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Product Reviews

• DeVilbiss IntelliPAP with SmartFlex
• Mirage FX Review
• Quattro FX Review
• Fisher and Paykel ICON- Auto Review
• CSS Top 5 Products of 2010
• Long Term Review: Opus 360 by Fisher & Paykel
• Update: New Swift FX for Her
• Fisher & Paykel Icon
• Comfort Gel vs. Mirage SoftGel
• ResMed Mirage Softgel
• Philips Respironics EasyLife Mask Review
• Resmed S9 Review
• ResMed Swift FX Review
• Fisher & Paykel Zest Standard Nasal Mask Review
• Philips Respironics System One CPAP Review

DeVilbiss IntelliPAP with SmartFlex

Pros: Compact; Easy-to-use; Intuitive design

Cons: Rubber Stopper when not using the heated humidifier could be improved; Joint clips on the humidifier chamber may be perceived as fragile

Overall: “A Jack of All Traits”, Balanced, Deserves serious consideration now that we have support in Canada

 

Introduction

During the past summer I needed to haul a CPAP machine all over southern California as I headed off to my much needed summer vacation. In the past I would’ve chosen to bring either a ResMed, Fisher & Paykel, or a Philips Respironics, or even the now discontinued AEIOMed CPAP machine... this time however I chose to bring the DeVilbiss IntelliPAP Why you may ask? Well first of all prior to my trip I was contacted by the DeVilbiss corporate office representative to inform me that they have now opened a Canadian division and are no longer supported by a third-party distributor. Timing being everything, I thought to myself, why not give this brand another try. After all it is quite a portable unit.

Design

One of the most marketable aspects of the DeVilbiss IntelliPAP has been its compact design. Even when you are viewing the bag alone, it is distinctly smaller than most of the carrying cases of the current CPAP units from the other manufacturer. It’s probably between 10-25% smaller. Despite the size, however, there is enough room to carry all the necessities inside, with exception of the extra-large and thick patient manual (if you wanted to take that on your travels). With or without the humidifier, this unit has one of the smallest footprints of any CPAP machine. Only one comparable of the current units is the Icon from Fisher & Paykel. But regardless of whether you decide to bring the Heated Humidifier on your travels or not, you really would not notice a difference in the amount of space it takes up.

The stackable design is quite nice, the only quirk might be the rubber stopper that has to be switched around if you decided not to bring the heated humidifier unit with you. Otherwise, it’s rather simple to use. The sliding humidifier tray is also quite intuitive; easy to clean, and has a spill proof filling design. They make the chamber out of a plastic called Lexan which is a very durable material, however I still wish the chamber didn’t have the joints sticking out of the rear which may give it a perception of fragility.

One of the best design features of the IntelliPAP is the lack of an external power supply or “power brick”. Over the past few years, most of the CPAP manufacturers have transitioned to this type of power supply and it has really annoyed some long time users. Certainly not great for traveling since every power supply is proprietary to the CPAP; so if you forgot it then that just too bad. DeVilbiss, on the other hand, stuck to a standard plug... if you forgot it, just go to any old electronic store that sells a standard printer or radio plug an “wallah!”, you’re back in business.

Performance

So I put the CPAP to its paces. I’ve been using a constant CPAP pressure of 8 cmH2O for the past 2 months since my weight loss but want to evaluate this unit for noise level in the real world so I used a pressure of 10 cmH2O during this test phase. The noise output on inhalation and exhalation is comparable to all the other CPAP units in the market. I wouldn’t say that it is neither quieter or noisier than the rest. There is a distinct pitch change in transition that can be noticed, though I personally do not find it disturbing.

The Heated Humidifier output was consistent throughout my trip. The consumption was predictable. It also has a wide range of settings to cater to everyone demand requirements. I really like the fact that the chamber allow a greater surface area for the air to travel; it’s a combination of a cool passover system with a heated stainless steel plate for greater efficiency in the delivery of humidity to the patient. I recall a day it was 106 degrees Fahrenheit (41 degrees Celcius) in California and I decided to use the humidifier as a cool passover for the first time in years. I still received adequate humidification considering the conditions.

Recently I was able to test the SmartFlex technology on both an Auto and Standard CPAP. Please note that this was not the unit I used on my travels but I felt it was necessary to include this feature after the fact because it is essential in the review of this CPAP. This is a similar technology as C-Flex, A-Flex, and EPR seen in the Philips Respironics, and ResMed CPAP units. Certainly the SmartFlex proved to be comparable to those other technologies. The transition between breaths was smooth but noticeable enough to invoke a sense of relief when exhaling against the CPAP pressure. It feels more like the ResMed EPR in my opinion.

Other Observations

A a clinical provider, I really enjoy the “cable-free” system to report the recorded patient data from the CPAP machines. The fact that one can go to the website and input 2 sets of codes to generate quite a detailed report, is a true benefit to the CPAP user wanting to monitor themselves on therapy. We are often asked about purchasing proprietary software for the different CPAP units, but this does away with all of that.

Conclusion

I can truly say that I am pleased that I gave this brand another glance. Initially it was for the portability (and I do consider it the most portable unit with a heated humidifier attached to it) but it has really outperformed my expectations. Now that we are able to get the support in Canada that we have been deprived of for years both as a provider and consumer, I think the Devilbiss CPAP line should really demand serious consideration. If there is one thing about the “older” Devilbiss units that I continue to see come through our clinic from the mid to late 1990’s, is that they still keep on going! So if size, durability, and quality are what you are looking for, this might be the CPAP for you.

 

Mirage FX Review

Pros: Lightweight, easy to fit, leave little to no marks on the face in the morning, the seal is excellent.

Cons: Looks fragile

Overall: Try it and chances are you won’t be disappointed.

