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CPAP for inhale or exhale?
#1
CPAP for inhale or exhale?
Dumb question (?) Is positive airway pressure intended To keep the airway open during the exhale or the inhale of your breath? Or both?

I find my throat closes off more often while exhaling ... Despite being on CPAP for over a year, I don’t think I’ve ever really understood this question.
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#2
RE: CPAP for inhale or exhale?
Pressure is pressure, it will splint in either direction.  take a look at this condition, Palatal Prolapse.  Look at your waveform, note the very frequent stoppage of exhalation.  I haven't looked at your waveforms.

http://www.apneaboard.com/wiki/index.php...l_Prolapse
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#3
RE: CPAP for inhale or exhale?
(08-27-2019, 09:53 AM)allanri Wrote: Dumb question (?) Is positive airway pressure intended To keep the airway open during the exhale or the inhale of your breath? Or both?

I find my throat closes off more often while exhaling ... Despite being on CPAP for over a year, I don’t think I’ve ever really understood this question.

It's a tired old platitude, but when it comes to health, there really are no dumb questions.  Now, some of the answers might be dumb...... Too-funny 

Obstructive apnea has two sides, sometimes only one in a given patient, but it could be two: inhalation and exhalation.  

I'm a little curious; what have you used for reliable and predictable information to conclude that your throat closes off most frequently during exhalation?
Serial Tapist
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#4
RE: CPAP for inhale or exhale?
(08-27-2019, 12:06 PM)mesenteria Wrote: I'm a little curious; what have you used for reliable and predictable information to conclude that your throat closes off most frequently during exhalation?
Well, I notice it when I'm lying down, before I go to sleep.  I *seem* to have no problem with inhaling, at least while awake, but I find my throat frequently closes off when I'm exhaling; air comes out from neither my nose or mouth.  It resolves itself requiring much thought on my part, but I figured if it happens while I'm awake, it could happen while I'm sleeping.  My waveform seems to me to suggest this does in fact happen, at least if I'm interpreting the info bonjour provided a link to correctly:
   
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#5
RE: CPAP for inhale or exhale?
This would suggest to me the need for greater pressure support for the expiratory phase of my breathing ... does that make sense?
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#6
RE: CPAP for inhale or exhale?
alanri, I haven't gone back through your other threads to refresh my memory; sorry.

is the clear airway setting on (for flags; at the bottom, left I think, on daily/events tab) or are you not having any ca?

you stopped using asv and are now using an autoset for her? what's the story there?
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#7
RE: CPAP for inhale or exhale?
(08-27-2019, 02:08 PM)sheepless Wrote: alanri, I haven't gone back through your other threads to refresh my memory; sorry.  

is the clear airway setting on (for flags; at the bottom, left I think, on daily/events tab) or are you not having any ca?

you stopped using asv and are now using an autoset for her?  what's the story there?

Well, since you asked ... Wink
  • I just upgraded to Oscar, and didn't notice that CA flags was't set to "on" ... so they didn't show in any screen shots.  I've just turned it on.
  • I have been using an ASV machine for a while now, but I need to go back to CPAP, I think, for a few months, as my GP and my new sleep doctor are - as a result of a number of issues I've raised with them - paying closer attention to my treatment right now. The ASV was very good; it was only with this therapy that my AHI ever went below 3.  But I was using the machine clandestinely; my doctors didn't know about it. I'm not comfortable "coming out" about my use of ASV ... though maybe I'm just being silly. But if these two doctors (and there will soon be two more; a urologist and a neurologist) are trying to get to the heart of what's going on with me (nocturia numbness in my hands while sleeping on my side), I figure it would be best if I not stray too far from the recommendations they're making, and one of those is using fixed pressure CPAP.
  • In going back to CPAP for the near future, I am prepared to deviate from the sleep doctor's prescribed 10 cmH20 a little bit if it will get me better results.  Right now, with the pressure I was prescribed, I'm getting anywhere between 9 and 15 for my AHI each night.  I do not believe anyone has looked at my waveforms since my initial titration, which itself was a bit of a disaster; all my last doctor (he recently retired) ever did was look at AHI history.  If I am experiencing palatal prolapse, no-one seems to recognize this. So I would like to figure out if there's a way to treat this using CPAP. I'm assuming it would require higher fixed pressure ...?  I tried to use AutoSet last night, but it didn't work out very well for me:
         
    Contrast this with the previous night on ASV:
       
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#8
RE: CPAP for inhale or exhale?
the asv chart is clearly better than the for her chart. I wish I understood why docs seem reluctant to use asv for mixed apnea since it's the only machine that is designed to treat ca. let's hope they know what they're doing, there's a method to their madness and with patience they'll get you to some adequate therapy.

last I read, yrnkrn tried without success to treat palatal collapse with higher pressure. I don't remember if he had a bilevel though. seems like raising epap should help during exhalation by splinting the airway but maybe the palate and airway are affected differently.

have you given much thought to what's waking you up? taken close looks at the last few minutes of sleep sessions? nocturia may or may not be a cause; it could be coincident with something else. I'd forgotten but now you mention it, there was a while when I woke up with hands asleep. don't know why it happened and why it stopped but I haven't experienced it in a while.

the asv chart shows some clustering of h; the autoset chart shows some clustering of oa and h. I'm sure you've read about the various ways to address that. it looks like some more work in that department could help lower your ahi.

it'll be very interesting to see if you end up with asv. personally I wouldn't withhold perfectly good information from your trial with asv from your docs. it's your health and your expense (time and money, even with insurance). they might refuse to look / hear, and they might refuse to treat you if you keep it up, but you can't get in trouble for having tried asv. still, I understand the need to go along with their methods.
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#9
RE: CPAP for inhale or exhale?
One thing that stands out in several of the charts is clustering of OAs and Hs. This indicates positional apnea, probably due to chin tucking. A soft cervical collar worn just loose enough to prevent your chin tucking behind it should reduce obstructive events. It seems the ASV is the better choice for you given that most of your apneas with the autoset appear to be central.
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#10
RE: CPAP for inhale or exhale?
P.S. to my post #7 ... my  decision to go back to CPAP came about as a result of a long meeting I had with my GP yesterday about my sleep issues.   Had we not had that long conversation, I’d probably still be trying to get ASV to work.
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