Ramblings of a sleep apnea e-patient

CPAP models seem to change every two to three years. Soon, we’re likely to see new models that are more than a pretty makeover of the previous models. Manufacturers will have been combing the forums and looking for feedback from veteran CPAPers for the kinds of things interested CPAP users might want in their blowers.

What follows is an abridged and summarized list of the kinds of things people want to see. I’ve limited this to the two most popular models for ease of writing, but there’s no reason why a less popular model couldn’t wow us with actual options that please informed cpap e-patients.

Our two current models are the ResMed S9 series and the Phillips Respironics System One. We’re proposing things we’d like to see on the “S10” and the “PRS2”. Some changes we saw in the S9 and the PRS1 from their precursor models include the use of an SD card and software for users to track their own sleep data. Even better, they paid attention by making the data easy to import into third-party ventures like Sleepyhead and Onkor. They included a heated hose. They made filling the tank easier. Tanks can be washed in a dishwasher.. They did so many things right, and we’re grateful for that. Can they impress us again with more new goodness?

Wishlist for all manufacturers:

  • Physical Aspects
    • Even quieter machine. Let’s see if we can get rid of the whistle on the S9, anything parallel on the PRS1.
    • Settings Screen
      • Stay away from light blue backgrounds on patient-available screens, because light blue is supposed to be a wake-trigger.
      • Stay away from blue LED’s altogether where appropriate. Use red, yellow or green LED’s to get your point across.
      • Make the screen bigger, AMOLED, color. A lot of us aren’t wearing our glasses when we’ve got our masks on. How about making it a little easier on us? Use bigger fonts on the larger screen.
      • Light Sensor next to screen to determine how dark the room is. Use a bright color scheme when the lights are on and darker colors when the lights are off.
    • Inexpensive patient-avialable Bluetooth, Wifi, USB3 connections to download data, after the fact and/or live.
    • RF Remote control – buttons to turn on/off, turn up/down humidity, ramp on demand. Remote will have not lights on it.
    • Reintroduce the dedicated ramp-on-demand button.
    • User-replaceable time-keeping battery. No more soldered-in cells. Use a standard computer-standard time-keeper cells. Give us an access slot on the back or the bottom where we can change the battery easily.
    • Ramp-on-demand button, especially for high pressures during mid-sleep wake-ups.
    • Use 16GB internal flash RAM to keep all data. Use 16GB SD Card to transfer data.
    • Add USB3 port for faster data transfer to computer.
    • Hose Management
      • Integrated eight-foot heated hose. Sure, a six-foot hose is okay, but many of us add a two-foot extender. Why not just give us an eight-foot option?
      • More durable transition where the hose meets the hose end. A heated hose should last longer because it’s more expensive. The stress point between the hose and hose-connector is always first to rip and show holes. Let’s fix that.
    • Travel Considerations
      • A cpap under a kilogram (2.2 pounds), including the power wart.
      • Smaller, more compact.
      • A humidifier tank that can be stowed with water in it: stow and go.
      • Better luggage:
        • better padded, securable, roomier,
        • decent stowage pockets, flaps, compartments, etc. for extra CPAP equipment
        • a medical-equipment patch velcroed into place for carry-on, but removeable and quickly stowable so we don’t have to advertise it when we don’t want to.
        • It should look like a regular carryon bag, but easily openable for inspection by the owner without a lot of touching by inspectors.
        • Enough room for an eight-foot hose, hose cover, two masks, chin straps, various adapters and a liter of water.
  • Firmware Aspects
    • Keep a year or more of all high-rate and medium rate data on the machine, even without the SD card. Transfer the high-rate and medium-rate data to the SD card upon insertion, so we don’t lose data when we forget to put the card in one night. Because we do that.
    • Use round-robin file removal only when the SD card is approaching full.
    • Make firmware patient-upgradeable (free), so if something new comes along that the machine can offer for users, we can just update the firmware.
  • Software Aspects
    • Wifi or bluetooth transfer of data to computer or phone, automated, on-demand and/or live.
    • Social Media, Apps
      • A bluetooth app for phones and tablets, iOS and android, that allows us to view our data without having to turn on the computer. Data should be held locally on an external microSD card, and only uploaded elsewhere at the express wish of the patient to the doctor. HIPAA security should be an important consideration for this.
      • Ability to share some less-personal data in an easy format for forums to get questions answered.
      • Ability for patient advocate to track a family member or client from a phone or tablet while in the next room, with live alerts for mask-off, large leak and other causes for alarm.
  • Admin Settings
    • Timekeeping
      • Settable time-keeping. Stop the factory preset or special cables.
      • Perhaps with radio-enabled atomic-clock sync.
      • Admin-settable day-light savings preferences.
    • Data Collection
      • Give us a choice of High-rate and medium-rate data collection schemas: 1 month, 3 months, 6 months, all-time, etc.
      • Keep all low-rate data, even past a year, regardless.
  • Patient Settings
    • Show me the time in big numbers (maybe date too, but smaller) on the home screen. It’s not like there isn’t room.
