Professional Attitudes about Sleep Technology Equipment: Part I

In the modern world we are constantly inundated with technological advances, mostly designed to improve the quality of our lives, increase efficiency or expediency in tasks we are obligated to perform, and enhance certain entertainment or recreational experiences. All around us we have experienced new things just in the past 10 to 20 years that have dramatically altered the ways in which we live, play and work. Just think back not that long ago to when you wrote letters to friends and family and how much of your communication now is through emailing or texting. Some people have ceased talking on the telephone, preferring instead all forms of electronic communication as well as social media interactions.

It could be argued these changes have greatly enhanced our capacity to communicate innumerable pieces of information to each other with incredible efficiency and expediency and that doing so has improved the quality of our lives and perhaps improved aspects of our leisure time. Some might argue that not speaking on the telephone so much has diminished an important component of human interaction, namely, dialogues with other people, but regardless of where you stand on these issues, there is no question that lifestyles have been deeply affected by these changes in communication technology.

That so many people have embraced these changes and now frequently use these tools reveals how technological advances easily diffuse into society for better or worse.   When you stop to think about specific advances in the present day, it is interesting to reflect on what life would be like if we suddenly were without fax machines, email devices, microwave ovens, skype software, computers, iphones, video games, not to mention amazing health technology like insulin pumps, implantable defibrillators, prosthetic limbs...and let’s not forget PAP devices.

What would life be like without your PAP machine? What if there was no such thing as oral appliance therapy (OAT) or throat surgery? It is interesting but not surprising that the timing of the discovery of OSA/UARS coincided both with the advancement in technology to measure respiration and brain waves as well as the advancement in technology to treat the sleep breathing condition, including advances that led to PAP devices, OAT, or even more sophisticated surgical techniques.

Even so, the first question that always arises when new technology emerges in the marketplace is how well does it work? Does it improve upon an existing piece of technology or is it brand new? PAP of course was brand new in 1981 when it first appeared, and it is well-documented that the rise of PAP technology was the major impetus leading to the widespread dissemination of new sleep centers and laboratories in the 1990s. In other words, PAP provided the foundation for a business model, because not only could it treat a newly recognized sleep disorder—OSA/UARS—but the early results were so dramatic on the most severe cases, it was clear to the certain fields of medicine (e.g. pulmonary medicine, neurology and psychiatry) that a resource distribution network would need to be organized to serve patients.

Fast forward to the present, and we know there are many sleep centers and durable medical equipment (DMEs) companies serving our interests by functioning as the conduits through which patients are treated with professional medical care and receiving medical technology in the form of PAP devices to treat OSA/UARS.

With this backdrop, I want to point out one very interesting flaw (perhaps better described as a human fallacy) in this system, which is predicated on the specific experiences of the medical professionals in this medical technology loop. For example, you know from past posts that our center often prescribes advanced PAP devices like ASV and ABPAP, therefore you might imagine that every DME with whom we conduct business must be very aware of our approach to patient care and our emphasis on using advanced PAP technology. To use a common phrase, you might say our center is on the cutting edge in so prominently wanting our patients on advanced PAP devices.

At the other end of the spectrum we find sleep centers and DMEs that largely prescribe CPAP devices and only CPAP devices (or maybe a few APAPs or BPAPs), either because they are persuaded CPAP provides satisfactory results to nearly all patients or no devices currently exist that have proven superior to CPAP. From this vantage point, these sleep professionals, both the sleep center staff and DME personnel, have determined their business model revolves around CPAP, and they see no convincing evidence to change that approach.

From the standpoint of new technology, it is a curious thing when someone chooses not to pursue advanced PAP technology, because such behavior is almost always in diametric opposition what happens within the general population of consumers. Thus, if we look at how new technology in general disseminates into society, we are routinely hearing about someone getting the latest and greatest smart phone, right? We hear about such purchases quite a bit from friends and family. And, while part of this “trading in for the new model” is akin to “keeping up with the Joneses,” nowadays an even greater motivator is that there truly is an extra benefit as advertised for the new smart phone. The individual buyer sincerely believes that this new benefit is something desirable. It may be faster internet speed, better photo quality, greater memory, etc. It is common knowledge that many people pursue their new technology for such attributes, and we see many news items and photographs of long lines of consumers waiting outside stores to purchase the most advanced smart phone.

Now, pause for a moment and think how fundamentally different this consumer driven approach plays out compared to how a sleep doctor makes a decision to switch from prescribing CPAP devices to BPAP or BPAP to ABPAP or ABPAP to ASV? By understanding this distinction, it is much easier to predict which sleep docs and sleep centers use advanced devices and which hold off on such changes. In the next post we will delve into the different perspectives that cause some people to forge ahead into a new frontier while others wait back at the fort so to speak and continue with what appears to be stable approaches to solving problems.

Barry Krakow MD


Dr Krakow’s 27 years of sleep research have focused on the complex relationship between physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.

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