Breathe 'n' Air Respiratory Services Inc, 59 Chapais Drive, Lower Sackville, NS (2025)

06/11/2025

My Mate From Down Under! Uncle Nicko
On Kricket KPAP

G’day legends 👋

Strap yourselves in because something very big just happened in the world of sleep therapy and I reckon we’ll be talking (debating 😂) this one for years to come right here in the pro community forum.

A couple of years back, a sleep and respiratory physician named Dr. William Noah (He’s been on the channel before, top bloke, bit headstrong (like yours truly), but you’ve got to admire the conviction.) was digging through some old research papers when he stumbled upon what he believes is a major flaw in how CPAP therapy has been delivered for the past 40 years.

💭 His theory? We’ve got it inside out, upside down and back to front!

Right now, every CPAP/APAP/BiPAP machine delivers higher pressure during inhalation (IPAP) and lower pressure during exhalation (EPAP). But Dr. Noah reckons we should flip that: lower pressure on the way in, higher pressure on the way out. He believes all that high-pressure inflow causes unnecessary side effects like leaks, discomfort, and poor compliance and that we can get the same treatment results (or better) without blasting the air in like a leaf blower.

So what did he do?

He started with a little experimental device called the V-Com (or as he calls it a dumb resistor), many pro members currently use it or have tried it. You pop it in your tubing and it softens the airflow during inhalation, while maintaining pressure on exhalation. We call it the training wheels of CPAP, and it's helped thousands of SleepHQ users get more comfortable with therapy.

But Dr. Noah didn’t stop there…

🚨 Today, at the SLEEP 2025 show in Seattle, he unveiled an entirely new CPAP device. Actually, scrap that, he’s crossed out the “C” and replaced it with a K. He’s calling it:

🦗 Kricket — the world’s first K-PAP machine

Here’s a peek:
👉 kricket.com

This little beast looks like a bit like a hybrid travel cpap. USB + SD card slots, integrated humidifier (250mL - Small), and a sleek new pressure delivery algorithm based around V-Com ideology and airway physiology.

Instead of just blasting in air all night long, KPAP reduces pressure during inhalation by 5cm, holds it through the start of exhalation and then gradually increases it during end exhalation, right when your airway is most at risk of collapsing. Think of it like a balloon that holds its shape just a bit longer, helping to keep everything stented open without the brute force.

📊 What about results?

Well, the early trials are wild. In a comfort study:

At 9cm pressure: 139 out of 150 patients said they preferred KPAP to CPAP.

At 13cm pressure: 140 out of 150 preferred KPAP.

That’s just nuts.

And even in early treatment efficacy testing, KPAP is showing very similar AHI results to traditional CPAP. Not perfect studies (split-night design, which isn't ideal), but promising enough to raise eyebrows.

Now before you go reaching for your wallets, it’s not for sale yet. It's still under FDA review (510k) and the team is aiming to release it later this year. But it’s real, it’s happening, and it could shake things up in a massive way.

💬 Final thoughts

What if… we’ve been doing this wrong for 40 years?

What happens if I hand this device to 100 patients… and 90 of them prefer it?

What does that mean for ResMed? For the industry? For therapy as we know it?

I’m backing it. If it improves comfort, if it gets more people to stick with therapy, I’m all in. Massive congrats to Dr. Noah and the whole team at SleepRes for daring to challenge the status quo.

That said, I’ve got a sneaky feeling this new therapy mode won’t be the silver bullet for everyone, especially those dealing with UARS. As I’ve shown in a few recent videos, some members actually achieve better results by doing the opposite: cranking up their IPAP and dialing back their EPAP. That extra inspiratory support can make a huge difference when you’re battling flow limitation or subtle arousals that don’t show up in your AHI.

This might just be the beginning of a new era in sleep therapy.