Let me start by saying that this is simply the best nasal mask that I’ve ever used personally! I guess that first sentence says it all but I still have to validate my opinion with some facts. For everyone that has followed my reviews and blogs over the past year, you would’ve known that I have religiously used a nasal pillow mask for years... 9 years to be precise. Occasionally I would use the other masks to critique them and try to figure out how to effectively place them on different people, but I always went back to my trusty nasal pillow mask. After trying the new Mirage FX mask from ResMed, however, I may never go back!

Having said that, it does not mean that this mask is for everyone. In fact the sizing is quite limited; they came out with 3 sizes: a standard size, a version “For Her”, and a wide size. They all generally fit an average to small nose... but if it fits you, you will not be disappointed.

The FX line of masks are designed to give the experience of having less on their face when using a CPAP mask. Less Material = Less Weight = Less Movement = Leaks = Less Irritation = Less discomfort = More effective use of your CPAP! The Mirage FX certainly has all of that. Let me start with the changes they have made when compared to the standard nasal masks ResMed has had in the past. Starting from the Ultra Mirage, then the Micro, the Activa / Activa LT, and the SoftGel masks, they were all quite “beefy” masks with a smaller than average sizing to the silicone seal. The Mirage FX is nothing like those masks. Even the silicone used for the seal is much lighter and softer than the material used previously. ResMed has now gone to using a single seal “pimpled” silicone which I find more comfortable and creates a better seal with minimal tension required. Another advantage is that it leave less marks on the face in the morning. My face tends to have those lines from the seal and headgear that can last between 30 minutes to an hour, but with this mask I surprisingly have not had any marks at all.

At first glance the mask does look fragile. I was actually afraid to break it when putting it on and off. In order to test its durability, however, I had to put it to its paces... on day 5 of using it, I started to remove the mask by pulling it from the long thin spine of the mask and just tried to drop it intentionally a few times. Much to my surprise, I have not damaged it in any way. The other part that concerned me was the hook where the lower straps are attached. They also look like they would snap off despite the rubberized tips. I continue to tug on the straps everyday when removing it or putting it on and it seem to be holding up quite well.

Mask leaks with this mask have been minimal whether you are a side sleeper or a back sleeper. The new exhalation port design is also so quiet that my wife half asleep on my shoulder reminded me to put my CPAP on thinking that I did not have it on yet. As I mentioned above, headgear tension can be kept to a minimum with this mask... the dynamics of the cushion are just superior to any other standard nasal mask out there.

I’m still using this mask after 3 weeks and all I have to say is try this mask...enough said!

Instant Quote for Mirage FX or Mirage FX for Her

 

Quattro FX Review

Pros: Lighter and smaller than most other full face masks

Cons: Tendency to slide up

Overall: A good mask for those who need a full face mask but want to have the feeling of less material on your face.

Resmed has always been one of the leaders in technologies regarding CPAP therapy and equipment but where they seem stand out the most is with their line of Full Face Masks. Through the years there have been a numerous number of full face masks that have come out from the different manufacturers such as Philips Respironics, Fisher & Paykel, and Hans Rudolph, but the Mirage line from ResMed has always proven superior. In my opinion, it is the balance between form and function that has allowed it to stand apart from the rest. Starting from the Mirage technology used for the silicone seal and recent technologies added like the Micro adjustment, it allows their full face mask line fit a larger population base. More comfort, a better seal, and less bulk is always a good formula when you require such a large mask to use with you CPAP therapy.

The new Quattro FX is the newest installment to their line of full face masks. It reminds me a lot of an earlier mask called the Mirage Full Face Mask that was available in the late 90’s. The idea behind the new design was to create a full face mask to be lightweight, unobtrusive, and smaller in size. This seems to be the direction that ResMed is moving towards with their FX line of masks. The mask comes in 3 sizes (small, medium, and large) but the mask looks smaller than a typical full face mask would look at first glance - I’m sure this was the visual response that ResMed was hoping to achieve. The mask can be broken down to 4 main components - the SpringAir cushion (silicone seal), the spring frame, headgear, and the elbow. More importantly, however when compared to the original Mirage Full Face Masks and similar to the Mirage Quattro, it has less parts to worry about.

When I first put on the mask, it reminded me of those fighter pilots in Top Gun; call it childhood nostalgia but it really felt that way especially with how ResMed recommends placing it on your face. This, by the way, is crucial in establishing a good fit and seal from the start. If you decide to purchase this mask, follow the guide precisely for a better experience. The mask is as advertised, lighter and smaller - my basis of comparison is the Mirage Quattro as well as a similar design mask, the Full Life full face mask from Philips Respironics. It eliminates a lot of the frontal obstruction typical of most nasal and full face masks.

I used the Quattro FX for 1 week; the tendencies of the mask was to slide upward towards the eyes. I suspected that this would be the main problem considering that they eliminated the forehead piece that prevents some of that type of movement. The seal, however was very comfortable; it may take a bit of getting used to since the place the silicon seal sits on the nose is slightly lower on the bridge of the nose when compared to other masks. The weight of the mask being lighter can be both an advantage and disadvantage; my suggestion is to use this mask in conjunction with a lighter tube such as the slimline tube by Resmed or the performance tube if you are using a Respironics CPAP machine. I also noticed that adjusting the upper straps too tight worsens the problem of the mask moving upwards therefore tightening the mask is somewhat limited to the lower straps.

The mask is very quiet which has always been a staple with ResMed masks. Cleaning this mask is simple and easy even when you dismantle the mask into its different components. Normally, you would just need to clean the seal and the headgear.