    • Screen-brightness. Button and tank LED brightness/on/off. Patient screens blind us in the middle of the night with bright colors when we’re up for a pee break. Let’s reduce that.
    • Make light sensor sensitivity selectable in the patient settings.
    • Screen ‘themes’ – regular colors and dark theme colors. How about a variety?
    • Visual cue on screen: a “warning” dialog that tells me the machine is still writing to the SD card when I turn off the blower, or store all waiting data immediately to the card when I turn the blower off. Allow me to turn the machine back on even if the dialog is still saving.
  • More Hardware Options
    • Inexpensive integrated patient-available oximetry option with high-rate data plethy capture. Yes, sleepyhead comes closest to integration, but PR and ResMed are both losing a whole market of patients by not making this a cheap and easily accessible option. Oximetry needs no prescription. This really seems like a no brainer to me, but also seems less likely than the others above because the makers are probably being pressed by DME’s to keep patients out of the loop. That seems like bad science and bad health to me, but what do I know?
    • Oximetry clip that doesn’t leave marks or hurt, including an earlobe oximetery clip..
    • Aerophagia event capture (since it can wake some of us), and patient-optional aerophagia-based intelligent pressure reduction in Auto models.
    • Inexpensive integrated patient-available thoracic band option
    • Oxygen Considerations:
      • Concentrator connectivity – turn on/off concentrator when the CPAP is turned on/off.
      • O2 cylinder connectivity smart valve – turn on/off cylinder when CPAP is turned on/off.
      • O2 twofer valve – Intelligent valve switch that turns on cylinder if concentrator fails and CPAP remains on, or if cylinder is empty, turn off the cylinder and turn on the concentrator if CPAP remains on. Patient-selectable preference for cylinder or concentrator as main and backup. Optional alarm if neither cylinder or concentrator are available. (This is an on-off valve with safety shutoff. Actual O2 settings are done manually on cylinder or concentrator.)
      • Reduce line clutter to the head and hands.
  • Big Picture
    • Self-titration is an important step in the progress of modern sleep disordered breathing. Most people’s needs are met by CPAP, but more people could self-titrate with an Auto, getting better treatment faster. Make the base machine a standard data-capable Auto that can be transformed into a CPAP. “AutoIQ” should be one Admin-selectable mode of three: Auto, AutoIQ, CPAP. The cost of production would be reduced if manufacturers didn’t have to create three machines to please so many different patients’ needs. They’re probably all using the same hardware with only a difference in some firmware and a chip or two. Let’s simplify.
    • An algorithm that senses whether it’s likely the patient should be on ASV and gives a warning in daily uploads and on the main screen to that effect, based on clear airway apneas, periodic breathing and any other appropriate baseline scoreable data.
    • In general, less proprietary methodology. It’s nice to see SD cards incorporated in this generation of devices, as well as open-source data recording methods. Oximeters aren’t that expensive anymore. The cheap ones are just as reliable as the vetted expensive ones and are also FDA approved. Why not bridge the gap?
    • Open Source Raspberry Pi interface
      • Make available five or ten extra user-definable graph sections for the S10 Autoset/PRS2 Auto.
      • Create open source data logger using Raspberry Pi hardware and an interface cord that will allow users to capture high-rate or medium rate data and log it on the machine. This could be insanely useful for sleep medicine students who can’t afford the big machines or time in the sleep lab, but want to prototype a new data logger. It could also be useful for hobbyists who want to get even more education and entertainment out of their own machines. It would also give sleep apnea machine developers a wider pool of makers who like to hack and create brilliant interfaces that could outshine or eclipse current standards.
      • Things that could be measured include:
        • Ambient external stimuli: light, sound, movement of other people, pets.
        • Ambient room humidity, temperature, etc., as wake-trigger. (For me 74 degrees and 70% humidity is a wake trigger.)
        • Body position: right/left side, belly, back…
        • Plethysmography, heart rate, O2, CO2, etc.
    • Omit materials of manufacture like BPA-containing and other outgassing substances that have been banned.
  • PRS2 considerations

    • A filter guard so the air filter doesn’t pop out when you cough or sneeze.
    • Full color display (preferably AMOLED, but backlit if necessary)
    • Ramp for Cflex/Aflex
    • Turn Cflex/Aflex on/off while machine is running.
    • More intuitive large leak indicator on screen. Other intuitive on-screen alerts when therapy needs are not met.
    • Encore Viewer and Pro
      • Improve encore software
      • Higher-resolution graphing on screen
      • Better accessibility of data on screen rather than as a printout
      • Better printouts.
      • Better data archiving for Encore viewer. Allow encore viewer to keep a copy of all previous data on the computer – not just view what’s on the card.
      • Find a better method than SQL database for Encore Pro, because – wow – is that unweildy for this kind of data.
  • ResMed S10 considerations
    • Washable tank should come with all S10’s. Stop making disposable tanks.
    • Design out the machine whistle on exhale.

To see more about what current users want, check out this thread on CPAPtalk.com.

 

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