Meet the minds behind the S9

[jnk]

. . . at the end of the day what has that video you voluntarily (Resmed did not send it to you) sought out & peeked at, really got to do with SDB & a box of plastic & metal designed to treat it ?. Is this a storm in a tea cup ? . . .

Any time a company puts out a video that says "we did a bunch of research so we know exactly what the patients want" has to expect a number of patients to speak up and say "hey, that's not what I want" if that is the case. We hunt down the video because we want to know about the product. We all have a right to react to it when we find it insulting. And I do.

I have read about the S9 and I am convinced by what I've read that it does not address my personal needs. I don't need smiley faces--I need useful, detailed info easily accessed from the screen. I don't need FOT to tell me that when I turn the pressure up, my AI increases. I have solved my rain-out problem without a proprietary hose. So this machine has nothing I personally want. And I have a right to proclaim so to the world in this forum just as everyone else has.

Any time a company puts out a machine that does not significantly increase the amount of usable data available to the patient, but instead hands out gold stars and smiley faces and does a little happy-feet dance for the sake of marketing, I will be disappointed. And I will say so. If you can put a color-coded smiley face, you could have put a color-coded leak chart or an AHI chart there instead. Why didn't you? Because people would have less reason to keep contact with the B&M DME, that's why.

Yes, I believe ResMed did a butt-load of market research by interviewing their real customers--the brick-and-mortar DMEs. And I believe those real customers will be happy with it. They are welcome to it. They can sell it to themselves.

I may have to pull a carbonman and stock my closet with S8II's.

[jnk]

Bob,

In this thread you said this:

. . . Any modern autoPAP machine you purchase today from a legit source is going to provide effective therapy. . .

I had a fairly good idea what you meant, because in another thread you said this:

. . . Literary hyperbole is my M.O., amigo . . .

However, I was glad when ozij clarified your statement with the statement that said this:

. . . That does not mean it treats all people well. . . .

Window dressing? Call it that, if you want. But the more you read in this forum, the more your opinions on such things, and your opinions of the windows themselves, are likely to change, in my opinion. But then again, you may prove me wrong on that.

jeff

[ozij]

given how drastically different APAP and CPAP are in terms of the technique of applying therapy, yet how similar compliance rates and similar effects on AHI and RDI are, I find it hard to believe that different manufracturers' APAP algorithms might create such a huge difference in treatment effectiveness that some machines work for some people, but not others, while other machines might inverse this

Since none of the studies you quoted showed 100% effectivenss, you have no way of knowing how many of the non-compliers (or compliers with unsuccessful results) would have done better with another algorithm.

Some facts about Automatic algorithms (you will find references to them on company sites):
The DeVilbiss only responds to apneas, snores and hypopneas, and does not respond to flow limitations at all.
The ResMed only responds to apneas snores and flow limitations, and does not respond to hypopneas at all.

A Respironcis machine will respond to apneas at almost any pressure between 10 and 20. A ResMed will stop at 10. On a Fisher & Paykel, and on a Sandman you can change the level at which response to apneas stop.

The Sandman Auto has an on/off switch that changes its respnonse to flow limitation runs. It is there because the Sandman misinterprets some breathing patterns and raises pressure uncontrollably.

You are uninformed about the way the machines work, and their impact on different breathing patterns. Peer reviewed studies will not make you more informed about that -- and you are basing what you call you "informed" opinion on flawed logical assumptions that have nothing to do with the information you collected.

O.

[Bob3000]

Since none of the studies you quoted showed 100% effectivenss, you have no way of knowing how many of the non-compliers (or compliers with unsuccessful results) would have done better with another algorithm.

Some facts about Automatic algorithms (you will find references to them on company sites):
The DeVilbiss only responds to apneas, snores and hypopneas, and does not respond to flow limitations at all.
The ResMed only responds to apneas snores and flow limitations, and does not respond to hypopneas at all.

A Respironcis machine will respond to apneas at almost any pressure between 10 and 20. A ResMed will stop at 10. On a Fisher & Paykel, and on a Sandman you can change the level at which response to apneas stop.

