Changed Machines. Lots of therapy Questions Now

[Croatoan]

Hello all. I've finally gotten the parts for the EERS and last night was my first night with the EERS. The results are not what I had hoped for but they look a bit different then the first clusters of central apneas i posted. Here's some pictures from last night. Let me know what you all think.

Thanks!
           

[Sleeprider]

Let's review your EERS fabrication. What mask, vents blocked, What length of tube was used to the expiratory vent?

[Croatoan]

Sure.

Im using the airfit f30. Ive blocked the vents around the face but not the larger silicone events that open if pressure drops (when the machine turns off). I've installed a six inch length of tubing and to that i've attached a Philips whisper swivel before connecting to the normal cpap hose.

   

[Croatoan]

If you have any suggestions for changes to the setup I'll be happy to make them before I head to sleep tonight. Otherwise I'll give it another shot as is and post more sleepyhead shots in the morning.

[Sleeprider]

No, that's fine, and it's good to block the vents but leave the antiasphixiation valve intact. You are currently using only one 6-inch section of Corr-a-Flex tube (58 mL), so we may need more sections to provide more rebreathing space.

[Croatoan]

I got your reply before i went to bed and i swapped out the 6 inch tubing for a 12 inch segment. I did get different results last night. I've rarely had an AHI below 5 in the 4+ years i've been on treatment. Its too early to say if this is a long term solution but I'm really happy with the dramatic decrease in central apneas. If you'd like for me to zoom into anything on the chart let me know. There's no really good clusters to inspect.
   

[Sleeprider]

Hey! this looks great and I hope you found what you need.  The best thing to do now is to get some baseline data with a 12-inch section, and if needed we can add the 6" back in for a total of 18".  I'll have to keep track of this thread and link to it from the wiki.  In addition to the reduction in events, take a look at your median tidal volume respiration rate and minute vent. Notice a difference?   Most people find they breathe more deeply and at the same or higher rate.  This is the effect of the rebreathing space improving respiratory drive.

Let's quickly compare your EERS with 6" vs 12" rebreathing space:
With 6: your tidal volume is 460 mL and a minute vent of 8.13, CAI of 6.6 and HAI of 2.43.  Note the uneven respiratory flow rate with lots of spikes through the night.



With 12" tube, tidal volume has increased substantially to 520 mL with minute vent at 9.13 L/min.  Respiratory rate is unchanged but CAI is a promising 1.34 and HAI is down to less than 1/hour at 0.74.  Even flow limitation is lower.

[Gideon]

After some time with 12 inches, add 1 cmw of EPR in, looking for comfort. Adding EPR in slowly because it does tend to increase CAI which we know that you are somewhat susceptible too.

[sawinglogz]

Those 12" numbers look MUCH better!

And you're right not to cover the anti-asphyxiation safety valve with putty!

Also, I can't quite tell from your picture, but it looks like you've installed the swivel valve backwards. I don't think it much matters, other than blowing air at your face instead of away from it...

[Croatoan]

Hey All,

Wanted to give an update on the therapy. Everything seems to be consistent still. Heres some of my 3 most recent nights of therapy. So far im really happy with it! It the best numbers ive gotten since i started therapy ~4 years ago.