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The CPAP jailbreak community was eye-opening when I first learned of it. I never expected something like that, but with the draconian policies it's not surpris

The CPAP jailbreak community was eye-opening when I first learned of it. I never expected something like that, but with the draconian policies it's not surprising. For example, my CPAP has a CDMA radio inside, which transmits usage data back to the manufacturer & my doctor. Insurance won't pay for it unless the machine tells them I'm using it – so a medical device company has a record of when I sleep and wake, which is mildly unnerving. Edit: I think sleepyhead[0] was the biggest project when I started looking into it, but it isn't under active development anymore. Apparently forked to OSCAR[1]. [0]https://gitlab.com/sleepyhead/sleepyhead-code https://gitlab.com/sleepyhead/sleepyhead-code [1]https://gitlab.com/pholy/OSCAR-code https://gitlab.com/pholy/OSCAR-code

reaperducer 7y ago
Once the insurance has finished paying for it (eight months in my case), you can disable the radio. Some doctors (mine included) prefer getting your data off the memory card when you visit the office, rather than downloading it from the internet anyway. The radio has to be optional for people whose beds are in places with unreliable or no cellular service (high up in buildings, in basements, fringe areas, etc...)
- rootusrootus 7y ago
  IIRC the data sent over the cellular connection is just summary information, it doesn't contain a full dump of the detailed measurements that will be stored on the SD card.
- favorited 7y ago
  I actually already have the option of disabling it (it has an airplane mode), but it spams me to turn the network back on. I just kinda gave in, to be honest. They're going to get the data anyway, and it is valuable to the doctor. I just don't need the device manufacturer to be storing it.
- surge 7y ago
  Yeah the radio is there as an added convenience so you don't have to keep a log and send it in for several months as evidence of usage. This is the fallback for those without radio, and its easy enough to put it in airplane mode. That said, Resmed provides a nice enough interface where you can track your sleep habits. To be fair it seems all they seem to track is how much you sleep each day, not when, where, etc. So they only collect data on usage, and also they feed some of the data (like detected apnea incidents) to my sleep clinic for review. The medical supply company stops providing the data to my insurance after the probationary period is up. Remember, your insurance already has access to a great deal of your medical information already, this isn't that invasive, and CPAP's are expensive and take a while to adjust to, so I understand why they want to ensure people are using them and they're working if its going to be purchased.
  - johnchristopher 7y ago
    That app isn't available everywhere though. I bought a secondary unit recently and I can't register it with the app (that I can't even download if I remember correctly). At least my other CPAP has an SD card.
    - surge 7y ago
      The app was just a website. The whole thing was administered through my doctor/supplier when they programmed the thing. It is a bit locked down, but I think its because its a machine that's "prescribed".
joshstrange 7y ago
You might also find the hacks for diabetes pumps to create closed loops equally fascinating. That and all the projects around it like Nightscout [0]. [0] http://www.nightscout.info/ http://www.nightscout.info/
ars 7y ago
The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to change the settings on the machine. So they lock them down, which adds even more to the cost. And then they are prescription only, so they have to go through specialized distributors because heaven forbid someone actually buy one without a Dr. letting them. The end result of all this is lots of people making money, and higher costs for the patient in the form of higher insurance premiums.
- BurningFrog 7y ago
  Maybe it's my bias, but I assume most of that 10x comes from the overly strict medical device regulations from the FDA.
  - nx2059 7y ago
    Why was this downvoted? Do people here seriously believe that the US doesn't have a system of crony capitalism? Is it so implausible to believe that regulations, while created with the best intent, are not susceptible to corruption via lobbying by powerful corporations to keep competitors out of the market?
  - xnyan 7y ago
    >overly strict Disclaimer: my opinions, not my company. I worked as a project engineer for a major testing company (underwriters laboratories). This is a vast simplification, but in essence the difference between medical device testing verses say, household electronics, is that in practice household electronics get evaluated with a "safety checklist" of all the serious and common problems to that kind of device (plus additional testing if deemed necessary which is not common) that UL and industry have seen over the years. In contrast, each and every kind medical device is torn apart and subject to a clean evaluation. There are still checklists and common issues they look out for of course, but in practice each device is considered novel while the same is not really true for more common devices. I think the latter type of testing is fundamentally more expensive, that said I think there are tons of regulatory issues that add to cost - I just want to argue that medical device testing will probably never be cheap.
NoInputSignal 7y ago
Don't really know how viable this question is, but for curiousity's sake, is it possible to build a Faraday cage around the machine?
- GordonS 7y ago
  How would that help with this part: > Insurance won't pay for it unless the machine tells them I'm using it
  - Frost1x 7y ago
    You instead need to throw most the board of directors of the insurance provider and device manufacturer in question into a Faraday cage, lock it, and walk away. On a more serious note, this is a new world of crazy for me I wasn't aware of. I wonder how difficult it would be to push forged data back to the monitoring agency with physical access to the machine with an independent setup. Then, simply put your actual device in a Faraday cage so you can still use your device as needed, with insurance covering it, without insurance invading your privacy and likely using that data for other unscrupulous purposes as well.
    - ethbro 7y ago
      Might we want to consider that medical insurance fraud is in fact a serious concern? From prior work in the industry, durable medical equipment is one of the most targeted areas for scams. Relatively high cost, amortized over an extended utilization time. I'm not particularly surprised that insurance companies (and therefore manufacturers that are supplying them) include such features. It'd be borderline negligent from a financial perspective not to.
- Relys 7y ago
  It would just be easier to remove the chip lol
- wormyrocks 7y ago
  The machine still works if you yank the 4-pin connector from the cellular board, so that's the easiest way. We gotta add that to the instructions...