The Sandman Auto has an on/off switch that changes its respnonse to flow limitation runs. It is there because the Sandman misinterprets some breathing patterns and raises pressure uncontrollably.

You are uninformed about the way the machines work, and their impact on different breathing patterns. Peer reviewed studies will not make you more informed about that -- and you are basing what you call you "informed" opinion on flawed logical assumptions that have nothing to do with the information you collected.

O.

And yet despite these proposed differences in aPAP algorithms, no company has been able to conduct and publish a clinical trial demonstrating the superiority of their algorithm over their competitor's algorithms. The only such studies have demonstrated 'similar levels of treatment'. If and when a study comes out demonstrating that one algorithm is superior to another, even if only under certain conditions, I'll be more inclined to believe you. If in fact a particular algorithm is more effective at large or for a sub-population of OSA sufferers, there would be clinical trials demonstrating this if only so that the company could profit by advertising this advantage. At this point, you rely on hearsay and single patient accounts, which are notoriously unreliable. I am much more inclined to believe that in any single case of someone seeing a dramatic benefit by switching aPAP machines, the patient also knowlingly or unknowingly changed one or more other variables that would account for the improvement better than the switching of the aPAP device. Correlation does not equal causation, which is exactly why peer-reviewed studies of clinical trials exist, and are the best way to answer the questions we're discussing.

[dsm]

Thanks, Doug. You're right, we went looking for the video. And the technology side of the S9s sounds promising and intriguing. I guess I just found the marketing strategy a real let-down and disappontment and so far fetched from what seemed to be Resmed's determination to get as much data as easily available to their end-users as they could w/o torquing the jaws of the sleep doctors who want the control for themselves.

Slinky

Lets apply some logic & work out just who we can point the finger at re that video.

I doubt it was the CEO who conjured it up, nor the international product manager. The usual approach here is just what Apple did with their iPhone then iPad launches, you go to a premium advertising agency & say "we have a product launch & want you to devise a campaign for it"

The adv agency sends along some of their creative young (old - who cares) guns full of brilliant ideas OR the execs at Resmed might have said, we want a campaign just like the Apple launch - white backgrounds, casually dressed Apple designers speaking about the greatness & purity of the design yadda yadda yadda.

I am sure you know where this is heading

Advertising agencies have signature styles & what struck me very quickly was how similar the style was to the recent videos put out by Apple for their iPad launch. So, it is possible Resmed in San Diego commissioned the same agency Apple in Palo Alto used. West Coast hot shots. If they did choose someone else then the someone else look like they plagiarized Apples agency.

So the agency sends in their team who may have decided from the start that they needed white simple backgrounds & to have the designers & a product person talking sincerely about why the product was so good. They ask their questions such as what are the features you want to highlight. Then they blend that into the theme & produce some sample interviews which are typically taken from casual conversations recorded with the chosen participants. That technique of switching from front to the side as the person speaks is how they blend different segments of an overall interview into core points and segments & how they also trim the interviews. Get the speaker relaxed - video from 2 sides, ask questions - record the responses - then trim & blend.

So lets lay the blame at the feet of the real perps.

The advertising agency & the Resmed exec who signed off on the final product (the video that is). Resmed people themselves came along for the ride.

DSM

[NewsmanBG]

Okay, newbie voice here. I like this. A few points:

1. It's funny; when my neurologist was first telling me about the treatment options for my OSA, he pointed to two posters on his wall, one of ResMed CPAP (S8) machines and one of ResMed masks. I (kid) you not -- my immediate comment was, "Wow, can't somebody come along and give this stuff the iPhone treatment?" The hospital-like appearance of the machine made me reluctant to use what was rationally the best treatment option available to me. It reminded me of the stuff around my dad's bed as he was dying in the hospital.

2. Millions of people are either undiagnosed with sleep apnea or diagnosed and refuse therapy. My buddy Karl is one. He said, "I'm not using the machine. Getting sex around my house is iffy enough as it is. That thing isn't going to help my chances any." Why not make the device more attractive so people who need it will use it? In so doing, ResMed sells more machines to people who need them and makes more money. And deserves to.

