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Comment by NelsonMinar | Hacker News Reader

Starlink provides a router with their ISP package. For the last year the router comes without an ethernet port. Wireless only. They've never said why but I assume it's because of a chip shortage. (There is an add-on for ethernet you can order for a modest price.)

ResMed started selling a version of their popular AirSense 10 AutoSet sleep apnea machine without a cellular modem. Normally the product uploads treatment data to some cloud service that ResMed then resells to your doctor. Again they haven't said explicitly but it sounds like they couldn't source the part they needed, so did without. (Hilariously the branding for this is "Card-to-Cloud", as in "you carry an SD card to your PC and upload the data manually to the cloud".)

I guess what bugs me is these companies are selling things with important features removed but aren't acknowledging they are lesser products.

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there is no shortage of 1000BaseT PHY and ethernet chips or you would see absolute chaos in the market of $50 to $150 home/small office routers and ethernet switches. The sort of all-in-one CPU/RAM/ethernet chip that's built into a small router like the starlink one already implements ethernet it just needs the PHY to do it

If mikrotik and ubiquiti can still source the chips to build $50 routers, which is the case, there is no extreme shortage that spacex could not handle through its own ability to find manufacturers and vendors.

The starlink v2 terminal coming with a weird proprietary copper cable interface and wifi-only-to-clients is for entirely other weird spacex related reasons.

edit: here is a photo of the starlink proprietary-connector-to-1000BaseT adapter, there is not a whole lot going on here.

https://www.reddit.com/r/Starlink/comments/rxoz16/gen_3_ethe...

Well there is shortage of PHY chips. Decent TI chips go for 50$ a piece over broker. Minimum order quantity 200 pieces. We took ancient Realtek parts for 7$ from broker. Normally it’s <4$. These are sad news from last 2 months. Regular distribution channels have zero stock with funny lead times of 1,5 years.

At the quantities and price constraints that spacex is manufacturing the low cost home router/poe injector for the v2 and v3 standard model starlink terminals, however, i don't think they have any difference in purchasing power or use of low cost PHY compared to what you'd find in like a $50 mikrotik:

https://mikrotik.com/product/hex_s

https://viva-telecom.org/images/MIKROTIK/hex-s_6.jpg

Co-incidentally, today I started looking for PHY chips for the product we're working on, and indeed, there's basically nothing available at 10/100.

>some cloud service that ResMed then resells to your doctor.

Why would they resell to the doctor, or why would the doctor be buying the info? Seems like the user should be the one charged for the data that could then be shared with their doctor. I just don't see the business sense for it being purchased by the docs unless the docs just turn around and upcharge the patient?

I should clarify I'm talking about the American system. Doctors pay for access to ResMed data. It's a convenience; otherwise the patient has to carry the SD card into the doctor's office and hope they bother to upload and analyze it. (Yes, this is stupid.)

While I'm at it, patients really interested in their sleep apnea data can use OSCAR or https://sleephq.com/ to analyze the data from the ResMed SD card themselves. These don't use the cloud service. ResMed also has a limited site for the patient themselves to see a limited version of their cloud data.

>I just don't see the business sense for it being purchased by the docs unless the docs just turn around and upcharge the patient?

Seems like you understand perfectly. The doctor is the one who can interpret the data, so they can ask their patient to come in for regular checkups and make sure everything is going great

I've commented on this before on HN. I have sleep apnea and a ResMed CPAP. A very US-centric response:

Insurance also seems to have access to this data in one way or another (not sure if direct with ResMed or via your doctor). If you don't hit your "compliance target" for treatment, insurance will cease paying 'their share' of the cost.

So I found myself in a downward spiral of 0. Struggling to sleep with sleep apnea. Tons of ramifications of not getting good sleep that I don't need to get into. 1. Struggling to adapt to sleeping with this device strapped to my face. I would take it off unconsciously.. I would often find the hose laying next to me in the morning still "pumping", or be told by my wife of belligerent (unconscious) responses to her prompting me to put it back on in the middle of the night. 2. Losing sleep from constantly waking up throughout the night because of the CPAP/from anxiety 3. Anxiety over not meeting my compliance target of 4 hours of use per night (as interpreted by the CPAP knowing the proper amount of back-pressure when in use i.e. not just turned on and not worn). 4. Getting charged more because I did not meet my targets for enough time 5. Eventually owning the CPAP outright 6. Eventually discontinuing therapy and somehow having slightly improved levels of sleep that I've never bothered to attempt to restart therapy

It took me weeks to get used to mine, but I find I do sleep better with it than without my CPAP machine. With respect to insurance, I replaced my original machine without going through insurance. It would have cost me more out of pocket for the doctor visit and on-site sleep study.

The state of health “insurance” in this country is mind-boggling. But we continue to vote for politicians that vote against our own best interests. We need more than these two f’d up parties.

We need more than these two f’d up parties.

I've said it in other threads, but these "two f'd up parties" are the expected end result of our electoral system[1]. While we very occasionally see one of the parties replaced with an upstart, the parties eventually return to a similar status quo. Grassroots movements to implement run-off elections, approval voting, or other similar plans are seeing some traction. If you really want to see change, searching for these groups locally (and volunteering or donating) might be worth the effort.

