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Can and/or should I change any settings?
#1
Can and/or should I change any settings?
First question is - am I allowed to change the settings.  I know its not illegal or anything, but I'm in my compliance period still, haven't had my first follow up, my insurance is renting my machine.  Is there any risk to going in and dorking with the settings myself?  Like will my insurance stop paying or anything? 

Second question is should I be changing anything with my current results? - I attached some OSCAR screenshots. We have a baby so I get up to change a diapers and such, sometimes I turn machine off, sometimes I just set mask down and leave it going.  AHI is typically around 1.5-2 though, which I guess is good, I just want to be getting the best possible sleep. 

My main issue is that it feels like I'm not getting enough air while trying to fall asleep and it keeps me awake, both because I'm having to remove my mask to take some deep breaths and because then my mind is actively thinking about breathing and my perceived lack of air.  If I have to wake up to manage the baby or pee or anything repeat the process of falling asleep slowing because the machine has reset to the lowest possible pressure.  Will upping the minimum pressure help with that? 

I have a dream station auto cpap, dreamwear nasal mask I think its called, with humidity, pressure is 5-20, but its been starting at 6 for some reason, flex is on at 2, no mask is set but looks like that doesn't really matter for the dreamstations? ramp is off (I'm half sure)

not sure if its needed but heres the stats as well


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#2
RE: Can and/or should I change any settings?
G'day Rick. Welcome to Apnea Board.

Should you change your settings? If it was me, I would make some small adjustments. Your numbers are pretty good (discounting the fragmented sleep) but I think we could improve them a bit and improve your sleep quality as well.

Can you change your settings? Please note I'm in Australia and we have a completely different system here, so what I'm about to say is what I've heard from others on this forum... Your insurance company does not care about your prescription, it only cares that you are compliant. ie that you are using the machine enough to justify their investment. And you are doing that, no worries. Your sleep doctor or therapist probably has to provide the compliance certificate, so if you change your own settings you'll need to square it away with them at some stage. Unfortunately some people in the health system develop a Napoleon complex and their orders are not to be questioned. We've heard of docs threatening to refuse the compliance certificate if patients do their own thing. Hopefully your doc/therapist is not like that. I usually work on the adage that it's easier to beg forgiveness than get permission.

As to the recommended changes, let's look at your charts. You've said you struggle to get enough air when you first mask up - this is evidenced by the number of yellow events each time you go to sleep. These are respiratory effort related arousals (RERA). They are not apneas, but a disturbance in your sleep caused by an inability to get enough air in. The answer is to increase the minimum pressure and increase pressure support (flex). I'd increase the minimum pressure to around 8.0, and set the flex to 3 (maximum). Leave the maximum pressure where it is. You should find breathing is much easier and you won't be stirring so much in your sleep.

Give it a try and let us know how you get on.
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#3
RE: Can and/or should I change any settings?
Thanks, I'll call my DME today and double check if there are any reasons why I cannot personally change my settings and if there is I can at least bug them at the same time to do it remotely (I believe they can do that).  This morning I woke up air starved and saw the pressure was down to 5.5.  Somethings gotta give.
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#4
RE: Can and/or should I change any settings?
DME just told me that my insurance will stop paying the rental if I change my pressures myself.
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#5
RE: Can and/or should I change any settings?
Based on your reports, your 95% pressure is over 9-cm and you would benefit from increasing the minimum CPAP pressure from 5.0 to 8.0. This would result in significantly less pressure fluctuation through the night, more effective therapy, and less sleep disruption. If you want to go through "channels" the correct call is to your doctor. Request an increase in minimum CPAP pressure based on a median pressure at 7.75 and 95% pressure at 9.9. Explain you are uncomfortable at the minimum pressure and request a minimum pressure of 8.0. The doctor can make that order through the DME and I see no reason it would not be allowed. Alternatively, make the change yourself.

Compliance means that you use the machine more than 4 hours per day on at least 70% of days in a 30 day compliance period. More simply it is 21 of 30 days with more than 4-hours of use. Compliance is n insurance requirement to ensure you will actually use the device. Nothing in compliance prevents you from making appropriate setting changes. Sometimes a DME will tell you it's illegal or you're not allowed to do that, but they cannot take the machine unless you simply don't use it. Rental is there to protect the insurer, not the DME or you. Read more here https://www.apneaboard.com/adjust-cpap-p...tup-manual
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Can and/or should I change any settings?
Last time I went through my doc I didn't get a response for 2 weeks. I guess worst case I have my first followup at the end of the month.

It does seem pretty idiotic that my prescription is a wide range and I can't make small adjustments still within that range without being threatened. I'm still paranoid about making adjustments on my own, even in that link it says once you "OWN" the machine do whatever you want with it, I don't own mine, at least not for another 12 months, its a rental now apparently.

Funny thing is, game of phone tag this morning I got different answers from the DME customer service. Got voicemail saying no I can't do it myself, called back and spoke to someone else who told me to just go to youtube and learn how, then got another call back from original person correcting that saying "no, insurance will stop paying the rental... WA state law says they cant set anything without doc order because its an Rx" last correspondence with the doc said just ask all my questions to the DME, what a cluster.

DME did tell me she changed a setting that had to do with my comfort but wouldn't actually tell me what it was, just that it should help...

I'll figure it all out, thanks for the help and specific advice should I ever work up the courage to just get into the settings myself.

Thanks for the help you two.
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#7
RE: Can and/or should I change any settings?
Comfort settings are usually things like Flex or Ramp on your machine. When I was given my first auto CPAP, it came with orders to self-titrate. Anyway, it's too easy. Just make the changes you want, and double check the settings before bed to make sure no one changed them. The DME cannot make therapy settings without an order by the doctor, but you are not under that restriction. Read the link I gave you to the CPAP Setup manuals, and get your own copy of the clinical manual. Make the changes that make you feel better and sleep well.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Can and/or should I change any settings?
If my issue is that i feel my pressure starts too low then I probably want ramp just totally off right?
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#9
RE: Can and/or should I change any settings?
Turn off ramp.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Can and/or should I change any settings?
One lady that worked as an adviser at my DME supplier told me that if I made changes to my equipment settings I could make my lungs explode. Smile I laughed and made changes based on recommendations I received here and never looked back. She didn't work there for very long I noticed...
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