How Philips’ Systems Architect Reinvented the CPAP Mask

It’s most likely not unusual for an engineer to be obsessed with geometry.

But the geometry of faces? That’s a little different.

Then again, Jonathan Grashow isn’t an ordinary engineer. He’s principal systems architect at Philips, and he came up with the company’s revolutionary mask design more than a decade ago. His motivation? Working directly with—and changing outcomes for—people.

“As an engineer, it’s really easy to be stuck developing some little square piece that’s inside of a machine that no one will ever see,” Grashow said. “Getting to work with real people and things that directly impact people in their lives was just really exciting to me, and I’ve always been interested in human factors and usability and things like that.

“It’s such a thrill for me, as an engineer, to run into someone on the street who says, ‘I’m using that master design,’” 
he said.

Adapting Systems

For his graduate work at the University of Pittsburgh, Grashow focused on soft tissue biomechanics, including the tissues of the face and skin. After completing his master’s in bioengineering, he spent several years with Evaheart, a startup company working on artificial hearts, until he joined the team at Philips Respironics in 2011.

“I kind of joke that I went from beats per minute to breaths per minute,” he said—and then explained that continuous positive airway pressure (CPAP) devices and artificial hearts aren’t as different as you might think. Both run on centrifugal pumps, and both depend on matching the body’s essential rhythms, whether that’s the heart’s pulse or the inspiration and expiration of breathing. That means Grashow was able to pull from his experience at Evaheart and adapt it to the respiratory system.

But there are special challenges when it comes to continuous positive airway pressure. Faces are soft and lumpy and each is different, so it’s hard to get a good seal. To make matters worse, the user isn’t in control of their position because they’re asleep, often rolling around in a semi-conscious state.

Perhaps the biggest obstacle is the fact that a lot of CPAP users don’t want to be, period. They’ve been told they need ongoing sleep therapy, which means a machine by their bedside and a mask on their head for the rest of their nights. No wonder as many as half of all people prescribed CPAP therapy don’t stick with it.

“There’s resistance, there’s fear, there’s anxiety, there’s claustrophobia, there’s embarrassment,” Grashow said. “There are so many things that people have to deal with on top of just the nuts and bolts of using the equipment.”

In looking for a solution. Grashow went back to the archives and studied old patents and medical articles. He found previous designs with a hose connecting at the top of the head, but none were able to make a usable product

“I don’t know what those people went through and why they never were able to release something, but I think the challenge was how do you really do it in a way that performs well, is easy to use and is also comfortable for the patient to wear,” Grashow said.

His answer? Philips’ DreamWear mask—first announced in late 2015 and widely available in 2016—was the first on the market without front-facing tubing; instead, it had an over-the-head hose swivel and under-the-nose cushion. A soft mask frame with airflow running through it allows users to sleep in any position and to read or watch TV in bed.

“It got so much great press, and people were just clearly so excited about it,” Grashow recalled. “I was talking to one durable medical equipment owner, and he said, ‘I don’t know what you did, but I have people coming in my door asking for this mask, and that has never happened before.’”

In its first year on the market, the DreamWear family raked in honors, including the Medtrade Providers’ Choice Gold Award, the iF Design Award and the Red Dot award. Ten million masks and cushions were sold in the first three years. That popularity changed many manufacturers’ approach to CPAP therapy, kicking off an industrial competition that still continues 10-plus years later.

But the initial idea didn’t sail through without resistance.

“I had respiratory therapists telling me, ‘This isn’t right,’” Grashow said. They told him that there needed to be pillows in the nose, that the air was traveling too far, that there would be too much carbon dioxide in the system—all concerns he considered valid and took into consideration. Grashow’s team went through multiple rounds of testing in the laboratory and on real-life users.

“It really spoke to just how radically different the design was from anything anyone had seen,” he said. “From an engineering perspective, we really took our time and broke it down into every single little thing and investigated each one of those.”

When More=Less

The new mask design kicked off a whole line of products and a new approach to mask design. As Grashow explains, it was the first time the company had designed a mask off the face using electronic and imaging technology.

They started scanning thousands of people’s faces and using the data to build new products—but discovered that trying to create small, medium and large sizes to fit on a huge number of faces posed another new challenge.

“Luckily, I work with some really talented scientists and mathematicians who pulled out some next-level analysis to help us quantify that and understand,” Grashow said. “As you and your readers know, faces don’t sort of scale up and down—they’ve got lots of different shapes, and how do you bake that into a set of sizes for a mask? That also took a lot of work.”

Today, as Grashow and his team continue to work on an ever-expanding line of masks, he sometimes has to remind himself to keep it simple in order to make the end product usable from day one.

“We can design more and more and more features into CPAP masks, right? We could put 100 straps on this thing and make it work so well—but no one would be able to use it in the real world,” he said. “So it’s always been a challenge of, ‘How can I make this mask work well for a patient who just learned about it and it’s their first night, they’re tired and they’re trying to figure out how to put it on.’”

That doesn’t mean he’s not looking for breakthroughs. Lately, he’s been ordering the high-tech models of running shoes and dissecting them to see how designers are innovating to better support and fit feet—and how that might provide inspiration for CPAP masks.

“CPAP masks are medical equipment, but they’re also a garment that someone has to wear to sleep every night,” he explained. “How do we take advantage of all the great things that people are doing to develop new things for running marathons, for example, and allow that to benefit people who are sleeping?”

Down the road, he says, sleep therapy—and medical equipment in general—is likely to be increasingly tailored to the individual.

“There are so many different types of people, and almost every person has a unique set of needs or issues that they’re dealing with, whether it’s with their sleep apnea or heart disease or cancer or whatever it is,” he said. “I really think the future that we’re moving toward is one in which the equipment is more personalized to the patient, but I also think the key is that it needs to be done in a smart way.”

Will that mean something like 3D-printed mask, custom-designed to the user’s order? Likely not, he said, given the urgent logistics of a respiratory therapist needing a mask today to fit a patient with a new prescription.

The real holy grail, he said, would be to find a cure for obstructive sleep apnea. But does that mean he’ll eventually engineer himself right out of a job?

“It would probably be great for patients’ motivation if you could say, you’re only going to be on this device for a short period of time until you don’t need it anymore,” Grashow said. “But so far, from what I’ve seen, you’ll still probably need some help from a CPAP or something like it.”

Either way, he hopes to keep working on changing lives.

“I think as engineers we tend to try to always be on the leading edge of technology. So I, as an engineer, would probably reinvent myself,” Grashow said.