3. Given how poor DMEs are about helping you get your therapy to an optimal point, any automatic things the machine can do to help tweak settings to prevent apneas is a huge plus. I think most people just take the machine as set up, then use it (or, if they don't feel they're getting results, stop using it). Many could be getting better therapy, but they're not savvy or motivated enough to go all-in like the true believers on this board do. (My hat's off to the true believers on this board, by the way.)

4. A heated hose standard. What's not to like there? Being able to set temp independent of humidity. I'd say they are listening to patients on that one, whether the video says so or not.

5. Now get to work on a sleek-looking mask. I have some ideas: Something that looks spalike, something that looks like a motorcycle or bike helmet, etc.

6. Partly to muffle any noise, but also because it's so ugly, I keep my S8 on a baking sheet that I keep slid under the bed whenever I'm not pressing the buttons on the S8. I would happily have this machine on my bedside table.

Any gripes about functionality are certainly legit. It must work great and do what we need it to. But why in the world shouldn't they expend a great deal of effort making it look great?

[Slinky]

The S8s ugly?? Ugly are the Respironics pre-M Series and M Series black boxes! But given beauty is in the eye of the beholder lets move on to the "hospital-like appearance of the machine". Say what?? I see nothing hospital-like with the S8s!

[dsm]

The S8s ugly?? Ugly are the Respironics pre-M Series and M Series black boxes! But given beauty is in the eye of the beholder lets move on to the "hospital-like appearance of the machine". Say what?? I see nothing hospital-like with the S8s!

I thought the S8 was the cutest lil ole cpap there was. I still think it is the neatest plus the PB4xx range. The S8 seemed a highly practical design with its
easy to set up hose & easy to fill water reservoir.

DSM

[Slinky]

The S8s are so SIMPLE to set up and use and take down again if you are traveling!

Snap the humidifier unto the CPAP, fill the humidifier tank, plug in the cord, attach hose to humidifier and to mask, push button to turn on CPAP, don mask and go to sleep. What could be more simple?

Wanna check your efficacy data? Press two buttons. Wanna change your therapy settings? Press two buttons.

In the morning, empty humidifier tank, remove hose from humidifier and mask, put tank in humidifier and CPAP and humidifier in carrying case, put mask, hose and plug in carrying case. Zip up and move on out.

Even a caveman can do it!!!

[NewsmanBG]

Oh -- is there reason to believe the S9 won't be easy to take apart and pack?

[tillymarigold]

Me: Their marketing strategy seems to be "people will want it because it looks nifty."
DH: Why not? It works for Macs.

[jnk]

I'm trying hard not to comment on how it looks. Slinky makes fun of me for having no taste in my liking the looks of the Respironics M series machines. They look rugged and manly and sturdy and no-nonsense to me, and I like that. The S8s look to me like, well, as someone once posted, overgrown Fisher-Price toys. But I love my S8 for all the reasons Slinky lists and more. So I ignore how it looks and just enjoy what it does.

[ozij]

And yet despite these proposed differences in aPAP algorithms, no company has been able to conduct and publish a clinical trial demonstrating the superiority of their algorithm over their competitor's algorithms.

My point exactly.
Company A is good for 75% of the population.
Company B is good for 75% of the population.

50% of the population will do great on either company A's algorithm or company B's algorithm.
A's 25% failure (lets call them A25) would do fine on B's algorithm.
B's 25% failure (lets call them B25) would do fine on A's algorithm.

Neither algorithm is superior -- and I never maintained there was one algorithm superior to another in all cases. And yet, when you add A25 +B25 you get 50% of the population that would have done better on another machine.

You can play around with the number as much as you want -- unless you have a 100% success on all parameters, your point about the window dressing is untenable.

If in fact a particular algorithm is more effective at large or for a sub-population of OSA sufferers, there would be clinical trials demonstrating this if only so that the company could profit by advertising this advantage.

An assumption.
If company A advertises B25 do better on their algorithm company B can respond that that A25 do better on theirs. Both companies would prefer to have their equipment sold to 100% of the population, not the 75% it treats effectively, and will go to any lengths to sell their machines.
If that means advertising their machine as a the next magic cure that will work fine when set at a 4-20 range, they will do so, and have done so.

