Is changing cpap/bipap pressure yourself illegal?

Alright... I want everyone here to put your hands up against the wall and spread em' Do you have anything that will poke, cut or stick me? mmm? What's this in your back pocket? Seems that I find myself sayin' this more and more with this current group...bunch of rascals!!

Sheriff

Pugsy wrote:Well at least the clear airway (central) events decreased.
I forgot your PS has a minimum and maximum. That's new to the 60 series.
Interested that it seems to allow the PS to stay fixed now...when you have minimum equal to maximum.
My machine doesn't offer that choice..and thus my PS will roam between 2 cm and 4 cm.....this seems to mimic ResMed's way of doing thing. Interesting. Not a problem though.

Are you sure IPAP max was set to 20?.....the graph shows reaching 25 cm...
After ramp it shows EPAP being around 18 and up and not 15 and up.
Can you confirm in your machine settings that you had 15 EPAP and max IPAP of 20?
I don't know if the machine is set differently than I expected or SleepyHead is having a little bug in the software.

Do you have EncoreBasic software? I think I would like to see that report if at all possible.

Actually...I am thrilled that the centrals essentially went away. That's a huge relief.

I just noticed that as well, but I think it might be a bug in sleepyhead. It showed up correctly in Encore Basic, and I will upload that chart too in the evening. I was relieved too to see the Central's go away

sleepapnea123 wrote: I just noticed that as well, but I think it might be a bug in sleepyhead. It showed up correctly in Encore Basic, and I will upload that chart too in the evening. I was relieved too to see the Central's go away

We probably should use the Encore reports for evaluation instead of SleepyHead if it still wants to report the pressure incorrectly. Just the single daily detailed report in Basic is enough. You can still upload to SH for quick review of the other stuff.
I am also relieved that what I see with the pressure is a SH bug because if it wasn't...you need more pressure and I didn't know where we were going to find it. So that's a relief too.

Tonight if it were me I think I would increase the EPAP min from 15 to 16...change the PS since you have a choice...PS min 2 and PS max 4...max IPAP at 21.
If we were closer to 5 AHI ...we might go with 0.5 cm increases but I don't think we are to that point yet.
We could also probably open max IPAP up....but it won't hurt to go up slowly. My main reason for limiting IPAP was the centrals and since they are essentially gone I think we are safe in assuming complex sleep apnea isn't an issue and that is a huge relief.

For a first night experiment...I am thrilled with what you show for last night. It tells us there is way to improve pretty much everything with just a little fine tuning.
Actually...when I saw the absence of the centrals...I wanted to get up and do this.
Hopefully I won't jinx things.

Sheriff Buford wrote:Alright... I want everyone here to put your hands up against the wall and spread em' Do you have anything that will poke, cut or stick me? mmm? What's this in your back pocket? Seems that I find myself sayin' this more and more with this current group...bunch of rascals!!

Sheriff

Put down the clinician's manual and step away from the car?

Your question of asking us about how to set your machine pressures by yourself is according to the FDA akin to asking posters to share their Rx with you. So if I use Paxil, Xanax, and Ambien which were prescribed to me by a licensed physician, it should be OK for you to ask me to send you some.

Another issue: your treatment data looks quite bad to me. If you are following medical advice given by laymen (and laywomen) posters and let's say that you die. Wouldn't your spouse or a relative come and sue posters on this board who gave you medical advice? All Doctors carry insurance for such purposes. But not posters in a chatroom even though they are liable to be sued.

"Medical advice is the provision of a formal professional opinion regarding what a specific individual should or should not do to restore or preserve health. Typically, medical advice involves giving a diagnosis and/or prescribing a treatment for medical condition. Medical advice is given in the context of a doctor–patient relationship. A licensed health care professional can be held legally liable for the advice he or she gives to a patient; giving bad advice may be considered medical malpractice under specified circumstances. Medical advice can be distinguished from medical information, which is the relation of facts. Discussing facts and information is considered a fundamental free speech right and is not considered medical advice. Medical advice can also be distinguished from personal advice, even if the advice concerns medical care."

avi123 wrote:Your question of asking us about how to set your machine pressures by yourself is according to the FDA akin to asking posters to share their Rx with you. So if I use Paxil, Xanax, and Ambien which were prescribed to me by a licensed physician, it should be OK for you to ask me to send you some.

