[Pressure] You CAN Adjust your own CPAP Pressure

[SuperSleeper]

[Note: parts of this thread were copied over from our old forum (thread started in June, 2007); some posts have not been included for the sake of brevity, and some posts have been cleaned up for clarity, accuracy & updated info]


Go ahead and adjust the pressure on your own CPAP machine

There is a lot of talk about how it's "illegal" to adjust one's own CPAP machine pressure, that only a licensed, certified or qualified technician, physician or clinician can do it.

First of all, I challenge anyone to show me any local, state or federal law that makes adjusting your own legally-obtained CPAP machine a crime, or even threatens punitive action for doing so. Go ahead - I double-dog dare 'ya.
B) If you can show me such a law, I'll give you a one-year free membership on Apnea Board. Oh, wait... that's already free. Moving right along...

Yes, you must first have a prescription to obtain a CPAP machine - but after you OWN one, you are within your rights to do whatever you darn well please with it, including using it as a leaf blower, running it over with the family car, or... (oh no!) - changing your own pressure settings. :o

Below is some excellent info someone emailed to me regarding setting pressures on common CPAP machines.

Remember the last time you went to the pharmacy to pick up a prescription? You walked up to the counter, handed over the script, waited a few minutes and received a full bottle or package of something - pills, liquids, whatever. "Take the prescribed dose once per day for ten days, with food", the pharmacist said.

Fast forward to right now. You've just bought a CPAP machine - or maybe you've been using a CPAP machine for years - and you've discovered that you don't know how to adjust the pressure setting. The primary function of the CPAP machine is to blow air at a certain pressure, and you don't even know how to change the pressure? That's like not knowing how to change the ringer volume on your cell phone, isn't it? Isn't that a vital function that all CPAP users should be familiar with? To you - and to most other CPAP users - the CPAP machine is a mysterious "black box". Something only someone else knows how to program. You just turn the thing on, put on your CPAP mask and hope your CPAP therapy works as advertised.

So why is that you don't know how to adjust the pressure setting on your CPAP machine? It's a 30-second procedure that takes only a few pushes of a couple of buttons. The problem is that the manufacturer of your CPAP machine has hidden some controls from you. In fact they've hidden an entire menu of controls found in what is commonly referred to as the "clinician's setup" or "provider setup" mode.

Before I begin spilling the beans about the clinician's setup, consider that trip to the pharmacy one more time. When you think about it, there's an awful lot of trust between you and your doctor, the doctor and the pharmacist, and the pharmacist and you. You've been told what to do, and they're assuming you're going to do it - correctly. You're also assuming your doctor wrote the right prescription and the pharmacist filled it as written.

Taking this trust issue a step further, consider the fact that when you get a prescription filled at the pharmacy, you don't have to go get one pill at a time. You're trusted with the whole bottle of pills and everyone involved is assuming that you're responsible enough not to do anything stupid with those pills.

So given the secret of the clinician's setup mode would you suddenly become irresponsible? Untrustworthy and reckless? Bent on self destruction by way of CPAP machine? It could happen. But I don't think it will.

I firmly believe you are your own best primary care provider - that nobody else is looking out for your health and well being as much as you are. I therefore think you should be trusted with the knowledge of how to adjust the pressure setting on your CPAP machine. Don't get me wrong. I'm not advocating changing the pressure setting on your CPAP machine willy nilly, without regard for your own well being, and I'm certainly not providing you with medical advice (primarily because I don't know you and I'm not a doctor). I think all responsible CPAP users should use common sense when using their CPAP machines, and I think it's a very good idea to talk with your physician or sleep therapist before making any changes to your CPAP therapy. Pressures should be changed slowly, in small increments, over a long period of time. Be sure to note any changes in how you feel. Sleep apnea is a very serious condition, and altering your prescribed therapy settings could reduce the effectiveness of your CPAP therapy.

Whether you have a constant pressure "regular" CPAP machine, an automatic CPAP machine or a bilevel CPAP machine, getting into the clinician's setup mode is fairly simple. I'll outine the process for the three popular model lines of CPAP machines.

