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Follow-Up Appt. with Doctor & Changing Own Settings
#1
Good afternoon! Hope everyone is having a good day.

I'm curious if there are any ramifications with physicians if one chooses to adjust one's own machine settings without consulting them? Since I am able to change my machine myself (thank you, Apnea Board), I don't see any reason not to. My husband is a little freaked out that I would consider this, but I explained that I'm not making any crazy changes (changing from straight CPAP to auto, and bumping the max by a smidge). I also explained to him that it's just like using a computer (nothing complex), and that I received the clinician's guide for my machine. He's worried the doctor will drop me and that the insurance company might frown upon it, also.  

Thoughts and experiences on this matter?

Thank you, again, for all the help.
--Leslie

"It will all be fine in the end. If it isn't fine, it isn't the end."
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#2
As stated in the Wiki link below it is not illegal or improper to change your settings but it is recommended that you consult a qualified sleep doctor before making any changes to sleep apnea therapy - that's simply common sense.

http://www.apneaboard.com/wiki/index.php...P_pressure
Coffee

Happy Pappin'
Never Give In, Never Give Up


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. 
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#3
The DME and the insurance ONLY care about compliance.

Usually the Dr. will frown on it but if you demonstrate knowledge, with copies of charts and show that you are being well treated as evidenced by AHI under 5.0, they usually accept it.
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#4
(05-03-2017, 04:43 PM)sonicboom Wrote: As stated in the Wiki link below it is not illegal or improper to change your settings but it is recommended that you consult a qualified sleep doctor before making any changes to sleep apnea therapy - that's simply common sense.

http://www.apneaboard.com/wiki/index.php...P_pressure
Yes, I plan on consulting with him before making changes. I definitely want to change from straight CPAP to auto; I have a great machine and think auto would also provide a more comfortable night.
--Leslie

"It will all be fine in the end. If it isn't fine, it isn't the end."
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#5
(05-03-2017, 04:43 PM)bonjour Wrote: The DME and the insurance ONLY care about compliance.

Usually the Dr. will frown on it but if you demonstrate knowledge, with copies of charts and show that you are being well treated as evidenced by AHI under 5.0, they usually accept it.

I'm a big fan of providing evidence to support my thinking and actions Big Grin , and Seepyhead certainly makes that easy.    And thank you for the heads up on attachments!
--Leslie

"It will all be fine in the end. If it isn't fine, it isn't the end."
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#6
My sleep center is quite accustomed to patients who go rogue apparently because they didn't bat an eye over it. They had no issue with doing my doing my own settings but gave parameters. If for instance, I had to increase pressure above 13, then I needed to call the office and talk to the PA. Auto or straight - they didn't care since I was using Sleepyhead.

As always, you will have some docs who are very controlling, but as has been shown commonly on this forum, many sleep docs only care about compliance. Even if you tell them you are still tired, nothing happens.

My suggestion - start with the doctor's settings for a week or two. Then start adjusting. Remember that adjustments should be slow. Unless you have fragile blood pressure, a heart problem or a known lung problem, switching to APAP is a no brainer. You'll know within 3-4 nights if the apap is totally not working for you (usually the algorithm isn't a fit for you).
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#7
Some of us were issued auto CPAPs and told to self-titrate. Somehow, I think we got the best bargain compared to those with control-freak doctor that want to specify settings and get all offended if the patient takes initiative. PAP therapy kind of lends itself to DIY, and the more information you have, and the more involved you get, the better.

Good luck. I'm sure you can show the progress and improvement your choices make over the original "suggestion" / prescription.
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#8
I had the same apprehension as the OP.  The first thing my sleep doctor said to me was, "I see you've switched your settings."  But she was fine with it.  She sked me where I got my information and why I set it the way I did.  Then she told me I had done a great job with the settings.  She did change them ever so slightly before I left (she makes patients bring their machine in) and explained why--she wanted just a tiny bit more on the high side in case something changed and I needed it.

Turns out the DME has staff in her office.  When I told her that the mask was leaking around my eyes, she told me she would fix it and she sent in the same technician who had set up my original system in my home.  It was kinda handy having him there and I ended up with a different mask that fits much better.

Long story short, hopefully your sleep doctor is like mine and understands.  I think most will.
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#9
I had the same concern so I emailed my Dr. with a request to change my settings from constant pressure to APAP. I mentioned that I had acquired software to look at the data and cited some of the data. I did not mention that I had recommendations from a forum. I wasn't sure that would go down well. A couple of days later the settings of my machine magically changed. (She sent a new prescription to the DME and they made the changes.)

When I went in for my compliance visit I took SleepyHead charts and asked if it was OK to change settings on my own. She said no! Then she winked and said if I did she wouldn't tell anyone.
I made a change a week or so later and have not heard any protests in the 6 weeks since.

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#10
I have over the past 6 months brought my treated AHI from 4/5, to .9/0.0,

Have on several occasions found the settings changed. speaking with the (DME/RT) they admitted reverting to the original Rx, stating <5 was OK. Removed Modem..

Spoke with primary and specialist, supplied my charts, they were both surprised of my success, have indicated I continue my own adjustment Wink

RT no longer wishes to deal with me..

.... Philip
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