The Good, The Bad, and The Just Plain Weird
I have been doing sleep and respiratory for a long time. In fact, I usually say dinosaurs roamed when I started. I remember rolling H cylinders into patients' rooms and using Bird ventilators in the ER. When I learned sleep I was taught how to do 12 channel pnuemograms on newborns and used a DOS version of Biologics to do overnight adult studies. Now we have more choices than ever for CPAP devices and masks and the testing has changed both in facility and in home.
I think that CPAP machines have changed so much for the better. I used to set up BiPAP STs and Quantum's with no humidity when I started doing DME. Now the machines such as the system 1 and S9 are small, quiet and allow the air to be heated properly. There are algorithms built into them to allow the flow to be more natural. There is monitoring that I could not have imagined back then. Not only can we monitor how much time the machines was on but if there are mask leaks, residual respiratory events and snoring. You can even use a modem to monitor them. If you want a CPAP with good looks the Fisher Paykel Ion looks just like an alarm clock and you can download music to be woken up by. The weird came along when I saw the Transcend. It is an interesting idea. You actually wear the machine on your head like a baseball cap. I have to admit that there is less hose but I can not imagine rolling over while I have a machine on my head.
Masks have gotten so much more creative as well. I do not have access to every mask out there but I have seen many of them. There are some really great ideas and sometimes I wish I could build a mask using parts from several different masks. I have to admit when I saw the Fulllife face shield type mask I was not sure about it. But I have to say I have several patients who have done fantastic with it. Most of them are small older women who were hard to fit with traditional masks and were claustrophobic. Who would have ever thought that bigger was better?
And now Respironics and Resmed have designed masks specifically for men and women. I think this is an interesting idea but that just means I have to take more room in my already limited space to store more masks. My favorite thing however is the gel and bandage type guards to protect the bridge of a patient's nose. This is something that really will help over time to protect those patients who have prominent noses, fragile skin or are on blood thinners and need a little extra protection.
Of course I always want to know what is new in sleep testing equipment especially since I run a lab and I teach sleep at the local community college. What made me do extra research was the fact that we are looking to expand to a second site and I need to add two more beds of equipment.
I found that there are systems that work on Bluetooth so you do not need to have the patient equipment connected to the PC. I found another company that sells the software and amplifiers but you have to supply the computers. But I did not find any equipment that was truly different from any other.
This is not true on home sleep testing equipment. Now there is a huge difference between systems. To be honest I am not sure I could even begin to decide which system is the best or most user friendly. I can tell you that I have two systems in my lab because there are always patients that these types of tests can be used for. In particular we use them a lot for the self pay patient who can more easily afford a HST versus the in-facility test, especially when we do not know whether they have a sleep disorder. I personally use the Stardust and the Apnea Link. Both have their good and bad points but being a creature of habit I usually go for the Stardust first because I find it easier to review the study before it goes to our medical director. I am not sure I know enough about the Watch-pat to make a decision on that device. It sounds like it might be the easiest to use, but since it does not have a respiratory component I worry about how accurate it is.
I am so excited to be part of a profession that is always coming out with something new; whether it is creating machines and masks that are aesthetically pleasing, less invasive equipment or trying something totally different like making a machine that sits on the patient's head. Our field is growing and the more creative we are in the field the better we will be able to serve out patients.