Issues with Compliance

[Wulfman...]

[. If we can get an armband that records our number of steps and reports the results to a bluetooth enabled device, why can't we get xPAP machines to provide our sleep data in the same way.
I.

As Jedimark and palerider angrily shake their fist's in the air "these people will never be happy"

An obvious oversight on my part is to point out that I in no way want this to be construed as a complaint regarding Sleepyhead. The fact that two members of this forum have to put the time and energy into creating a terrific product that OSA sufferers can use, is in fact an illustration of the problem. Sleep docs and DME's seem to think that since we are sleep deprived, we aren't capable of examining our own data and make intelligent decisions/adjustments to our treatment, that avoid delays of weeks or months to achieve optimal treatment.

My sincere apologizes to Jedimark and palerider if I've slighted their terrific work, in any way.

btw... I took 5 days of Sleepyhead reports into my doc (PCP; I don't have an actual sleep doc) and he was amazed at the simple and interpretable representation of a full night's sleep data.

All of these comments have hit the nail right on the head.
Specialy the part about JediMark not enableing the CMS 50i yet or bluetooth and wifi. who cares if the machines don't offer it he should be able to work around such minor issues as that.
And the part about EDUCATION, I didn't think that was allowed in colleges our universities unless it specifically addresses Gendoer or Race issues.

The MAIN thing that needs to be addressed is who OWNS and CONTROLS all the data about MY BODY. I believe I should own and control it. the medical mafia think they do. The govenment wants to take over and be totaly in charge. I read a statement today attributed to the designer of Obamcare - no one should be seeking medical or other care in an atempt to extend their life beyond the age of 75.
Once everyone agrees it is my body and my data and I AM THE CUSTOMER, NOT THE DME OR DOCTOR OR INSURANCE COMPANY, then maybe the manufacturers will start to shape up.

NC has started something here. If his team could take the responses to the manufacturers of our equipment and to congress, maybe they could actually make a difference.

Yes, WE own the "data". It's ours from our sleep. Kind of along the lines of "HIPAA". However, how that data gets collected and formatted can be an issue with the manufacturers. I can't/won't comment on the particulars, but I had some experience with an issue in this regard about 20-some years ago with a different industry.

Also, with every different generation of these machines, the manufacturers change the data structure. It could be come an endless challenge for someone to keep up with writing code to interpret the data. The guy who wrote "MyEncore" found that out as did the other one who wrote "Encore Pro Analyzer".


Den

.

[NCSUStudent]

All,

Thanks for all of the feedback so far. How many of you all use a third-party application to monitor your sleep/CPAP?

[Wulfman...]

All,

Thanks for all of the feedback so far. How many of you all use a third-party application to monitor your sleep/CPAP?

Please define "third-party".
The manufacturers have their own software for monitoring therapy. (whether it would be for DMEs, doctors or for users). That would be considered "first party".

Then, there is currently user-developed software like "Sleepyhead"........which would be considered "second party".
To me, anyone developing software OTHER THAN the manufacturer would be "second party". Right?


Den

Edit: I realize the term "third party" is often/frequently used, but I think it's an over-used or misused term.

.

[Greg Riddle]

You are first party. Machine manufacturer is second. Sleepyhead would be third

[anomie]

The vendor is the first party.
The user is the second party.
Anyone else is 'third party'

Who is who will change depending on context. 'Third Party Software' when speaking in the context of, say, Microsoft Windows is anything put on the box that was written by someone other than Microsoft or the end user.

In the context of, say, the Mozilla web browser, a 'Third Party Plugin' would be a plugin written for the browser that was written by someone other than a) the people who wrote the browser and b) the person using the browser.

Edit: it looks like it may have originally come from vendors and clients having contracts with each other, and anyone else not being a party to the contract.

[Wulfman...]

You are first party. Machine manufacturer is second. Sleepyhead would be third

But, according to the manufacturers, WE aren't even the customers......the DMEs are.
(I'm not sure who they think uses the machines, but I've gathered WE aren't even part of the equation.)


Den

.

[Wulfman...]

The vendor is the first party.
The user is the second party.
Anyone else is 'third party'

Who is who will change depending on context. 'Third Party Software' when speaking in the context of, say, Microsoft Windows is anything put on the box that was written by someone other than Microsoft or the end user.

In the context of, say, the Mozilla web browser, a 'Third Party Plugin' would be a plugin written for the browser that was written by someone other than a) the people who wrote the browser and b) the person using the browser.

Edit: it looks like it may have originally come from vendors and clients having contracts with each other, and anyone else not being a party to the contract.

