Engineer, and I'm curious if I can help

One of the worst parts of using CPAP is the corrupt, self serving, distribution chain and medical system.

Many doctors are very ignorant of the mechanics of using a CPAP machine and using a mask. They dump everything on the DME.

Many DMEs are ignorant, arrogant, or simply minimizing time and maximizing profit when dealing with the patient.

If you can figure out how to better educate DMEs about how to properly fit your masks, you'd have a competitive advantage.

For instance, many masks seal better if you don't overtighten them. They have inflatable seals that need space to inflate properly. Many DMEs simply keep tightening the mask to stop leaks.

A FFM (Full Face Mask) should always be a last resort for those who can't adapt to a nasal or nasal pillow mask and stop mouth leaks, or who can't nose breathe. Many DMEs simply slap a FFM on all patients so they don't have to deal with mouth leaks. Patients suffer from uncomfortable masks that don't fit well, leak more, and FFMs may push the jaw back.

Many DMEs don't know this or just take the easy route. Bad masks lead a lot of people to abandon CPAP.

Be sure to consider how the DME is going to choose masks, and how he's going to figure out how to fit your mask properly. You may have the best mask in the world, but if the DME can't get it adjusted right, or doesn't know to use it, it won't benefit anyone.

You need to realize that your mask is often going to be chosen, dispensed, and adjusted by someone who's basically an ignorant store clerk.

comfort gel mask was the most comfortable but had some leaks and the fit life was ok, but when tightened was uncomfortable, mirage Quattro was ok

I can't get a mask that will work well with the non-ramp resmed asv vpap adapt s9, the pressure shoots up uncomfortably high and I keep demasking many nights on it

Leaks are a big problem.

Poor adjustment is often a problem. Make adjustment easy, and provide information to show the patient and DME how to do it right.

People who use ramp or auto pressure often have problems because they adjust at the ramp pressure or starting auto pressure. When the pressure increases, they have leaks.

Something like the Provent devices that hooks to a CPAP machine would have great potential for eliminating leaks. i.e. have something like a band aid that attaches the hose to the nose.

Many people have problems with the air from the vent blowing on themselves or their partner. Either use some sort of diffuser like the Oracle mask uses, or figure out something that vents air over a larger area and doesn't produce an airstream. One idea would be to have something like a tube that attaches on the output of the exhaust port and then runs down the hose slowly leaking air as it goes.

Improve cleaning. Make the mask from parts that disassemble easily and can be cleaned easily and thoroughly. Many patients can't figure it out. Making the parts dishwasher safe would be a good idea too. I know my dishwasher gets things much cleaner than I can.

I really like a mask that works well with eyeglasses. I often put on my mask while reading or watching TV because I often do that when I'm trying to sleep. Or I'll try to go to sleep and do some TV or reading when I can't fall asleep immediately. Even those without glasses find some masks make it difficult because they block their vision.

My ComfortGel blue was good because it had room around the cushion and under the frame where I could wear my eyeglasses. My Swift FX is better because I have more room and can even take off my glasses with the mask on.

BlackSpinner wrote:

Denial Dave wrote:I am certainly not a Ken.

I have mostly English / Irish ancestry with small nose, etc...and I have a near non-existant chin.... the Quattro works just fine for me..

BlackSpinner wrote:Full face masks for people who are Ken & Barbie. In other words for those billions of people who do not have standard European faces, who have high broad cheek bones, flat noses and small, non prominent, chins.
The resmed quatro rocks on my cheek bones and either I have leaks near my eyes or at my chin. For the mask to snuggle against my chin I need to add a folded tissue to the forehead support - however then it leaks into my eyes.

I think it is the Slavic cheek bones I inherited from those great great grandmothers brought back from the Ukraine and Russia by the ancestral family sailors.
Me and my youngest daughter.

Beautiful photograph!

Regards, Nate

enghelp wrote:Hello CPAP community. I am a product engineer for CPAP masks. I have been in this for more than a couple years now and am seeing CPAP masks going though significant changes both the the past couple years and in the next couple years. As you can guess, just like the scientests in Area 51, they don't let us out much.

I would like to extend myself to see if I can answer any questions you have and listen to any complaints you have about any masks you are wearing. I am sure all of you know that wearing a mask on your face every night isnt easy and it is a very intimate thing. My job is to make putting up with the therapy as easy as possible. Please feel free to ask anything, I will answer the best I can, and offer up and problems you wish we would correct and don't be shy. We can't fix a problem if we don't know about it. One side note, please don't offer solutions, there is a whole bunch of lawyer junk and other stuff in there but basically if you suggest a solution, I can no longer use it.

I don't wear CPAP myself so I cannot join you completely there, but I do trial almost every mask we release prior to it releaseing and my Dad has CPAP as well and I trial everything on him. I hope you guys will accept me and we can help each other out. TTFN!

