The introduction of the V̇-Com™ last year has changed the delivery of CPAP therapy for the current and future generations. The inventor, William Noah, MD, credits several registered polysomnographic technologists (RPSGTs) as being instrumental in its development and success, so we wanted to learn more from these sleep technologists. V̇-Com™ was selected by both this magazine and the American Academy of Sleep Medicine as the top innovation in the sleep field for 2022. The V̇-Com™ is a specially engineered resistor placed in the CPAP circuit between the mask and the positive airway pressure (PAP) device, which lowers inspiratory pressure (IPAP) for comfort and reduces adverse effects but maintains expiratory pressure (EPAP) for therapy. It also reduces the noise of PAP therapy which helps bedpartners as well.
RPSGTs Play a Vital Role
Both Bryan Hughes, RPSGT, and Evelyn Thompson, RPSGT, have worked with Dr. Noah for almost 30 years at Sleep Centers of Middle Tennessee, and both oversee the more than 12,000 sleep tests performed each year. “Both of our roles changed a year ago when we began patient trials with the V̇-Com™,” said Thompson. “Our sleep techs are ready to stop research and just begin all studies with V̇-Com™. We have discovered less leaks and mouth openings, less mask changes, resolution of TECSA [treatment emergent central sleep apnea], less aerophagia, and better initial tolerance.”
“I was one of the first to try a 3-D printed V̇-Com™ prototype back in July 2021,” said Hughes. “It was crazy. 18 cmH2O with the V̇-Com™ was more comfortable than 14 cmH2O without. My work today is more challenging, but it is cool to know you are improving the field. Hey, I’m a long-term CPAP user myself, and V̇-Com™ has certainly helped me at night.”
Disruptive Technology
Emerson Kerr, president-elect of the American Association of Sleep Technologists, visited Dr. Noah at his research facility in September 2021, representing Philips while Noah was meeting with Philips mask engineers. After the meeting, Noah let Kerr secretly try a prototype V̇-Com™. “I may have been the first to make [Noah] realize how disruptive this would be,” said Kerr. “It’s not just the obvious comfort. It’s the fact that by lowering inspiratory pressure and maintaining therapy, you are, in essence, reversing over 20 years of understanding. I was a big C-Flex/A-Flex advocate, but they don’t approach the comfort of V̇-Com™. The funny part is that he, being a physician, didn’t like me describing his discovery as “disruptive.” I had to explain how disruption can be a good thing.”
Sleep Technologist Makes Discovery
Carmen Keasling, RPSGT, who has worked with Noah, Thompson, and Hughes for nearly 25 years, is the one who discovered how reducing IPAP with the V̇-Com™ reduces mouth openings by 80%. “It was late May 2022, and we just finished all the FDA requirements and started putting V̇-Com™ on patients in the sleep lab,” said Keasling. “This patient had horrible mouth openings during titration, and I suggested to the other tech try the V̇-Com™ before using a chinstrap. Well, it worked, and now after two hundred more episodes, the V̇-Com™ is reducing the need for chinstraps or full-face masks by 80%. But of course, now we know V̇-Com™ reduces unintentional leak in 88% of CPAP users whether they have a ResMed, React Health, or Philips device.”
Sleep Professionals Provide Industry Guidance
Both Robert Miller, RPSGT, Vice President of Sleep Business for Apria Healthcare, and Dr. Gerald Mannikarote, a longtime sleep technologist, along with Kerr, host the popular SleepTech Talk podcast now featured on the SleepWorld Podcast Network. Noah credits all three with wise counsel over the past year. Miller was introduced to the V̇-Com™ just before its launch and immediately recognized its future impact. But he also recognized the apathy that follows any innovation. “It’s tough trying to change the world. Even when you have the science behind you,” said Miller. “People are often slow to investigate, and sometimes fearful to change. Bottom line is Dr. Noah is focused on the same thing we are, improving care. I know he appreciates all my encouragement.”
“I just tell him to keep the patience he has already shown and be thankful for the large change that has already happened,” said Dr. Mannikarote. “By the way, if anyone reading this doesn’t understand about the V̇-Com™, they should read his white paper (Go to SleepRes.com) and experience the V̇-Com™ comfort themself. I am a long-term CPAP user and the V̇-Com™ greatly improved my nightly experience. Wouldn’t go without it.”
This article originally appeared in Sleepworld Magazine May/June 2023 and was written by the SleepWorld Magazine staff.
