What would an ideal APAP/CPAP machine be? What features etc?

[sndraco]

This isn't really about optimizing therapy/current equipment, however on looking at the Resmed 11 vs. 10 (and maybe I am missing something but seems like the main feature add is the touchscreen, which doesn't really improve therapy) and even from the Resmed 9 to 11 the level of improvement re therapy outcomes is small, and also the issues people have with therapy I was wondering how much more optimization is possible based on the ideal machine. 

Items than can be optimized (or at least aren't optimal now) (just my list, and welcome feedback and add/edits)

- APAP machines only report AHI, if they reported RDI and arousals (not sure if thats possible) likely an improvement. 

- AHI below 5 is considered fine, and we know thats not the case. So either moving away from only AHI (from the medical side), or capturing more info/optimizing other variables is needed. Looks like arousals and UARS are really the two that aren't optimized by most doctors and most/all machines.

- Can Flow rate be measured and affected much more? This is out of the box, ideally though one would think that the machine's purpose is to have the inhalation and exhalation curves match normal/ideal curves for every breath. Not sure what tech would be necesary. 

- Algorithm improvement (maybe use of AI) as one its reactive (and quite non predictive) and also once reacts stays there for a while. Maybe this is best possible but...

- Maybe apap's should have bipap capabilities as not sure in what scenarios apap only ie without bipap is better. I understand folks may not need bipap however and this is anecdotal based on Dr. Barry Krakows experience seems like more folks than seem could benefit from Bipap. 

- Better reporting capabilities (for oscar but also to the 

With the number of people suffering from apnea/sleep disordered breathing, the huge difference (mine and seems like others experiences) between so-so results and optimal results and their demographic (usually mid to later in life), impact,  seems like there should be enough economic incentive to have a much more rapid improvement in diagnosis, treatment and equipment. I realize the field is newish first cpap machine in I think 1981, however 42 years seems like more progress is possible and not sure why it isn't happening. 

Shri

I was partly wondering what it would take to get the best machine possible and what barriers are.

[srlevine1]

Considering the differences in human physiology, environmental factors, and individual compliance would such a mythical machine be possible using algorithms, or would it require artificial intelligence learning capabilities for continuous micro-adjustments? And would micro-adjustments be practical or beneficial over the long run?

I think the greatest gains might be achieved by better diagnostics instead of a hit-or-miss sleep test under stressful conditions followed by more patient education.

[desaturator]

- APAP machines only report AHI, if they reported RDI and arousals (not sure if thats possible) likely an improvement. 

I'd like to see a PAP machine that measured and, to some extent, interpreted oxygen saturation. As my username suggests, I'm very concerned about this, and wearing another sensor and integrating its data is a PITA. My feeling, though, is that most people who use PAP are more concerned about arousals, and (for the most part) don't show particular deranged oxygenation. Also, I don't believe that a machine would, or even could, use oxygenation data in its treatment delivery. But just reporting/warning would be a step forward.
Being able to report arousals would be a big step forward, in my view. I think that the arterial tonography method that the WatchPAT units employ offers a reasonable measure of arousals, and is a lot easier to use than EEG. However, I believe that the sensors for this are consumable, which would add to the expense.
What I'd quite like a machine to have is a remote control. Maybe some of the newer ones already do.
BW, DS

[srlevine1]

@desaturator Have you seen the pulse/oximeter adapters for the S9 and S10 -- but not the S11 yet. My oxygen levels are available on both ResScan and Oscar. All data is integrated and stored on the SD card.

[desaturator]

@desaturator  Have you seen the pulse/oximeter adapters for the S9 and S10 -- but not the S11 yet.

No -- please tell me more. I currently use a Wellue, which works fine, but keeping the times of my S9 and my Wellue in sync is a bear.

BW, DS

[Crimson Nape]

desaturator - As of OSCAR version 1.3.0, you can easily sync the Wellue to your CPAP by changing the time in the Wellue's filename. Import the CPAP data and record its starting time. Rename the Wellue file to match and then import it.

[sndraco]

You are right better testing/diagnosis and titration are likely the first big bang for the buck items. 

I do think though given possible wrong flagging of events, and also way algorithm reacts if there isn't improvement possible to further optimize treatment (the point on variability of patients and symptoms is valid, though think machines with more flexibility could help)

My main frustration was seeming lack of innovation and wondering if thats because there is nothing else to really improve on the machines or there are many avenues for exploration/improvement. 

Thanks

S

[Millstone50]

The AirSense 11 pretty much hits the mark, except the humidifier reservoir is small, the clock drifts, and yeah I guess a nice feature would be a Bluetooth pulse oximiter that would save data to the SD card.

[desaturator]

As of OSCAR version 1.3.0, you can easily sync the Wellue to your CPAP by changing the time in the Wellue's filename. 

Ah, OK, thanks. I thought the timestamp was actually recorded in the Wellue data file somewhere (as it is when I do a CSV export).

But, really, I need to synchronize the CPAP, rather than the other way around, because I also have a security camera for recording my sleep movements -- and that is already synchronized to the Wellue, because both are synchronized to my phone.

So I might add another feature request: an ability to set the time on the CPAP to the second. On my S9 I have wait for a minute to roll around, and then change the time by one minute and then change it back again. I think more modern machines use some sort of network synchronization anyway, so this might no longer be a problem. 

BW, DS

[sndraco]

The AirSense 11 pretty much hits the mark, except the humidifier reservoir is small, the clock drifts, and yeah I guess a nice feature would be a Bluetooth pulse oximiter that would save data to the SD card.

Isn't the Airsense 11 very similar to the Airsense 10 except for touch screen? ie rest of the system, algorithm, pressure changes, what it measures, how it measures, reports etc all the same as the 10?

S