For the CPAP manufacturers – a few suggestions

For the CPAP manufacturers – a few suggestions

1. Reduce the noise and vibration levels IN THE CPAP TUBE AND MASK. The air from the CPAP is in the airway and therefore literally the “other side” of the pressure the ear drum feels (and hears). As well I find my airway sensitive to the vibration of the fan blades whirring by. People are trying to sleep!! It needs to be quiet in there.

2. Use “compressible airspace”. I find that adding about four liters (I use two liter chambers) of airspace to the CPAP circuit eliminates the nasty “pressure bump” which results as my exhale meets the “spun up for inhale” fan. The result “feels” much more like breathing into simple air. It is so nice!!!

3. If you “must” change pressure do it slowly. I mean like 1 cm/H2O per ten seconds rather than a few hundred milliseconds!! And yes I really do think that the Clear Airway sensing pressure pulses and for goodness sake any pacing pulses must go. Because they tend to fracture sleep if the arousal threshold is low and that can come down in anyone at anytime.

Todzo wrote:For the CPAP manufacturers – a few suggestions

1. Reduce the noise and vibration levels IN THE CPAP TUBE AND MASK. The air from the CPAP is in the airway and therefore literally the “other side” of the pressure the ear drum feels (and hears). As well I find my airway sensitive to the vibration of the fan blades whirring by. People are trying to sleep!! It needs to be quiet in there.

2. Use “compressible airspace”. I find that adding about four liters (I use two liter chambers) of airspace to the CPAP circuit eliminates the nasty “pressure bump” which results as my exhale meets the “spun up for inhale” fan. The result “feels” much more like breathing into simple air. It is so nice!!!

3. If you “must” change pressure do it slowly. I mean like 1 cm/H2O per ten seconds rather than a few hundred milliseconds!! And yes I really do think that the Clear Airway sensing pressure pulses and for goodness sake any pacing pulses must go. Because they tend to fracture sleep if the arousal threshold is low and that can come down in anyone at anytime.

Why tell us...write to the manufacturers

In dealing with the noise issue, I find that a good set of ear-plugs with a rating over 30 does the job.

It would also be nice to have auto-downloading to a center where the data is made available on the web to the person and doctor(s) and flagged if problems are indicated.

Todzo wrote:It would also be nice to have auto-downloading to a center where the data is made available on the web to the person and doctor(s) and flagged if problems are indicated.

i think they do that now
unfortunately the patient is left out of the loop
only the dr, dme, & sleep lab get to see how you are doing

their thinking is if you want to see it you can get it from the dr dme or lab
and all they care about is hrs of use, getting you past the insurance hurdles
they dont look at any daily details or care about leaks
i think their thinking needs to change

if i was a new pt today i would not sign off on any modem program which excludes
me the patient
if i dont get a copy then neither do they

sleepy guesty wrote:

Todzo wrote:It would also be nice to have auto-downloading to a center where the data is made available on the web to the person and doctor(s) and flagged if problems are indicated.

i think they do that now unfortunately the patient is left out of the loop only the dr, dme, & sleep lab get to see how you are doing

their thinking is if you want to see it you can get it from the dr dme or lab and all they care about is hrs of use, getting you past the insurance hurdles they dont look at any daily details or care about leaks i think their thinking needs to change

if i was a new pt today i would not sign off on any modem program which excludes me the patient if i dont get a copy then neither do they

I have found the information from my downloaded data invaluable to help me maintain a healthy lifestyle. We need good sleep!!! If we are not getting it we need to know!!! So we can correct the situation.

I agree with those who have expressed the concern that CPAP is severely under monitored by those who prescribe it.

But it is the person using the device who needs the information right now so he can deal with the situation right now!!!

Todzo suggests...
1. Reduce the noise and vibration levels IN THE CPAP TUBE AND MASK. The air from the CPAP is in the airway and therefore literally the “other side” of the pressure the ear drum feels (and hears). As well I find my airway sensitive to the vibration of the fan blades whirring by. People are trying to sleep!! It needs to be quiet in there.

2. Use “compressible airspace”. I find that adding about four liters (I use two liter chambers) of airspace to the CPAP circuit eliminates the nasty “pressure bump” which results as my exhale meets the “spun up for inhale” fan. The result “feels” much more like breathing into simple air. It is so nice!!!

3. If you “must” change pressure do it slowly. I mean like 1 cm/H2O per ten seconds rather than a few hundred milliseconds!! And yes I really do think that the Clear Airway sensing pressure pulses and for goodness sake any pacing pulses must go. Because they tend to fracture sleep if the arousal threshold is low and that can come down in anyone at anytime.

Interesting recommendations, and I'll wager that the manufacturers consider them.

I must be a rare case as the machine noise doesn't bother me (to me, it's sort of like waves lapping on the beach), and I'm happy with Aflex = 2 as far as anything to do w pressure changes.

If I could change anything, it would be the stupid beeps that the machine seems to think that I need to hear (shutoff button, removing software card). There should at least be a software code to eliminate every beep. Also, and to prove that I truly am a rare apneic patient, I miss the blue lights that everyone else hated. Again, this is a thing that could be patient-controlled.