Let me know your thoughts in the comments below

Cheers mates
Nicko 🙌

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05/28/2025

Does anyone wonder why Sleep Apnea rates are so high? Possible link to Climate Change:

Summary: A global study found that rising temperatures significantly increase the severity and prevalence of OSA, and modeling predicts that under likely climate change scenarios, the societal burden of OSA could double or triple by 2100.
Key Takeaways:

• Rising ambient temperatures are associated with a 45% increased likelihood of OSA events on a given night.
• The burden of OSA has already risen an estimated 50% to 100% since 2000 due to climate change.
• Regional variation exists, with European countries more affected by temperature-related OSA severity than Australia or the US.
________________________________________
Rising temperatures are linked to increased severity of obstructive sleep apnea (OSA), according to a large new study published at the ATS 2025 International Conference. The study also found that, under the most likely climate change scenarios, the societal burden of OSA is expected to double in most countries over the next 75 years.

In addition to highlighting the critical importance of limiting global warming, the findings also emphasize the immediate need for strategies to alleviate the health and economic impacts of OSA as it becomes more common and severe, the researchers say.

“This study really highlights the societal burden associated with the increase in OSA prevalence due to rising temperatures,” says Bastien Lechat, PhD, a senior research fellow at FHMRI: Sleep Health at Flinders University, in a release.

For the study, researchers analyzed a consumer database of more than 116,000 worldwide users of an under-mattress sensor validated to estimate OSA severity. The dataset included around 500 repeat measurements per user. Researchers then analyzed this data against 24-hour ambient temperatures extracted from climate models.

Overall, higher temperatures were associated with a 45% increased likelihood of a sleeper experiencing OSA on a given night. However, these findings varied by region, with people in European countries seeing higher rates of OSA when temperatures rise than those in Australia and the United States.

“We were surprised by the magnitude of the association between ambient temperature and OSA severity,” Lechat says.
Researchers then sought to estimate how burdensome the increase in OSA prevalence due to rising temperature is to society in terms of well-being and economic loss. They conducted modeling, including disability-adjusted-life-years, productivity losses, and health economics, to estimate the OSA burden under several climate scenarios.

They found that any scenario that involved temperatures rising 2 degrees Celsius or higher would result in a 1.5-fold to 3-fold increase to the OSA burden by the year 2100. They estimated that climate change has already increased the OSA burden by 50% to 100% since the year 2000.

In addition to providing further evidence of the major threat of climate change to human health and well-being, Lechat says the study highlighted the importance of developing effective interventions to diagnose and manage OSA.

“The high prevalence undiagnosed and untreated OSA amplifies the effect of global warming on the societal burden associated with OSA,” he says. “Higher rates of diagnosis and treatment is likely to reduce the health and productivity burden due to rising temperature and increased OSA prevalence.”

Next, the team plans to develop intervention studies looking at strategies to mitigate the effects of temperature on OSA. They also hope to study the physiological mechanisms linking OSA severity to temperature.
ID 120477670 © Dezzor | Dreamstime.com

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05/28/2025

A new paper publishes the differences in the costs of Medicare claims for three cohorts: people who met the CPAP adherence threshold, people who started CPAP but did not meet the threshold, and those who did not try CPAP at all.

By Sree Roy
Many US health insurers refuse to cover CPAP for obstructive sleep apnea (OSA) unless adherence thresholds are met—but new data challenge that binary thinking. A large-scale actuarial analysis sponsored by EnsoData suggests that CPAP delivers measurable cost savings for Medicare beneficiaries, and it links simply starting the therapy to reduced healthcare utilization among people with OSA.

Among more than 28,000 beneficiaries studied who were diagnosed with OSA between 2016 and 2019, those who started CPAP but discontinued it within the first year still incurred significantly lower healthcare costs than those who never initiated treatment. The implication being that any CPAP use—regardless of adherence to a four-hour threshold—can lower the OSA-linked healthcare burden. In the study, the beneficiaries who met the adherence threshold had even greater healthcare cost savings per member per month. (Anytime a study analyzes retrospective data, such as Medicare claims, it is vital to remember that cause-and-effect cannot be determined; only an association can be noted.)

“Our economic study shows that diagnosing and treating obstructive sleep apnea is a healthcare economic winner for payors,” says study co-author Nathaniel F. Watson, MD, MSc, chief medical officer at EnsoData. “In other words, any costs associated with diagnosing and treating obstructive sleep apnea will be recouped by payors over time by reduced healthcare costs.”

