***WOULD YOU CHANGE PRESSURE WITHOUT DOCTOR'S KNOWLEDGE...??

I had my titration sleep study and the tech told me I needed pressure at 9.
It will take two weeks before I see the doctor.
I have the technician's manual so I can change the pressure, myself.
I really want to start feeling better - it is currently set at the minimun pressure 4, just to get used to the machine and mask.
I want to change the pressure myself, but am worried about what the doctor/technician will say.
Does anyone have opinions on this...?
Is there any harm in changing the pressure?
What should I tell the doctor?
If I reset the pressure before my next appointment, will the doctor be able to tell...?

Thanks for any advice!
Just want to start feeling better.

Where did you get the machine??? They should have set it to the doctor's prescribed pressure from the titration. When the machine is delivered to you it should have been pre set.

Yes, the doctor can tell. When my doctor downloaded the data on my card, the printout for each day has all of the settings, including pressure, humidifier, etc.

I can see where they are going with starting you off at a lower pressure, but a pressure of 9 really isn't that high. I started off at 8 and didn't have any problems (now up to 10). At a pressure of 4, that's low enough that it could cause discomfort and feelings of not getting enough air through the mask.

Why not just call your doctor in the morning and tell them that you don't feel like you are getting enough air at the current setting and you'd feel more comfortable with it if they could raise it. Most likely, the doctor will agree, and then you can change it and everybody's happy.

Well, you could kick it up a bit. A pressure of 9 isn't really that much. Some folks can't even breathe well at 4. But, remember, it takes a week or two at each pressure to see if it helps. If you get impatient you'll end up chasing your tail. Also, don't expect much relief until you get mask leaks under control and are sleeping fairly well. It's hard to sleep with a hunk of plastic stuck to your face until you get used to it. Good therapy happens AT night...but not overnight. Give it some time.

As to your doctor, I would be upfront that you intend to take control of your therapy. Some like/encourage that; others don't. Best to find out now which he is. Mine was delighted that I took an interest.

Best of luck in your new adventure in sleeping!!!

The doctor works FOR YOU! He / she is your employee! Take control over your life.

Would I? Absolutely! In fact, that's what I did six years ago after I got my first machine. I couldn't handle the prescribed pressure of 18 cm., so less than an hour after trying it, I reset the pressure to 10 cm. so I could get used to it. I already had the software to monitor my results, so I was prepared to make changes if necessary. It turned out that a pressure of 10 - 12 cm. was just right.

It's MY therapy, not the doctor's (I fired him anyway). I have to sleep with it every night, so if I can tweak it to a better therapy with a more comfortable pressure, so be it.


Den

mikeandtina59 wrote:I want to change the pressure myself, but am worried about what the doctor/technician will say.

This is a viable concern.

Does anyone have opinions on this...?

Not about YOUR doctor because I don't know how he/she will react and how much you need him/her in particular and whether you can be forthright or you need to just do it their way, etc. Some doctors don't mind, some do.

Is there any harm in changing the pressure?

Some people get central apneas if they go too high on the pressure. There's risks of aerophagia, discomfort, arousals, etc. Nothing VERY risky that I've heard of.

What should I tell the doctor?

If I reset the pressure before my next appointment, will the doctor be able to tell...?

See above re: I'm not sure about YOUR doctor.

Yes, if he/she looks, he will be able to tell (assuming you have a data capable machine).

Answer to the title of your thread, "Would you change pressure without doctor's knowledge?" I would and I have, but my first doctor didn't care. The whole point of what we were doing was an empiric trial of CPAP prior to my OSA diagnosis, so changing pressures was part of the plan and I wasn't about to stay home waiting for an RT to come over and change it to what the doctor prescribed when the doctor could just tell me and I could change it myself. That evolved to my changing it myself without her necessarily ordering it, but I would tell her, and I'd send her downloads, so she knew and was OK with it. My current doctor doesn't care much about what I do or not do, as long as I don't take up too much time. I'm pretty sure he's aware that I change my own pressures, but I just don't think he cares.

Is your presssure REALLY set at 4 cms? Or is it just set to START at 4 cms and build up over a specified period of time (up to 45 minutes) to your titrated pressure? (This would be the Ramp feature).