Another issue: your treatment data looks quite bad to me. If you are following medical advice given by laymen (and laywomen) posters and let's say that you die. Wouldn't your spouse or a relative come and sue posters on this board who gave you medical advice? All Doctors carry insurance for such purposes. But not posters in a chatroom even though they are liable to be sued.

"Medical advice is the provision of a formal professional opinion regarding what a specific individual should or should not do to restore or preserve health. Typically, medical advice involves giving a diagnosis and/or prescribing a treatment for medical condition. Medical advice is given in the context of a doctor–patient relationship. A licensed health care professional can be held legally liable for the advice he or she gives to a patient; giving bad advice may be considered medical malpractice under specified circumstances. Medical advice can be distinguished from medical information, which is the relation of facts. Discussing facts and information is considered a fundamental free speech right and is not considered medical advice. Medical advice can also be distinguished from personal advice, even if the advice concerns medical care."

I've highlighted the sections in the quote which seem to argue against your own statements above. I think a more accurate comparison you've noted above would be telling you what my pressures are (my rx) and telling you what medications I take (again, my rx). Telling you my pressure settings (my rx) and giving you drugs are not comparable.

Sleepapnea123....I will be away from the computer this afternoon through the early part of tomorrow so if I don't get back with you straight away...don't worry. I will catch up.
Taking a short little holiday with hubby.

Side note...I hope that you understand where my ideas are coming from so that you understand what and why I offer the ideas that I offer. My goal is for you to understand what you are seeing and have you understand what we are wanting to do so that you are an informed individual making your own decisions. That's why I tried to explain my rationale behind my thoughts instead of just tossing out numbers.

First idea was to help reduce the obstructive events in hopes that the centrals were related to arousals from the obstructive events and not popping up on their own due to unstable breathing. Try to fix what obviously needed fixing first and hope that the second problem (centrals) would go away and we got lucky there. Whew...

Now it is really relatively easy to see what needs to be done...a little more EPAP to deal with the obstructives and combine with pressure support and max IPAP to offer comfort and hopefully easier breathing and sleeping better.
You could probably get similar results with cpap at a fixed higher pressure but who wants to try to exhale at 18 or 19 cm all night long when we can use pressure support and a little tweaking with auto mode to offer you a more comfortable alternative. That's why we have bilevel machines so we might as well utilize it for what it was intended.
You could also probably achieve similar results in the straight bilevel mode you were originally in...but with higher EPAP and IPAP.
Lots of ways to get to where you want to be...just maybe different roads to take you there.

So if you have questions or need something clarified...please ask and we will try to explain things better.
My goal is for you to look at your reports and understand what you are seeing and be able to formulate your own thoughts as to what and why we do something. I know it looks like a massive learning curve right now but it will get a lot easier for you to understand. Mostly it is common sense stuff anyway.
The hardest part for me to understand was the EPAP for obstructives and IPAP for hyponeas...it just seemed backwards to me for some reason. It took me quite a while to wrap my brain around that one.

So that's why I tend to write novels when offering ideas. I like to include the "whys" so that it's a learning experience instead of tossing out numbers with no thoughts as to what or why they are being tossed out.
Goes back to the old saying...teach a hungry man to fish and he can feed himself...or something along those lines...you know what I mean.

[quote="avi123"]Your question of asking us about how to set your machine pressures by yourself is according to the FDA akin to asking posters to share their Rx with you. So if I use Paxil, Xanax, and Ambien which were prescribed to me by a licensed physician, it should be OK for you to ask me to send you some.

Another issue: your treatment data looks quite bad to me. If you are following medical advice given by laymen (and laywomen) posters and let's say that you die. Wouldn't your spouse or a relative come and sue posters on this board who gave you medical advice? All Doctors carry insurance for such purposes. But not posters in a chatroom even though they are liable to be sued.



The difference between a CPAP and a prescription Rx is that with a data capable machine, I can see the results immediately and change accordingly. I can't do that with an Rx there are just too many unknown variables. When I have issues and need a pressure change it takes at least a week to get an appointment, they call the doctor for a new prescription and I have to go back a day or two later with my machine. Some times the Dr wants to see me first and that takes at least another two to three weeks to get an appointment.

