CPAP the next generation

We are indeed listening!

DeVilbiss Marketing wrote:We are indeed listening!

Good to hear! I'm one who has almost no obstructive apneas (avg 0.1) but quite a few hypopneas that make my therapy results average an AHI of 5-10 events/hour and occasionally. I have found that setting the trigger % for hypopnea to 40% reduces the number significantly but I'd have to reduce it in increments nightly to form a picture of just how much I'm restricting and since there are nightly changes in the way I sleep, that isn't even enough information to form an opinion on what is happening.

IMO, flow graphs are essential in determining what happened in my breathing to trigger an event. I'm of the opinion that including them in the nightly Smartlink software data would increase your sales significantly. With the price and performance of this unit, including flow graphs would present a huge incentive for people who are spending more on CPAP to consider the Intellipap in their purchase considerations.

Thanks for responding. You may include this post in your attempts to convince your design department that flow info is essential.

archangle wrote:I'd like to see the reporting be a little smarter. Instead of simply counting the events, score them somehow. The current models give the same weight to an 11 second apnea that they do to a 120 second apnea.

We need a better number than AHI.

Agreed, but it is a problem that goes beyond the Cpap machine. The industry needs to wake up and assign some weighting to the events that make up the AHI, as well as, perhaps, including some other, additional factors.

A good and easy first step would be simply to incorporate weighting, perhaps giving more weight to an OA than to an OH, and counting each according to a multiple of the minimal significant time intervals that it spanned. That is, if an OA of 10 seconds is deemed to be the minimal significant event, timewise, then an OA lasting 20 seconds should be counted as a "2" and one lasting 30 seconds as a "3," etc. The weighting maybe should also be non-linear, as an apnea lasting 200 seconds likely does more harm than 20 apneas each lasting 10 seconds.

Thanks. We agree that higher resolution flow data is beneficial to understanding therapy performance. Unfortunately, we will not be including this our next release of the SmartLink software (due out very soon). There is more to capturing this data than the software. Please note that this is a top priority requirement for our next generation platform.

DeVilbiss Marketing wrote:Thanks. We agree that higher resolution flow data is beneficial to understanding therapy performance. Unfortunately, we will not be including this our next release of the SmartLink software (due out very soon). There is more to capturing this data than the software. Please note that this is a top priority requirement for our next generation platform.

It's commendable that you have made capturing higher resolution flow data a top priority for your next generation of machines.

Any chance that DeVilbiss might become the first company to make and sell only machines with full efficacy data? As in eliminating all machines that record only compliance data from the next generation of machines? And make sure that the SmartLink software is indeed put in the hands of all the patients with DeVilbiss machines?

DeVilbiss Marketing wrote:Thanks. We agree that higher resolution flow data is beneficial to understanding therapy performance. Unfortunately, we will not be including this our next release of the SmartLink software (due out very soon). There is more to capturing this data than the software. Please note that this is a top priority requirement for our next generation platform.

This is good to read. I used a IntelliPAP bi-level for a few months. The only thing I didn't like about the machine was the lack of flow data.

archangle wrote:What do you folks see that would be a real improvement in the next generation of CPAP

I'd prefer to see an elimination of the need for cpap and not a continuation of dependance and drain on society's resources. I hold out the hope some smart person will figure this out. Given enough time, they usually do.

I'd like to see the next generation machine have a small inbuilt microphone and record audio whenever the machine is on. It would make it a lot easier to correlate major disturbances with flow data and events. For instance, if I notice a major leak, I could just say something to make a note about it without even having to open my eyes.

I have to say that I think it is awesome that DeVilbiss is looking at the forum. I think it is kinda a shame not to see some of the other Cpap makers on here.
I too would like to see a true hepa filter, to help with allergies. Also I think that some suction cups on the bottom of the machine (optional) that you can put on or take off, to help some people keep their machine in place while they sleep. It was a big problem when I first started, that I would pull my machine off the table. It doesn't happen anymore, but it would have been a really simple, helpful thing for when I was starting out. I can't believe that it would cost much for some suction cups?
I would like to see more data to help us understand what is going on, and especially data that would be easy to understand, even for those of us who are unable to interpret the current data on our machine.
I would love to see some wifi built into it. I know this seems to scare some people, but I don't really see anything to be afraid of right now. People turning up your air flow, would just be a waste of time, and you would wake up if it happened. You could put a little on/off switch to turn the wifi on and off when you wanted to use it.
I think all machines should come with a cleanable water tank as standard.
It would be nice to see the machine use BPA free plastics. I know it is a hot topic, of which I don't really know much about, but it is just a thought.
Or what about a water tank that was antibaterial, like the plastics used at some grocery stores for the kids, that help minimize bateria.
We probably could come up with a few hundred interesting improvements!