1 - https://en.wikipedia.org/wiki/Duverger%27s_law

As someone who couldn't hit compliance either, any other sleep apnea solutions that have worked for you (or others?)

(apologies about derailing into subthread)

>(apologies about derailing into subthread)

this is the natural evolution of a conversation. i feel no apology should be necessary. taking a conversation to new related directions is often where that Aha! or Eureka! moment is found.

personally, i find people that get upset and feel an apology is warranted are people i find quite boring to have a conversation with

There's a couple of sleep apnea forums that might be helpful to you; I like http://www.apneaboard.com/

Before I got my CPAP set up the one thing I found that really helped me was sleeping on an inclined pillow, up about 20 degrees. Not comfortable but helped me breathe. There are other treatments for sleep apnea if CPAP isn't working for you; some surgical options, oral appliances, fancier breathing machines. Worth talking to a sleep specialist doctor about.

Well I broke up with my long term girlfriend and complaints about my sleep apnea stopped. Not sure if this approach is viable for you, but it will solve most peoples’ sleep apnea problem (snoring annoying other people).

Other good ideas are to try one of the mouth guards or a new pillow that keeps your head/throat area sort of tight.

>Well I broke up with my long term girlfriend and complaints about my sleep apnea stopped

If we just stop testing people, the number of cases will go down.

If you turn up the radio, that weird noise the car is making will go away.

Sorry I can't be more helpful, as I have no good answer. I do have good periods and bad periods.

Though not massively overweight (26.5 BMI), better eating and fitness habits seemed to have helped. Still working on getting to a healthier shape. Depending on the type of apnea, this can help a good deal.

Less electronics/screens in the evening. No more streaming tv/video games until right before bed. Jury's still out on the effects of blue light etc but I really try to limit my electronics to a Kindle (Oasis with the warm color temp feature) before bed.

I admit I didn't try too hard with different masks/setups, that could help. Though I was mostly using one of the most comfortable "nasal pillow" interfaces already.

I will second another commenter's suggestion of a more elevated pillow setup. I use a regular pillow with a buckwheat hull pillow on top. Bad for my neck but I've slept that way for awhile and have adjusted, it's hard to go back to a "more optimal pillow height".

Here in Germany, "Mandibular advancement splint"[1] is a popular device recommended by doctors for less severe apnea cases. I was diagnosed with a light apnea and now I am getting this device as my test results showed that a CPAP treatment would be overkill but this could help. I am afraid I can't share more experiences as I am waiting the device to be prepared after 2 hours of dentist visit where they took some measurements.

[1] https://en.wikipedia.org/wiki/Mandibular_advancement_splint

For me, it's a combination of always ensuring my sinuses stay open and proper head placement for the mask to stay tight. Google "ayr gel" - I use the gel specifically. In dry periods or for congestion, that seems to (often) be enough to keep my sinuses open. For my current cpap mask I have to lay flat with no pillows for a proper fit. Then there's all the sleep hygiene stuff - no lights, proper bedroom temperature (cold), etc. (No lights means no lights - not even reflections from hall lights or the indicator lights from electronics can be tolerated.)

I'm so sorry you've gone through this, that sounds miserable. When you feel up for it I hope you can seek treatment again.

For context for other readers: the cost of one of these machines is about $800. That's a very small amount of money, often less than a single month's insurance premium. And for that the insurance companies turn medical treatment devices into anxiety-inducing spy machines. It's hideous.

> 800 […] That's a very small amount of money, often less than a single month's insurance premium.

Jesus fucking christ, what the fuck ?! How much does health insurance cost in the US ?

I pay ~$500/month for "pretty good" health insurance, and my employer pays roughly the same (a "benefit" that the employer pays 'half'! /s )

And then you have to pay small fees when you go visit a doctor ($25-ish each time), pay for medications (expensive). Emergency room swipes your credit card before a doctor even sees you ($150 co-pay for my plan). Pay thousands for an MRI (that the insurance company has graciously negotiated down 95%!)

"thousands for an MRI"

MDSave.

I got a brain MRI for ~$450.

Prices vary widely and many Americans have no idea because their employer pays it.

You can shop California's market yourself; try 94114 for San Francisco. https://www.coveredca.com/

For a 30 year old it's $400 to $1100 a month depending on coverage level. A mediocre "Silver" plan is $400 at age 20 to $1060 at age 65, at which point you qualify for nationalized healthcare.

Is this really the first time on the internet that you've encountered a discussion about US healthcare costs?

I am American, and that sounds really high.

Healthcare cost, no, but monthly insurance cost, yes.

$800 per months plus out of pocket sums for each appointment is batshit insane.

Plus, loosing it when you loose your job is even more difficult. I think I finally understand why every Michael Bay movie is starting with a surprise medical bill. I always thought it was somewhat silly.

To give you a example, I pay 75€ per months for the entire family, and we don't have to pay anything when going to the doctor.

I have been having enough difficulty I've actually tried to restart in recent times. Vicious cycle of allergies and sleep deprivation make it hard to continue certain times of the year.

It was a lesson to be learned, I was unaware when starting treatment that you could buy one outright. Being a 60601 medical device I thought I had to just go along for the ride...

If you haven't already, take a look at the Phillips Dreamwear. It is the least uncomfortable CPAP mask.

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