A good friend of mine just returned from a tour of duty in Iraq. I took off work to spend time with him and soon found myself committed to a 108° degree, 4-hour hike up an Arizona canyon. I knew I was in for a struggle. Unlike my physically fit, ruck sack hiking friend, I sell CPAP equipment for a living while seated comfortably behind my desk. I needed every possible advantage. I realized that I couldn’t control the desert, but I could control the gear I brought with me. I started to think of each item I packed as a tool I could use to adjust to the challenge ahead. The hike was as advertised, but the items I carefully packed kept me going. I finished the hike!
My experience got me thinking about CPAP users. The machine, mask, and hose they receive during a traditional setup are the hiking equivalent of shoes, a day pack, and a jug of water. If everything goes according to plan, all will likely be well. However, when undertaking a desert hike or adjusting to CPAP, unexpected issues tend to crop up. A patient’s ability to adjust when faced with unexpected issues can mean the difference between long-term use and noncompliance. Fortunately, new tools are available that make this job much easier than it used to be. We no longer have to send patients into the desert armed only with the basics.
In recent years, a cottage industry of small businesses have had success selling products that make using CPAP equipment more comfortable. These businesses are often run by clinicians, sleep techs, or CPAP users who decided to make a product out of a problem they frequently encountered. These products have been sold over the Internet for some time now, but durable medical equipment providers (DMEs) and sleep labs are starting to get in on the action. According to a recent Wachovia Securities/Sleep Review Sleep Center Survey, 20% of sleep centers surveyed in Q1 2010 are currently selling masks and the trend is rising. Comfort items are a natural extension of this trend and can be sold for cash as a supplement to traditional insurance billable items. They are sourced directly from the manufacturer, or multiple brands of items are ordered at once from Internet retailers. Providers are finding that they can improve their cash flow and at the same time give their patients the tools to succeed.
Let’s take a tour of the most popular and innovative comfort items available today.
SOFT TOUCH ITEMS
SnuggleHose Cover from SnuggleHose
Hose wraps are typically made of a soft fleece material that slides over a CPAP hose and fastens with Velcro. CPAP hoses are typically cold and bumpy because of their coil design. This can make a hose dragged across bare skin quite a shock for a sleeping patient. Hose wraps make hoses warm, smooth, and soft. In addition to the tactile benefit, the fabric around the hose serves as an insulator and prevents mild cases of water in the tube or “rain out” that can occur with heated humidification. Hose wraps also make CPAP equipment look less medical, which is especially important for new users during their adjustment period.
SnuggleHose was a pioneer of hose wraps and continues to be a strong player. It has since been challenged by large players such as ResMed and Respironics as well as several smaller distributors.
Mask strap pads are typically made of micro fleece and slide over or are wrapped around CPAP mask straps in places where the strap can rub bare skin and cause painful red marks. In addition to being soft and reducing friction, a good mask strap pad must be very breathable to avoid heat buildup during use. Not all straps work for all masks due to their unique designs and headgear structures. This can cause straps to “hang off” too far or to run short. Each vendor approaches this problem in a different way, and it is best to check carefully before ordering straps. As a general rule, one strap will fit most popular nasal CPAP masks. The need for customization of mask strap pads is heaviest for nasal pillow CPAP masks. Avoid mask strap pads that do not wrap their strap attachments in soft material as catching the edge of a Velcro strip can be the same as or worse than the headgear itself.
Pad A Cheek was an early innovator of mask strap pads and was quickly joined by SnuggleHose and StrapGuard. ResMed offers custom straps for its line of Swift FX and LT nasal pillow masks.
Soft Wrap from ResMed
Custom CPAP bed pillows allow CPAP masks to hang off the edge of the pillow or hang over an indention in the pillow, which prevents patients from torquing their mask as they shift positions during sleep. The “hang off” style of pillow looks like a butterfly or like a traditional pillow with half moon cutouts of the sides and bottoms. The “hang over” style is a smooth rectangle with cutouts to the left and right of the center of the pillow where the head is placed. Bed pillows are available in a variety of fillings including polyester fiber, memory foam mix, all memory foam, synthetic down, latex foam, and buckwheat hull. Polyester fiber and memory foam fix are the most popular. Most bed pillows are hypoallergenic, and some even come treated to resist common household bed pests as well as stains and odors.