I'd sure be on "the horn" first thing Monday morning to the DME provider's RRT about this - and also to the prescribing doctor. And patient patient that I am I would give them all of Monday to get it corrected. Monday night I'd be changing the pressure setting at least to 6 cms on my own if I didn't have any response to the contrary by the close of business Monday. And if I had to resort to that I'd be on "the horn" first thing Tuesday morning again, telling them I had raised the pressure to 6 cms and ask if and what they intend to do to help you out or are you on your own. I wouldn't immediately change the pressure to 9 cms. I'd stay at 6 cms for a week if I could w/o feeling oxygen starved and suffacating at that pressure.

And I'd sure as the devil turn the Ramp feature OFF at that low a pressure!!!

Slinky wrote:And I'd sure as the devil turn the Ramp feature OFF at that low a pressure!!!

I don't think ramp can start lower than 4... So if the pressure is set to 4, there is essentially no ramp. That's my understanding anyway.

We don't actually know HOW this machine is configured. After re-reading the first post, I'm of the opinion that the setting of "4" may actually be the starting Ramp as Slinky suspects.
The OP says they have the setup manual/instructions, so what really needs to happen is that they need to go through the complete configuration and write everything down........bring it back here and post it. THEN, we will be better able to advise them. Heck, we don't even know what make or model of machine it is.


Den

Many docs will only see the hours used so prob won't know or care but there are always exceptions. I think Wulfman's advise to write things down and let us know what equipment you are using will also help you deal with doc and dme...

Now go forth and read, read, then READ some more.

Thank you one and all.

Sorry if I was not clear in my initial post.
My pressure starts at 4 and goes up to 5.3
It was set this low before I had the titration study so I could get used the machine and mask.
The technician at the titration sleep study told me that the doctor would probably set my pressure at 8 or 9.
I guess I'm just so tired and don't want to keep waiting so thought I might just go ahead and change it myself.
I just want to feel better.

My machine:
I have a Phillips Respironics REMstar Auto A-Flex - System One.
I have the mask with the pillows.

Thank you again very much! You are awesome to take the time to help me.

Tina

I stand by my original comment. Turn off Ramp, turn off Flex and set pressure at 6 if you make those phone calls first thing tomorrow morning and don't have a response by the end of the business day tomorrow. If no response tomorrow, call again Tuesday. And Wednesay. And Thursday. Until SOMEONE gets off their duff and actually DOES something to assist you. The squeaky wheel gets the grease. The "squeak" shoud be tactful but FIRM. You need HELP and expect it to be forthcoming in a timely manner.

You've been going without CPAP for many years. Another two weeks with less than "optimal" pressure is not likely to do you more harm than you've already got.

Are you comfortable with your breathing? Can you sleep with the CPAP running? Do you get a suffocating feeling?

If you're not having these problems, it may be a good thing to get adapted to the pressure at the current level for a couple of weeks.

Even when you get the "correct" pressure that eliminates all apneas, you may not feel better for quite a while. (Some do, some don't.) CPAP is probably for the rest of your life, don't get in a hurry and screw something up.

Slinky wrote:set pressure at 6

I agree. And if 6 feels "ok" to you, then I'd try 7...and 8, and 9.
I'd try those pressures with the machine set for "CPAP" mode.. not auto mode.

I'd experiment with all those pressures during the day, sitting up...trying them out.

I'd also try the various C-Flex settings - 1, 2, 3, and off. If the machine has C-Flex+, I'd try that instead of plain C-Flex.

After a minute of breathing at any of those pressures, if they feel comfortable, I would use any one of them and I'd keep it in just CPAP mode.

If I wanted to try Auto mode, I'd try that too... with a range of minimum pressure 6, maximum pressure 10.

In Auto mode, I'd also try out the various A-Flex settings.

I wouldn't use "ramp" at all.

But...that's just what I'd do, and I'm not a doctor. Since the machine was given to you just to "get you used to machine and mask", I'd play around all I wanted to with all those pressures I mentioned, and with all the Flex features.

I'd get so familiar with the machine's settings that I'd know more about how to "set" it than the DME employee will, who eventually will "set up" a machine for you.

I'd also do everything I could to have the doctor let me keep THAT machine after the trial period is over...and not swap it for a straight CPAP machine, which is almost surely what the home health care people (the DME) expect to do. Even if the doctor wants you to use straight CPAP afterwards, the autopap you are using now can be set for straight CPAP mode, exactly as if it WERE a CPAP. So, I'd really push for keeping that machine even if it is to be set for "CPAP." You can always change it back to auto mode if that works better for you. Or use it in CPAP mode if that works better. It's a much more versatile machine than a plain CPAP machine would be.