In the patient population studied:

45% were CPAP adherers, meaning Medicare was charged at least four times for the patient’s device;
44% were non-initiators, meaning Medicare was never charged for a CPAP; and 10% were non-adherers, meaning Medicare was charged at least once for a CPAP but not more than three times—implying the person tried the device but did not stick with it in Medicare’s rent-to-own protocol.

Just Starting CPAP Might Matter
Study co-author Chris Fernandez, co-founder, executive chairman, and chief research officer at EnsoData, expresses surprise that the started-but-did-not-adhere cohort experienced significant cost savings, overall and when grouped by their comorbidities, compared to the people who did not try CPAP.

Over two years, people who started CPAP spent $153 less per month on healthcare costs versus those who did not give the therapy a try. The people who met the CPAP adherence threshold spent $196 less per month compared to the non-initiators—within the first two years on therapy. So the cost savings show up right away, Fernandez notes.

“This is motivating for the field,” Fernandez says. “Maybe it’s not binary, like above or below four hours. The more the better, and there’s a real benefit to supporting patients and trying to maximize and optimize their therapy.”

First author Emerson M. Wickwire, PhD, ABPP, CBSM, DBSM, says the findings make sense. “A number of studies have demonstrated that even partial [C]PAP adherence can lead to improved health outcomes,” he says. “It stands to reason that the same would also be true for economic costs.”

Cost Savings in People with OSA Comorbidities
Far from excluding OSA patients with comorbidities, the study leaned into them. The investigators further analyzed the cost differences in the three cohorts by separating them by seven common chronic conditions: chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), depression, hypertension, type 2 diabetes, obesity, and stroke.

The differences in per-member per-month costs for the people who were CPAP adherent versus those who did not try CPAP were:

Stroke: $396
CHF: $347
COPD: $266
Depression: $256
Obesity: $225
Hypertension: $205
Diabetes: $181

“We want to try to make an economic argument about why treating sleep apnea is important beyond the improvements in quality of life, sleepiness, health, and well-being,” co-author Watson says. “We also want to highlight the economic opportunity here if we diagnose and treat sleep apnea across the board.”

Fernandez adds, “We hope that sleep physicians use these findings to promote more collaboration with other specialties,” including primary care, cardiology, and psychiatry. “It is something that can be immediately helpful,” he says. “Beyond that, part of why we did this work was, I think, that the health outcomes are better understood than the financial outcomes.

“We have a complex healthcare system with a lot of stakeholders…and being able to understand the benefits of the things that we do, both in health outcomes terms and in financial outcomes terms, can be really helpful to moving the whole system into a place that it would be better for all of us.”

Valuing Sleep within Healthcare
Co-author Wickwire, a professor and section chief (sleep medicine) at the University of Maryland School of Medicine and the University of Maryland Medical Center, says, “One of the key lessons is that to define, demonstrate, and maximize the value of sleep, we need to understand what matters to those stakeholders whom we serve—our patients, referring providers, payors, the public, and so on.

“In the short term, OSA care increases costs: for physician visits, diagnostic sleep testing, [C]PAP machines (or oral appliances or medications), and so on. These costs are generally front-loaded in year one, then decrease over time. This is why time horizon is so important when considering economic aspects of OSA care. It makes a big difference whether we look one or five years out.”

Fernandez hopes studies like this will ultimately result in a greater healthcare investment in sleep. He says, “We hope this contributes to the appreciation [of the value] that sleep apnea treatment has not only for quality of life and longevity, but also for its hard dollars impact.”

Reference
Wickwire EM, Fernandez CR, Huynh N, et al. Association between positive airway pressure therapy and healthcare costs among older adults with comorbid obstructive sleep apnea and common chronic conditions: an actuarial analysis. Sleep. 2025 Jan 13:zsaf009.

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04/19/2025

CPAP Linked to Living Longer, Meta-Analysis Finds:

Summary: A large meta-analysis on the long-term benefits of CPAP therapy, published in The Lancet Respiratory Medicine, found that in people with sleep apnea, CPAP therapy lowered the overall chance of dying by 37% and the chance of heart-related death by 55%.

Key Takeaways:

The meta-analysis reviewed data from over 1 million patients with obstructive sleep apnea (OSA), compiling findings from 30 studies, including 10 randomized controlled trials and 20 real-world studies.
Greater consistency and longer duration of nightly CPAP use are directly correlated with increased survival benefits.

