CPAP the next generation

[archangle]

I've seen a number of questions about when "the next generation" of CPAP is likely to come out. I'd like to change the question a bit.

What is likely to constitute the next generation of CPAP?

Between the M series and PRS1 generation, they added flow waveform recording. To me, that's the big difference. Yes, they tweaked some algorithms and added a few more events they score. They also went from proprietary data cards to SD cards. ResMed made similar improvements between S8 and S9.

I see the flow waveform recording as a BIG improvement. I think everyone should be using a machine that records flow waveforms. It tells a good sleep specialist or knowledgeable user so much more than a simply event count.

What do you folks see that would be a real improvement in the next generation of CPAP? Actual improvements instead of just marketing hype?

I also see some dangerous possibilities like making it impossible for the user to control their own machine or see the data. I'm sure the medical cartel would love to remove those abilities from us users.

[robysue]

I
Between the M series and PRS1 generation, they added flow waveform recording. To me, that's the big difference. Yes, they tweaked some algorithms and added a few more events they score. They also went from proprietary data cards to SD cards. ResMed made similar improvements between S8 and S9.

I see the flow waveform recording as a BIG improvement. I think everyone should be using a machine that records flow waveforms. It tells a good sleep specialist or knowledgeable user so much more than a simply event count.

I agree 100% with this. Recording (and showing) the waveform represents a giant leap forward. I just wish that more sleep specialists were actually interested in looking at the flow wave forms---at least when a newbie is having serious trouble adjusting.

What do you folks see that would be a real improvement in the next generation of CPAP? Actual improvements instead of just marketing hype?

My biggest wish? Simply NOT making a stripped down version that records nothing but compliance data. Get rid of that problem right at the source.

Other things where I think some useful improvements can be made:

• Easier integration of O2 sensors and the xPAP machine. And a crazy idea would be to try to integrate data from something like the zeo with the data from the machine. But I think that's a bit too far out ...
  
  Continue the work on reducing the sound level---even though the machines seem virtually silent to most of us, it's still an ongoing issue with some users and some significant others of users. And as part of noise reduction, look at minimizing the amount of conducted noise through the hose. There has to be some way of designing the hose to make it less likely to conduct and magnify the sound of your own breathing, which can be very alarming to some and can be disrupt the sleep of others.
  
  Continue the work on reducing the size of the footprint. While the units are much smaller than they used to be, they do still take up an amazing amount of space if you have a normal size bedside table.
  
  Make sure the user has full control over the ramp: The starting ramp pressure (S1, yes; S9, no). The ramp time (S1, no; S9, yes). And making the default setting "no ramp" with the ramp easy to start by simply hitting a big button. The sad thing here, is that this one should be a no-brainer.

And finally, fix some stupid things:

• For example, my PR S1 is certainly small enough to be able to travel. But the its travel case is actually very awkwardly shaped and significantly larger than the machine. I've not yet flown with the thing, but I can already see dealing with both it and my oversized backpack will be difficult. The travel case for the S9 was much better. But back to the point
  
  Intelligent placement of the hose outlet: For all the great things about the S9, the placement of the hose outlet on the back of the humidifier is genuienly stupid and represents a step backward for Resmed. Coming out of the back definitely puts stress on the hose right at the coupling and my first Slimline developed tears there before it was a month and a half old.

I also see some dangerous possibilities like making it impossible for the user to control their own machine or see the data. I'm sure the medical cartel would love to remove those abilities from us users.

And this thought makes me shudder to think of it. The answer here is to somehow educate that medical cartel that knowledgeable CPAPers are more likely to stick with therapy---not for six months or a year, but for the rest of their lives. Meaning much, much more money for those making and selling the equipment.

Think about it: How much money does a DME actually make by giving a brick to someone who tosses it the closest before they even go through one full cycle of replacing the consumables---the mask, the pillows or cushion, the hose, the humidifier tank, and the filters. And how much do they earn from one customer who's given a decent machine to start with and who then chooses to continue patronizing the DME to by all those consumables over the course of 5 or more years and who then chooses to replace their machine with another machine from the same DME and by replacement parts for another 5 or more years, and repeats this process possibly for several decades of natural life?

