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Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

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Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#101

Post by nx2059 »

BurningFrog wrote: post #93
ars wrote: post #81

Earlier quoted context omitted.

The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to cha…

Maybe it's my bias, but I assume most of that 10x comes from the overly strict medical device regulations from the FDA.

Why was this downvoted? Do people here seriously believe that the US doesn't have a system of crony capitalism? Is it so implausible to believe that regulations, while created with the best intent, are not susceptible to corruption via lobbying by powerful corporations to keep competitors out of the market?

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#102

Post by xnyan »

BurningFrog wrote: post #93
ars wrote: post #81

Earlier quoted context omitted.

The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to cha…

Maybe it's my bias, but I assume most of that 10x comes from the overly strict medical device regulations from the FDA.

>overly strict

Disclaimer: my opinions, not my company.

I worked as a project engineer for a major testing company (underwriters laboratories). This is a vast simplification, but in essence the difference between medical device testing verses say, household electronics, is that in practice household electronics get evaluated with a "safety checklist" of all the serious and common problems to that kind of device (plus additional testing if deemed necessary which is not common) that UL and industry have seen over the years.

In contrast, each and every kind medical device is torn apart and subject to a clean evaluation. There are still checklists and common issues they look out for of course, but in practice each device is considered novel while the same is not really true for more common devices.

I think the latter type of testing is fundamentally more expensive, that said I think there are tons of regulatory issues that add to cost - I just want to argue that medical device testing will probably never be cheap.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#103

Post by SubiculumCode »

favorited wrote: post #99
SubiculumCode wrote: post #95

Earlier quoted context omitted.

Its worse than that. Before receiving a CPAP machine ~$1,000, most doctor's require a sleep study, which costs many thousands of dollars, and many times wait months to get the appointment. CPAP machines are usually the ultimate solution to reported sleep problems involving repeatedly waking up, and I don't see why they can't be prescribed immediately to see if they solve the problem.

My insurance wouldn't even pay for a monitored sleep study before I did an at-home study. Luckily, the at-home device showed moderate apnea, so I didn't have to do the lab study.

That's what they did for me as well, but not for other people I know living in a less affluent area of California. The take-home solution is much more cost-effective, it is a wonder that it hasn't been adopted universally. Also, I LOVE my CPAP.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#104

Post by surge »

reaperducer wrote: post #44
favorited wrote: post #23

The CPAP jailbreak community was eye-opening when I first learned of it. I never expected something like that, but with the draconian policies it's not surprising. For example, my CPAP has a CDMA radio inside, which transmits usage data back to the manufacturer & my doctor. Insurance won't pay for it unless the machine tells them I'm using it – so a medical device company has a record of when I sleep and wake, which…

Once the insurance has finished paying for it (eight months in my case), you can disable the radio. Some doctors (mine included) prefer getting your data off the memory card when you visit the office, rather than downloading it from the internet anyway. The radio has to be optional for people whose beds are in places with unreliable or no cellular service (high up in buildings, in basements, fringe areas, etc...)

Yeah the radio is there as an added convenience so you don't have to keep a log and send it in for several months as evidence of usage. This is the fallback for those without radio, and its easy enough to put it in airplane mode.

That said, Resmed provides a nice enough interface where you can track your sleep habits. To be fair it seems all they seem to track is how much you sleep each day, not when, where, etc. So they only collect data on usage, and also they feed some of the data (like detected apnea incidents) to my sleep clinic for review. The medical supply company stops providing the data to my insurance after the probationary period is up. Remember, your insurance already has access to a great deal of your medical information already, this isn't that invasive, and CPAP's are expensive and take a while to adjust to, so I understand why they want to ensure people are using them and they're working if its going to be purchased.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#105

Post by ars »

BurningFrog wrote: post #93
ars wrote: post #81

Earlier quoted context omitted.

The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to cha…

Maybe it's my bias, but I assume most of that 10x comes from the overly strict medical device regulations from the FDA.

It doesn't. You can buy CPAP machines from manufacturers that don't work with insurance companies for far less (around 1/4 of the price).

The machines are also not locked down, however they do still require a prescription so that part of the cost still exists.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#106

Post by ars »

SubiculumCode wrote: post #95
ars wrote: post #81

Earlier quoted context omitted.

