Comment by blackeyeblitzar

Comment by blackeyeblitzar 10 months ago

The problem is that these at home tests aren’t good enough to eliminate the costly and time consuming and inconvenient step of a sleep study in the lab. At least near me, to get a CPAP you first do a take home study with a wrist based (watch like) recorder. Then they make you go into the lab for an overnight sleep study (or multiple of them) anyways, for a study that costs your insurance several thousand dollars per night (and you have some copay potentially) and it is of course a massive hassle and barrier to getting CPAP treatment. They claim it is so they know your air pressure numbers but it is all just regulatory capture, because CPAP machines can auto adjust your pressure and people like to tweak numbers manually to their comfort level anyways.

Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

Bluecobra 10 months ago

> Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

I sure hope so, because my experiences with sleep apnea made it seemed very quack-ish. I keep on hearing ads on the radio by a company called ADVENT with a catchy jingle promising that surgery is the solution to snoring. At the time I had my study (2013) I did not have an in-home test and had a sleep test (which was an awful experience). I was prescribed a Phillips CPAP machine and was very good about adhering to it and keeping up with regular doctor visits. During the 3 years I had it, I lost a significant amount of weight and each time my doctor re-programmed my CPAP SD card so it was a lower and lower setting. I always had very little face time with the doctor, I wish I knew about Sleepyhead earlier as I could have done this myself. The practice I was referred to would always try to sell me stuff like new masks, tubes, etc. when everything I had was in good condition and frequently cleaned. I even used distilled water in the CPAP itself. Eventually I went on a long vacation and didn't bring my machine and been off it since. I'm glad I did, it turns out Phillips was negligent about foam breaking down in their CPAP machines and even the replacement devices have this issue as well. At this point I don't know who to trust, and with something with Apple's name on it would give to some more legitimacy.

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elric 10 months ago

> They claim it is so they know your air pressure numbers but it is all just regulatory capture

I disagree. In lab titration is not about regulatory capture. It's the best place to get a good ballpark start. The rest should be up to the patient, but informing the patient of that is where things go wrong, alas.

> CPAP machines can auto adjust your pressure and people like to tweak numbers manually to their comfort level anyways.

They cannot. See my rant about APAP in the comments here, or my previous APAP rants in my history. Current generation APAP is awful and it needs to die. PAP machines are awful at detecting events. This could probably be partially mitigate with better software. But there is a reason why a sleep study is very much the gold standard. 12+ channels of valuable information. Versus 1 channel on the PAP device.

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blackeyeblitzar 10 months ago

Current generation APAP works great - not sure why you’re calling it awful. And I disagree that more channels are necessary - that’s a statistical implication that not true in general and shouldn’t be assumed blindly here. What needs to die is regulatory capture and bureaucratic barriers that take health care out of patients own hands, which is what the sleep study scam does, at least in the US, where you cannot get a CPAP/APAP device otherwise.

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- elric 10 months ago
  
  > Current generation APAP works great - not sure why you’re calling it awful
  It doesn't. Your PAP machine doesn't even know whether you're awake or sleeping. It can only ever play catch-up to your breathing getting worse. Properly titrated CPAP (or BiLevel or ASV) is vastly superior both in terms of therapy and comfort.
  > What needs to die is regulatory capture and bureaucratic barriers
  That I agree with.
  > which is what the sleep study scam does
  It's not a scam. It provides incredibly useful data. Sleep problems are not just a boolean sleep apnea yes/no. All kinds of shit can go wrong during sleep. Maybe you have central sleep apneas, or complex apneas, maybe you need ASV rather than CPAP. Maybe you have restless leg syndrome (orthogonal to sleep disordered breathing). Maybe you just have positional apnea. Maybe you have REM disorders. Your apple watch won't tell you any of that.
  Many people end up getting a sleep study because they're tired. That doesn't have to be apnea. Other people get sleep studies because they snore or because a bedpartner tells them they breathe weird in their sleep. That's more likely to be apnea.
  
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outworlder 10 months ago

The largest barrier by far is actually starting the process to get a diagnosis. It's often a family member that notices and raises the alarm.

Note that you can be diagnosed with sleep apnea based on the home study alone, you don't always have to go to a sleep clinic. If you are really sure you have sleep apnea (and you can be pretty certain with a home sleep study + symptoms) you can just go online and get a prescription for free by talking to a doctor at one of the companies that resell CPAP machines. At least in the US, other countries can be more bureaucratic.

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makeitdouble 10 months ago

> Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

Integrate with the existing providers (= making deals with all the existing players and provide the adequate SDKs) and bring more accurate and reliable measurements than dedicated, calibrated devices.

That sure could be possible, but has Apple ever done anything like that ?

They couldn't come to an agreement wit Massimo, I wouldn't be holding my breath on them sealing deals with the incumbents in the field.

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