Overall, the Quattro FX is what I expected from a ResMed designed full face mask. Since a full face mask is probably the hardest style to redesign to be smaller, lighter, and still fit the majority of patients. Through the years, a number of my patients who used to use the Mirage Full Face mask have been asking about a similar mask and this certainly is a better version of that mask. Generally the mask performs well though I still think that the stability of the Mirage Quattro is better. I would recommend this mask for patients who require a full face mask but are claustrophobic and/or want to avoid the conventional design of a full face mask.

Instant Quote for Quattro FX

 

Fisher and Paykel ICON- Auto Review

PROs: Packed with all the technologies; compact size and space saving features; excellent heated humidifier; quiet operation.

CONs: Stays warm even when not operational; needs chamber that is easier to clean; operation to change certain settings may be difficult for some.

OVERALL: Excellent Auto-CPAP for the frequent traveler and the “home-body”

 

The Icon Auto is the most advanced unit of the Fisher & Paykel Icon line of CPAP machines. It is the replacement for the HC254 which was the first Auto-CPAP unit that Fisher & Paykel developed. As with the Icon Premo, this was a total redesign of the HC254. It essentially combines all the technologies that Fisher & Paykel has been renowned for, particularly their industry leading heated humidifier, all into one small and unique package.

DESIGN

The biggest “knock” on the old Fisher & Paykel line of CPAP units were that they started to look dated, and for almost 10 years, the basic look of the unit was just not up to par with the other CPAP manufacturers. When the Icon Premo (standard CPAP unit) came out it late 2010, it was certainly a sight for sore eyes. The New Icon Auto is even more aesthetically appealing with its metallic silver paint and its unique built-in alarm clock design. When you really think of it, most people have an alarm clock beside their CPAP machine and together, this takes up most of the bedside table space. Having the built-in alarm clock is not only an useful feature from day-to-day, but it frees up the space you otherwise thus making the unit a true “space-saver”. It also has pre-loaded MP3 tunes called AlarmTunes for the alarm should you decide to utilize this feature. Despite the added features, the footprint of the actual unit is smaller than most other CPAP units and it certainly does not look like a CPAP machine at your bedside when you are not using it.

TECHNOLOGY

If I had a wish list for the old HC234, was that they should’ve had the Thermosmart tube available on the HC604. Wallah! The Icon Auto certainly delivered on that wish. They also kept the patented SensAwake technology that reduces the Auto-CPAP pressure to the lowest setting when a breathing pattern of ”wakefulness” is detected. The combination of the high efficiency heated humidifier from the Thermosmart tube combined with the lower mean pressure from the Auto-CPAP and SensAwake, really help to minimize dryness, resistance, congestion, and possible inflammation of the nasal cavity. The result is a more comfortable CPAP therapy experience.

One observation I had about the unit was that it stayed warm even when the unit was not running. Some of my patients were concerned that the heated humidifier never turned off; in actuality, the unit technically stays on because it is still a clock unlike other CPAP machines. This results is a continuous current to the unit itself which in turn causes the heat. The other concern was in regards to cleaning the heated humidifier chamber; though it is easy to take out and place back into the unit, it is not easy to pull apart to clean. It is dishwasher safe however, therefore opening the chamber completely for cleaning is more of a preference rather than a necessity. Lastly, the dial on the front can be confusing to some, it is an intuitive system once you get the hang of it but it may require a slightly higher learning curve to return to the default screen when one accidentally presses the an unintended setting. (Please note that all CPAP settings are “locked” and can’t be changed accidentally to affect your therapy)

CONCLUSION

I think the Icon Auto is one of the best overall CPAP units out there, especially if you are one who takes a large number of medications that may cause dryness and/ or someone who has chronic allergies that can be adequately managed with good humidification. Knowing that this is a totally new platform for Fisher & Paykel, I expect a few glitches along the way with their earlier versions of the unit but knowing that their product is backed by a 3 year exchange warrant is ample reassurance to get the unit. I have a few more wish list on improving the product but I’ll reserve those for my Long-Term review of the product to truly evaluate it to its fullest before making any possible unfair conclusions.

CSS Top 5 Products of 2010

#5: Mirage Gel and Activa LT combo pack

This type of technology with interchangeable nasal mask material (Silicone and Gel) has been long awaited. It seems so logical and yet for years it has never been a reality until now. I wish they would make it interchangeable with the Mirage Micro as well!

#4: Its a Tie - ResMed S9 & Philips Respironics System One

What great products... and they are similar in so many ways! Compared to their predecessors, they both improved their humidifiers. One has the Climateline system and the other has the “System One”. The both tried to imporve their tube design; one has the slimline tube and the other has an ultra-light design. They look similar in shape and form. Most of all they are well received by the people who used them. It was very hard to decide and thus they came in a tie! Wish they didn?t go bigger from the model they replaced though.

#3: Icon Premo

Great looking platform! has all the benefits of all the other units but in a smaller package. It has an alarm clock too which is an added touch! Yes the chamber is cleanable, you just have to know how to open it. (It’s difficult but video coming soon). Auto version please come out soon!

#2: Swift FX and FX for Her

Hands down to be the most versatile mask... not only because they made one for him and her. It’s just simple and it works. Probably the mask I’ve had the least problems with in general! (by the way, it’s “On Sale!” for the holiday season)

#1: Easylife

For a long time, the standard nasal mask design has remained stagnant with its development. I think everyone started to ignore it and focused on the development of the Nasal Pillow design. The Easylife filled a void in the industry. Most of all the mask REALLY works. It is lightweight, reduces irritations to the bridge of the nose, it’s quiet, durable, and it just fits well with a lot of people. What else can you ask for from a mask. I know this decision is debatable but for me when you don’t reinvent the wheel but rather make the wheel better, then it deserves praise!

Long Term Review: Opus 360 by Fisher & Paykel

The Opus 360 from Fisher & Paykel has been one of our most successful nasal pillow mask since it was revised a few years ago. Unlike the previous versions of the mask, the most recent one has some unique characteristics that differentiate it from the other pillow masks out in the market.

