CPAP Designer asks: What changes would you like to see made?

CPAPDesigner · Post by **CPAPDesigner** » Mon Sep 10, 2007 4:08 pm

I am design student who is looking to redesign CPAP machines and equipment.
It has been facinating to make my way through all the thousands of threads. Amazing insight from posters. Incredible innovation happening on the individual level.

Yet I thought I might give you the chance to be in touch with someone who could ease your experience living with sleep apnea.

So let loose and tell me every little insight you have made and every change you would like to make to the equipment, to sleep studies, to the insurance policies, to the masks, machines and software.
Every step of the sleep apnea experience!

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

CPAPDesigner · Post by **CPAPDesigner** » Mon Sep 10, 2007 4:16 pm

I'm excited to see the posts that will come of the this thread.
I know this passionate community has amazing thoughts to offer that will one day ease the life of those with sleep apnea.

TXKajun · Post by **TXKajun** » Mon Sep 10, 2007 4:18 pm

Hmmm, this thread seems like deja vu....all over again.

We've already had several requests over the last couple of years for changes/improvements/suggestions for CPAPs, so you might want to do a search of topics to see what we've already covered.

Good luck.

Kajun

CPAPDesigner · Post by **CPAPDesigner** » Mon Sep 10, 2007 4:23 pm

I did an initial search for threads about improvements but found none.
I will keep looking or perhaps you can point me in the direction.

But in the meantime, I would
still love to hear people's thoughts and insights.

Thanks

Slinky · Post by **Slinky** » Mon Sep 10, 2007 5:16 pm

You asked for it!!!

Sleep evaluation.
1. Do NOT insist that we sleep on our back all night. Explain it is necessary to spend some time on our backs and why, but then let us sleep in the positions we NORMALLY do. I didn't have that problem but many in the forums had.
2. Offer us a copy of the full summary data report, including graphs along w/the dictated report.
3. Don't leave us hanging for days and weeks waiting to learn the results!
4. Schedule a TIMELY tentative titration study appointment AND follow up appointment for an explanation of our titration results at the time you schedule the sleep evaluation. If we don't need or qualify for xPAP those appointments can be cancelled by your office.
5. Explain what the leads/wires are for as you place them on us.
6. Suggest prior to the evaluation study that we wear PJs as the legs help to keep the wires from getting tangled and that a button top PJ helps to control the chest wires and gives easy egress for the wires between 2 buttons.

Titration study.
1. Offer and try a variety of masks on us and fit them PROPERLY, laying down w/CPAP running at least at 6 cms. Make sure we know which mask we end up using the most successfully.
2. Provide a private bath AND shower facility. Some of us do go to work that same day and need to wash our hair!! At the very least a bathroom sink should allow for ease in washing our hair in the sink.
3. Offer us a copy of the video taken during our evaluation and titration.
4. Offer us a copy of the full summary data report, including graphs along w/the dictated report.
5. Don't leave us hanging for days and weeks waiting to learn the results!
6. Don't order our equipment w/o discussing our needs w/us and asking if we have any preferences in equipment.
7. If we do have preferences in equipment try to accomodate as much as possible and reasonable. Explan whys and why nots. AND KNOW WHAT YOU ARE TALKING ABOUT!
8. Give us a copy of our script when it is written.

DME supplier
1. Make sure your RT knows how to PROPERLY fit a mask, provide the facilities (bed, couch or cot and working CPAP machine they know how to set to our at least minimum pressure) for your RT to do so.
2. Offer a variety of nasal pillows, nasal cushions and full face masks for fitting. (Why can't you keep a supply to be used just for fitting, not for sale, that you CAN sterilize and use for the next fittings) and just sell a new, unopened mask that we select based on the "used, sterilized" ones we tried.
3. Have a reasonable mask exchange policy. Understand that it can sometimes take up to 2 weeks to find that the mask we chose is irritating our face, or brusing the bridge of our nose, etc.
4. If you RT doesn't know the answer to our question, admit it! Don't brush off our questions, don't play dumb, AND DON'T LIE or twist the truth.
5. Make sure you RT knows the machines and their capabilities.
6. Don't provide anything but a FULLY DATA CAPABLE CPAP to any of your patients except those w/no insurance or poor insurance and unable to self-pay for any but a bare bones, compliance data only CPAP.
7. Provide IN WRITING the accurate description of our equipment we can understand (brand and model), the billable amount, replacement and maintence times.
8. Be sincere, encourage us to come to you w/problems, advise us when we need to ask the doctor for help because you can't.
9. Have insurance coders and billing clerks that know what they are doing and bill things properly and know how to work w/the various insurance companies.

xPAP machines
1. Follow Resmed's example w/the easy access Advanced Patient menu data being available via the GOOD SIZE, EASY TO READ LED screen, except don't leave it up to the doctor to know that he can and has to include the order for that access. Pressure, leak, AHI, AI, HI, hours used, total nights used, nights used more than 4 hours. (S8 Elite and above)
2. Follow Respironics' example w/the Daily Events Per Hour chart.
3. Allow the patient's to purchase the software at a reasonable price.
4. Configure it for easy installation like Resmed's AutoScan and reader cable driver
5. Reduce the number of bare bones, compliance data capable machines produced. Encourange DME suppliers and sleep doctors to provide fully data capable xPAPs.