These findings provide clinicians concrete evidence to motivate patients to start CPAP therapy and to encourage existing users to increase nightly usage.

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04/09/2025

This is important, especially if you are not on city water!

Summary: The CDC advises physicians to counsel patients about potential fatal Acanthamoeba infections linked to using tap water in CPAP machine humidifiers, following a recent patient death.

Key Takeaways:

Physicians should counsel CPAP users on the risk of infections from using tap water in humidifiers.

A patient’s death from Acanthamoeba encephalitis was linked to tap water used in both a CPAP machine and electronic nasal irrigation device.

The CDC advises using distilled, sterile, or boiled and cooled water for nasal irrigation and strictly following CPAP manufacturers’ instructions.

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03/15/2025

A study evaluated the accuracy of sleep-staging algorithms in three consumer wearable devices—Oura Ring, Fitbit Sense, and Apple Watch—against gold-standard polysomnography.

Summary: A study funded by ŌURA and conducted by Brigham and Women’s Hospital compared the sleep-tracking accuracy of the Oura Ring, Apple Watch, and Fitbit Sense against gold-standard polysomnography. The study found that the Oura Ring outperformed the other two devices in four-stage sleep classification accuracy, wake detection, and deep sleep detection. While all three devices were effective at distinguishing sleep from wake, the Oura Ring demonstrated the highest overall accuracy and sensitivity.

Key Takeaways:

Oura Ring Leads in Accuracy: The Oura Ring was found to be 5% more accurate than the Apple Watch and 10% more accurate than Fitbit in four-stage sleep classification compared to polysomnography.
Superior Wake and Deep Sleep Detection: Oura Ring had the highest sensitivity for both wake detection (68.6%) and deep sleep detection (79.5%), outperforming both the Apple Watch and Fitbit in these metrics.
No Significant Misestimations: Unlike the Apple Watch, which overestimated light and deep sleep, the Oura Ring did not significantly underestimate or overestimate any of the four sleep stages.

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03/12/2025

Immediate CPAP Therapy Linked to Reduced Parkinson’s Risk in People with Sleep Apnea:

Summary: A preliminary study of veterans found that obstructive sleep apnea increases the risk of Parkinson’s disease, but early CPAP treatment—within two years of diagnosis—may help reduce that risk.

Key Takeaways:
• People with obstructive sleep apnea have a higher risk of developing Parkinson’s disease.
• Using CPAP within two years of an OSA diagnosis was associated with fewer cases of Parkinson’s, while delayed CPAP use did not show the same benefit.
• The study could confirm CPAP device ownership but could not track how consistently participants used their therapy.
• Findings will be shared at the American Academy of Neurology’s 77th Annual Meeting in April 2025.
________________________________________
People with obstructive sleep apnea have an increased risk of Parkinson’s disease, but if started early enough, CPAP may reduce that risk, according to a preliminary study released March 2, 2025, that will be presented at the American Academy of Neurology’s 77th Annual Meeting taking place April 5–9, 2025, in San Diego and online. The study found using CPAP within two years of a sleep apnea diagnosis reduced the risk of Parkinson’s.
“Obstructive sleep apnea is common and previous research has found when untreated, it is associated with an increased risk of heart attack and stroke,” says study author Gregory D. Scott, MD, PhD, of the VA Portland Health Care System in Oregon, in a release. “While our study found an increased risk of Parkinson’s disease, the good news is people can do something about it, by using CPAP as soon as they are diagnosed with the sleep disorder.

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02/27/2025

How a Single Sleepless Night Can Impact Your Immune System

Summary: A new study reveals that even a single night of sleep deprivation can alter immune cell profiles to resemble those seen in obesity, potentially increasing inflammation and the risk of chronic diseases like diabetes and cardiovascular conditions.
Key Takeaways:
• A single night of sleep deprivation can alter immune cell profiles, making them resemble those found in individuals with obesity, a condition linked to chronic inflammation.

• Poor sleep quality may contribute to long-term inflammatory states, potentially increasing the risk of diseases like obesity, diabetes, and cardiovascular conditions.