Respironics REMstar M Series
To get into the clinician's setup mode in a REMstar M Series CPAP machine or a BiPAP M Series CPAP machine follow these steps:

1. unplug the power cord from the back of the CPAP machine
2. lift the LCD cover and press the two buttons closest to the back of the CPAP machine
3. while pressing the two buttons, plug the power cord into the CPAP machine

You'll hear two beeps and then you'll see the word setup in the lower right corner of the LCD screen. When you select setup you'll be in the clinician's mode where you can adjust every feature of the CPAP machine, including the pressure setting. Below is the list of settings you can cycle through on a REMstar Plus M Series:

* CPAP Pressure (only in provider setup mode)
* Altitude
* Fine Pressure Adjustment (only in provider setup mode)
* C-Flex Setting
* Ramp Time
* Ramp Start Pressure
* Mask Alert
* Auto Off
* Patient Reminder (only in provider setup mode)

Puritan Bennett GoodKnight 420 Series
To get into the clinician's setup mode in a 420 series CPAP machine follow these steps:

1. make sure the CPAP machine is plugged in
2. find the secret button beneath the two "o"s in the word GoodKnight which appears just above the LCD screen
3. press the secret button and the Information Access button simultaneously for 2 or 3 seconds.

The CPAP machine will now be in the provider setup mode. Press the Information Access button to cycle through the list of adjustable settings, and use the arrow buttons to make adjustments. Below is a list of settings you can cycle through on a Puritan Bennett 420G:

* CPAP Pressure (only in provider setup mode)
* Ramp Time
* Ramp Start Pressure
* Hour Meter Value (which cannot be adjusted)
* Compliance Meter Value (which can only be reset to 0)
* Offset of Pressure Sensor (used for calibration purposes) (only in provider setup mode)
* Machine ID Number (which cannot be adjusted)

ResMed S8 Series
To get into the provider setup mode in a ResMed S8 CPAP machine - such as the S8 Compact, S8 Elite or S8 AutoSet Vantage - follow these steps:

1. press the right and down arrows simultaneously for about 3 seconds until the word "clinical" appears
2. select Menu

Use the left and right arrows to cycle through the settings and use the up and down arrows to make adjustments. Below is a list of settings you can cycle through on an S8 AutoSet Vantage automatic CPAP machine. There are four groups of settings which have adjustments and data within them.

* Settings
o CPAP Mode
o Minimum CPAP Pressure
o Maximum CPAP Pressure
o Maximum Settling / Ramp
o Mask Type
o Tube Length
o Humidifier
o Smart Start
o Leak Alert
* Results
o Efficacy Data
o Usage Data
* Options
o Smart Data
o Reminders
o Factory Defaults
o Erase Data
o Date
o Time
o Menu Type
o Language
* Servicing
o Run Hours
o Serial Number
o PCV Number
o SW Number
o BR Number

I have uploaded PDF files for the setup of some more common CPAP machines. Here is a link to our web page - the PDF files of the CPAP manuals are near the bottom... USE AT YOUR OWN RISK:

http://www.apneaboard.com/CPAP%20Adjustment.htm

There you have it. Take control of your Sleep Apnea, and be safe.

DISCLAIMER & LEGAL NOTICE: BY USING THESE CPAP SETUP DIRECTIONS AND SETUP GUIDES, YOU UNDERSTAND THAT YOU ARE PERSONALLY ASSUMING ALL RISK FOR USING INFORMATION ON THIS WEB PAGE AND IN THESE DOCUMENTS AND WILL NOT HOLD APNEA BOARD, ITS MEMBERS, OWNERS, ADMINISTRATORS AND MODERATORS LIABLE FOR ANY PROBLEMS, DAMAGES, PHYSICAL HARM, (INCLUDING DEATH), MENTAL HARM OR ANY OTHER HARM THAT MAY COME TO YOU, YOUR FAMILY MEMBERS, FRIENDS, CO-WORKERS OR ANY OTHER PERSONS WHO MAY RECEIVE THIS INFORMATION FROM YOU. YOU MAY NOT USE, COPY OR DOWNLOAD THESE DOCUMENTS UNLESS YOU HAVE A LEGAL RIGHT TO DO SO UNDER ALL APPLICABLE U.S. LAWS. INFORMATION CONTAINED ON THIS WEB PAGE, APNEA BOARD FORUMS AND ON THE APNEABOARD.COM WEB SITE SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A QUALIFIED PHYSICIAN BEFORE SEEKING TREATMENT FOR ANY MEDICAL CONDITION, INCLUDING SLEEP APNEA. ALWAYS SEEK THE ADVICE OF A QUALIFIED PHYSICIAN BEFORE CHANGING PRESSURE ON ANY MEDICAL DEVICE, INCLUDING CPAP MACHINES.

