[Pressure] You CAN Adjust your own CPAP Pressure

[SuperSleeper]

SuperSleeper - I understand your issue that people who are unemployed also don't have the insurance necessary to have a new sleep study and have their CPAP pressure readjusted, if necessary. You're presuming that no job = no insurance so therefore people should take the initiative and make their own adjustments to their CPAP machine. No job = no insurance doesn't need to = no sleep study.

There are non profit organizations that provide access to 175 online public healthcare programs. There are applications to fill out on these sites and acceptance is determined very quickly. Many of these organizations specialize in finding affordable health insurance for unemployed Americans. People can also ask about their eligibility for state-sponsored health care, as well as Medicaid.

So advocating that people make their own CPAP adjustments because they don't have insurance to pay for a sleep study is inaccurate.

[SuperSleeper]

So advocating that people make their own CPAP adjustments because they don't have insurance to pay for a sleep study is inaccurate.

tiredgrl, I'm sorry, but it is your statement that is inaccurate. I know, because I was unemployed for a long period of time and in my state anyway, I looked for all available opportunities for what you call "affordable" health insurance.

Yes, there are reduced-premium, state-sponsored (and other) insurance programs available that are cheaper than standard plans (primarily for low-income households). But if you have $0 coming into your household each week, it does not matter that the premium has been reduced from $500/month down to $150/month. You don't even have the money to pay for the "affordable" $150 per month plan... and even then, these plans usually only cover 70-80% of the cost at best. How are you to pay the additional costs with no income?

In addition, getting on one of these low-income health insurance plans takes time - many times well over a month or two before they "approve you" into their system; some of them require you first to apply for food stamps or public assistance prior to your application (in my state, that process alone can take up to 60 days, and you won't qualify if you were recently laid off - their qualification process demands that you be "low income" [usually at or below 150% of the official poverty line] for six months prior to your application date). If you had a good job prior to getting let go, you'll simply have to wait six months before you qualify.

With these government-subsidized programs, the "claims" of "fast approval" does not equate to "fast coverage". Again, in my state, with one of the better of these types of plans, even if you qualify (see above) people are "approved" in less than a week... but their COVERAGE does not start until 60 days later. Then... after the coverage starts, the insurance company will not pay for a sleep study if you have had one within the previous 2 years, because it's not considered "medically necessary" - never mind the fact that you may have lost a lot of weight and your pressure settings have changed due to the weight loss.

Dealing with the stress of being unemployed, having bills to pay, not getting proper sleep at night, and on top of that arguing with insurance companies on a daily basis to get them to cover you is just plain horrendous.

I now wish I would have had the knowledge I now have with regard to changing my own CPAP pressure when I was unemployed. I would have saved myself a ton of money, a ton of time, and my health would have been much, much better and my stress level would have been far less... if I had only changed my pressure MYSELF, and told the insurance companies and the socialistic government system to take a flying leap.

[SuperSleeper]

Thank you Supersleeper. It was a snap. I was wondering if after a few years my pressure was still @ 14.0. It was and I adjusted it to 14.6, If I don't like it I will adjust it again. What great information.Thanks again. I have another question but I won't hijack this post. Brian

After adjusting from 14.0 to 14.8. I absolutly feel better. Thanks again Supersleeper.

[SuperSleeper]

Thanks for the information--I'm tired of the medical field telling me they are smarter than I am! I bought a second unit online to keep at my girlfriends house and they didn't set the pressures right--finally figured out how to reprogram my new unit with your help and now it works great!

[SuperSleeper]

I am a Board Certified Sleep specialist and find it amusing that someone would recommend that patients adjust their own CPAP pressure. This reminds me of a patient who thought he had too much pressure and punched holes in his hose. It takes a little more than just common sense to adjust the pressure correctly. It is difficult even in the sleep lab, while doing the CPAP titration study, when we are monitoring the patient on each breath. So, I don't recommend such practice. You are better off asking for a flow-sensitive Auto CPAP machine. And even then, as a physician, I have to analyze the compliance report information, the air leak data, and interview the patient, before making a decision. I understand some patients have no insurance and limited income; I deal with this all the time, and try to help patients as best I can. A blanket statement about adjusting your own CPAP pressure is not acceptable. And, Arizona, having spent 27 years in a classroom gives me the option of saying that the medical comunity is, often, smarter than you. No offense.

I wonder if someone has instructions for people to do their own root canals?

[SuperSleeper]

after adjusting the pressure do you need to change ramp or anything else?

[SuperSleeper]

apneamd said:

I am a Board Certified Sleep specialist and find it amusing that someone would recommend that patients adjust their own CPAP pressure.

Glad we provide you with some amusement, Doc.

This reminds me of a patient who thought he had too much pressure and punched holes in his hose.

We're a little smarter than that... but feel free to ridicule us, as it makes you feel more important and justified in your talking down to us. We can take it.