• The study highlights changes in non-classical monocytes, which regulate immune responses, as a potential link between sleep loss and increased inflammation.

• Researchers suggest that disrupted sleep may impact blood vessel function and stress hormone regulation, triggering immune system changes.

• With sleep increasingly disrupted by technology and modern lifestyles, improving sleep quality could be a strategy to reduce inflammation-related health risks.
________________________________________
New research reveals insight into the impact sleep quality has on a person’s immune system, and how it could be linked to the development of diseases such as obesity, diabetes, and cardiovascular diseases.

The study of 237 people, published in The Journal of Immunology, found that even a single night of 24-hour sleep deprivation in young, lean, and healthy individuals altered the profile of immune cells that help regulate the immune system to resemble that of individuals with obesity— a condition known to drive chronic inflammation. This suggests that the immune system is highly sensitive to sleep and may adapt rapidly to changes in sleep pattern. According to the researchers, if these shifts persist, they could contribute to long-term inflammatory states and increase the risk of disease.

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10/16/2024

Looking for a Sleep Ring / watch for monitoring sleep:

A study evaluated the accuracy of sleep-staging algorithms in three consumer wearable devices—Oura Ring, Fitbit Sense, and Apple Watch—against gold-standard polysomnography.
Summary: A study funded by ŌURA and conducted by Brigham and Women’s Hospital compared the sleep-tracking accuracy of the Oura Ring, Apple Watch, and Fitbit Sense against gold-standard polysomnography. The study found that the Oura Ring outperformed the other two devices in four-stage sleep classification accuracy, wake detection, and deep sleep detection. While all three devices were effective at distinguishing sleep from wake, the Oura Ring demonstrated the highest overall accuracy and sensitivity.

Key Takeaways:

Oura Ring Leads in Accuracy: The Oura Ring was found to be 5% more accurate than the Apple Watch and 10% more accurate than Fitbit in four-stage sleep classification compared to polysomnography.
Superior Wake and Deep Sleep Detection: Oura Ring had the highest sensitivity for both wake detection (68.6%) and deep sleep detection (79.5%), outperforming both the Apple Watch and Fitbit in these metrics.
No Significant Misestimations: Unlike the Apple Watch, which overestimated light and deep sleep, the Oura Ring did not significantly underestimate or overestimate any of the four sleep stages.
A study evaluating the accuracy of sleep-staging algorithms in three consumer wearable devices—Oura Ring, Fitbit Sense, and Apple Watch—against gold-standard polysomnography found that Oura Ring was the most accurate sleep tracker in four-stage sleep classification.

The study was funded by ŌURA and independently designed and conducted by researchers at the Brigham and Women’s Hospital (BWH) and carried out in the BWH Center for Clinical Investigation. The study was published in Sensors and presented at Sleep Europe 2024.

“While polysomnography remains the gold standard of sleep assessment, wearable technology offers promise for measuring sleep continuously, less intrusively, and more naturally, making it a more scalable solution for sleep measurement,” says Rebecca Robbins, PhD, lead author of the study, sleep scientist at Brigham and Women’s Hospital, and medical advisor for ŌURA, in a release. “For those looking to use consumer sleep trackers to identify patterns and address sleep issues, reliability, and accuracy are paramount when navigating the variety of offerings available.”

To evaluate the accuracy of the three devices, 35 participants were recruited for a single-night in-patient study. During the study, they were monitored with polysomnography while also wearing an Oura Ring, Apple Watch, and Fitbit Sense.

The results of the validation study revealed that “all the devices exhibited sensitivity of 95% or more for identifying sleep and more than 90% agreement in the determination of sleep vs wake (ie, a two-stage classification), surpassing many older research-grade actigraphy devices, which in many cases demonstrated 86–94% agreement with PSG in a two-stage classification,” the researchers write.

The researchers conclude, “Our analyses revealed that all three devices perform extremely well in distinguishing between sleep and wake.”

