All About Options

The owner of Austin InstaTech carries many CPAP/mask brands, but she favors one brand in particular when it comes to humidification.

As the owner of a DME and sleep lab “with a twist,” Debbie Downey, RRT, RPSGT, works with physicians to -provide their patients with sleep testing and medical equipment as needed. Sleep docs want to know that their patients are being well taken care of, and anything less is bound to mean reduced referrals.

Austin InstaTech is a subcontractor that physicians rely on, and Downey’s experience has taught her that one size does not fit all when it comes to boosting patient compliance. Patients typically are prescribed one of three different types of CPAP, APAP, BiPAP, and masks. “Every patient is different, not one mask fits everyone and not one machine fits all,” she says. “The need for better humidification is a constant. Without it, CPAP can be a miserable experience. For a long time, Fisher & Paykel in particular has preached that humidification matters, and I agree with them.”

As a respiratory therapist, Downey first encountered Calif- based Fisher & Paykel’s humidification technology within the world of ventilators. Similar to its effects in ventilation, efficient humidification wards off excessive drying and swelling. When F&P rolled humidification into PAP therapy, Downey established a relationship with the company that she maintains to this day.

Downey usually opts to put out units with heated humidification and heated tubing if it becomes necessary. “We don’t put out dry PAP devices,” says Downey. “When we have patients with excessive dryness, or excessive reactive mucosa due to dryness, we verify a good mask fit and switch them to the heated tubing to increase humidification.”

ICON Aims for Aesthetics

Fisher & Paykel Healthcare’s ICON is designed to push the aesthetic envelope, while weaving in proprietary ThermoSmart™ technology to match clinical effectiveness with sleek design.

Engineers designed the ICON™ using input culled from in-depth patient and clinician feedback. On the global market for more than a year, the ICON is aiming to capture market share in a highly competitive niche.

When F&P remodeled their PAP device to the ICON platform, Downey gave the unit another look and liked what she saw. “In the past, the F&P design had been rather bulky even though their humidification was elegant,” says Downey. “We have a mobile population these days, and the bigger the CPAP, the less likely it is to travel with the patient on business or vacation. They made the footprint smaller, and patients like that less of their bedside table gets taken up. It is lighter, less cumbersome and the humidifier chamber drops down into the top of the machine, which also makes it easier to use.”

Downey was one of the first sleep professionals in the United States to carry the ICON. According to Masoud Vahidi, senior product manager, Fisher & Paykel, Irvine, Calif, the reception in Australia, New Zealand, and Europe has been enthusiastic. “At CPAPTalk.com, every discussion we have seen has been very positive,” says Vahidi. “Respiratory therapists and sleep technicians are wowed. We, as well as our customers, get daily calls from patients asking when ICON is going to be available, so there is great excitement.”

Clinicians have embraced the ICON’s ThermoSmart™ technology which mimics the ability of the nose to heat and humidify the air to prevent symptoms such as dryness and congestion caused by CPAP use. A recent bench study found that ThermoSmart™ delivered average absolute humidity levels greater than 27 mg/L, and without causing condensation.1

Appealing to Patients

With neutral colors, Vahidi believes the ICON can discreetly blend into the bedroom environment. Since it also comes with full digital clock and alarm capabilities, it can free up limited space on the nightstand.

Downey initially pegged the digital clock and alarm additions as non therapeutic “hooey,” but now she admits with a chuckle that it was a good idea. “In Austin, Texas, we have a lot of 30-something guys who come in for CPAP therapy, and it’s not very sexy,” she says. “You have the ability to download music to the ICON. It’s not a therapeutic thing, but this type of ‘cool technology’ makes it more approachable to them. I did not think it would be popular, but when I tell them they can download different ring tones and alarm tones, it’s a feature they like. If it can boost compliance, I am for it. It goes to show that it is not always about therapeutic applications.”

“The ICON will fit in well in a patient’s bedroom,” adds Vahidi. “It has a forward facing display and a clock that blends in well. If you look at what people usually have on their nightstand— a radio, clock, phone, a book—the ICON fits right in and replaces the need for a clock. In the past, many patients have felt uncomfortable being on CPAP therapy and elected to take their CPAP units off the nightstand and hide it underneath the bed while not in use. With the ICON, they can feel comfortable leaving it out.”

The high-tech look goes well with a computer-driven interactivity that features more menus that patients can access. The menus provide familiar ways for patients to look at data and get feedback on how they are doing with the therapy. “In this day and age, where patients are relatively computer savvy, this can be really helpful,” enthuses Downey. “When you tell patients they can turn to this menu and see how many apneas they had last night they can correlate that to the type of mask they were using, because that might affect results.

What were the circumstances in the home that may have changed the numbers?”

Feedback allows patients to become active participants in their care. “Instead of guessing, they have empirical data that is right there on the screen,” says Downey. “You give patients some measure of control, and they know we want a certain number. They become more compliant, accepting more responsibility for therapy outcomes.”

Ultimately, Downey evaluates every new advance based on the holy grail of compliance and therapeutic results. She appreciates the ICON’s improved ability to allow a greater range of internal temperature settings for heated humidification, a feature that allows her to bracket low, medium, and high temperature ranges. If patients don’t get enough humidity, they can choose a low, medium, or high temperature range.

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1 Virag R. Evaluation of the performance of CPAP heated humidifiers for use in sleep apnea therapy: a comparative study of humidification effectiveness Sleep 2008; 31: A382.

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