[SuperSleeper]

1) Won't air pressure adjustment by the user void the CPAP's warranty?

2) I own a Fisher & Paykel HC604 - I don't see adjustment instructions on the list. Is there a way I can find this?

[SuperSleeper]

Two questions regarding this:

1) Won't air pressure adjustment by the user void the CPAP's warranty?

2) I own a Fisher & Paykel HC604 - I don't see adjustment instructions on the list. Is there a way I can find this?

Not sure on the warranty. If you have a CPAP, read your warranty and that ought to tell you. But in any case, if you have issues with your machine that require replacement/repair through your warranty, I'm not sure how they could tell you had set the pressure yourself anyway, so I think it's really a non-issue, unless you inform them of it.

Please see our Clinician Manuals Page for how to set up the HC604.

[SuperSleeper]

Well, I imagine that the CPAP provider could tell if you adjusted the output pressure by comparing the setting - should you ever have to return it for a problem - to the one they have on file. Assuming you forgot to set it to it's original output level prior to bringing it in, that is.

Also, the things count the hours used so (and I could be wrong here) I imagine that it would also carry a log of air pressure hours too, which would be re-set as the air pressure is re-set. Or maybe I'm giving these devices too much credit.

[SuperSleeper]

I am intrigued by your assertion that once you own a prescription CPAP you are free to change the settings.

Taking your "walk into a pharmacy" analogy a bit further...

If you are prescribed a controlled-substance (narcotic) for medical purposes you, indeed, can legally purchase it at a pharmacy. Are you saying that once purchased, you are free to increase the dosage or decrease the interval between doses at will? To me that would be abuse, pretty clearly. And probably illegal.

Your CPAP prescription includes a prescribed pressure. Changing that is the equivalent of popping 2 Darvons in lieu of the prescribed 1.

I cannot find a specific law that prohibits either practice, tho. No free membership for me....lol

[SuperSleeper]

I am intrigued by your assertion that once you own a prescription CPAP you are free to change the settings.

Taking your "walk into a pharmacy" analogy a bit further...

If you are prescribed a controlled-substance (narcotic) for medical purposes you, indeed, can legally purchase it at a pharmacy. Are you saying that once purchased, you are free to increase the dosage or decrease the interval between doses at will? To me that would be abuse, pretty clearly. And probably illegal.

Your CPAP prescription includes a prescribed pressure. Changing that is the equivalent of popping 2 Darvons in lieu of the prescribed 1.

I cannot find a specific law that prohibits either practice, tho. No free membership for me....lol

I'm all about having personal freedoms along with personal responsibility, Daysleeper. I'm also all for getting the government out of the business of telling me, under penalty of law, what is, and what is not best for my personal health. That is a decision that I make for myself, thank you, after I have consulted with those whom I consider experts. And trust me, I don't consider most government bureaucrats to be experts at anything but pushing paper.

I don't like the modern Nanny-state, nor do I like most of the cradle-to-grave socialistic, anti-freedom controls that government agencies have forced upon pharmaceutical companies, durable medical equipment companies, doctors and upon the end-users of their products and services.

If an "abuser of prescription meds", (because an intentional overdose), loses control of their car and kills someone, he or she should be prosecuted for that. (held personally responsible). But I notice that when pharmacies distribute that little bottle of pills, they don't make the customers come back each day for a new pill, now do they? NOPE. They hand over the whole bottle and the responsibility then is transferred to the END USER.

