Thank you, almost got a brick.

dme,
your analogy has faulty reasoning: you say "that would be the same as a pharmacist giving you a stronger dosage than what was ordered"
NO, it is not, if you as a dme tech change the pressure without the doctor's order then you are medically and legally in trouble. Giving the manuals is not the same as you changing the pressure arbitrarily.
The only thing that's restricted by federal law is buying a cpap with a doctor's order. The machine includes ALL of the manuals and they have disclaimers on its use and setting/adjustments to be done by trained staff.
The fact that dme's choose to remove the clinician's manual does not make that part legal. You would do a better job of paternalistic "protection" of the public by assisting the patient when the patient comes to you with problems, instead of withholding part of the information.
What I do with my meds once I go home is under my responsibility I could snort my antacid pill or triple it, but the pharmacist does provides me with all the instructions and pamphelts, that covers his you know what legally. We all know there's plenty people who take their meds wrong, be it 'cause they don't pay attention, or are out of it, or are just plain dumb (sorry anyone out there ,if shoe fits)
Learn so you can educate your patients, that would be more useful,
DR

ChasDME wrote: Being a DME provider I want to clear up a few things that concern/upset me. Legally I cannot give you a clinician manual. Your doctor prescribed you a certain pressure, I cannot provide you with a manual to change that pressure. That would be the same as a pharmacist giving you a stronger dosage than what was ordered. It can and will hurt you.

WIth that being said, I am sad to see how many people change their own pressure. This is dangerous and you should speak with your doctor. A CPAP is suppose to help you, but fiddling with your pressure will not help you!

This is up for debate. Often titrations done at sleep studies are not optimal and need to be tweaked in the home setting. An APAP is useful for this, as it can be if the patient's weight fluctuates or sleeping position changes and less/more pressure is required.

Also, an educated CPAP user is not unlike an educated diabetic who needs to test blood sugar and inject insulin. An insulin overdose could kill you, but diabetics monitor and make these changes every day. Adjusting pressure in most cases would not be remotely as dangerous.

CPAP.com will happily sell you an Autoset with a Rx for straight CPAP.

I purchased one and billed the insurance myself, easy

If a pharmacy sold me a glucometer, and STOLE the directions before passing it over to me, it would be a crime.
I don't see how the cpap manual is any different!

ChasDME wrote: WIth that being said, I am sad to see how many people change their own pressure. This is dangerous and you should speak with your doctor. A CPAP is suppose to help you, but fiddling with your pressure will not help you!

And a sub-optimal pressure that fails to adequately stop OAs will? Excuse me while I stuff my machine in the closet What if I have a slew of centrals lasting between 60 and 90 secs? Oh, that's right, a straight CPAP (much less a BRICK) will flag those for my Dr's attention.

Oh, and of course my doctor is actually the one who reviews my reports, and he answers his own phone too!

Seriously, I have to wonder what fantasy world some people live in

ChasDME wrote: Your doctor prescribed you a certain pressure, I cannot provide you with a manual to change that pressure. That would be the same as a pharmacist giving you a stronger dosage than what was ordered. It can and will hurt you.

WIth that being said, I am sad to see how many people change their own pressure. This is dangerous and you should speak with your doctor. A CPAP is suppose to help you, but fiddling with your pressure will not help you!

I see many people wanting auto machines. I am assuming these people have not gone through formal titration studies?

I think you are poorly informed about some things including how an educated CPAP patient responsibly manages his therapy. Here is my critique of some of the things you said.

ChasDME wrote: Your doctor prescribed you a certain pressure, I cannot provide you with a manual to change that pressure. That would be the same as a pharmacist giving you a stronger dosage than what was ordered.

Just a point of logic, but this is a poor analogy. I would not make the analogy at all, but since you did it might be improved by replacing the last sentence with, "That would be the same as a pharmacist giving you the prescription drug leaflet."

ChasDME wrote:

I see many people wanting auto machines. I am assuming these people have not gone through formal titration studies?

Bad assumption. Many of us have gone through formal titrations (often more than one). We understand that our body needs different pressures at different times of the night. In my case I need more pressure when supine as compared to on my sides. My auto settings will recognize this via my breathing and adjust the pressure. This allows me to use a lower, more comfortable pressure for sleeping on my side.

I also need a very high pressure when I am in REM stage. I can sleep a few hours at a lower, more comfortable pressure and when I hit long REM periods the machine recognizes the breathing difficulty and raises the pressure.

Do you not know that some doctors prefer APAP with a pressure range for some of their patients? My doctor is fully aware of what I am doing to manage my settings and supports what I am doing.

ChasDME wrote: It (patient changing pressure) can and will hurt you.

"Will" is a strong statement. Most educated patients do not hurt themselves by changing the pressure.

ChasDME wrote: I am sad to see how many people change their own pressure. This is dangerous and you should speak with your doctor. A CPAP is suppose to help you, but fiddling with your pressure will not help you!

I am saddened to see so many people who do not know how to change their pressure, have not educated themselves and do not know how to monitor their therapy with CPAP software.

I am not sure I would be alive today (I certainly would not be healthy) if I have not "fiddled" with the settings until I achieved optimal settings. My doctors and the sleep labs were not getting an optimal titration during the titration studies and many consultations with the doctors.

Thank God I learned how to do it myself.

I was titrated at 14cm.
With my Auto, I have discovered my 95% pressure is from 10.2-12.4; and with an auto, my AHI runs a THIRD of what it was on straight CPAP.
The PSG is far from infallible. To assume it is so is ignorant and arrogant.

ChasDME wrote: I hate to see that so many people feel their DME is lying or misleading them. You have a right to switch! It is a HUGE pain insurance wise but you still have that right! Don't ever stay with any healthcare professional that you feel is not completely honest with you!

If you ever want honest info from a DME manager, let me know! I am an open book!

RandyJ wrote: This is up for debate. Often titrations done at sleep studies are not optimal and need to be tweaked in the home setting. An APAP is useful for this, as it can be if the patient's weight fluctuates or sleeping position changes and less/more pressure is required.

Also, an educated CPAP user is not unlike an educated diabetic who needs to test blood sugar and inject insulin. An insulin overdose could kill you, but diabetics monitor and make these changes every day. Adjusting pressure in most cases would not be remotely as dangerous.

Great anology Randy......

I have to adjust my insulin doses quite often. I know how to test and adjust my basal rate, carb ratio and correction factors all on the fly as needed. I adjust my meal time insulin for every meal. One does have to be CAREFUL about such things, or can get into trouble (been there done that) and end up in ER or even hospitalized.

Knowledge is Power! Educate yourself.

Little kids do it every day.
Oh, look! the emperor is NAKED!