I spent most of my life as a product design engineer and many of those years as the Director of Engineering for the product design department, and can only make a few suggestions to you.

IMHO, you will be unsuccessful until you have personally worn a mask for 30 nights. Get a machine and set it on a very low number like 10 cm as many people have to use theirs on 16 to 20 cm. It is just air and it won't hurt you. Look at the leaks each day and see how your face feels after a week or so. The Quattro is a mask that fits some people and is totally unusable for many others. It is designed for wide faces and is not as forgiving as the Full Face Ultra Mirage. The swivel on the Quattro is also very poor (and squeaks) as is the nose bridge. The Respironics full face Comfort Mask is way to heavy to work successfully in all sleep positions.

As a product engineer, you are probably totally inadequate to evaluate all the things that users already understand. The second best thing is to find a forum like this one with some really enthusiastic users and give out a few hundred of the masks you are trying to evaluate, get measurements of their faces, collect comments and suggestions, do a low cost retooling, and repeat the process a couple more times. I have found that DME's are not the best source of assistance as they don't have to use or put up with what they sell. The respiratory therapists are trained and some do a better job than others, particularly is a hospital setting and can certainly help in an evaluation of several masks and can do a fair job of determining mask fit under pressure and position.

CPAP.com has done several evaluations of mask X vs mask Y and the dat is public and available. The problem is that they do not cover nearly all ranges of faces that people have. ResMed has 6 versions available for many of their masks, and that will still only properly fit a percentage of the using population. Masks are so expensive that most people only get a chance to evaluate a few and then give up or suffer quietly!

You also have to have a good sense of humor and a thick skin. One vendor had convinced several DME's to buy his product, but when he had several members of this forum try it, he became irate and never finished the evaluation feeling that people should be grateful for having a chance to get his product for free, even if it did not perform very well.

Most engineers don't interact very well with non-engineers, so you may need some help from someone who really understands the problems that users face and can extract that information in a form that you can use. I am certainly not that person, but there are several people on this forum that might be of considerable assistance to you. I guess the best mask ever designed was the IRON LUNG since it did not touch your face, leak, or cause skin problems but was very costly and bulky.

the pump idea has been brought up before but if it gets a hole in it then the patient can no longer get therapy which is a little more critical than shoes not having quite as much support as you want. I haven't seen the bike helmet that pumps, i would expect they have the same concerns because it is dangerous if the helmet doesn't pad well enough. I guess they weighed the pros and cons and came up with a different solution.

Just a reminder guys, like i said, I can't take away solutions, only problems. if you guys throw out solutions we can't use them in products unless we can prove in court that we thought up the idea first.

chunkyfrog wrote:I have a bike helmet that has an inflatable headband, like the old "pump" athletic shoes.
I would love to have cushions that will do that, customizable to the profile of my face.
The inflatable part could be FABRIC, for coolness and comfort.
Doggone it--as much as these things cost, I would not consider a little effort unreasonable at all.

Uncle_Bob wrote:

NateS wrote: 1) Mouth breathing. So far, there doesn't really seem to be a good solution for mouth breathing for people unwilling to wear a full face mask. Most chinstraps are rather ineffective.

I disagree. I uses the papCap chin strap which prevents my jaw dropping and mouth leaking, it gets me a 0.0L rate.
I can also use the ruby red but find the papCap more comfortable,

~UB

+1

I know... not something we all agree with but it is a trick companies use to make the DMEs happier so they buy our masks over the compitition. I receintly had this arguement and lost. Our hope is that the majority of DMEs will give out all the sizes to give the patient the ablity to choose at home thereby decreaseing the callbacks to the DME.

Unrelated... Nate, PLEASE TELL ME THAT IS YOUR REAL BEARD!!!!! It is AWSOME!

enghelp,

This brings to your attention a problem you may not be aware of. When the manufacturer issues a mask consumer prepackaged with the three different sizes of nasal pillows or a nosepiece, many local DMEs open the consumer package, make a decision with or without the patient as to which size pillow the patient needs, and then hand the mask with that one size pillow to the patient in a ziplock bag, keeping the other two sizes to resell to some other customer!

Cuz DMEs keep the DVDs for some reason... and we make the youtube videos to reach the most people for free basically. DVDs aren't expensive but you would be annoyed if I told you how much it costs to make a mask vs how much it is sold for (remember there is a lot of overhead in a regualted industry) and adding anything to the package adds money. Like I said in an earlier post, look to start losing anything that isnt completely nessicary with competitive bidding hitting the USA and reinbursement dropping. Marketing also has some statistic (that i dont believe) that a HUGE percentage of the CPAP community have smart phones and use the internet well enough to see the videos. That is also why you see more CPAP help apps comming out from the OEMs.

NateS wrote:enghelp,

If they create these fitting videos for xpap users, why don't they include the pertinent one on a DVD packaged with every mask? Almost everyone would open the package with the mask when they got home, plop the DVD into their DVD player or computer, and watch it.

