[Pressure] You CAN Adjust your own CPAP Pressure

[SuperSleeper]

Sheepdog,

Many people on auto-CPAP start their pressure at a higher setting than the minimum (4.0), primarily because that's so small of pressure that some folks (including me) feel suffocated until the pressure gets a bit higher. I currently have mine set for a range between 9.5 and 20 cm/H20.

Yes, modern auto-CPAPs are "smart enough" to deliver the appropriate pressure at the appropriate time, within the parameters that you set (for me, this would be between 9.5 and 20).

I am surprised that if your prescribed pressure is 20 that a doctor would want you on auto-CPAP that can delivery 20 and no greater pressure. Most folks that need that high of pressure are given a prescription for a Bi-PAP, at least that will go up to 25 on the pressure. Maybe I misunderstood you and your prescribed pressure is not 20?

[SuperSleeper]

Yes it is 20. I was only offered the M series 501 as that was "the machine we use for everything". It was so much better than what I had before that I didnt quibble.

I changed the min pressure to 10.5 cm and slept much better. I was thinking stay this way for a bit then go back 1cm or .5 cm until I find the perfect pressure. 9 or 9.5 doesnt seem so drastic a pullback to me.

I really thought 4 was doable. Guess I know better now. My current insurance stinks in that it is way too expensive to keep and covers very little anymore. Every time I use it I go further in debt so will have to stick with the 501 for a while.

Thanks for the help so far. I am so glad I found your site.

[SuperSleeper]

I am so thankful for this site.... My insurance was great for taking care of the sleep studies, no cost to me except for the copay to see the doctor. When it was time for me to meet with the sleep specialist and get a machine, they told me that I needed $600 down and could make payments for the rest. Total cost for the machine was almost $2400. My insurance has a $3500 deductable for durable medical equipment, so I was out-of-luck. Anyway, I had already been looking at machines on the "net" and knew what the cost of the machine they were trying to set me up with was, approximately 1/3 the cost the were wanting me to pay. When I asked the tech why it cost so much more, he replied that they have to make money too. I told him that I refuse to overpay for anything and requested my prescription so that I could leave. He brought my prescription and the comfort gel mask that I liked, as a parting gift. Just so happened that my sister had a brand new ResMed S8 Elite II that she got a couple of days before she was admitted to the hospital with breathing problems, for which she will probably spend the rest of her days in a nursing home. When she found out that I was getting a machine, she told me that I could have her machine and that she had never used it. I told her thanks, but no thanks because I didn't like the thoughts of using a previosly used machine (I figured she had to at least try it out....). Of course I changed my mind when I realized how badly the sleep center was trying to steal my money and the local DME's were just as bad. I asked her where it was and went over and picked it up. It was packaged neatly in a travel bag and looked like it had never been touched. Pressure was set at 10 and my scrip was for 8. I was looking for information on changing the pressure and found this site, which has been a tremendous motivator for me to control my OSA. I have used the machine everynight for the past month, and with the help of this site, have determined that I have the best sleep with the pressure at 9.2. I constantly wonder how the sleep center thinks it can determine the best pressure for a person during a one night visit. I have had great results from cpap and can't believe how great I felt after the first couple of days. I just wanted to say thanks to all the people who post here and support my new "hobby". Before cpap, I was a walking Zombie and hated to go to bed because I knew that I would wake feeling worse that I did when I went to sleep. Now I no longer get dog tired by 2pm and never feel the need for a nap. Also, I had nagging sports injuries that never seemed to heal, but have vanished since I finally get some good sleep again.

[SuperSleeper]

she told me that I could have her machine and that she had never used it. I told her thanks, but no thanks because I didn't like the thoughts of using a previosly used machine (I figured she had to at least try it out....).

Welcome to our site.

Don't worry about disease from a used CPAP machine. Remember air goes from the machine to the patient, not from the patient to the machine. The machine sucks air in the back through some replaceable filters. Unless the previous user has TB or is the crazy cat lady with cat stuff piled up around the machine, there shouldn't be anything to worry about inside the machine.

If you get a used machine, you can replace the mask, hose, and filters. Clean the humidifier water tank or replace if you're extra paranoid. You can even sanitize the mask and hose if you want to. I got a used mask, and disassembled it and threw the parts into a pot of water I had just boiled and turned off the stove. After 5 minutes or so, I took them out and they were OK. If they had been damaged, I would have simply thrown them away.

[SuperSleeper]

I am looking to update the pressure settings on my husband's first breathing machine (his other machines have already been raised). It is a Respironics Duet Lx AM Deluxe. I checking the settings and can't find anything on the display. We want to leave this at our camp. Thanks!