Insurance companies
1. Provide CLEAR, easy to understand, written benefits for DME supplies, co-pays, deductables.
2. Shorten the compliance period to 90 days and then purchase the xPAP outright.
3. Allow the patient to purchase their xPAPs from reputable online DME suppliers and reimburse them when they provide proof w/paid invoice. You contract w/local DME suppliers w/no regard for the lousy service they provide their CPAP patients; no reason you can't establish which online DME suppliers are reputable that you will accept paid invoices from your patients.
4. Keep a record of your insured patient's complaints against a local DME supplier and consider putting pressure on that DME supplier to shape or you will no longer contract w/them.
5. Try to contract w/at least 2, preferably more, local DME suppliers in any one area.
6. Don't overlook the small DME suppliers specializing in just respiratory/CPAP equipment when contracting w/local DME suppliers. The smaller outfits often provide more and better service than the big guys.

I'm sure I'll think of more for each category. Remember, you asked for it!!! And thanks for the opportunity to voice our wishes!

bdp522 · Post by **bdp522** » Mon Sep 10, 2007 5:20 pm

One of the things that is asked for on a regular basis is smaller masks for those of us with small faces. Many are having problems getting masks(especially full face) that will seal properly, the masks are just too big.

For me...
Equipment; make the data and software available to all who want it.
Sleep Studies; Have all sleep labs have several masks to try, and at least one tech that will come when you call. Have a real sleep doctor go over the results and speak to you about them.Then give you a copy of it before you leave.
Insurance; Provide at least a years worth of filters at a time so you don't have to call and order 2 each month.I don't know anyone who needs a new hose every month, maybe change it to every other month and allow more filters. Allow US to choose OUR DME.
Masks; I seem to get just about any mask to work for me, but maybe they should all come with teflon plumbers tape, rubber bands, ear plugs, and at least a couple of spare clips for headgear.
Machines; All should be data capable! All need to be quiet, eliminate blue lights.
Software; YES...we want software!! It should be included free with each machine!!

Brenda

Bearded_One · Post by **Bearded_One** » Mon Sep 10, 2007 5:42 pm

Mask headgear is weird. The straps that attach to the mask tend to be adjustable, but the vertical strap in the back is not adjustable, and I find it to be too long.

Less packaging for masks. I recently opened a mask that was packed is a plastic bag and I think that the paper and CD! weighed more than the mask. Put ALL of the English language instructions and other stuff on one single, separate page rather than forcing users to fight a huge piece of paper and a number of smaller pieces of paper trying to find the English instructions and other information.

When odd extra bits or alternate pieces are included; LABEL the bag describing what the bit or piece is for. Why not print something like "Medium size bit" or "alternate, shorter piece" on the plastic bag holding the bit or piece?

It would be nice if the plastic bag that the mask is packed in were a reusable zip-lock bag.

catbirdgirl · Post by **catbirdgirl** » Mon Sep 10, 2007 5:43 pm

I'd like ALWAYS to be tested in my own bed with wireless sensors.

also, I'd like the option of a small battery to be easily modularly swapped in and included in the initial purchase of my cpap, so I can go camping wihtout spending 200 dollars!

also lighter tubes. and softer straps.

Bearded_One · Post by **Bearded_One** » Mon Sep 10, 2007 6:49 pm

Flow generators and humidifiers should not have LEDs or any other lights -- of any color.

Power switches should be easily found and identified by feel.

Vertically mounted SmartCard slots should identify which way the SmartCard label is supposed to face when it is inserted. If the SmartCard slot is mounted horizontally, the label should be inserted face up.

DC power input should be specified to work with a voltage input of between 10 volts and 15 volts.

AC powered flow generators and humidifiers should operate just fine from a modified sine wave inverter.

BarbarainCT · Post by **BarbarainCT** » Mon Sep 10, 2007 6:52 pm

I have a Remstar M series and I would like to see it miniaturized with the power supply housed within the unit. There are too many wires on the exterior of the unit that have to be bundled. It looks messy although it seems to work well.

RosemaryB · Post by **RosemaryB** » Mon Sep 10, 2007 6:55 pm

Except for a mask that fits, far and away the most important thing for me was to have a FULLY data capable machine with CHARTS that show real time data. While some, like Slinky, like to have the readout on the machine, that's just a couple of numbers, for me having the whole night charts tracking leaks and events has been very important. I would want more than a readout. Here's one example for me:

With the chart, I can see when my apneas occur. If I see them resembling the pattern I saw on my first sleep study, I assume that they are occuring when I am sleeping on my back and experiencing REM.