It takes a little more than just common sense to adjust the pressure correctly. It is difficult even in the sleep lab, while doing the CPAP titration study, when we are monitoring the patient on each breath. So, I don't recommend such practice.

I would agree that it takes more than just common sense, but quite a number of us sleep apnea patients have "health care providers" who seem to have NO common sense, and treat us as though we are stupid cows, needing to be led by the nose with no explanation whatsoever. You may not be one of those types of doctors, so this may not apply to you.

Many of us have the intelligence to study up on this subject and we like the ability and freedom to take your advice as a Doc, plus what we've learned in books and on the Web, and combine those elements with common sense to form a sound conclusion as we make our own health care decisions.

You are better off asking for a flow-sensitive Auto CPAP machine.

Absolutely and completely AGREE, but not everyone can afford a new auto-PAP.

And even then, as a physician, I have to analyze the compliance report information, the air leak data, and interview the patient, before making a decision.

News Flash, Doc: It's not your decision, it's our decision as a patient. You work for us, remember? We pay you. You can only advise us and recommend we follow your advice - you don't make the decisions for us.

Are you saying that we cannot educate ourselves, using provider-level analysis software that can be purchased over the Internet? We're too stupid to do that, I suppose? You need to read the various forum posts where we discussed this. Nowhere do we ever say that you should not consult with a sleep doctor while making changes to your pressure... we actually recommend that as the best option. As a doc, one would think you would be more thorough in your analysis, prior to making a sweeping judgment against our web site and forum - sure hope you're not as slip-shod while diagnosing your patients.

I understand some patients have no insurance and limited income; I deal with this all the time, and try to help patients as best I can.

Good for you. Wish more health care workers would do that. I salute you.

A blanket statement about adjusting your own CPAP pressure is not acceptable.

There you go again, making a "blanket statement" about us. Nowhere did anyone on this website or forum recommend that we completely disregard our doctors' advice. That would be stupid.

having spent 27 years in a classroom gives me the option of saying that the medical comunity is, often, smarter than you. No offense.

This is really what "gets us riled up" - you feel some sort of perverted "need" to tell us that you are smarter than we are. What gives with that attitude? So what if you are? Do you need to state it? And, you know what, you're not smarter than us in all areas - maybe in medicine or sleep issues, yes. Try respecting your patients more and talking down to us less. Help us... educate us... answer our questions... but don't insult our intelligence, even if it is true that you are smarter than your patients in most cases.

I wonder if someone has instructions for people to do their own root canals?

You know, in the old days, all 'ya needed was a quart of whiskey, a friend handy with a pair of pliers, and heck, most toothaches could be solved overnight. Yeah, maybe we should start a web page for those who want to do their own tooth extraction... not a bad idea.

Welcome to Apnea Board, doc. Care to help us Sleep Apnea patients with some solid, helpful advice to make it less risky if we want to adjust our own CPAP pressure, or are you going to continue to rant on how we can't do it ourselves without paying an expert? Come on, become part of the solution, rather than putting up walls between the doctor and patient. I bet you'd actually be more satisfied in your profession if you started doing that more often. B)

[SuperSleeper]

after adjusting the pressure do you need to change ramp or anything else?

There you go doc - could you answer jmuncy's question, or does he have to pay you for an answer?

Edited to add:

jmuncy, not sure if the Doc is going to answer, but I would think that you don't necessarily need to change your ramp settings unless you're having trouble adjusting to the higher pressure when you first go to bed.

But keep in mind, it's best to change your pressure settings in very small increments, over a long period of time, monitoring how you feel. Don't make any large changes quickly, and talk with your doc if you can do so.

[SuperSleeper]

I have a respironics REMstar "m" series bipap w/ biflex and humidifier. I got the machine from my father when he past away in jan. this year. I got my test results and could not afford the machine,so i'm going to set this one. I need to set it to 15cm of H2O,but this machine has a IPAP and EPAP settings.Do i need to set both at 15cm of H20.

I don't use a Bi-PAP, but I believe the IPAP is your inhalation pressure and the EPEP is your expiration pressure.

So, it's just my guess, but your IPAP setting should be 15, and your EPAP should be a few cm's lower than that, depending upon what you're comfortable with. I'd try setting the EPAP at 10 and see how it goes. If you can call up your doc or sleep technician and ask them, that might be the best bet.

If anyone knows more on this, please reply.

[SuperSleeper]

My thanks to this board for supplying information on setup pressure change on my newer model CPAP. When I was first diagnosed about 2 years ago, my machine was a previous model Respironics that worked wonders. I had never slept like that in my life. My machine was updated to the new System One A-Flex and, with the change to a lower pressure following my yearly followup, life hasn't been the same. I have consistently gone down in sleep time and quality. I'll check with the doctor later but, right now I have the info to adjust to where I was before. I slept like a baby with a pressure of 12 but they changed to 9 with the new machine with too long of a ramp time.

Anyway, I'm new to the board and look forward to returning often. Thanks again.