I personally have used this pillow style mask and placed it on hundreds of patients throughout the years. The 2 main characteristics that the Opus 360 has that sets it apart from other masks of a similar style are the tapered nasal pillow design and the “Off-the-Lip” position of the nasal pillow. Most masks (both nasal mask and nasal pillow masks) have always had a unavoidable pressure point on the upper lip. It is often the part that receives the most pressure because it is essential both for stability and to create an adequate seal. The Opus 360 eliminates that by tapering the nasal pillow away from the upper lip, thus improving comfort. Surprisingly, this feature did not compromise any stability of the mask either which was very important. Where I find this most useful are for individuals who have a lot of sensitivity around the area of the upper lip, individuals who remove their dentures at night because the mask position is altered significantly, and finally individuals who wear a night guard for bruxism as the tension from other standard mask tend to cause an irritation to the upper gums and lip.

The narrow nasal pillow design has also been very useful in the “hard-to-fit” individuals who prefer the nasal pillow style mask. Before the Opus 360 came out, I could recall a large number of patients who would’ve benefited from trying this mask and may have improved their comfort. Some may have even prevented them from discontinuing their CPAP therapy if only it was available. Unfortunately we, like in most industries, are limited by the available technologies. The Opus 360 would probably benefit you if you tend to have a more elongated and narrow nostril shape, if you have a deviated septum that make one nostril significantly narrower. Finally if you have a small nose and nostril size in general, the small nasal pillow for the Opus 360 is one of the smallest when compare to similar styled masks.

I've attached a video to show you the mask but if you haven’t tried this mask yet, and you fit into one of the descriptions of ideal candidates I described above, I don’t think you’ll be disappointed.

(Note: There is a Pre-Launch Sale for all Fisher and Paykel Products: Additional 10% Discount Available with Free Shipping throughout Canada)

Update: New Swift FX for Her

The new Swift FX for her is now available! This new mask from ResMed takes all the good things from the original Swift FX and made it softer, lighter, and more streamlined. The new pink and grey headstraps that it comes with was not changed only for aesthetic reasons, they are slightly shorter to accommodate the smaller female profiles. It also now comes with an extra small nasal pillows.  

 

Fisher & Paykel Icon

First Look: Fisher & Paykel Icon
By: Cox Tan-Ngo, RRT

I have been fortunate enough to be one of the first people in North America to see Fisher & Paykel’s new CPAP platform called the Icon. Though I was not able to take it home even for a night, I was able to briefly play around with the unit and it left me with a very good first impression.

The one knock on Fisher & Paykel units have been their styling. In fact going back as far as 2001, their CPAP units did not changed too much in overall appearances except for relocation of the buttons. The proportions were very similar that they have used the same humidifier chamber on the HC220 series from 2001 with the HC234 and HC254 units available currently. That is not necessarily a bad thing but generally they made some aesthetic changes but the form has been the same. Now comes the Icon... if you are looking for something different, this is the CPAP you’ve been waiting for. It has no resemblance to any unit in the market and to be honest, it does not even look like a CPAP machine!

Simple lines, simple color, simple display... all-in-all it is just simple looking. Standing on the corner of my desk, it looked like an alarm clock. Don’t be mistaken by the simplicity, however, because it is full featured in their full line-up of models. It will first be introduced with the Premo and Auto units and later on they will bring in the most basic unit Novo.

The units will still pack their full technologies for their heated humidifier including the heated tube in all their models. They will still have the largest humidifier container in the market at 420 ml to match. Their Auto-CPAP technology should remain unchanged. My initial impressions on the noise level of the device was that it had a similar pitch and volume as the previous Fisher & Paykel models which were probably considered the quietest in the industry. The true test will come when I am able to sleep with the device. They have “officially” announced the unit to North America but they have not indicated a shipping date. Please stay tuned for a full review which will be coming soon!

To receive a full brochure of the New Icon click here and type Icon Brochure in the comments box.

Comfort Gel vs. Mirage SoftGel

 

The Comfort Gel vs. Mirage SoftGel

"In the Blue corner is the is the long time champion of the Gel Seal Masks... Comfort Gel by Philips Respironics"

"In the White Corner is the the newest challenger... Mirage SoftGel by ResMed"

For as long as I can remember, Respironics (before they were acquired by Philips) has been the dominant player in creating the “Gel Seal”. This started to with the Gold Seal, then the Profile Lite, and now the Comfort Gel. In a lot of ways, the Gel Seal technology was revolutionary because it improved the ability of a standard nasal mask to seal onto difficult to fit faces and nose types... even ones who have facial hair tend to find success with it.

The problem with the earlier versions of this type of a mask is that the gel seal was fused to the frame. If the seal wore out or was accidentally punctured, then a gradual seeping of “goo-like” material started to occur. This rendered the mask useless. Then came the Comfort Gel, replaceable gel seal protected by a outer secondary silicone seal! What a great idea! Sure enough, it became one of the better masks in the market for a number of years. The only problem was the durability of the mask as a whole. The socket for the ball clips kept breaking, the “teeth” for the adjustable forehead spacer also broke quite easily, and the plastic ring around the silicone seal kept cracking (though it did not affect the performance of the mask too much in most cases).

Fortunately all of these problems have been fixed by the recent upgrades made to the Comfort Gel series. For the most part, we have had very few to no issues of these problems happening that I can recall in the past few months.

This brings us to the new contender, ResMed’s Mirage SoftGel. When I first saw this mask, my first impression was “FINALLY a worthy option”. The only other Gel mask that was not a Respironics brand that I could recall was one made by DeVilbiss called the FlexSet with a Gel seal but that was not too good at all. The SoftGel really looked very typical of the ResMed series of masks like the Mirage Micro and Activa LT. It had all the technologies available in the other mask which have been proven to work well through the years. In fact, the Activa LT and the SoftGel share a single frame and are interchangeable; I think they should do more of this type of technology of cross compatibility because it makes sense and should not be too difficult to implement. ResMed will be releasing a combo pack soon where both types of seals are available in one pack so stay tuned.