What this means is that even if my AHI is under 5, if I can see those clusters, I'm likely still having disrupted REM, and it's still going to affect me, because those apneas are not evenly spread out at regular intervals, but are wildly attacking an important phase of my sleep.

The other thing to realize is that patients should be given the tools to set their own pressure. I have moderate sleep apnea and was titrated at 5. My titration study tech clearly didn't know what she was doing. If you were to see the charts with me titrated at 5, you would see the charts of someone with mild sleep apnea and an AHI of around 7 or 8. This was with an autotitrating machine set at 5-10, so it wasn't as bad as a straight 5.

Using the auto machine with software to determine my correct pressure, I was able to change the setting on my machine. Understand that I did this with my doctor's blessing. Luckily I have a gp who likes techie stuff and so he was thrilled with the data reporting stuff. Also, I have a GP who respects my intelligence enough to want me to learn to manage my own treatment.

That leads to my second big recommendation: The companies need to do some patient education that will help nearly all patients learn to monitor their own treatment via software printouts. This needs to be serious in-depth education. The companies should also be training people to adjust their own machines, including pressure and pressure relief.

A patient with diabetes is expected to monitor blood sugar and adjust insulin accordingly. This is certainly a much more risky procedure than setting a cpap machine. Yet people do it every day. This should be the model for cpap as well.

Instead, the RT who gave me a machine treated me like a 2 year old who couldn't possibly understand the mysterious workings of my machine. For pity's sake, anyone who can program a digital watch or a DVD player can do this. It was just plain silly. Respecting people's intelligence should be part of the training.

I agree with most everything Slinky said (except for the part noted above).

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, Titration, CPAP, AHI, auto

Organplayer · Post by **Organplayer** » Mon Sep 10, 2007 7:09 pm

Ditto to what Slinky and Rosemary said.

I am fortunate that I have an RT that will help me and a pcp that will support my decisions and challenge me when necessary. But by the many comments here and others, the biggest obstacle to cpap is the unwillingness of many to truly support the patient. From the makers of flow generators who will not make software available to RTs who know little more than their clients.

This forum is a godsend for those of us who want to make our lives better using cpap. Let those who make the products be as involved. We need software. We need better education for RTs and DMEs.

In grateful praise of this forum and hopes that the fear and confusion of using cpap will be removed.

Kevin

kteague · Post by **kteague** » Mon Sep 10, 2007 7:16 pm

Masks: Fully instruct patients where potential issues may arise. I'm guessing lack of info is intentional so as not to give power to suggestion. But users waste time thinking they just need to adjust, when they needed to get a different mask in the first place. Direct stomach sleepers to masks proven to work best for that position. Don't tell everyone that every mask is good for side sleeping. Have them test it. Don't push everyone toward the same mask. Point out things like the vent holes and have them lie down in a normal position and see if the air flow would irritate them or their partner. Same with hose direction. Same with stiff swivels. Users shouldn't have to find all this out by trial and error. Incorporate the fixes found on here into the original designs. Shouldn't need to rig something just purchased.

Headgear: If it's hot and bulky, who wants it? Seems like all the advances in materials in both health care products and sporting goods would have translated to more user friendly cpap headgear. I don't want rubber next to my head nor plastic nor foam that thins my hair. I don't want to have to add extra straps when I already paid for an item that's supposed to be secure. I want the option of the chin strap incorporated into the main headgear so as not to be double and triple strapped. Just seems a good textile engineer should be able to strategically design all straps needed for comfort, position and function. Maybe we need to recruit a good bra designer - they've already worked the bugs out of these issues.

Slinky · Post by **Slinky** » Mon Sep 10, 2007 7:21 pm

I also need the Small or Petite mask sizes!!!! Not just length of the cushion opening but width as well, especially at the bridge of nose and eyes. I have pretty deep "seams" from outside of bottom of nostrils towards corners of the mouth, too many masks are too wide to fit that area w/o severe leaking.

Well, you asked!!! I told you I would think of more suggestions! I'm sure I'm not done yet.

Wulfman... · Post by **Wulfman...** » Mon Sep 10, 2007 7:35 pm

TXKajun wrote:Hmmm, this thread seems like deja vu....all over again.

We've already had several requests over the last couple of years for changes/improvements/suggestions for CPAPs, so you might want to do a search of topics to see what we've already covered.

Good luck.

Kajun

Yeah, I know what you mean, Kajun.

I did a couple of searches and came up with these two.....I'm sure there were more.
It isn't that hard to find what the users want by searching through this forum or just reading.

viewtopic.php?t=9850

viewtopic.php?t=1233

Den (ain't feedin' the trolls)

CPAP Designer asks: What changes would you like to see made?

CPAP Designer asks: What changes would you like to see made?

Excited to see future posts

Thanks. I'll look for those postings

ch ch ch changes

Changes, changes, changes

Mask	Humidifier