The PAPillow was early to the market and specializes in several varieties of the butterfly design. Contour Products offers a hang over style pillow and has marketed more widely than traditional CPAP channels; you can see its product offered in CSN Stores and Target. SnuggleHose and Hudson Medical Products also offer CPAP pillow products.
CLEANING AND FRESHENING
Citrus II CPAP Mask Wipes from Beaumont Products
Mask wipes give a fresh scent to CPAP equipment while removing dirt, hair, grime, and oils. As most patients have used baby wipes to care for children or Clorox wipes to clean their kitchen, they tend to see using wipes to clean CPAP equipment as a logical extension. This makes wipes a very popular and attractive CPAP accessory. Mask wipes tend to be packaged much like major consumer wipes with convenient “one per pull” dispensing and tamper-evident seals. Wipes are solvent free, contain no alcohol, and will not break down the mask’s cushion. Wipes will refresh and deodorize equipment but are not disinfectants. Scents used are commonly gathered from distilled natural ingredients such as coconut and citrus. Patients who are bothered by their mask’s latex or plastic smell commonly use wipes as a simple fix. Unscented wipes are also available.
Beaumont Products produces popular citrus-scented wipes and A World of Wipes produces unscented wipes. MVAP Medical Supplies produces a line of sprays and soaks that produce results functionally equivalent to those of mask wipes.
Disinfecting solutions offer patients access to a hospital grade germicide in the comfort of their own home. Unlike mask wipes, disinfecting solutions come in concentrated form and must be mixed with water before use. Patients will either soak their equipment in mixed solution or mix solution in a spray bottle and apply via a fine spray. Once mixed, disinfecting solutions typically have a 10- to 15-day shelf life. While not as convenient as mask wipes, disinfecting solutions make sense for the patient who wants a higher level of germ protection. Maril Products produces popular disinfecting solutions.
Aromatherapy for CPAP consists of essential oils dripped onto a pad, which is placed near the CPAP machine’s air intake. A familiar, pleasant, or relaxing smell can be the “little thing” that a patient needs to relax, adjust, and ultimately accept CPAP therapy. In addition to aromatherapy’s desensitization benefits, it is a great way to add some luxury to a sometimes monotonous medical ritual.
Pur-sleep makes a full line of aromatherapy products designed for CPAP users.
MASK LEAKS AND POSITIONING
Aromatherapy for CPAP Machines, Basic Starter Pack from Pur-Sleep
Mask pads are winged gel ovals that sit on the bridge of the nose between the CPAP mask and the patient’s face. The bridge of the human nose differs in shape according to the person and tends to lack natural padding as it is composed largely of skin and cartilage. Many popular nasal masks require a snug or even overtightened fit to seal properly. This combination often leads to sore red spots. Mask pads provide extra padding and also prevent leaks by smoothing out the area over which a CPAP mask seals. Mask pads are new to the market. While the pads will make a lot of CPAP users happy in time, they are very new and the bugs are still being worked out. Some early adopters have struggled with pad sliding as the stickiness wears out, and others have reported sizing difficulties. Improved patient instructions, a second version of existing pads, and competition from others entering the market should mean a bright future for mask pads.
SeQual Technologies has pioneered the mask pad market and advertises its mask pad as reimbursable using code A7032.
Hose management systems suspend the CPAP hose above the patient, preventing it from becoming entangled or requiring adjustment during sleep. These systems provide the necessary slack to prevent masks from leaking due to hose torque. They work by inserting a flat base between the bed spring and mattress, which is attached to a pole running up and toward the patient. The hose is then attached at multiple points along the pole, which allows it to hang from above. Heights are typically variable. Early models of these types of systems were made of heavy, bulky metals, but recently, travel-friendly systems have been introduced that work well. Most of these travel systems follow the traditional design but use materials similar to that used in camping tents. One new product goes even further and consists of a wall-mounted hook and two spring-loaded, self-retracting reels with line that holds the hose up and out of the way.
ResMed once offered the now discontinued “swingarm” hose management system. Bro-Gho, Arden Innovations, Levitation Systems, and Pur-Sleep have been passed the torch and continue to innovate in this niche.
Comfort accessories are tools that break down compliance barriers. There are even more CPAP comfort products available than I have discussed in this article. I encourage you to visit the accessory section of any popular CPAP Web site and check out the bed coolers, mask liners, sinus rinses, bacteria filters, dry eye goggles, CPAP batteries, and other accessories.
Johnny Goodman, is general manager at CPAP.com. The author can be reached at [email protected].