The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to cha…

Its worse than that. Before receiving a CPAP machine ~$1,000, most doctor's require a sleep study, which costs many thousands of dollars, and many times wait months to get the appointment. CPAP machines are usually the ultimate solution to reported sleep problems involving repeatedly waking up, and I don't see why they can't be prescribed immediately to see if they solve the problem.

Completely agree. And the worst part is sleep studies are medically unnecessary - an APAP machine (automatic machine) can auto-set the necessary pressure, and no sleep study is needed.

Simply sleep with an APAP for a week, review the pressure graph and draw a line at the bottom of the values. Then set the minimum pressure to that number, or slightly less and done.

Review every few months.

If you ask a Dr. about this they'll talk about the 1% of less cases that will not be correctly adjusted by such a machine. But all you need to do is ask the patient after a week "do you feel better?". If they say no you can go for the more complicated options.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#107

Post by BurningFrog »

xnyan wrote: post #102
BurningFrog wrote: post #93

Earlier quoted context omitted.

Maybe it's my bias, but I assume most of that 10x comes from the overly strict medical device regulations from the FDA.

>overly strict Disclaimer: my opinions, not my company. I worked as a project engineer for a major testing company (underwriters laboratories). This is a vast simplification, but in essence the difference between medical device testing verses say, household electronics, is that in practice household electronics get evaluated with a "safety checklist" of all the serious and common problems to that kind of device (plus…

I don't disagree.

Testing should be as strict as is needed. I'm arguing/assuming that US testing standards for medical devices is overly strict.

I think* there is the same "maximum" standard for all medical devices. But what's appropriate for a pacemaker is overkill for a CPAP machine.

* but am happy to be corrected (Cunningham's Law)

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#108

Post by prostheticvamp »

SubiculumCode wrote: post #95
ars wrote: post #81

Earlier quoted context omitted.

The CPAP world is a microcosm of what's wrong in the medical world, i.e. why things cost so much. A CPAP machines costs about 10x as much as it should, and a part of that is insurance companies wanting to make sure they are not paying for a device you are not using. Which then increases the price, which makes insurance companies even more worried about them. Then you are paternalism where only a Dr. is allowed to cha…

Its worse than that. Before receiving a CPAP machine ~$1,000, most doctor's require a sleep study, which costs many thousands of dollars, and many times wait months to get the appointment. CPAP machines are usually the ultimate solution to reported sleep problems involving repeatedly waking up, and I don't see why they can't be prescribed immediately to see if they solve the problem.

Because (a) there are problems that are not sleep apnea that should not be missed, and (b) the cpap pressure needs to be titrated to your need, it’s not a binary device.

Admittedly, (b) is now less of an issue since there are a handful of auto-titrating machines on the market now. They’re less reliable than a sleep study, but they’re better than nothing.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#109

Post by prostheticvamp »

ars wrote: post #106
SubiculumCode wrote: post #95

Earlier quoted context omitted.

Its worse than that. Before receiving a CPAP machine ~$1,000, most doctor's require a sleep study, which costs many thousands of dollars, and many times wait months to get the appointment. CPAP machines are usually the ultimate solution to reported sleep problems involving repeatedly waking up, and I don't see why they can't be prescribed immediately to see if they solve the problem.

Completely agree. And the worst part is sleep studies are medically unnecessary - an APAP machine (automatic machine) can auto-set the necessary pressure, and no sleep study is needed. Simply sleep with an APAP for a week, review the pressure graph and draw a line at the bottom of the values. Then set the minimum pressure to that number, or slightly less and done. Review every few months. If you ask a Dr. about this…

Hahahahah. Oh man.

The vast majority of patients take months or longer to get acclimated to the machine. Most will say they feel /worse/, because the machine gets in the way of their sleep at first.

I look forward to hearing more medical pearls from the web design community.

Re: Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators

#110

Post by ENOTTY »

wormyrocks wrote: post #56

Hi, I worked on this project and have a couple comments to address the issues people are raising. - There are established medical protocols to treat COVID-19 patients with BiPAP machines, including the addition of a viral filter to mitigate aerosolizing the virus. People are using these protocols now and we link to them from the site. - There are two separate firmware hacks presented. The first one modifies ~20 bytes…

What are the differences in the sensors?
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