So, you can "be intrigued" all you want.

You asked, "Are you saying that once purchased, you are free to increase the dosage or decrease the interval between doses at will?"

My answer is "yes - you are free to increase the dosage". Anyone can pop 20 Darvons in their mouth and wash it down with a quart of whiskey if they want... But they should be held responsible for any harm to others their actions may cause.

We don't need more laws (many of which are unenforceable at best) - we need to hold people accountable for their actions.

It's called LIBERTY and PERSONAL RESPONSIBILITY. We used to have that in America.

[SuperSleeper]

My only input here is that going too high on the pressure can have some un-wanted side effects, so I hope that anyone who changes their own machine will be very careful in doing so.

Absolutely agree Julie, anyone wishing to change their own pressure should consult with those whom they consider experts prior to doing so, preferably their doctor, assuming they can afford it. The smaller the adjustment, the less negative effect, I would think also.

[SuperSleeper]

I am a Atty and former Hospital Administrator. I now specializing in medical law.
I'm not going to give any legal advice but I can give you one good reason NOT to change the pressure on your machine without telling your MD that you are going to.

The modern machines keep all your statistics on a daily, weekly and monthly running basis.

Therefore if you increase the pressure for a period of time, the ststistics you get when you look at them or the Dr downloads them, will MISLEAD your Dr. into thinking that the therapy is working at the pressure he ordered when it really may not have been. The statistics would be partly based on what he ordered the pressure set at and partly on the pressure you set it at.

The long term statistics are useless but he will not know that if he doesn't know that the pressure has been increased by you.

If you decrease the pressure the stats will mislead him into thinking that the pressure he ordered isn't working 'and therefore needs to be increased when it actually might have worked if you had not decreased it for whatever the reason

I am now using an ASV machine, ResMed's VPAP Adapt SV

When I first got the machine I had trouble getting used to it because the tech had set the pressure very high.

I had the manual because the machine was new to both the Dr and myself and I requested it so I could understand this rather complicated device. He knew I wouldn't change anything without consulting him.

There's only ONE pressure setting on this machine. It's the baseline pressure the Dr wants the machine to stay above at all times, similar to an expiratory pressure on a Bi-Pap.

During normal breathing the algorythm uses this as a GUIDE to what minimum pressure to use and then determines the high pressure needed on a breath by breath basis. It does this by using it's external sensor tube to the mask to calculate a good estimate of the actual Tidal Volume of each breath and adjust accordingly.

If the Tidal Volume decreases over two breaths or so, the theory seems to be that this predicts an imminent apnea and the machine increases the preassure to "head it off" before it happens. This works for obstructive or Central apneas so no "dumb timer" has to be built into the machine to respond to them. If an unanticipated central apnea occurs the Tidal volume is reported as 0 and the machine responds accordingly. So there is no "breaths per min" setting... the machine' microprocessor calculates your natural breaths per min. and gradually gets into synch with you.

However the machine's microprocessor has to "learn" how fast you breath, what your average Tidal volume is before it can adjust itself to you. So it takes a few days before it works just right when you first put it on.

When I first started the tech set it for the TOP pressure that was required in my titration.... but that's not what this new machine uses and the pressure was far too high.

In a call to the Dr. I related this to him and he told me to start it at 7 and work it up every few days until the daily statistics began to show a change. This I did until I hit 10cm as a base figure. At this setting the machine actually never goes below 11 and cycles to 14 or so in regular breathing. The average pressure is 12.4 but it will go as high as it needs to if I forget and hold my breath, simulating a central apnea..

Now, however my physician and I know that the monthly statistics are meaningless... that was the period I was working the pressure up into the "clinically effective" range. I need to get current statistics for him but they will have to be the averages for the last week when no changes were made.

If your Physician works with you like this you have to be disiplined and "follow the protocol". Each time I changed the pressure I wrote down the prior weeks averages for comparison purposes and never changed anything until I had at least a full weeks new data to collect.