The Tale of Two Seals

The Comfort Gel has 2 two separate seals, the Gel and Silicone seals; while the Mirage SoftGel has a multi-density seal (the clear gel is softer than the blue gel beneath it) with an extra flap hanging out to simulate an outer protective seal that makes contact to the face. The densities and firmness of the gels are what makes the two so different. The Comfort Gel has a thinner profile and a wider opening; this make is more conducive to people who have a wider base of the nose. The height of the Gel is also not as prominent and when combined with the softer gel material, it tends to collapse closer to the face when placed on.

The Mirage SoftGel is quite a bit more dense thereby collapses less when worn. The opening is smaller (typical of the ResMed sizing on their other masks which tends to fit smaller) so people with a narrower nose profile may do a bit better with this mask. When placed on, it seals very well but you may get a sense that your nose has very little wiggle room because of the greater volume of gel that is on your face.

Both masks create a good seal, but the added density and volume of the gel on the Mirage SoftGel gives it a slight edge in performance. The Comfort Gel, however, may fit a larger population group because of the shape of the opening of the seal.

The seals for both masks are easy to remove, replace, or clean. Both also seem to be quite durable; the Comfort Gel used to last a year before needing to be replaced so I would expect the same from the Mirage SoftGel. In any case, parts are also readily available for both which is a plus.

Overall

So who makes a better Gel Mask? Honestly, they really are both very good masks that fit a different population group in my opinion because of sizing. I had tremendous success with the Comfort Gel in the past and so far the Mirage SoftGel has not disappointed either since it came out. It’s really hard to find a problem with either mask but if I had to decide who to give the edge to, it would be the Mirage SoftGel only because it has a quieter exhalation vent and a better clip system to release the headgear.

*** UPDATE: Philips Respironics has just released the Comfort Gel Blue with some new technologies and enhancements. Stay tuned for the review of this mask ***

 

ResMed Mirage Softgel

Video Review By: Steve Archer, RRT

ResMed Mirage Softgel Video Review

A comparison review comparing the ResMed Mirage SoftGel with the Philips Respironics Comfort Gel will follow so stay tuned!

Philips Respironics EasyLife Mask Review

By: Cox Tan-Ngo, RRT

Pros: Easy to fit; large selection of inner seal sizes; soft materials used for the seal and forehead spacer

Cons: May be difficult to put back together after cleaning for some users; no quick release for the headgear; some whistling noise from the exhalation port at higher CPAP pressures.

Overall: Despite the unique design concept, the technologies are effective in improving the user experience and comfort.

The EasyLife mask from Philips Respironics (click to see product) has been around for a number of months here in Canada and recently I was able to test it out for one week. According to Philips Respironics, this mask was intended to make fitting a mask “automatic” through their Auto Seal Technology and should fit a large population group who uses a standard nasal mask for their CPAP therapy.

Design

At first glance, this mask almost looks like the Comfort Classic from the front in its overall size and shape (for those familiar with the older masks from Respironics). When you flip the mask over, the new technologies are revealed with new materials, shape, and the dual-cushion design of the mask. Visually, the dual-cushions look unorthodox because it can be confusing to distinguish which part of the mask is actually making the seal to the nose. When I first saw a picture of this mask, I actually thought that both seals are doing a similar function but this is actually not the case. The inner seal creates the seal to maintain the pressure from the CPAP and the outer seal maintains stability of the mask.

The inner seal comes in Small, Medium, Medium-Wide, and Large. The way this mask is fitted is not the conventional manner which is typically measured from the top of the bridge of the nose to a point below the base of the nose. Instead the reference point is slightly below the bridge of the nose similar to another of their earlier masks called the Simplicity or even the simple cushion of the Comfort-Lite mask. The outer seal only comes in one size but this part of the mask gives a visual perception that the mask seal is bigger than it actually is. Once you put it on, however, it does not feel as large on the face because the materials used for the seals are soft and lightweight. In fact the mask itself as a whole is relatively light which is a bonus for any standard nasal mask design.

Performance

The main performance feature for this product is the Auto Seal Technology that is intended to make fitting the mask easier and eliminate over-tightening of the mask headgear. Though I was skeptical at first, this features does work well; the dual seal system improved the seal even on side-to side movement in bed where your cheeks may compress on the pillow. The outer seal does add to the overall balance of the mask at a different point of the face instead of depending on a single seal to try to do all the work to conform to the contours of the face.

For the first time that I can recall in any mask, the materials used for the for the forehead spacer is the same as the one used for the seal around the nose. This to me was one of the primary benefits of the outer seal; it was just more comfortable than the rigid silicone material typically used in other masks of this style. The soft materials used on both the inner and outer seal are also an advantage to reduce pressure points on the nose and I found it to be very comfortable to the face even after using it for an average of 6.5 hours continuously for a number of days. The mask is quiet at low pressure but the new exhalation port design tended to emit a slight “whistle” on CPAP pressures of 15 cmH2O and above which can be a problem for some people.

Durability and Cleaning

Although we don’t have ability to predict the longevity of the mask, the quality of the materials used appear to be durable. Unless the seal or frame is mishandled, I do not think that there are any obvious parts that are prone to breakage or tearing (unlike the earlier versions of the comfort gel with the frame easily breaking at the ball-and-socket joint). The mask is easy to pull apart but if you have dexterity problems, it may not be as easy to put the mask back together; I can see some people having problems aligning the inner seal and outer seal properly after cleaning.