Discovering reliably that a specific APAP does not fit a specific patient and has to be done on a case by case basis. It has nothing to do with the size of the population that in not well served by one algorithm or another. It could be 0.01% of the population. So what? Those people exist, and need good therapy.

At this point, you rely on hearsay and single patient accounts, which are notoriously unreliable. I am much more inclined to believe that in any single case of someone seeing a dramatic benefit by switching aPAP machines, the patient also knowlingly or unknowingly changed one or more other variables that would account for the improvement better than the switching of the aPAP device.

In other words, you prefer to rely on your thoughts and your beliefs your assumptions, to the data presented by patients. You assume you know better than the person who tells you "I changed a machine, and wow, what a difference that has made!".

Correlation does not equal causation

,
How very true.

which is exactly why peer-reviewed studies of clinical trials exist, and are the best way to answer the questions we're discussing.

Only experiments, in which you control variables are proof of causation.
I maintain the people who changed machines and felt better (or worse) were running a controlled experiment in which they changed only one variable -- the algorithm. You have no basis for your assumption that they were incapable of running those experiments and of interpreting their results. The world is full of valid experiment run every day by people trying to better their live, get and give good therapy, and those excellent experimnts are not published anywhere. As a matter of fact, you doctor and you were running one such experiment when you, as a team, solved your cpap therapy problem. The fact it was not published in a peer reviewed journal is neither here nor there.

A general claim that "one algorithm is superior to the other" is as ridiculous as the claim that one mask is superior to the other.
ResMed claims their Quattro mask fits 95% of the population. Is that a reason for me to maintain that you, "the patient also knowingly or unknowingly changed one or more other variables that would account for the improvement better than the switching of the mask"?

Peer reviewed studies are very important for describing a general rule. Therapy however always has to be is decided by careful observation on the single case facing you. Never confuse them. If you want to serve an instition and save it money, then by all means, use generalizations and go by the rules that are right for 99.999% of the population. If you want to give good therapy to the one human being facing you, you had better observe him or her very very carefully, control all variables as you try to understand what is going on there, and the give this person the therapy that works for 1 in 10,000, if that is what that person needs. Because the minute a person begins interacting with you, he or she becomes 100% of your population.

[Bob3000]

...

* r.e. aPAP algorithms, if it hasn't been demonstrated in an experiment, it may or may not be true, but I am not going to jump to conclusions based on a few anecdotal stories I read on the internet. And yes, I believe companies most certainly would be advertising 'we are better than the competition at treating ___ patient subpopulation'. Yet they don't, and no studies I've seen suggest that one apap algorithm is better than others for any population, sub or otherwise.

* Even if aPAP algorithms matter for X% of the population, we have no evidence that the engineers who programmed the S9 slacked off because the design team wanted to make the unit sexy. Despite this, the reaction in this thread seems to be that RESMED focused on the wrong stuff. All we're seeing is the marketing strategy, we've no idea what the programmers did or did not focus on.

* I'm glad RESMED is trying to make these machines more attractive and adding features like climate control. Having never used an S9, I've no idea how user friendly it is, but even if they took a few steps back, I like the way they're thinking about xPAP.

[ozij]

...

* r.e. aPAP algorithms, if it hasn't been demonstrated in an experiment, it may or may not be true, but I am not going to jump to conclusions based on a few anecdotal stories I read on the internet. And yes, I believe companies most certainly would be advertising 'we are better than the competition at treating ___ patient subpopulation'. Yet they don't, and no studies I've seen suggest that one apap algorithm is better than others for any population, sub or otherwise.

I note that your only response to my statements is reiteration of your beliefs, and a devaluation of anything not published in peer reviewed journals.
You seem to be saying that the only valid data for you to review exists in published peer reviewed studies.
However, you did not base you own therapy solely on what you found in peer reviewed journals, you joined an internet forum.

* Even if aPAP algorithms matter for X% of the population, we have no evidence that the engineers who programmed the S9 slacked off because the design team wanted to make the unit sexy.

We have no evidence of anything, but what we see in the video -- a design team very proud of having listened to distributors, and engineers very proud of their new algorithm.