This way I have not had to even talk to the doctor for 6 weeks but now have the pressure up to the point where the statistics are not changing (indicating an improvment over the last setting) and I am feeling much better. THAT is the patient's main "statistic". You know when you are feeling better and that is what matters.

But you don't want to get the pressure too high.. that leads to a decrease in the Carbon Dioxide in the blood. This is needed to trigger the brain's "need to breath" reflex. Without it the brain "forgets" to initiate a breath and the patient ends up with Complex apnea.

Many cases of complex apnea are probably due to physicians in the early days of sleep medicine setting CPAP machines so high they got rid of ALL the apneas. This would be a setting that would suppress the level of Carbon Dioxide; but at that time they were not aware of the "complex apnea" problem. It didn't exist untill they created it!!

Now that I have the presure up to where it's working, it will take a second titration to determine whether it needs to go up a notch, down one or whether it's OK right where it is.

But if I had not told him what I thought I needed to do the statistics for the last month would be what he would look at and they would lead him to a false conclusion.

At LEAST tell the Doc what you want to try and find out what kind of record keeping you need to do to keep the data usable. If you try an experiment you may need to dump all the old data and start over again.

[SuperSleeper]

At LEAST tell the Doc what you want to try and find out what kind of record keeping you need to do to keep the data usable. If you try an experiment you may need to dump all the old data and start over again.

Good advice, KenAngel. Allow me to use your post as a springboard to further elaborate on this issue...

The reason we started Apnea Board was to empower people to help themselves and help other Sleep Apnea patients. If a person has the insurance, resources, money etc. to get as much professional help as possible when analyzing and adjusting their CPAP pressure, I'm all for them doing just that - it will be far less trouble for them down the line if they do so.

On another note, increasingly in today's economy, many people do not have the money to get the health care they may desire.

The health care industry (which includes doctors, hospitals, sleep centers, DMEs, CPAP manufactures, health insurance companies etc.) are in these businesses to make money. That's the bottom line. Nothing wrong with that at all - free enterprise is one of the concepts that has made our nation so strong.

However, the natural equalizer of the free enterprise system-- caveat emptor-- applies to these issues also.

Some financially-strapped Sleep Apnea patients cannot afford to pay $200-400 a month for quality health care insurance, nor can they shell out $1200 to pay for a new sleep study if they were just laid off from their job and are struggling to pinch every penny just to keep a roof over their head...

My question is - what do these people do when they need to adjust their own CPAP pressure?

Yes, it's easy for us to tell them "yes, you must get professional help through a doctor"...

But paying for that professional help may be another matter entirely.

Some say that "the government" (that means you and me) should pay for the health care of everyone, through a mandatory national health care "insurance" program. Well, that may be okay for socialist countries, but as far as I'm concerned, we ought to stick to the free enterprise system that made our country great. And besides, I don't like being forced to pay for other people's health insurance, anymore than I like being forced to pay for people's food or housing - and - contrary to what some say, health insurance is not a "right"... sorry, just ain't in the Constitution as far as I can tell, regardless of what some politicians may claim.

That is why I believe the answer lies in empowering people to HELP THEMSELVES and giving them the INFORMATION they need to help themselves - with as little cash outlay as possible, if that's their only option. That's why this board exists; that's why we've posted CPAP manuals for people to read.

It is no surprise that I have taken a lot of flack from some who may have a financial interest in keeping people in the dark with regard to the "secret settings" of the mysterious and wondrous CPAP machine-- I've been told I'm a criminal, I've been told that I could be sued, I've been told that I could be responsible for killing people, etc.-- all because I've posted CPAP manuals online which are distributed freely in the packaging of these machines by the very companies who some say will come after me for "doing something illegal". I tell them to show me which law I have violated or prove that I have broken an implied or express contract with any party. They end up dropping the subject - because they know they have no leg to stand upon. All they have in their arsenal is the power of fear. But, I don't scare easily. And besides that, I have an attorney friend who would just love to take anyone to task if they press the issue. He thinks that I'm on completely sound legal ground - and, if you are an attorney, you probably know that I am also.