Hi Boomers, welcome to Apnea Board!

The Duet LX is an old Bi-PAP machine, made in the year 2000. Unless you know what specific settings have been prescribed for your husband, I wouldn't let him use the machine unless you're absolutely sure you have the correct settings (inhale & exhale pressures).

To change pressure settings, you'll need to get into the "clinician setup mode" for your machine, which on these older Respironics machines, is usually some combination of plugging the machine in while holding two of the buttons on the top of the machine (either of the two user buttons and the ramp button) down (doing all three simultaneously) for about 3 seconds until you see the display beeping and going into the setup mode... It varies as to which specific two buttons you'll need to hold down as you plug it in... I wish I knew the correct combination on your Duet LX, but if you'd like to experiment with various combinations, you might want to try it. You usually save the settings in clinician setup mode by hitting the power-on button, which turns the machine off. Then you turn it back on to use it.

If you do find the specific combination that works, come back and post it, so others can be helped.

[Toby6698]

I only read the first few sentences of the post stating that it does not require a licensed medical professional to set the pressures on a pap machine. I can assure you that this information is not correct and, while each state has different laws, both the state of North and South Carolina, and probably many more or most states ABSOLUTELY DO require that only medical professionals licensed through the state's Respiratory Care Board can manipulate the pressure settings on pap machines, perform mask fittings and provide any medical education about the usage of these items. I am an RT licensed in both NC and SC and the company that I work for found out the hard way that this was true, after sending out an email to their employees stating that an RT license was not required to preform CPAP set ups, pressure changes or mask fittings. The company was reported to one state board and that board notified the other state board and they almost shut the company down over it. I have always known this to be within the law of these two states, but I took the time then to look up the laws for myself and I spoke with the SC State Board and confirmed that only a licensed Respiratory Therapist can perform these tasks and that the ONLY way that a physician, nurse or other medical professional can perform these tasks legally is by individually applying for a special license through the Respiratory Care Board. There is an application fee that must be paid and then the board decides on each individual application whether or not to grant approval and approval is only granted after specific education and competences, also approved by the board, have been completed. Violation of these laws can carry severe fines and punishment, with fines up to $30,000 or more and/or prison time. Don't believe me? Then I welcome you to contact either one of these state boards or look up their laws concerning positive pressure devices on their websites. They are easy to contact by phone and you will have your answer within minutes or you can read it on there websites for yourself, but I absolutely 100% guarantee you that there are laws in place stating that only licensed RTs or medical professionals who have been granted permission by the state Respiratory Care Board can legally set or change pressures on a CPAP machine. You are very wrong on this one, my friend.[/align]

[MobileBasset]

Toby6698,
Medical licenses are designed to regulate the profession. To keep people from indiscriminately presenting themselves as medical professionals and providing paid services to the general population without the proper training.

All the RT licensing language, regulations, and fines to which you are referring are directed at regulating professional RTs and those who present themselves as professionals.

Licensing has nothing to do with how we chose to treat ourselves. When a doctor prescribes durable medical equipment there are absolutely no legal restrictions on how we choose to adjust it and use it for our own benefit. Also we will not be sueing the doctor or RT if our own adjustments affect us negatively. Although we could probably sue for failure to instruct.

If it gets adjusted by a "provider" then it must be a licensed RT and adjusted to the doctor's script.

The gist of this thread is that the information one needs to take control of their own therapy is available here and can make all the difference when the doctors and RTs are incompetent, non-responsive, poorly informed, over scheduled or otherwise inadequate.

[SuperSleeper]

Violation of these laws can carry severe fines and punishment, with fines up to $30,000 or more and/or prison time. Don't believe me? Then I welcome you to contact either one of these state boards or look up their laws concerning positive pressure devices on their websites. They are easy to contact by phone and you will have your answer within minutes or you can read it on there websites for yourself, but I absolutely 100% guarantee you that there are laws in place stating that only licensed RTs or medical professionals who have been granted permission by the state Respiratory Care Board can legally set or change pressures on a CPAP machine. You are very wrong on this one, my friend.

Please provide a direct link from any official state or federal website in the U.S. where it categorically states that a patient is violating any law whatsoever when they adjust their own legally-obtained CPAP machine.

Have any link to any official government website that states there are such fines or prison time for adjusting one's own CPAP pressure?

Yeah, no such links? No kidding. Because it's not illegal to adjust one's own CPAP pressure.