And just what is the mark-up on those little filter babies? Out of pocket, my DME charges me about $6 or $7 for each little tagless fine filter for my PR S1, with insurance? I pay $2.50 and the insurance company pays $2.50. (I know, I know, I could get the variety with the tag much, much cheaper from cpap.com.)

[Otter]

What do you folks see that would be a real improvement in the next generation of CPAP? Actual improvements instead of just marketing hype?

DeVilbiss attitude + Resmed/Respironics data and diagnostic features.

A "true HEPA", sealed filter.

A truly good interface on the machine. But I get the impression that's sort of like asking for good customer service from Comcast.

Hmmmm, how about an engineer who is actually a CPAP user?

A non-proprietary bus for oximeters and other sensors. A Zeo-like module would be nice, but if the oximeters that will interface with the current CPAP machines are any gauge, EEG input would start at two arms and a leg. What we need is a jack of some sort that is as the SD card is to the Smartcard. Then Zeo or someone can make a cheap aftermarket EEG. I suspect the technology is already there, or will be very soon.

[ameriken]

The other day I was thinking (which is amazing in and of itself) about how we now have wireless phones, wireless computers, wireless guitar/amp setups, etc.

So, wouldn't it be awesome if one day there were a hoseless xPAP machine and mask?

(Probably a few generations away, or by then they'll have a completely different solution to apnea.)

[archangle]

So, wouldn't it be awesome if one day there were a hoseless xPAP machine and mask?

Instead of bluetooth, we'll have bluenose devices.

Just have a mask with a built in fan, pressure sensor, and flow meter. The CPAP unit is just a display, control panel, and charging stand for the mask.

Batteries that will last the night would be a problem.

A water tank for the humidifier is going to be an even worse problem.

[archangle]

Wireless is a good point. Have it connect wirelessly to your home network so you can download your data without messing with a data card. It could also use your local wireless network to send data to the DME/Doctor instead of having the separate modem. A computer app that can control the CPAP and display data.

Good luck on that happening. The medical mafia would flip on the user having data access. And the manufacturers love renting those separate modems and data service out at highly profitable rates.

Wireless or Ethernet based network for data download, SPO2 sensors, etc. Non proprietary data transfer protocol.

[BluRayLeader]

I used to work in the medical device industry and wireless would be a big pain in the tukuss to implement. Any change or update requires allot of testing and validation.

[gasp]

If they are ever wireless then I hope there is a better connect/drop statistics than we currently have. Otherwise we'll need to have the reports add "Connectivity Issue Event" : )


Ah hem, back to the post . . .
What is a flow waveform as it pertains to XPAP and what would we see in reports to help us reduce events?

[archangle]

A flow waveform is a graph of the rate of air flow through the CPAP machine. Think of the EKG graphs you see on TV, but for CPAP.

If you have an apnea, for instance, you can look at the flow waveform and see how long it lasted. Is it a 100% air stoppage, or just a reduction in flow? Did you gasp for air at the end, or did you just slowly start breathing again? And so on.

I find flow waveforms very helpful because some events are more severe than others. Some that the machine flags as an event don't really look like anything at all. With older machines, you just get something like "You had an obstructive apnea at 2:15 AM." Or on ResMed, you may get a time duration listed. The actual flow waveform tells you a lot more about what happened.

Is that what you were asking about?

[chunkyfrog]

Let us not forget the mask issue.
There are still way more sizes and shapes of faces than there are masks.
I can buy any one style of shoe in at least 9 sizes, but a mask--? No way!
My Swift FX is basically the CPAP version of the flip-flop.
If I couldn't use that--I would be totally screwed.

[Tip10]

I'm with the Frog!

I think the dataless brick is well on its way out , I feel the full data machines will become the norm. I'm less inclined to want any sort of wireless network connection or anything like that. I do however, want to see a lot and I mean a LOT of improvement in the interface. In this day and age of custom just about everything the idea of one (or even two or three) size fits all masks is absurd.