reaperducer 7y ago

Once the insurance has finished paying for it (eight months in my case), you can disable the radio. Some doctors (mine included) prefer getting your data off the memory card when you visit the office, rather than downloading it from the internet anyway. The radio has to be optional for people whose beds are in places with unreliable or no cellular service (high up in buildings, in basements, fringe areas, etc...)

rootusrootus 7y ago
IIRC the data sent over the cellular connection is just summary information, it doesn't contain a full dump of the detailed measurements that will be stored on the SD card.
favorited 7y ago
I actually already have the option of disabling it (it has an airplane mode), but it spams me to turn the network back on. I just kinda gave in, to be honest. They're going to get the data anyway, and it is valuable to the doctor. I just don't need the device manufacturer to be storing it.
surge 7y ago
Yeah the radio is there as an added convenience so you don't have to keep a log and send it in for several months as evidence of usage. This is the fallback for those without radio, and its easy enough to put it in airplane mode. That said, Resmed provides a nice enough interface where you can track your sleep habits. To be fair it seems all they seem to track is how much you sleep each day, not when, where, etc. So they only collect data on usage, and also they feed some of the data (like detected apnea incidents) to my sleep clinic for review. The medical supply company stops providing the data to my insurance after the probationary period is up. Remember, your insurance already has access to a great deal of your medical information already, this isn't that invasive, and CPAP's are expensive and take a while to adjust to, so I understand why they want to ensure people are using them and they're working if its going to be purchased.
- johnchristopher 7y ago
  That app isn't available everywhere though. I bought a secondary unit recently and I can't register it with the app (that I can't even download if I remember correctly). At least my other CPAP has an SD card.
  - surge 7y ago
    The app was just a website. The whole thing was administered through my doctor/supplier when they programmed the thing. It is a bit locked down, but I think its because its a machine that's "prescribed".

joshstrange 7y ago

You might also find the hacks for diabetes pumps to create closed loops equally fascinating. That and all the projects around it like Nightscout [0]. [0] http://www.nightscout.info/ http://www.nightscout.info/

ars 7y ago

The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to change the settings on the machine. So they lock them down, which adds even more to the cost. And then they are prescription only, so they have to go through specialized distributors because heaven forbid someone actually buy one without a Dr. letting them. The end result of all this is lots of people making money, and higher costs for the patient in the form of higher insurance premiums.

BurningFrog 7y ago
Maybe it's my bias, but I assume most of that 10x comes from the overly strict medical device regulations from the FDA.
- nx2059 7y ago
  Why was this downvoted? Do people here seriously believe that the US doesn't have a system of crony capitalism? Is it so implausible to believe that regulations, while created with the best intent, are not susceptible to corruption via lobbying by powerful corporations to keep competitors out of the market?
- xnyan 7y ago
  >overly strict Disclaimer: my opinions, not my company. I worked as a project engineer for a major testing company (underwriters laboratories). This is a vast simplification, but in essence the difference between medical device testing verses say, household electronics, is that in practice household electronics get evaluated with a "safety checklist" of all the serious and common problems to that kind of device (plus additional testing if deemed necessary which is not common) that UL and industry have seen over the years. In contrast, each and every kind medical device is torn apart and subject to a clean evaluation. There are still checklists and common issues they look out for of course, but in practice each device is considered novel while the same is not really true for more common devices. I think the latter type of testing is fundamentally more expensive, that said I think there are tons of regulatory issues that add to cost - I just want to argue that medical device testing will probably never be cheap.

NoInputSignal 7y ago

Don't really know how viable this question is, but for curiousity's sake, is it possible to build a Faraday cage around the machine?

GordonS 7y ago
How would that help with this part: > Insurance won't pay for it unless the machine tells them I'm using it
- Frost1x 7y ago
  You instead need to throw most the board of directors of the insurance provider and device manufacturer in question into a Faraday cage, lock it, and walk away. On a more serious note, this is a new world of crazy for me I wasn't aware of. I wonder how difficult it would be to push forged data back to the monitoring agency with physical access to the machine with an independent setup. Then, simply put your actual device in a Faraday cage so you can still use your device as needed, with insurance covering it, without insurance invading your privacy and likely using that data for other unscrupulous purposes as well.
  - ethbro 7y ago
    Might we want to consider that medical insurance fraud is in fact a serious concern? From prior work in the industry, durable medical equipment is one of the most targeted areas for scams. Relatively high cost, amortized over an extended utilization time. I'm not particularly surprised that insurance companies (and therefore manufacturers that are supplying them) include such features. It'd be borderline negligent from a financial perspective not to.
Relys 7y ago
It would just be easier to remove the chip lol
wormyrocks 7y ago
The machine still works if you yank the 4-pin connector from the cellular board, so that's the easiest way. We gotta add that to the instructions...