One quick story about machine noise. A few years back, someone posted a note that he got a quieter machine...and his wife asked him to go back to the noisier one. She had become used to the machine noise, and missed it once it was gone.

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Captain_Midnight wrote:Todzo suggests...
1. Reduce the noise and vibration levels IN THE CPAP TUBE AND MASK. The air from the CPAP is in the airway and therefore literally the “other side” of the pressure the ear drum feels (and hears). As well I find my airway sensitive to the vibration of the fan blades whirring by. People are trying to sleep!! It needs to be quiet in there.

2. Use “compressible airspace”. I find that adding about four liters (I use two liter chambers) of airspace to the CPAP circuit eliminates the nasty “pressure bump” which results as my exhale meets the “spun up for inhale” fan. The result “feels” much more like breathing into simple air. It is so nice!!!

3. If you “must” change pressure do it slowly. I mean like 1 cm/H2O per ten seconds rather than a few hundred milliseconds!! And yes I really do think that the Clear Airway sensing pressure pulses and for goodness sake any pacing pulses must go. Because they tend to fracture sleep if the arousal threshold is low and that can come down in anyone at anytime.

Interesting recommendations, and I'll wager that the manufacturers consider them.

I must be a rare case as the machine noise doesn't bother me (to me, it's sort of like waves lapping on the beach), and I'm happy with Aflex = 2 as far as anything to do w pressure changes.

If I could change anything, it would be the stupid beeps that the machine seems to think that I need to hear (shutoff button, removing software card). There should at least be a software code to eliminate every beep. Also, and to prove that I truly am a rare apneic patient, I miss the blue lights that everyone else hated. Again, this is a thing that could be patient-controlled.

One quick story about machine noise. A few years back, someone posted a note that he got a quieter machine...and his wife asked him to go back to the noisier one. She had become used to the machine noise, and missed it once it was gone.

.

When I added the "compressible air space" it also reduced the noise and vibration considerably. I have been using CPAP for a decade and my current machine for over four years so I was "used" to it I suppose, and would probably have replied such as you I suppose. But the change was such a relief!!

And then I talked with my brother recently about his use of BiPap. I should mention that he is a musician, sensitive ears and all. He told me that the “tone changes” (fan spin speed changing to make the Bi-pressures I suppose) bothered him a lot. He sleeps with a couple of fans going in the room to mask the noise.

My CPAP flow data shows me much more relaxed. Yes I do think we need quiet to sleep well.

Well an automobile engine produces a lot of noise and vibration. But human beings do not play well with a lot of noise and vibration. So we invented the muffler.

Simple device. Air chamber (makes for less energy per cubic inch or whatever) and several baffles. Of course they make many kinds.

Frankly I think that our CPAP machines need a muffler.

I have shared how adding about four liters of compressible airspace down wind of the CPAP eases the expiratory pressures in a way that feels natural and simply wonderful. Yup, two simple pop bottles do wonderful things for CPAP for me[3]. So now I am working on taking those pop bottles and cutting the ends off and then adding baffles (yogurt container lids??) with some holes in them and perhaps some clean sand held in place by cheese cloth (vibration absorption). Simply adding some elbows to the air path with the pop bottles added in with “T” sections reduced the noise and vibration notably. A real muffler design should move the system much closer to the great “quite air” experience I now long for.

So adding a very simple downstream device helps me with Expiratory Pressure Intolerance (EPI)[1] and very likely arousal threshold[2]. Frankly these mufflers could be built for a song and added to existing simple CPAP devices[3]. I think the simple devices would do very much better with a gallon volume muffler added. Indeed, when I looked into how the complex devices perform (reading research papers a couple of years ago) I noted that the complex machines always had more arousals than did well managed CPAP. So I have stayed with simple CPAP. I really think the whole idea is to prevent arousals and let the person sleep as naturally as possible. Let me sleep for goodness sake!

My data is very clear, I am sleeping more soundly. For example AHI from less than two to now often less than one. The air flow wave forms have much less variance. Pugsy's aliens are apparently much less in attendance.

And with all that room available why not add air flow sensing along with what is necessary to move the data to a central point, analyze it, and make it available to the person and their doctor with flags if there is trouble detected. If this were done for every person using CPAP I very much believe that there would be many many more people who would find CPAP something that they can use and therefore desire to use.



[1] http://www.sleepreviewmag.com/2014/01/a ... a-and-sdb/

[2] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[3] Special Note: In my case I use CPAP – constant pressure. My machine does not adjust pressure. Adding downstream compressible air space may well mess up “auto” style machines control of your breathing – so – do not try this at home. As well it is easy to choose materials which “off gas” bad stuff.

Someone mentioned that they thought ear plugs would help the sound issues. Well now, the sound I am talking about originates deep within the machine, travels up the CPAP tube and enters the airway by mask or pillow. So if you used plugs they would have to be itty-bitty ones you could somehow place into the ends of the eustachian tubes. And even if you were somehow able to do all of that it would not lessen the noise and vibration making its way into the ear drum area by conduction in skin and bone.

No we need to lessen the noise that comes from deep within the CPAP machine.