Conclusion

This may finally be the mask that can replace the Comfort Classic which continues to be used by long-time CPAP users because of some its simple but unique fitting characteristics. The EasiLife is a simple mask to use despite the unique visual design concept. The technologies that Philips Respironics has put into this mask is not only “for show”, but it actually enhances the user experience. If you are having problems with irritations to the bridge of the nose or if you need a wider base opening to accommodate you nose shape, this mask should be one of the ones to consider. If I had one wish for this mask, however, it would be to have a quick release system for the headgear like 99% of the standard nasal masks in the market have nowadays. 

ResMed Swift FX Review

 A review of ResMed's new Swift FX Nasal Mask

Pros: Stable even with movement; lightweight; perception that there’s less bulk on the face; minimal leaks due to nasal pillow design

Cons: No “over-the-head” interface; possible discoloration of the headgear.

Overall: One of the most superior nasal pillow masks I’ve ever used; I hope it will be the same for all my patients!

The Swift FX is the newest installment to the Swift series of nasal pillow masks. The enhancements to the design features of this new mask is based on the idea that “less is more”. This mask was intended to make you feel as if your wearing as little as possible on your face and yet have the confidence that it not leak or displace in the middle of the night.

My first impression of the mask was that it was very light and it really has the streamline design that ResMed was trying to acheive. At first, I was slightly skeptical about the silicone material they used for the headgear which the call the soft wrap but was impressed by how stable it was when I put it on. The clear silicone also gives the visual perception that you have less on your face. I’ve used a nasal pillow style mask for a long time starting with the Breeze Sleepgear from Puritan Bennett, the Opus masks from Fisher and Paykel , and the full line of Swift masks; I have to say this has to be one of the most comfortable masks I ever used.

Let me break down a few of the points that makes this mask work so well for me; Going back to the stability of the mask, the silicone headgear has a locking mechanism on the top similar to a “zip-tie” which reduces movement unlike the buckle system used on the previous Swift models. The material also plays a role with the increased feeling of recoil and a slight “grip” to the face that minimizes sliding especially when I rolled my cheeks onto the pillow. Although I was left with some markings on the face in the morning, it quickly went away. For those who may have a problem with that particular side-effect, the mask comes with fleece wraps similar to those found on the Swift LT for Her. I have to let you know that using this accessory negates some of the benefits of “grip” that I mentioned above. The strap that wraps behind the head to add stability also had a minor improvement but addresses a lot of my patients’ complaints from the previous models. They eliminated the buckle on the back of the head and moved the velcro to the side of the mask (above the ear). I believe this will improve comfort significantly by eliminating the “bump” at the back of the head if one is sleeping on his/her back.

Another improved feature is with the tubing; the tube was designed like a “slinky” which absorbs the opposite forces that occur when the weight and position of the tube from the CPAP pulls one direction and the individual move the other direction. Normally sudden movements pull the nasal pillows away from the nostrils, especially when the position of the tube is just hanging on one side of the bed (unlike the Swift II and Swift LT, the tubing has no fastener to place it on the top of your head). I was amazed how well this design works; ifn fact I think they should design CPAP tubing that way altogether!

The pillow design is similar to the Swift LT but with less volume. The flatter design actually helps to minimize leaks because it seems to wrap around the base of the nose better. It’s also what adds to the streamline feeling when wearing the mask.

Cleaning of the mask is simple. Everything can be pulled apart without fear of breaking it. The only concern I might have is related to the possible discoloration of the silicone over time due to the increased surface area contact with the face or the hair. The nasal pillows are replaceable just like in previous models.

As I mentioned earlier, this is really a well designed mask. Since I started wearing it, I still have not found any reason that has made me reconsider some of my early impressions about the mask. I would’ve loved to see an adaptor or attachment that will allow the tubing to come from above the head. Though it may be more of a personal preference, it would’ve been a nice option. If you are a nasal pillow user, this is definitely one mask you should try.

Resmed S9 Review

 

Pros: Ultra-quiet operation; ClimateLine tubing is highly effective to reduce rain-out; Intuitive user interface

Cons: Tube connection in the back of unit; has an external power supply; no travel bag included

Overall: It is a CPAP as beautiful as it it effective in delivering the needs of patients who require a CPAP to effectively manage their obstructive sleep apnea.

The new S9 line of CPAP machines are the newest line from ResMed. It is the replacement unit for the highly successful and regarded S8 platform that been available for the past few years. This line is currently available in the Elite and Autoset models and has the added feature called the “ClimateLine” Tube to deliver more efficient humidification while reducing rain-out.

Design

When I first heard about the S9 unit, I was quite excited. The pictures I saw was a beautiful industrial brushed aluminum design that looked more like a high-end stereo system than a CPAP machine. After getting my hands on it, the actual product did not disappoint, it is a nice looking unit though the shape and size looked eerily similar to the recently launched System One from Philips Respironics. The LCD screen is colored and very intuitive to use. In fact, I was able to program the unit without even looking at the manual except to learn how to unlock it to see the clinician’s menues. There is essentially 4 buttons on the unit however the “ON/OFF” button and the Push Dial are the ones that will be used most often.

Just like most CPAP machines available in the market, the unit can be separated into two parts, the CPAP unit and Humidifier with a simple latch as in the previous S8 model. When separated the CPAP is almost exactly half the size of the combined unit and is very light-weight and convenient to travel with. I had wished that they had a separate bag available to improve portability should one decide to carry just the unit without the humidifier. They had this previously available in the earlier editions of the S8 Model and it was quite popular.

The humidifier can be opened easily with a side-latch which may be a bit difficult for the elderly or if you have arthritis. Once opened however, the chamber is easily removed to fill with water. The unit we go had the cleanable chamber which is optional but is highly recommended to ensure proper hygiene. The chamber is definitely an upgrade to the S8 model since it is simple to assemble or disassemble and has a stainless steel base that is roughly a square shape making it easier to clean from day to day.

