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I generally agree with you but even people with a prescription who have sleep apnea have a lot of trouble using their CPAP consistently and correctly, even afte

I generally agree with you but even people with a prescription who have sleep apnea have a lot of trouble using their CPAP consistently and correctly, even after it is titrated by professionals in an overnight session. Some people obviously are capable of diagnosing and solving their own medical problems and are willing to learn and do the work but most people aren't. I don't think that opening up CPAPs to the masses would suddenly "solve" sleep apnea, most people will still need to go through a similar process that exists now. Regulation that streamlines the involvement of insurance providers would probably be enough IMO, they are the real reason it is difficult to get a CPAP most of the time.

deleted 2y ago
[deleted]
lysace 2y ago
> Regulation that streamlines the involvement of insurance providers would probably be enough IMO, they are the real reason it is difficult to get a CPAP most of the time. The obvious solution is to bypass the insurance providers. Also: when it comes to fitting masks to faces and figuring out the optimal pressure rates - these seem like pretty obvious application of machine learning algorithms, don't you think?
- rootusrootus 2y ago
  > these seem like pretty obvious application of machine learning algorithms, don't you think? Anecdotally, my impression is that most CPAP users are using APAPs at this point, like the very popular Resmed AirSense 10. Titration amounts to giving it a pretty wide range and letting the machine itself figure out the right pressure. It's not a complex learning algorithm, but seems to do the job.
  - wilsonnb3 2y ago
    I think APAP's are more about comfort and less about effectiveness, although making them more comfortable to use does make them more effective. The algorithm is more about detecting that you aren't asleep and thus don't need the full pressure at the moment and less about altering the target pressure setting on the fly. I could be wrong though, I use is a bipap which works a bit differently than CPAP or APAP.
    - rootusrootus 2y ago
      I have personal experience with the Airsense 10 and it doesn't detect sleep/awake, as far as I can tell. At least not for me; it starts at low pressure, ramps up over a set time to the bottom of the range, and then adjusts as necessary. Low flow or an apnea event will get it to increase the pressure. Sometimes if you are breathing kinda slow lying there awake you can trip it up and feel it start pulsing the pressure to get more air moving. To my understanding (no personal experience), Philips APAPs have a different algorithm to try and achieve the same goal, and are regarded as less aggressive about it than Resmed. There's also a new Resmed Airsense 11 out but I don't know anything about it and what changed. BiPAPs are definitely a different beast, for sure. My dad used one of those. Not automatic at all, right? Constant pressure, but different between inhale and exhale?
      - wkat4242 2y ago
        The pulsing is not to get the air moving but to see what kind of obstruction event it is. It's quite annoying to me and unfortunately it can't be turned off even in the full therapist menu :(
- wilsonnb3 2y ago
  > The obvious solution is to bypass the insurance providers. That is one solution but I think it would be better to make it easier for people to go through the current process rather than making them pay out of pocket (assuming that it what you meant by "bypass the insurance providers"). Assuming that we aren't going to also fix the entire American medical system, making it easier for people to use the insurance they already have to get a medical device they need seems like the best approach to me. > Also: when it comes to fitting masks to faces and figuring out the optimal pressure rates - these seem like pretty obvious application of machine learning algorithms, don't you think? Yes but I don't think that means we should take the human expert(s) out of the loop. I rather quickly changed the pressure settings on my bipap in the hidden menu after the titration but many, maybe most, people aren't like me and need there to be someone they can just say "this isn't working for me" to instead of being left on their own.
hombre_fatal 2y ago
> I don't think that opening up CPAPs to the masses would suddenly "solve" sleep apnea, most people will still need to go through a similar process that exists now. A $200 CPAP with a knob that lets you control pressure absolutely would solve sleep apnea for much more people than gatekeeping it behind an insane price + having to make a doctor's appointment through insurance just to get them to turn the knob for you. Because those who can't turn a knob themselves would still be able to schedule an appointment with a knob-turner without making the rest of us have to do it as well. I got a hand me down CPAP from my dad, bought a mask off Amazon, played with the knob a bit, and within a week I cured my central sleep apnea. It's just not hard for anyone who doesn't think the doctor has divine capabilities over what they could do themselves (turning a knob). But instead we infantilize everyone by requiring them to do the equivalent of taking their car in for a licensed professional to check their oil dipstick. And, of course, making them or their insurance pay $300 for the pleasure.