I want the features of my REMStar Pro with AutoIQ, with the size and portability of the Transcend II, and the price of the Zzz-PAP "Silent Traveler" all wirelessly controllable and monitorable via a mobile device.
And I want the ability to optionally add full instrumentation to it (oximeter, etc.) so I have a complete way to easily monitor my sleep health.
And I want the ability for power users (or medical professionals) to create complex alerting rules. For example, I want to wake up every morning and glance at my smartphone and see a very simple report that tells me the key information about how I slept. Others may just want notification on their smartphone, tablet, or computer when something went wrong.

There is a lot that seems possible technologically, but the need to get FDA approval and convince insurance companies to pay the extra costs disuades medical equipment companies from moving very rapidly. My cousin was asking me why some equipment she uses (for diabetes) had such a poor UI and why it couldn't be as thin, light, and user friendly as an iPhone. I told her that the company that makes her unit has exactly what she is asking for, but they don't sell it in the US because it hasn't been approved by the FDA. I'm not sure if it was just waiting for approval, or the cost of the approval process was just too high to bother. If you need the device you or your insurance company will pay for their less user friendly model anyway, so what's the benefit to the manufacturer of pushing to get the new one approved? There is none until one of their competitors submits one for approval. Arrgh, this dynamic plays out for all medical equipment and pharmaceuticals.

So biggest dynamic that would change and advance "CPAP" is to eliminate the requirement to have a prescription. APAP or auto-set CPAP machines make this medically viable. Once you do that the manufacturers have much greater incentive to quickly move towards devices offering best-of-breed characteristics at lower prices. Oh I'll get the device I described in the first line eventually, but it will take 3-5+ years. Without the prescription requirement it would take 2 at most.

It may actually take two generations to accomplish this, but let me restate my original comments this way. I want to see a generation of machines (and masks) so automatic, reliable, user friendly, and inexpensive that the manufacturer(s) go through the process of pushing the FDA to approve them for over-the-counter sales.

Real-time blue-tooth or WiFi, so we can check our data on our computer in the morning without juggling cards, etc.
With analysis software that flags if something unusual turns up that we need to forward to our doctor.
And a widget that does just that.

I would really like a ADVANCED USER mode that I could set the machine in so I could adjust the pressure without getting up and going into the clinician menu... Sometimes after I get settled, I just need to bump it up 0.2 or 0.4. If it had a mode where I could just reach over and push the knob for 3-5 seconds and then turn it 1 click to increase the pressure 0.2 I would be a happy camper.
An optional leak or mask off alarm on the S9 would be nice too. I'm fighting leaks now but sleep through them.
All in all though, I'm pretty damn happy with my S9.

Lots of great suggestions! Echoing Dreamdiver here.

(1) I would like to see waveforms like the Respironics System 1 ASV puts out.

(2) A cheap atomic clock can do it, our machines should be able to have the right time stamp on every data point. It drives me crazy that every device is just a little bit off in time (especially our units) and we have no good way to resynchronize these separate data streams.

(3) A standardized public domain data format. I had to take my laptop in to my doctors office to show him my data because they had no way to look at my SPO2 data. I can only wave my hands to try and show the pulse oximetry next to the my Encore Viewer output.

(4) If you make accessories available to plug into the data stream (such as a pulse oximeter) make a patient version (<$100) as well as the ($800) DME version.

Those are the biggies for me.

(5) In the absence of adding data ports, then bluetooth or wireless my ASV data to my home network so I can use my PC or my android phone to link it to my other sleep data. I have this $99 bluetooth device in my car that plugs into the diagnostic port on my car. Via bluetooth, the Torque app on my android cell phone then shows me real time my air temperatures, supercharger boost, air flow in grams per second, coolant temperatures, speed, rpm, oxygen sensors, etc. Then if I want to stream my pulse oximetry, or EKG, or microphone to my PC or my phone, I can.

We realize that a pulse oximeter designed by X corp will not necessarily put data out in a format that can go into our units. But look at the cost of the pulse oximeter offered with the system 1 units as an accessory. Nobody can afford that unless a doctor orders it. We just want something good enough to let us reason out our problems and take charge of our health care. So, make a $50 SPO2 attachment available that plugs into that port for the unwashed masses and if it becomes a medical necessity, then the doctor can order the $800 medically accurate SPO2 attachment.

Imagine being able to pick up your android phone or Ipad and see how you are doing both real time and just a few moments ago when something woke you.