Oh, and robysue -- I happen to think the hose outlet on the S9 is absolutely perfect. It's placement with relation to the controls and humidifier hatch and all that fit perfectly into my set-up on my nightstand. Hose comes straight off into the straps on my headboard that support it, on/off button is at the end right next to my pillow -- only deal is the screen is upside down for me but hey --- can't read it without my glasses anyhow! To each his own. Bet you sleep on the left side of the bed when facing the headboard don't you??

[DreamDiver]

1. CPAP's with inexpensive bundled oximetry - a washable, reusable sensor and lead that clips to the ear or finger comfortably. Users can understand that if their O2 is too low, they're dying. When you can show a plot of apnea and consequent 02 drop, it's the best incentive there is for continuing to try using CPAP. If they can make a $30 recording oximeter that is reliable, there is no reason why they couldn't include a similarly inexpensive one with the CPAP.
2. CPAP's with inexpensive Zeo-like bundled EEG with washable, reusable sensor(s) and lead(s) that rest on the forehead in pap-cap-style head-gear. Trends in sleep patterns over time could be helpful for doctors to decide for more sleep lab tests and could be useful for users to determine better habits for sleep hygiene.
3. Masks that sense facial topology and form-fit via contractile polymers (or something similar) that respond to the heat of the skin and/or electrical signals to seal properly, stretching or curving as necessary around the contours of the face. Don't you hate the leak in the eye that wakes you at 2:30 am? This could stop that.
4. Flow trends: Hey, we've got all this great data. We're automatically screening flow for various things already like apnea and cheyne-stokes breathing. Why not screen for other things as well? The machine doesn't have to do that. The software on our computers could easily do whatever complex algorithms are necessary to illuminate more complicated things both on a spot basis and over time.
5. Apnea duration is important. We don't really track it, or trend it over time. We should. There ought to be a number or ratio is governed by the following factors:
   
   1. the average duration of apneas for a night,
   2. a rating for apneas in specific duration ranges,
   3. a ratio or number that gives us a measure of how good or bad last night's apnea durations may have been based on the above numbers,
   4. and a long-term trend that shows whether our apneas are getting better, worse or remaining steady over the last month or two months.

[dsm]

Archangle,

Always a good topic this one

For me, it would be even better algorithms that get to be ever so accurate at picking likelihood of a central vs obstructive event. Perhaps the built in computers can profile the sleeper and build up a predictable set of patterns that could allow more accurate determination of state & events.

But, the #1 & #2 improvements have to be to the masks & fitting them and more accurately preventing leaks and responding better to them.

Am sure you will get a lot og good thoughts & ideas.

DSM

[justbreathe]

I think the wireless connection is a bad idea. It wold be bad if the neighbor kid hacked into your cpap and changed your pressure.

[JointPain]

My biggest wish? Simply NOT making a stripped down version that records nothing but compliance data. Get rid of that problem right at the source.

I agree 100%. In addition, users should be able to see their own efficacy data (without going via clinician manual).

Also get rid of straight CPAP machines in favor of APAP.

I find it hard to believe that the cost differences to the manufacturer are significant, so hopefully this will happen once they've recouped their R&D investment.

Are there any studies that compare compliance of people who have efficacy data available for review at any time with the compliance of people who don't? I doubt such a study exists.

Another wish is some way for the machine to upload data wirelessly and automatically to secure cloud storage where it can be reviewed by a) the patient, b) authorized medical personnel, and c) sophisticated computer systems that monitor trends and issues alerts to the patient and their medical provider if further investigation and/or adjustments are indicated. IBM, for instance, sells systems that monitor ER devices in real time and can predict/detect events and alert the ER staff much faster than traditional methods, and this saves lives. We don't need the real-time bit, but having machines review the data would remove the "waste of time/money" factor of reviewing lots of records that don't have any issues and let the DME concentrate on adjusting the treatment of those patients with issues.

The above is a bit of nirvana. Unfortunately, I don't trust the medical establishment to allow the patient to be self informed unless it's via government regulation.

Security is a concern. In the above, the machine can only upload data. Changing the settings on the machine should continue to require physical access.

Finally, there should be an industry standard data format for the way data is stored.