The first three months I was on the CPAP (A Brick) were like an extended titration study and results were painfully slow, changes were just a guess by my medical team. It took at least 10 trips the DME and Dr. Once I got an APAP with a prescription of 4-20 I was able to lower my AHI and increase my sleep time. I slowly changed my pressure until I am now at 9-17 and will make one more change to either 9.5 or 10-16 to see if I can reduce my AHI of 1.6. Unless it raises my AHI I will leave it alone until I have an issue.

The DME trips are free except for the time and gas it takes,the Dr is $127.00 for him to agree with me and make a change. Even with insurance it will cost me $30.00 that I don't have because I lost my job do to Apnea. Since October, I have been billed over $8000.00 for apnea diagnosis and treatment and need to control my expenses.

At my last visit to the DME I was told to keep doing what I was doing and I was getting the great results and to call if I needed help. I have an appointment with my Dr next month to get a compliance letter, if he has a problem with me making changes that are within his guidelines then it will be time to replace him. I would understand if they had an issue with me making changes outside of the 4-20 guidelines.

I would be more than happy to work with my DME/Dr on all changes if the would allow me to send them reports and give me suggestions for changes. It would save us all time and me money. I would be willing to pay $10. - $20 for an email response from my Dr for his time.

Now excuse me while I tear the remaining tags off my pillows and mattress.

Pugsy, have a good time off

Yes its starting to make sense now on how you decided the approach. I really appreciate you taking the time to write detailed explanations, as it will down the road help me tweak based on my reports etc on my own. I will update this thread with tonight's results, and reach out to you once you are back!

Thanks everyone else as well for your comments, I keep learning something new from each of them.

Dan6 wrote:Now excuse me while I tear the remaining tags off my pillows and mattress.

I get the same speech from Avi every time I offer an idea to someone.
It's okay for him to tell someone to do exactly what he does and offer his ideas as the gospel but not okay for anyone else to.
Especially me it seems like. Now if the idea or thoughts came from one of you guys and not me...I have seen him not say a thing about it. Even with changing ASV machine settings and those are a whole lot more critical than these little bilevel machine tweaks. He never says anything much when the "men" come up with an idea...he just seems to target "women's" ideas.

Trying to talk to Avi is like trying to talk to a brick wall. I quit trying a long time ago. I have better luck with my mentally challenged little Pug.

Pugsy wrote:

Dan6 wrote:Now excuse me while I tear the remaining tags off my pillows and mattress.

I get the same speech from Avi every time I offer an idea to someone.
It's okay for him to tell someone to do exactly what he does and offer his ideas as the gospel but not okay for anyone else to.
Especially me it seems like. Now if the idea or thoughts came from one of you guys and not me...I have seen him not say a thing about it. Even with changing ASV machine settings and those are a whole lot more critical than these little bilevel machine tweaks. He never says anything much when the "men" come up with an idea...he just seems to target "women's" ideas.

Trying to talk to Avi is like trying to talk to a brick wall. I quit trying a long time ago. I have better luck with my mentally challenged little Pug.

Thats too bad, some of the most inteligent people I know are women with my wife being at the top of my list. She has pretty good luck with her mentally challenged husband... Sometimes!

avi123 wrote:"...A licensed health care professional can be held legally liable for the advice he or she gives to a patient; giving bad advice may be considered medical malpractice under specified circumstances..."

Pugsy, do you have a covert degree?

dan6 wrote:Now excuse me while I tear the remaining tags off my pillows and mattress.

The hardest part for me to understand was the EPAP for obstructives and IPAP for hyponeas...it just seemed backwards to me for some reason. It took me quite a while to wrap my brain around that one.

I couldn't keep this straight no matter how hard I tried because like you, I felt the concept was backwards. Finally, as a memory mnemonic, I associated IPAP/Hypopneas with the restaurant chain, IHOP since the first two letters are IH.

Since all I had to was remember one part of the equation, the other one obviously fell in line.

49er

Trying to talk to Avi is like trying to talk to a brick wall. I quit trying a long time ago. I have better luck with my mentally challenged little Pug.

Dan6 wrote:<snip> if he has a problem with me making changes that are within his guidelines then it will be time to replace him. I would understand if they had an issue with me making changes outside of the 4-20 guidelines.

<snip>

You raise an interesting point. Why would the doctor object to me, for example, raising my minimum pressure if it already is in the pressure range prescribed, and I hit and pass that pressure level frequently as demonstrated in the data?