Performance

Most of the technologies from the S8 platform appears to have been carried over to the S9. The blower noise (tested at 12 - 14 cmH2O) we similar to the second generation of S8 such as the Elite II and AutoSet II. Though there is a slight wind noise from the machine, this was also evident in the previous models and the majority of our patients did not find this bothersome at all.

The biggest improvement in this model may be in the humidifier technology. When the first edition S8 came out, it probably had one of the worst output of humidity when compared to all other CPAP unit in the market. They have gradually improved that and I can honestly say that this platform may have caught up to the Fisher & Paykel HC604 which was the first CPAP with a heated tube. In this model, it has both a humidity and “climate control” on the tubing. Though the climate control can be adjusted manually to set the temperature of the tube, it is recommended that this setting be placed on AUTO. During my tests, rainout is reduced effectively and the humidity control can be set with confidence to be delivered more effectively. (Please note that the the standard S9 units do NOT come with the ClimateLine Tube and is a optional). I have used the HC 604 for years and found this equally as good during the few nights I used it while sleeping with the windows open in the room.

If the ClimateLine Tube is not purchased, the S9 comes with what they call a SlimLine Tube is included in the package. The smaller radius design and lightweight material used for the tube works well to reduce the displacement of the mask from the face during movement. The appearance is substantially smaller and does work well with the masks I tested which were the Swift FX and Mirage SoftGel. (Note: Standard tubing will still fit with the S9 units).

Other Observations

The S9 now uses an SD card to record all its data for compliance and is definitely a step up from the proprietary cards used in the past that required card readers. There are two problems I had with the unit: One was that the tubing came from the back of the unit. Though this may be a problem based on how orientate the unit on your side table, their old design on the S8 with the tube outlet in front I feel was better. The second is the presence of the power supply “brick”, though it has its purpose for overall reliability, it’s just not the most convenient for the frequent traveller to carry around.

Conclusion

ResMed have always made great CPAP machines. They are not only aesthetically pleasing to look at but they have the technologies to back it up. The blowers are quiet and “smooth” with the Easy-Breath motor and the algorithms used for their AutoSet units are very accurate and effective. The only thing that was missing in their previous models was a “good” humidifier but in the S9 they made an “outstanding” humidifier system from the chamber all the way to the delivery of the humidity to the patient. The S9 had large shoes to fill but I am confident that it can easily take the reigns despite the excellent reputation of the models that preceded it.

Fisher & Paykel Zest Standard Nasal Mask Review

Reviewed By: Cox Tan-Ngo, RRT and Steve Archer, RRT

Fisher and Paykel Zest Standard Nasal Mask Review from YouTube

Pros: Lightweight and simple design; fit most facial profiles with ease; improved materials for durability.

Cons: Minor sensation of airflow from the vents; needs a better forehead pad design

Overall: One of the best satandard nasal masks; positive imporvements from the FlexiFit series it replaces.

For a number of years, the FlexiFit series of masks from Fisher & Paykel has been one of our most successful standard nasal mask. The Zest mask is their newest installment to replace the FlexiFit line and it comes in 3 forms; the Zest, Zest Plus, and Zest Petite. Since it was released in the latter part of 2009, it has taken over where the FlexiFit series left off.

One of the reasons why the the FlexiFit and Zest have been so successful is due to its lightweight and streamline design. The biggest problem with most standard nasal masks is that they are built too bulky and as a result they feel quite heavy to the face. When one puts a standard nasal mask on for a few minutes, they generally feel comfortable and tolerable. However, since a CPAP is intended to be used between 4-8 hours during the night, it often causes irritations to pressure points on the face such as the bridge of the nose and on the cheeks. Movement also become a problem because the displacement of the mask is more likely with a heavier mask.

Design

The Zest mask frame is not as hefty as other masks but it remains durable and we’ve had no noticeable problems with breakage. Fisher & Paykel has also designed it to be more proportionate to the face The diffused exhalation ports have been moved to the top part of the frame and is intended to reduce condensations build-up on the mask. By avoiding the immediate contact of the varying air temperature (temperature difference between the CPAP and the exhaled air from our nose) this minimizes the potential for condensation inside the mask.

The major change they made to the mask is in the materials they used on the silicone seal and foam seal. The most common complaint patients had in the past was that the silicone seal was easy to remove but difficult to align properly to the frame on the FlexiFit line. The new silicone seal is now reinforced with a plastic ring. Initially, I had concerns that it would be a source of problems due to possible cracking or breaking. Fortunately the plastic they used seems to be very durable and the problem has not come up from normal use. Another change to the silicone is that they have now used a dual density silicone design wherein they made the different parts of the seal softer or harder depending on the requirement for structural integrity. The bridge of the nose was designed to be very soft and should benefit people who are proned to irritations to that part of the nose.

Another concern from the FlexiFit line that Fisher & Paykel improved on the Zest was in regards to the foam seal that is placed inside the silicone seal. The old design was problematic because is had a tendency to absorb a lot of moisture, causing it to expand almost 30% compare to its original size. Depending on a person’s humidity requirements and settings on the CPAP, this deterioration can occur within 3-4 months of consistent use. The new foam seal now has a different coating which repels most of the moisture and should last longer. They’ve also changed the shape of the seal (a design philosophy taken from their Forma full face mask) that they say is intended to distribute pressure points more appropriately and minimize leaks.