deleted 2y ago

[deleted]

lysace 2y ago

> Regulation that streamlines the involvement of insurance providers would probably be enough IMO, they are the real reason it is difficult to get a CPAP most of the time. The obvious solution is to bypass the insurance providers. Also: when it comes to fitting masks to faces and figuring out the optimal pressure rates - these seem like pretty obvious application of machine learning algorithms, don't you think?

rootusrootus 2y ago
> these seem like pretty obvious application of machine learning algorithms, don't you think? Anecdotally, my impression is that most CPAP users are using APAPs at this point, like the very popular Resmed AirSense 10. Titration amounts to giving it a pretty wide range and letting the machine itself figure out the right pressure. It's not a complex learning algorithm, but seems to do the job.
- wilsonnb3 2y ago
  I think APAP's are more about comfort and less about effectiveness, although making them more comfortable to use does make them more effective. The algorithm is more about detecting that you aren't asleep and thus don't need the full pressure at the moment and less about altering the target pressure setting on the fly. I could be wrong though, I use is a bipap which works a bit differently than CPAP or APAP.
  - rootusrootus 2y ago
    I have personal experience with the Airsense 10 and it doesn't detect sleep/awake, as far as I can tell. At least not for me; it starts at low pressure, ramps up over a set time to the bottom of the range, and then adjusts as necessary. Low flow or an apnea event will get it to increase the pressure. Sometimes if you are breathing kinda slow lying there awake you can trip it up and feel it start pulsing the pressure to get more air moving. To my understanding (no personal experience), Philips APAPs have a different algorithm to try and achieve the same goal, and are regarded as less aggressive about it than Resmed. There's also a new Resmed Airsense 11 out but I don't know anything about it and what changed. BiPAPs are definitely a different beast, for sure. My dad used one of those. Not automatic at all, right? Constant pressure, but different between inhale and exhale?
    - wkat4242 2y ago
      The pulsing is not to get the air moving but to see what kind of obstruction event it is. It's quite annoying to me and unfortunately it can't be turned off even in the full therapist menu :(
wilsonnb3 2y ago
> The obvious solution is to bypass the insurance providers. That is one solution but I think it would be better to make it easier for people to go through the current process rather than making them pay out of pocket (assuming that it what you meant by "bypass the insurance providers"). Assuming that we aren't going to also fix the entire American medical system, making it easier for people to use the insurance they already have to get a medical device they need seems like the best approach to me. > Also: when it comes to fitting masks to faces and figuring out the optimal pressure rates - these seem like pretty obvious application of machine learning algorithms, don't you think? Yes but I don't think that means we should take the human expert(s) out of the loop. I rather quickly changed the pressure settings on my bipap in the hidden menu after the titration but many, maybe most, people aren't like me and need there to be someone they can just say "this isn't working for me" to instead of being left on their own.

hombre_fatal 2y ago

> I don't think that opening up CPAPs to the masses would suddenly "solve" sleep apnea, most people will still need to go through a similar process that exists now. A $200 CPAP with a knob that lets you control pressure absolutely would solve sleep apnea for much more people than gatekeeping it behind an insane price + having to make a doctor's appointment through insurance just to get them to turn the knob for you. Because those who can't turn a knob themselves would still be able to schedule an appointment with a knob-turner without making the rest of us have to do it as well. I got a hand me down CPAP from my dad, bought a mask off Amazon, played with the knob a bit, and within a week I cured my central sleep apnea. It's just not hard for anyone who doesn't think the doctor has divine capabilities over what they could do themselves (turning a knob). But instead we infantilize everyone by requiring them to do the equivalent of taking their car in for a licensed professional to check their oil dipstick. And, of course, making them or their insurance pay $300 for the pleasure.