It seems that the few pennies spent on including the DVD would serve to reduce their cost in many returns, exchanges, complaints, service, etc.

Wouldn't it?

Regards, Nate

you may not be wrong. remember that OEMs trial in markets that product the most revenue, for example, if we sold $100,000,000,000 in France and only $1,000 a year in Russia, we are going to trial in France. (totally made up numbers by the way). I can suggest that each OEM does have a trialing program where they trial the masks they make before they release them. If you can figure out how to get on that trial list you could be part of the mask sizing and design process!

I think it is the Slavic cheek bones I inherited from those great great grandmothers brought back from the Ukraine and Russia by the ancestral family sailors.
Me and my youngest daughter.

enghelp wrote:t

Just a reminder guys, like i said, I can't take away solutions, only problems. if you guys throw out solutions we can't use them in products unless we can prove in court that we thought up the idea first.

The problem is that very many people have difficulty finding an interface (mask) that is effective, comfortable, and non-disturbing.
Heed WW's advice above.

Guest wrote:

enghelp wrote:t

Just a reminder guys, like i said, I can't take away solutions, only problems. if you guys throw out solutions we can't use them in products unless we can prove in court that we thought up the idea first.

The problem is that very many people have difficulty finding an interface (mask) that is effective, comfortable, and non-disturbing.
Heed WW's advice above.

+2

You are preaching to the choir on this one!!! I vented on an earlier post about my dad's poor experiance at a DME. We try our hardest from our end because the more we can educate them the more sucessful we are as a company. All I can say is we will continue to fight this one EVERYDAY. But you guys on this forum are the ones that really help out! Going in there educated knowing that there are more options than what is set in front of you and asking all the hard questions is important! DRs don't know because they don't want or don't have the time to learn everything they need to be sleep experts. As for DMEs, there are a lot of good ones out there, but for every good one there is a bad one that just wants you in and out as fast as possible to make the most money. DO NOT LEAVE TILL YOU ARE COMFERTABLE!!!! CPAP is new, and takes time to get used to, but it should NOT be painful.

archangle wrote:One of the worst parts of using CPAP is the corrupt, self serving, distribution chain and medical system.

Many doctors are very ignorant of the mechanics of using a CPAP machine and using a mask. They dump everything on the DME.

Many DMEs are ignorant, arrogant, or simply minimizing time and maximizing profit when dealing with the patient.

If you can figure out how to better educate DMEs about how to properly fit your masks, you'd have a competitive advantage.

For instance, many masks seal better if you don't overtighten them. They have inflatable seals that need space to inflate properly. Many DMEs simply keep tightening the mask to stop leaks.

A FFM (Full Face Mask) should always be a last resort for those who can't adapt to a nasal or nasal pillow mask and stop mouth leaks, or who can't nose breathe. Many DMEs simply slap a FFM on all patients so they don't have to deal with mouth leaks. Patients suffer from uncomfortable masks that don't fit well, leak more, and FFMs may push the jaw back.

Many DMEs don't know this or just take the easy route. Bad masks lead a lot of people to abandon CPAP.

Be sure to consider how the DME is going to choose masks, and how he's going to figure out how to fit your mask properly. You may have the best mask in the world, but if the DME can't get it adjusted right, or doesn't know to use it, it won't benefit anyone.

You need to realize that your mask is often going to be chosen, dispensed, and adjusted by someone who's basically an ignorant store clerk.

I don't know if this has been covered, but I am too tired to read through all the posts to find out. So if it has, forgive me.

One thing that is problematic for me is the clasps/hooks that attach the headgear to the mask. That is one of the things I like about the F&P masks. The clasp slides in, then is released with the touch of a button.

I think it is the Respironics masks -- they use a ball/joint type clasp and my muscle weakness makes those impossible for me to hook/unhook without help.

If a mask is absolutely perfect for me, but has the ball/joint clasp, I have to turn it away simply because I am unable to do it by myself.

Maintaining as much of my independence as possible is important to me. Luckily for me, the F&P 431 not only has an easy clasp - it also works well for me.

Madalot wrote: One thing that is problematic for me is the clasps/hooks that attach the headgear to the mask. That is one of the things I like about the F&P masks. The clasp slides in, then is released with the touch of a button.

I think it is the Respironics masks -- they use a ball/joint type clasp and my muscle weakness makes those impossible for me to hook/unhook without help.

If a mask is absolutely perfect for me, but has the ball/joint clasp, I have to turn it away simply because I am unable to do it by myself.

Maintaining as much of my independence as possible is important to me. Luckily for me, the F&P 431 not only has an easy clasp - it also works well for me.

You have a good point there. My mother has bad arthritis and she would have the same problem. My sister also has a muscle issue and she would not be able to use the resmed Quatro mask with its closures that you have to pinch to get undone.