And, if the manufacturer (ResMed or Philips/Respironics) writes the software???
So, Sleepyhead is "second party" software?


Den

.

[palerider]

The vendor is the first party.
The user is the second party.
Anyone else is 'third party'

Who is who will change depending on context. 'Third Party Software' when speaking in the context of, say, Microsoft Windows is anything put on the box that was written by someone other than Microsoft or the end user.

In the context of, say, the Mozilla web browser, a 'Third Party Plugin' would be a plugin written for the browser that was written by someone other than a) the people who wrote the browser and b) the person using the browser.

Edit: it looks like it may have originally come from vendors and clients having contracts with each other, and anyone else not being a party to the contract.

And, if the manufacturer (ResMed or Philips/Respironics) writes the software???
So, Sleepyhead is "second party" software?

SH is always 'third party' because it's not you, or the manufacturer doing it.

it's that unrelated 'third party'.

unless, I suppose, one happens to be jedimark, using it for his own purposes.

third par·ty

adjective
adjective: third-party; adjective: third party

1.
of or relating to a person or group besides the two primarily involved in a situation.
"third-party suppliers"

of course, given the attitude of mfgrs and DMEs, WE'RE third parties too!

[Wulfman...]

The vendor is the first party.
The user is the second party.
Anyone else is 'third party'

Who is who will change depending on context. 'Third Party Software' when speaking in the context of, say, Microsoft Windows is anything put on the box that was written by someone other than Microsoft or the end user.

In the context of, say, the Mozilla web browser, a 'Third Party Plugin' would be a plugin written for the browser that was written by someone other than a) the people who wrote the browser and b) the person using the browser.

Edit: it looks like it may have originally come from vendors and clients having contracts with each other, and anyone else not being a party to the contract.

And, if the manufacturer (ResMed or Philips/Respironics) writes the software???
So, Sleepyhead is "second party" software?

SH is always 'third party' because it's not you, or the manufacturer doing it.

it's that unrelated 'third party'.

unless, I suppose, one happens to be jedimark, using it for his own purposes.

third par·ty

adjective
adjective: third-party; adjective: third party

1.
of or relating to a person or group besides the two primarily involved in a situation.
"third-party suppliers"

of course, given the attitude of mfgrs and DMEs, WE'RE third parties too!

I realize how the "implied" definition is used. It's just that I think it's a little screwy in some cases.
To my way of thinking......
The manufacturer is the "first party"......and they write their own software like Encore and ResScan (PR & ResMed).
Jedimark is a user, so he writes "second party" software.

Personally, I use the "first party" software......"Encore Pro".......and second party software "MyEncore" (by Derek Rowell a forum member and user). I wouldn't attempt to write software for this stuff. COBOL, Basic and Dbase/Foxbase were about the extent of my code writing.......many years ago.

OK......I'm done messin' with y'all and splittin' hairs.

Den

.

[anomie]

I realize how the "implied" definition is used. It's just that I think it's a little screwy in some cases.
.

I don't think it is. It's just that it all depends on what relationship you're talking about.

SleepyHead is 'third party' in the context of your use of a particular vendor's machine - you use the vendor's machine, the vendor made the machine - in that context, SleepyHead is third party software, because it was written by someone other than the two parties in that relationship (you, the user, and the vendor, who made the machine).

But, say you use SleepyHead, and I write some software that, say, does something neat and useful to sleepyhead. In that context, you and SleepyHead would be parties, and *my* software would be third party.

The more I think about it the less I think it makes sense to try and assign 'first' and 'second' party - you're either a party in the relationship, or you're third party.

of course, given the attitude of mfgrs and DMEs, WE'RE third parties too!

If the CPAP manufacturer and the DME have some kind of contract that may well *actually* be the case in the context of that contract.

(and my DME is a 'third party' in the context of my insurance agreement, because they're not me, and they're not my insurance company)

[Wulfman...]

I realize how the "implied" definition is used. It's just that I think it's a little screwy in some cases.
.

I don't think it is. It's just that it all depends on what relationship you're talking about.

SleepyHead is 'third party' in the context of your use of a particular vendor's machine - you use the vendor's machine, the vendor made the machine - in that context, SleepyHead is third party software, because it was written by someone other than the two parties in that relationship (you, the user, and the vendor, who made the machine).

But, say you use SleepyHead, and I write some software that, say, does something neat and useful to sleepyhead. In that context, you and SleepyHead would be parties, and *my* software would be third party.

The more I think about it the less I think it makes sense to try and assign 'first' and 'second' party - you're either a party in the relationship, or you're third party.

of course, given the attitude of mfgrs and DMEs, WE'RE third parties too!