The love of money corrupts - and the fact is that all these companies involved with the Sleep Apnea industry sometimes put their financial interests before the interest of their customers. Not always the case, of course. One of the reasons they don't want you to adjust your own CPAP pressure is because they are afraid of litigation (thanks to our sue-happy court system and the outrageous monetary windfalls that judges award to patients who sue these companies). But the main reason is that they are in bed with the other Sleep Apnea stakeholders - namely, the doctors, insurance companies, durable medical equipment (DME) suppliers and sleep centers who recommend and prescribe their products to SA patients. If they get out of the "good graces" of these folk - they lose business.

There is no practical option for poor people who do not have the resources to get an expensive sleep study. NONE. Unless of course, we turn our country into a socialistic nation. But then, everything becomes even more expensive- due to the "government overhead" or "administrative costs" - and even after all that - as our Canadian brethren can tell you - you will pay much higher federal taxes and may have to wait in line for months upon months in order to get your "free" government health care, and have very little say in what doctors are "assigned" to you. So the net result of nationalized health care is that we end up paying more, waiting more, and forfeiting our freedom to choose our own health care provider.

I say, we need to give the people the information they need to help themselves.

If you can afford it, get all the paid advice your wallet can handle...

If you can't afford it, then go to the public library, use their free Internet computer and read up as much as possible on forums like this, and do what you have to do to bring yourself to good health.

Many people actually do have the mental ability to properly document their change of pressures, in small increments, scientifically as you have done, noting the effect it has upon one's overall health, while consulting with their family doctor. Many times, these SA industries assume that people are too stupid to do that. Some people are, I admit, but many are not, and they should not be forced, in a financial crisis, to suffer needlessly because someone isn't willing to give them the information they need to help themselves.

So, all that to say, this is the CORE reason why Apnea Board was created. It ain't gonna change, and I'm too old to change. <grin>

But, again, if you do have the financial resources to get professional help with regard to your health care, I think it's best to do just that.

[SuperSleeper]

SuperSleeper - I recognize and respect your opinion and rant against government and big brother. I get that you are your own person, no one is going to tell you what to do and that you will do what is right for you.

With that said...

What you are advocating and suggesting is highly irresponsible and dangerous. A specific prescription is written by an M.D. who specializes in sleep disorders (are you an M.D. or just someone who is anti-government?) The pressure setting is prescribed to a patient to provide the optimum treatment regimen. Fooling around with it counter-productive to effective treatment. People feel like crap in the first place to even have a sleep study, and then to suggest that people then go against the recommended treatment and adjust their pressure setting may be as conducive as not having any treatment at all.

But heck, why have a sleep study in the first place? Why not just hand out CPAP equipment and tell the person that they're on their own? Your suggestions are as logical as doing just that.

In no post have I suggested that we "hand out CPAP equipment and tell the person that they're on their own".

Please read the entire discussion. We're talking about people who have already had a sleep study, and have already been prescribed a CPAP machine.

If people can afford an updated sleep study, I have said that they should get one done.

I would be interested to hear what you think people should do who currently own a CPAP machine, and who, because of their current economic condition, CANNOT AFFORD the $1000 for an updated sleep study that they need because their pressure requirements have changed? I guess we just tell them, "sorry, you're too poor, so you'll just have to suffer through being stuck at a less-than-optimum pressure setting - come back and see the doctor when you're financially able to do so"...?

Nice try with the suggestion that I'm "anti-government". Nope, just anti-Nanny State. Proper government has a role, but that role does not extend into every crevice of my life. I am not a doctor, but I use doctor's advice - but I do not think that doctors are infallible. Many sleep apnea patients not only have the ability to participate in their own treatment, they have the right to do so also.

We're talking about giving people the power to help themselves. I realize that in today's socialistic-leaning popular culture, many would like us to hand over that power to "experts" whom they deem to have superior knowledge and experience. If you came for that type of advice, I would suggest there are other forums out there which may be more conducive to your philosophical belief system. BUT, if you read this forum's tagline, it is: "Sleep Apnea Patients Helping One Another". It is not "Big Brother Helping Sleep Apnea Patients".