you address the points they make instead of calling them names?

This site is great in many ways. I've seen a great deal of support for other users that are clearly in pain. I don't understand why experts get such a different treatment in this forum.

I am a CPAP user and not an expert in medical or legal fields. However, I'm very interested in learning more from all sides - both from other users and from experts. I've watched at least three other posters that claimed to be experts be chased away from this forum by the vitriol that spews forth every time that someone posts something that doesn't unequivocally support a patient's doing whatever they want to with their machines. I think it's a shame that we don't get to hear both sides of the story here.

xj220c wrote:Alright, this is just ridiculous now.

I tried twice. No more.

Thanks to all you actually wanted to have a discussion that could possibly improve people's understanding of the situation. That at least was enjoyable. I wish you luck and health in your treatment.

Cheers.

XJ out.

you thought you met 1 on the design post but you didnt know the village was full of em

In keeping with the spirit of this topic, I have changed my avatar. Like it?

xj220c wrote:

SleepingUgly wrote:Is it just me, or is it irrelevant to most people whether it is or is not legal to change their settings?

You're absolutely correct.

I agree. However, when someone starts walking around in my back yard, I sit up and pay attention. And no, I'm not a lawyer nor do I work in the medical device industry.

M.D.Hosehead wrote:Here's an angle that hasn't been mentioned.

Suppose I change my pressure settings.

I see my doc.

The doc prints out the data from my SD card, informing him/her of the settings on my machine.

If he/she then tells me to keep doing what I'm doing and come back in 6 months, is that not, in fact, a prescription for the new settings?

I did refer to that general concept in my first post in this thread.

SleepingUgly wrote:

M.D.Hosehead wrote:Here's an angle that hasn't been mentioned.

Suppose I change my pressure settings.

I see my doc.

The doc prints out the data from my SD card, informing him/her of the settings on my machine.

If he/she then tells me to keep doing what I'm doing and come back in 6 months, is that not, in fact, a prescription for the new settings?

Hmmm... I don't know... Say MD #1 prescribes me a long-acting NSAID for an extended period of time. MD #2 puts me on a PPI to protect my stomach from the NSAID. When I see MD #1, I tell him that I'm taking a PPI with the NSAID, and he says, "Good idea, keep taking it". Did he prescribe it for me?

Maybe this analogy isn't a good one. I'm not sure.

But doesn't a "prescription" technically have to be written or oral, accompanied by a DEA number?

I have had doctors who knew I knew how to change settings on my CPAP, and some of the time they still sent in an Rx to the DME to change my settings to what we discussed. An RT from the DME would call and say they want to come over to change my settings, and I would basically let them know that I wasn't going to stay home for that, but I'd do it myself. Was THAT a prescribed setting?

A prescription need not be written. Whatever my doctor advises me to do is her prescription. She may prescribe a surgical procedure. Dictionary definition of prescribe:

Medicine/Medical . to designate remedies, treatment, etc., to be used.

The point I was getting at--and didn't state directly--is that vagueness can invalidate a statute or regulation. And the boundaries of the term "adulterate" are so vague that the average person is unable to know whether changing a setting is "adulterating" the machine. The OP, a trained lawyer who has researched the question, can't say for sure (see the title of the thread).

Take my example one step further. Suppose I change a setting, tell my doctor (or he looks at the printout) and he says "Good". Do the current statutes and regulations mean that my machine was adulterated before he said "good," and then suddenly became un-adulterated? If the nod of a head can instantly change a single machine's adulteration status from yes to no, doesn't that indicate that the term "adulterate" is impossibly vague?

This is from Merriam Webster's Dictionary of Law:

Legal Dictionary

Main Entry: adul·ter·ate
Pronunciation: &-'d&l-t&-"rAt
Function: transitive verb
Inflected Forms: -at·ed ; -at·ing
: to corrupt, debase, or make impure by the addition of a foreign or inferior substance or element; especially : to prepare for sale by omitting a valuable ingredient or by replacing more valuable ingredients with less valuable or inert and usually harmful ingredients or with ingredients different from those claimed
NOTE: Under the federal Food, Drug, and Cosmetic Act, a device such as a piece of medical equipment that is defective in some way is considered adulterated. — adul·ter·a·tion /&-"d&l-t&-'rA-sh&n/ noun — adul·ter·a·tor /&-'d&l-t&-"rA-t&r/ noun

Counsel, please chime in.

howkim wrote:

M.D.Hosehead wrote:Here's an angle that hasn't been mentioned.

Suppose I change my pressure settings.

I see my doc.

The doc prints out the data from my SD card, informing him/her of the settings on my machine.

If he/she then tells me to keep doing what I'm doing and come back in 6 months, is that not, in fact, a prescription for the new settings?

I did refer to that general concept in my first post in this thread.

Yes, you did. My apologies.

MD horsehead, are you really a doctor?

The point I was getting at--and didn't state directly--is that vagueness can invalidate a statute or regulation. And the boundaries of the term "adulterate" are so vague that the average person is unable to know whether changing a setting is "adulterating" the machine. The OP, a trained lawyer who has researched the question, can't say for sure (see the title of the thread).

Vagueness of the law is on purpose. It allows the courts to define the terms as per "cultural norm". Since this can change then so can the law. This is very true with respect to "vice" laws. The kind of law used in the USA and Canada depends on the courts to make the fine definitions.

Currently most law makers have to deal with laws created long before the advent of modern technology plus they know that any laws they enact could be made moot by new technology. Just look at the whole copyright mess, laws to do with reproductive technology, laws to do with marriage.

Christen, I'm hoping that was just a "typo"!!

This has been a though provoking thread and good topic. It touches on the notion of the spirit of the law when it comes to prescriptions and the intent of the law. In also brings to light the question following:Based on the knowledge that one gains from learning about your own therapy and cpap equipment should you blindly follow the prescription based on data collection from one or two nights of sleep study or should you continually monitor and tune your therapy and treatment based on daily daily and careful analysis ? If you prefer to blindly follow the prescription and not monitor your own therapy then dont worry about data capable machines and sign up for costly sleep studies at least twice a year to make sure your pressure is set properly.
I know based on my own titration study that the prescribing sleep doctor did a decent job in my initial setting but I think his interpretation of the data is worth some more analysis and debate. My initial setting of 11 cm works well but causes a small number of central apneas and RERA. Based on my own analysis using software and also using APAP to validate settings, I see that 10.5 cm actually works better for me. I have a slightly higher VSI (vibratory snore index) but hardly ever have a central since I tuned my pressure a little.
The solution to the original question here is that 95% of patients should be prescribed an APAP with a range of pressure so that they dont have to modify their own machines (thus bringing the law into question). I know that most sleep labs just use the APAP and the clinical software to make the prescriptions anyway, why not trust the same tools to make sure the settings are kept up to date ?