Your air chamber seems like it may be a bad idea if you are using any form of Auto or EPR device. By increasing the total volume of gas between the pump and your lungs you are increasing the amount of work that needs to take place to make a pressure adjustment. If the device is reacting to changes in your breathing (e.g. trying to increase pressure exactly at the moment you switch from exhale to inhale, the point at which you are most likely to experience airway collapse) and takes more work and time to do so it may not compensate quickly enough to counteract the event.

Sounds like a creative idea but I wouldn't attempt it myself. I tend to have faith that the companies designing these products have spent good money on highly educated engineers and medical experts to find the best solution they can to treating the condition while delivering a comfortable experience. Obviously noise level is an important stat to a lot of consumers so if there were a simple way to decrease noise further while not impacting treatment I expect they'd have done so. Perhaps this is something that was cut out for size purposes or such though, I have no inside knowledge.

Captain_Midnight wrote:One quick story about machine noise. A few years back, someone posted a note that he got a quieter machine...and his wife asked him to go back to the noisier one. She had become used to the machine noise, and missed it once it was gone..

Funny you should mention that. My fiancee lives in another town and we spend 3-5 days together roughly every two weeks. She is a light sleeper and she used to wear earplugs to bed when we were together until I got my BiPAP 9 months ago. Lately she has started mentioning that she doesn't sleep as soundly and misses the rhythmic sound of the machine rising and falling with my breathing when we are not together.

The compressible airspace sounds like this:
http://www.plumbingsupply.com/waterhammerarresters.html

NameGoesHere wrote:Your air chamber seems like it may be a bad idea if you are using any form of Auto or EPR device.

Good Point!!!

Which is why I made a special note in a previous post this thread[3].

For my own use I thought it would mean that any apneas found would be scored “Clear Airway apnea (CA)” since the airspace is similar to our lung space. But I still am seeing the occasional “Obstructive Apnea (OA)”. My events appear to be one third of the number of events I was seeing before including the compressible air space (any kind of event).

NameGoesHere wrote: By increasing the total volume of gas between the pump and your lungs you are increasing the amount of work that needs to take place to make a pressure adjustment.

Another good point.

Indeed the reason I was trying the experiment was to smooth out the crazy “Clear Airway Sensing / Pacing” pulses and so limit their ability to cause arousal. And indeed the feel of the pulses is attenuated. They are “smoother” with the compressible air space in place and bother me less.

NameGoesHere wrote: If the device is reacting to changes in your breathing (e.g. trying to increase pressure exactly at the moment you switch from exhale to inhale, the point at which you are most likely to experience airway collapse) and takes more work and time to do so it may not compensate quickly enough to counteract the event.

I do not believe it works like that.

The clear airway sensing / pacing pulses I mention which are perhaps a change of 1 cm/H2O. They are smoothed but still occur in much less than a second. The change in time feels like from about one or two tenths of a second without the airspace to perhaps a quarter to one half a second with the airspace.

As well I think that part of the effect of the pressure of CPAP is to move blood and fluid a bit more away from the area of high pressure. Thus I believe it shrinks the tissues in the area a bit so they tend to cause less obstruction. But that probably takes many seconds if not minutes.

Simply I do not believe that slowing down the pressure transition by a couple of hundred milliseconds will make a significant change in terms of preventing events.

But what I am seeing in my own data is a great reduction in events likely because I am no longer needing to deal with high initial expiratory pressures nor as much noise nor as much intrusion from the pressure pulses.

NameGoesHere wrote:Sounds like a creative idea but I wouldn't attempt it myself. I tend to have faith that the companies designing these products have spent good money on highly educated engineers and medical experts to find the best solution they can to treating the condition while delivering a comfortable experience.

I happened upon this by chance. I have been watching the expiratory pressure thing but never would have thought of this way to handle it. But when I tried it . . .

So right now we have highly paid and educated engineers working on these black projects (I understand that not even the doctors know how the new CPAP ASV and all machines work – that is proprietary). The new high technology machines will go for perhaps five thousand to seven thousand dollars a shot.

First of all I do not think that a simple idea such as this would be anywhere near their “control the pressure with the fan” radar.

Second, if they did think of it – well $5K box verses $0.1K box – which am I more likely to be paid well for...

NameGoesHere wrote:Obviously noise level is an important stat to a lot of consumers

I think it relates to arousal level[2]. Be remember it also deals with Expiratory Pressure Intolerance[1].

NameGoesHere wrote: so if there were a simple way to decrease noise further while not impacting treatment I expect they'd have done so. Perhaps this is something that was cut out for size purposes or such though, I have no inside knowledge.

OSA appears to be a disease we do not know how to find and treat well.

[1] http://www.sleepreviewmag.com/2014/01/a ... a-and-sdb/

[2] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[3] Special Note: In my case I use CPAP – constant pressure. My machine does not adjust pressure. Adding downstream compressible air space may well mess up “auto” style machines control of your breathing – so – do not try this at home. As well it is easy to choose materials which “off gas” bad stuff.

NameGoesHere wrote: Sounds like a creative idea

One thing that I hoped to do with this thread is to inspire others to share their ideas.

Anyone with a good idea to improve CPAP?