Performance

If you are using a standard nasal mask, the Zest line is certainly one to consider. Once again the streamline design and lightweight characteristics really improve your chances to achieve a comfortable and effective therapy. When using the mask for a 3 week period, I would rate the mask leaks to be minimum to none on most nights. The diffused exhalation port of mask is also quiet but because it is positioned closer to the nose, I can feel the movement of air a bit more through the holes. I would like to see a redesign of the forehead pads because it needs a more even distribution of pressure on that part of the face. The 360 degree swivel where the hose connects to the mask seems to be smooth (at least in the mask that I tried) and it did not have a tendency to “squeek” which sometimes happened with the FlexiFit 407 I previously used.

Conclusion

Still one of the best standard nasal masks in the market. Make sure you get the right model. It comes in the Zest which is for standard noses; Zest Plus for patients with a taller nose bridge or wider nose base; and the Zest Petite for the patients with a small or “button” nose. Though I use a pillow style mask on a regular basis, I use this mask as my “relief” mask in case I want a break from wearing a mask that goes directly into the nostril. When looking for a standard nasal mask, this mask certainly has most of the attributes that one looks for and that is why I highly recommend it.  

Philips Respironics System One CPAP Review

Reviewed By: Cox Tan-Ngo, RRT and Steve Archer, RRT

Philips Respironics System One CPAP Review Video from YouTube

Pros: Improved humidifier system; Improved Latch system to separate humidifier for travel; SD Memory Card storage; Better detection of non-OSA related events; Intuitive toggle dial.

Cons: “Wind Noise”; Lack of a Silencer Cap; Continued presence of the external power Brick

Overall: An improvement to the out-going M-series platform. Despite the larger size, it appears to be well designed and is packed with technology especially with the Remstar Pro and Auto models.

**UPDATE**: Philips Respironics is currently working with Bose to improve or reduce the sound coming from the CPAP to be the quietest in the industry!

 

The new System One by Philips Respironics is the first CPAP unit developed since Philips Electronics acquired Respironics in 2007. This unit is intended to replace the Remstar M-Series platform which was release in Canada a few years ago.

The new platform boasts a number of new and enhanced technologies available in the M-series model. Available in their usual Remstar Plus, Pro, Auto, and BiPAP models. Continuing with their industry leading Flex Family Technologies. They will have the full line of the C-Flex, A-Flex, and Bi-Flex algorithms available in their standard CPAP, Auto-CPAP, and BiPAP units respectively. In addition to this, however, is the the new C-Flex+ which will be available on the Remstar Pro and the standard CPAP mode of the Auto-CPAP model. For those familiar with the A-Flex technology, it is intended to assist a persons breathing on inspirations as well as relieving some pressure on exhalation to deliver the right pressure throughout the breathing cycle. Most of my patients who have used A-Flex in the past have described the breathing cycle to be smoother and more comfortable when this feature is activated.

Features

One of the biggest problems with the M-Series platform was related to its humidifier. The trend during the time the M-series came out was to reduce the size of the CPAP units for greater portability and to make it more esthetically pleasing to CPAP users. Unfortunately, the reduction of the humidifier chamber resulted in patients drying out the chamber in the middle of the night. This was a problem especially with patients who used higher humidity setting and/or were on higher CPAP pressure levels. The System One has a new humidifier system which has a larger container and thus resulting in the slightly larger appearance to the unit. The humidifier also received some technological enhancements starting with the System One Humidity Control which prevents rainout and maintains consistent humidification by monitoring room temperature and room humidity. The second enhancement is their Dry Box system which is designed to prevent water from flowing back into the unit. In the past, CPAP machines tried to use baffler systems to prevent this from happening but the dry box system takes this a step further and in my opinion, I think they've done a very good job with this design. In my review video I've tried place the water in the chamber and tried to flip the unit up-side down and there were no problems with water flowing back into the main CPAP unit.

For those who use a Philips Respironics CPAP mask, the new System One Resistance Control is a new feature that compensates for different resistance levels the the different masks produce to once again improve patient comfort and compliance. This technology was only noticeable if you continue to have issues with the perceptions of increased resistance while using a CPAP. Being a long time CPAP user, this was not particularly important but I can see the benefits it may provide to new CPAP users and patients who continue to struggle with this problem due to higher pressure settings. (If you use a mask from another manufacturer, this technology should be turned off)

The data being monitored by the System One CPAPs have also been enhanced to identify clear airway apneas and periodic breathing to immediately identify patients who may need a more specialized form of therapy. After seeing thousand of people who have tried CPAP therapy, there certainly has been a significant number of patient that would've benefitted from this type of monitoring. We see more people who struggle and some fail their CPAP trials due to the presence of central sleep apnea, periodic breathing, and/or Complex sleep apneas. Earlier detection of these conditions during the trial will improve success and effective management of these patients.

Performance

The overall performance of the System One Unit has been favorable. The added technologies have certainly addressed some of the problems that plagued the M-series platform. Aside from a “wind noise” coming from the intake of the unit on higher pressures or with “hard” breathing, I found the unit quieter than the M-series. I wished they had a silencer cap like ones in their previous models to reduce that “wind noise” that some patients have noticed. The Flex technology is really a well developed technology and really enhances the patient experience when they have problems with intolerance to pressures produced by the CPAP. One of the most noticeable improvements based on the users point of view is the way the unit is separated from the heated humidifier. It is easier and more practical because it is no longer the necessary to use an adaptor when pulling the unit apart to make it functional. Other practical changes include the use of an SD card memory platform to record data which eliminates the need for a proprietary card reader to download into a computer (Note: The new Encore 2.0 is necessary to download data). Finally the toggle dial system for its operation is more intuitive and eliminates all the buttons from the previous models.

Conclusion

Though the size of the unit has increased when a heated humidifier is used, I feel that this unit is an improvement over the M-series. From a technical and practical point of view, The PR System One's technological package is difficult to ignore and with the Philips Healthcare's reputation for quality, this is definitely a CPAP to consider for new and experienced CPAP users.