Other findings include:

Oura Ring was 5% more accurate than Apple Watch and 10% more accurate than Fitbit in four-stage sleep classification, adjusted for chance and compared to gold standard assessments, based on Cohen’s kappa (Oura Ring: 0.65, Apple Watch: 0.60, Fitbit: 0.55).
Oura Ring had the highest sensitivity for wake detection at 68.6% compared to 67.7% for Fitbit and 52.4% for Apple Watch.
Oura Ring had the highest sensitivity for deep sleep detection at 79.5% compared to 61.7% for Fitbit and 50.5% for Apple Watch.
Oura Ring did not significantly underestimate or overestimate any of the four sleep stages, while Apple Watch overestimated light sleep by an average of 45 minutes and deep sleep by an average of 43 minutes.
Research shows that polysomnography, which relies on human coders to score the night of sleep after data collection, achieves 83% percent sleep stage agreement, meaning that two technicians scoring the same night on separate occasions may only agree for about 83% of the night.

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10/14/2024

Inspire for OSA: ??

In-Depth Interview with Dr. Ryan Nord: Exploring the Inspire Hypoglossal Nerve Implant for Sleep ApneaIn this video, I sit down with Associate Professor Of O...

10/02/2024

Researchers found that oxygen deficiency caused by obstructive sleep apnea increased the susceptibility of mice to develop abdominal aortic aneurysms.

Summary: A study from the University of Missouri School of Medicine and NextGen Precision Health found a link between obstructive sleep apnea and an increased risk of developing abdominal aortic aneurysms. The research showed that intermittent hypoxia caused by obstructive sleep apnea can make the aorta more susceptible to aneurysm formation, especially when combined with other metabolic conditions like obesity. The study’s findings suggest a potential need for monitoring and slowing the progression of aneurysms in patients with sleep apnea.

Three Key Takeaways:

Obstructive Sleep Apnea as a Risk Factor: Obstructive sleep apnea, particularly the intermittent hypoxia it causes, may increase the risk of developing abdominal aortic aneurysms.
Aorta Weakening Mechanism: The loss of oxygen during sleep apnea activates enzymes (MMPs) that degrade the aorta’s structure, increasing the chance of aneurysm formation.
Monitoring Sleep Apnea Patients: The study highlights the importance of monitoring abdominal aortic aneurysms in sleep apnea patients, especially those with additional risk factors like obesity.
Obstructive sleep apnea may be a risk factor for developing abdominal aortic aneurysms, according to researchers from the University of Missouri School of Medicine and NextGen Precision Health.

Abdominal aortic aneurysms occur when the main artery, the aorta, swells and potentially ruptures, causing life-threatening internal bleeding. Citing studies that indicate a higher prevalence of abdominal aortic aneurysms in patients with obstructive sleep apnea, University of Missouri researchers examined the link between the two using mouse models.

The research team found that intermittent hypoxia—when the body isn’t getting enough oxygen for a given period of time—caused by obstructive sleep apnea increased the susceptibility of mice to develop abdominal aortic aneurysms.

“Chronic intermittent hypoxia by itself is not enough to cause abdominal aortic aneurysms, but for a patient with obstructive sleep apnea who also has additional metabolic problems like obesity, our findings suggest it may help degrade aortic structures and promote aneurysm development,” says Luis Martinez-Lemus, DVM, PhD, study author, a professor of medical pharmacology and physiology, and a NextGen Precision Health investigator, in a release.

Hypoxia in Sleep Apnea May Trigger Aneurysm Development
Intermittent hypoxia happens during obstructive sleep apnea when throat muscles relax and block the flow of air into the lungs. According to the research, the loss of oxygen triggers certain enzymes called MMPs. The increased enzyme activity can degrade the extracellular matrix, which acts like a cell scaffolding network, weakening the aorta.

“Patients with abdominal aortic aneurysms usually don’t notice any symptoms, except for some back and belly pain, until the aneurysm bursts. Once that happens, it’s crucial to get the patient to surgery quickly so doctors can repair the aorta,” says Neekun Sharma, the lead author of the study and an assistant research professor in the Division of Endocrinology and Metabolism in the Department of Medicine, in a release. “Learning how these aneurysms develop can help us find ways to monitor or slow down their progression, especially for patients who have obstructive sleep apnea.”

The study was published in the Journal of Applied Physiology.

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10/01/2024

New ResMED Mask Release:

If you want to master CPAP therapy then check out my cloud-based analytics and reporting platform SleepHQ - It's free to use : SleepHQ Web App - https://slee...

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