$30,000 fines?!? Prison time?!? You've given me a good laugh today, I'll say that for you.

Nice try, Toby.

[Toby6698]

Please don't get me wrong, I do get and see the point you are making here and I did go back to read your post and clarified that you were speaking of an individual changing the pressure on their own machine. I have to say that I strongly disagree with that, also. Not because that I feel that a person doesn't know their own body and/or needs or that a person should not be able to receive appropriate help and care due to costs and affordability. I disagree, because the lay person does not know how much pressure their airway requires without causing other issues, such as inducing central apneas and/or cardiac arrhythmias. Just because the machine belongs to them, doesn't mean that it is ok for them to self diagnose and treat themselves. If they have a prescription from a doctor for a pressure change and they change the pressure themselves to that prescribed pressure, then more power to them, I really don't have a lot of problem with that, but if they are a patient with a DME provider who provided the machine and whom they get regular service and supplies with,,the change does have to be documented in that pt's medical record for purposes, such as, Joint Commission reviews. They can walk in a DME at anytime and pull a chart randomly and request to visit with that patient/person and everything must match up with the documentation....that's another trail to go down...lol. Anyway, I do get what you are saying, but that person's condition changing that makes them feel they need more pressure really should be evaluated by a medical doctor,,just to make sure that there is not bigger issues that wouldn't require more than a slight pressure change on their current machine. They could've nailed their issues and what they need on the head, but then again, their condition could've progressed to the point of needing a completely different type of machine or possibly even requiring supplemental oxygen to be bled into their current machine. If a pharmacist gives someone a whole bottle of pills, that doesn't mean it is ok to alter the dosing just because the desired results are not being obtained. Taking more or less than what is prescribed, may achieve the desired results, on one hand, but create other problems on the other hand. The same with an emphysema patient who becomes short of breath and they check their own O2 levels with their own pulse oximeter and find it to be low....their symptoms and oximeter reading makes them feel that increasing the amount of oxygen, prescribed by the doctor for them, needs to be increased....that would make common sense to many people and why go to the doctor and create more expense when the oxygen delivery device has been purchased or rented for them and is in their own home, so they manipulate the settings to what they feel is best for them. What they don't know or see in this, is the entire picture, and increasing the oxygen even just a tiny bit, can be a very deadly mistake. CPAP pressures are not something to be played around with or taken lightly, just because they are simple and easy to change. Odds are, if their machine is that old, their condition could have progressed gradually over the years, to much worse than they think, and as I said earlier, may require much more than a small pressure change. I once had one man come into our store begging me to either increase his pressure or show him how to do it, and he was positive that all he needed was just a little more pressure to solve his problems. I will admit, that in my mind I agreed with him, but I knew that I couldn't change or teach him how to change his pressures....he BEGGED me and even got a little upset because I refused to show him how. It ended up with him going to the doctor like I advised him to and he was found to have a malignant tumor in the upper part of his esophagus and it was pushing against his airway when he laid down at night. That man had flowers delivered to me, from his hospital bed, with a card thanking me for refusing to give into his requests and stated that the tumor was caught and removed in time, before it had spread to far. It was an aggressive cancer, also. I know that this situation is rare, but you can't just assume what can't be seen or verified. You also can't determine who is going to act responsibly and who is not, and believe me, I have seen many who do not, even though they think they know what they are doing. A person's change may also require them to be switched to a BIPAP or to an ASV. So just assuming a pressure change is needed and making it themselves, is not the best thing for people to do or be encouraged to do. There are reasons people are kept from the clinical menu, and most machines I deal with, say Clinical Menu, not just Clinical Set Up. Most DME companies of any worth, are more than willing to provide an auto adjusting machine for a 2-4week trial, free of charge, to assist the physician in determining the correct pressure for a patient and that company will also have their RT to adjust the pressure changes prescribed by the doctor, also free of charge. It's just good business and care for the patient to provide services like this. Each DME company I have worked for, provides free services like auto trials and pressure changes, even if the patient has never purchased one item from them. Like I said it's just good business and common courtesy for the community, so there are ways to obtain a proper pressure and pressure change for someone's current, older machine, without encouraging them to assume what they need or it costing them an arm and a leg. It's not something to play around with or tell somebody that it is ok to do.

[eseedhouse]

Well I totally disagree, along with, I suppose, many users of this board. And my Dr. and my Respiratory therapist agree with me.

As to your arguments, I might have gotten around to reading them if you'd thrown in the odd paragraph break. But my eyes and mind are no longer up to reading a thousand or so words all smushed together in one long line.