If the CPAP manufacturer and the DME have some kind of contract that may well *actually* be the case in the context of that contract.

(and my DME is a 'third party' in the context of my insurance agreement, because they're not me, and they're not my insurance company)

If anyone reading this wants to give themselves a headache (and maybe get a laugh).......and find out how many people DON'T understand these terms and see some convoluted answers........do a Google search on "first party, second party and third party software".


Den

.

[palerider]

If anyone reading this wants to give themselves a headache (and maybe get a laugh).......and find out how many people DON'T understand these terms and see some convoluted answers........do a Google search on "first party, second party and third party software".

nope, not that masochistic... thanks for the offer though.

[Krelvin]

All,

Thanks for all of the feedback so far. How many of you all use a third-party application to monitor your sleep/CPAP?

To Answer your question....

Until I got my most recent machine, I used the MFG's software which was Encore Pro and then as I upgraded my computer Encore Basic.

With my new machine I use the MFG's software Rescan primarily so that I can see what the sleep Dr will see and for my own use the 3rd party software SleepyHead. When I stop seeing the Sleep Dr which most likely will be the next visit, I won't bother with the Rescan software.

Currently, I am looking daily, but will if I continue to have the current performance that I am seeing, will slowly look less often.

With my previous machine, I went several years without looking since it was working fine and I was not having any unusual issues. Been using BiPap for 8 years now don't lie down or sleep without it.

[bwexler]

Who knows the address of the party? I want to come.

My earlier point was simply I want to be in charge.
I choose which doctor, insurance company, govt agency gets to see my info and when.
I have the right to see it first before it is filtered or viewed by anyone else.
They all have to get it from me and I don't need anyone's permission to see my info.

I am waiting for the results of a biopsy. The doctor has to bless it before I get to see it. That is backwards.

[Todzo]

Hello all,

I'm working on a school project at North Carolina State University. Our team is working to address CPAP compliance and we're wondering if any of your would be willing to share why you struggle with compliance.

What thoughts do you have?

Many, but few that I can share here. PM me if you wish.

Is it just a comfort issue with the machine?

Several things appear to work together to fracture sleep in those with Obstructive Sleep Apnea[1]:

Pcrit – Pressure Critical – the pressure needed to prevent obstructions (without the pressure from CPAP the obstructions would occur). Note that I find that this is not a static parameter. Indeed none of the items mentioned in this list are static. They vary hour to hour, night to night, season to season. Treatment must take this into account. This is what CPAP tries to deal with.

Arousal threshold – Technically the amount of respiratory effort that causes an arousal. I tend to think of this in a somewhat broader sense simply because other things cause arousal and arousal always fractures sleep. As well I am suspicious that if lower respiratory effort causes more arousals so will other things. CPAP may well tend to aggravate this.

Loop gain – Respiratory control loop gain. If higher than one instability results with excursions into high levels of breathing with the associated high respiratory effort (see Arousal Threshold). As well blood gas levels are affected (look up cerebrovascular CO2 reactivity e.g.[2]). CPAP tends to exacerbate this.

Muscle responsiveness – specifically genioglossus (tongue) muscle responsiveness. If it falls back it may well obstruct. Due to the size and weight of the tongue CPAP may have little effect regarding this.

Simply CPAP not only does not deal with the whole picture and tends to actually aggravate parts of it. Most have problems with it.

What could a device do to increase compliance?

If the process of using the nightly CPAP data were streamlined that would help immensely. I find that I really need the feedback to know how I am doing (or more properly why I am doing as I am doing) and to see problems that will always crop up and deal with them.

For example right now I am using modified EERS[3] to help deal with my loop gain issues observed in my nightly data (now linked to understanding of physical symptoms from experience).

What could a mobile application do to increase compliance?

Make the nightly data available easily and easily digested for the user – along with suggestions as to lifestyle changes that could help deal with the issues shown.

Could a sleep "score" increase compliance?

My tendency is to think that competition in the bedroom should probably be limited to very friendly “play” activities.

Could making use of the CPAP and getting a good night's sleep a game/competition help?

My first reaction to this is simply that I do not consider getting sleep a game at all. It is serious to my survival. However perhaps for some this would be a help.

Thanks for your input!

-Gavin S.

[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[2]Philip N. Ainslie , James Duffin , Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation. American Journal of Physiology - Regulatory, Integrative and Comparative PhysiologyPublished 1 May 2009 Vol. 296 no. 5, R1473-R1495 DOI: 10.1152/ajpregu.91008.2008

[3]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[4]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721