This started as a post about the new ResMed AirStart; but it gradually turned into a discussion about the ‘bricking’ of CPAP machines.
This topic needs a post all to itself. It is a complicated issue that gets peoples backs up. CPAP users often feel ripped off as a result of the practice, and it can leave a bad taste in CPAP users mouths.
What is ‘Bricking’?
Bricking refers to the (common) practice of using the same hardware in top and lower end devices; but turning off certain features in the lower spec machines. This allows manufacturers to streamline the design, engineering, and manufacturing of CPAP devices.
This has allows CPAP manufacturers to charge different amounts for fixed and auto pressure CPAP machines when they both have the same internal hardware. Effectively, the fixed pressure machines are ‘dumbed down’ versions of the more expensive option, with selective features turned off.
What does this mean for CPAP users?
The whole reason for this practice is for CPAP manufacturers to reduce the cost of production of the entire line of CPAP machines. So, it usually increases the cost of making a fixed pressure machine (as there are hardware features within the machine that will not be used), but it reduces the cost of making an auto machine (due to streamlining the process, and being able to upscale the production line).
Why don’t they just make them all Auto machines?
A good question, and to be honest I don’t know the full reason. But, we know it comes down to economics.
Take the mobile phone industry as an example; where you are able to choose from many different tiers of phones based upon the features that you need. Sometimes the cheaper phone will have exactly the same internals as the more expensive one, but will have certain features disabled.
However, from a CPAP user perspective, it’s hard to get past the thought: ‘if they can sell a fixed pressure machine at this lower price with the same hardware as the auto machine, why can’t they sell only auto machines at the current price of the fixed pressure ones?’
Hey, it makes sense; and it’s a bloody good point.
These are big companies, and their marketing teams would have done the sums. They would sell more machines if they offer machines at different price points, and it’s not cost effective to make completely unique machines for each price point.
One way of rationalizing the issue is to imagine the Auto machines as having a ‘software upgrade’ as opposed to the fixed pressure machine being deliberately ‘dumbed down’. I know from personal experience that I am sometimes happy to pay a little bit more for a piece of software, if it has additional features that I need. The same logic can be applied to CPAP machines.
Think of the Auto machines as having a ´software upgrage´
Are you sure they aren´t different on the inside: The story of one lucky CPAP customer
A funny incident happened to me in regards to this. A patient of mine decided to purchase a fixed pressure machine. Upon accessing the clinical settings, I came to realise that ResMed had accidentally loaded the AutoSet software to the machine. It was labelled, boxed, and priced as a fixed pressure machine; the only difference was the version of the software that was installed on the machine.
This highlights that it really is just the software that is different in the two machines.
Furthermore, it was a significant windfall for the patient. The cost of CPAP anywhere is bloody high, especially for uninsured clients. In Australia, it’s even worse. For example, RRP on the ResMed AirSense 10 Elite Fixed Pressure Machine is $1678.00. The AutoSet model retails at $2578.00!. Yes, over 2500 dollarydoos (the official Australian currency) Obviously they aren’t as outrageous in the USA, but it is still a significant investment.
That’s one expensive software upgrade!!
… and one very lucky guy.
What should I do?
If you are in the USA and you are lucky enough to be getting a machine through your health insurance, you will want to push the supplier to give you the best machine available . Sorry, I’m not entirely sure how the American insurance schemes work (I’m an Aussie) but my research suggests that DME providers get a set amount for providing CPAP to end users; and giving users a cheaper machine increases their profit margins. Push them to get the
However, some people cannot afford these more expensive machines.
In my line of work, I have seen many people who would clearly benefit from CPAP therapy but failed to get treated because of the cost. You may know someone yourself who’s sleep apnea wasn’t severe enough to have a machine given to them, and couldn’t afford one either. Honestly, it frustrates the hell out of me, and is incredibly sad to see.
If you can tolerate a fixed pressure machine; there is no reason that you shouldn’t buy one. If you are on a fixed CPAP pressure, there is no extra benefit in forking out for a ‘Premium’ Auto Machine as the hardware is effectively the same
For patients on a fixed CPAP pressure, there is no extra benefit in forking out for a ‘Premium’ Auto Machine as the hardware is effectively the same
What features are removed?
This depends on the machine, and what manufacturer made it.
Common features and data that are often removed in the cheaper machines include:
- – Auto Pressure
– Auto Ramp
– Pressure Drops during expiration
– Mask Leak
– AHI (Apnea Hyponea Index)
– RDI (Respiratory Disturbance Index)
What is removed from a particular machine depends on the make and model. For example, the Elite machines by ResMed have very similar functionality to the Auto machines (without the Auto capability). The AirStart machines on the other hand only record compliance data, and have most of the comfort features removed.
There are both advantages and disadvantages for the practice of ‘bricking’ of CPAP machines by manufacturers. On the whole, it reduces the cost of production of CPAP equipment (or arguably increases profit margins for the large manufacturers). Be as it may, nothing is likely to change the practice anytime soon, as it proves a useful tool that is employed by CPAP manufacturers and IT manufacturers alike.
The best you can do is to make sure you get the right machine for you, with the right features, without paying too much.