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EERS Experiment Data (sherwoga)
#31
RE: [split] EERS Experiment Data (sherwoga)
The high median tidal volume for the EERS nights might be concerning. You have obvious flow limitation which gets worse when you increase min pressure (the worse charts are on the nights you increase min pressure). You also have some periods of shallow breathing. Do you mouth breath or sleep on your back?

These charts are only from EPR 3 nights.
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Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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#32
RE: [split] EERS Experiment Data (sherwoga)
(12-04-2019, 01:51 PM)JoeyWallaby Wrote: The high median tidal volume for the EERS nights might be concerning. You have obvious flow limitation which gets worse when you increase min pressure (the worse charts are on the nights you increase min pressure). You also have some periods of shallow breathing. Do you mouth breath or sleep on your back?

I'm aware that Tidal Volume might be an issue, but I don't yet know what makes it an issue.  Tonight will be the first time I will have used any EERS at a min pressure below 8.  Tonight min pressure will be 5, EPR will be off or at 0, and the EERS will be 18 inches long.  Will lower min pressure exacerbate your concerns about Tidal Volume?

I often start out trying to sleep on my back, but invariably move to my side.  And it usually happens before drifting off as sleep doesn't come easily when I'm on my back.  I do return from the bathroom trip in the middle of the night and sometimes spend a long time asleep on my back.  If shallow breathing is occuring between about 12 midnight and 4 AM, it might reflect that sleeping position.  

I use a dental appliance every night that draws my lower jaw forward.  

Before I started using the same, initial use of nasal mask failed because of mouth breathing not solved with a chin strap. 

Initial use of full face mask also failed because even with a chin strap the pressures were great enough to inflate my cheeks and eventually cause flow of air through my open mouth back into the face mask.  (I didn't understand that phenomenon then and still don't because I couldn't see where the pressure differential was.)  I knew this was happening because I observed it while awake and happening while asleep because I would awaken with very, very dry mouth tissues, so dry my mouth hurt. My dry mouth became the reason for my arousal.  

Initial use of the dental appliance was similar.  I went back to the dentist that recommended and made this appliance and asked him to install additional posts located so as to allow additional elastic bands to hold the two piece of the appliance together vertically.  I no longer (and this is for over a year) am a mouth breather.  The appliance isn't terribly comfortable, but I'm used to it.  It was designed to help with OSA, but now it does both that and holds my mouth closed.  

I feel most nights by the time I put the dental appliance in my mouth, mount an oximeter on my wrist and finger, and put on my CPAP mask (which now can include the EERS with it's quilted wrap) that I am properly armored to do my "KNIGHTLY" battle to get some sleep.  


Why your focus on shallow breathing?  I'm still very much a novice at this!
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#33
RE: [split] EERS Experiment Data (sherwoga)
(12-04-2019, 02:44 PM)sherwoga Wrote:
(12-04-2019, 01:51 PM)JoeyWallaby Wrote: The high median tidal volume for the EERS nights might be concerning. You have obvious flow limitation which gets worse when you increase min pressure (the worse charts are on the nights you increase min pressure). You also have some periods of shallow breathing. Do you mouth breath or sleep on your back?

I'm aware that Tidal Volume might be an issue, but I don't yet know what makes it an issue.  Tonight will be the first time I will have used any EERS at a min pressure below 8.  Tonight min pressure will be 5, EPR will be off or at 0, and the EERS will be 18 inches long.  Will lower min pressure exacerbate your concerns about Tidal Volume?

Did you say this is the last night to test?

I'm curious what the data will show.

My guess is the additional deadspace will more-or-less be offset by the lower pressure, so that your TV may actually decline.

I'm not sure what the plan is with this thread. I can imagine it just focuses on the experimental data itself, and the implications for your therapy in another thread?

My hypothesis is that titrating EERS deadspace volume would be a balance between lowering CAs and raising TV, and that you don't want too much deadspace because you don't want too much TV.

Obviously you'd want some input from bonjour, sleeprider, etc. on the latter; should include a discussion of how one knows when TV is too high.
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#34
RE: [split] EERS Experiment Data (sherwoga)
(12-04-2019, 03:06 PM)slowriter Wrote:
(12-04-2019, 02:44 PM)sherwoga Wrote:
(12-04-2019, 01:51 PM)JoeyWallaby Wrote: The high median tidal volume for the EERS nights might be concerning. You have obvious flow limitation which gets worse when you increase min pressure (the worse charts are on the nights you increase min pressure). You also have some periods of shallow breathing. Do you mouth breath or sleep on your back?

... Will lower min pressure exacerbate your concerns about Tidal Volume?
My comments/answers inserted directly into the quote of your post in bold.

Did you say this is the last night to test? No.  Tonight is run number 6 of what will be 12 runs.  Four combinations by 3 replications leads to 12 runs.  I will have statistics (minimal) for each combination of the EPR/EERS settings.

I'm curious what the data will show. Me, too!

My guess is the additional deadspace will more-or-less be offset by the lower pressure, so that your TV may actually decline.

I'm not sure what the plan is with this thread. I can imagine it just focuses on the experimental data itself, and the implications for your therapy in another thread? I think Fred wanted this split to be just for data, but the interest in and discussion of my data has been useful to me.  I am keeping the data in a Word Document that I plan to post in some appropriate (to be determined) place and in some appropriate (to be determined) format.  

My hypothesis is that titrating EERS deadspace volume would be a balance between lowering CAs and raising TV, and that you don't want too much deadspace because you don't want too much TV. I have been asked by Fred to plan on testing setting combinations that fall between those I'm using in these 12 runs.  Doing so would be part of any designed experiment anyway.  So titrating EERS deadspace is a part of the long term plan.  

Obviously you'd want some input from bonjour, sleeprider, etc. on the latter; should include a discussion of how one knows when TV is too high.  I'm completely in the dark at this point regarding implications of high TV. So yes, I need input.
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#35
RE: [split] EERS Experiment Data (sherwoga)
(12-04-2019, 02:44 PM)sherwoga Wrote: I'm aware that Tidal Volume might be an issue, but I don't yet know what makes it an issue.  Tonight will be the first time I will have used any EERS at a min pressure below 8.  Tonight min pressure will be 5, EPR will be off or at 0, and the EERS will be 18 inches long.  Will lower min pressure exacerbate your concerns about Tidal Volume?

I often start out trying to sleep on my back, but invariably move to my side.  And it usually happens before drifting off as sleep doesn't come easily when I'm on my back.  I do return from the bathroom trip in the middle of the night and sometimes spend a long time asleep on my back.  If shallow breathing is occuring between about 12 midnight and 4 AM, it might reflect that sleeping position.  

I use a dental appliance every night that draws my lower jaw forward.  

Before I started using the same, initial use of nasal mask failed because of mouth breathing not solved with a chin strap. 

Initial use of full face mask also failed because even with a chin strap the pressures were great enough to inflate my cheeks and eventually cause flow of air through my open mouth back into the face mask.  (I didn't understand that phenomenon then and still don't because I couldn't see where the pressure differential was.)  I knew this was happening because I observed it while awake and happening while asleep because I would awaken with very, very dry mouth tissues, so dry my mouth hurt. My dry mouth became the reason for my arousal.  

Initial use of the dental appliance was similar.  I went back to the dentist that recommended and made this appliance and asked him to install additional posts located so as to allow additional elastic bands to hold the two piece of the appliance together vertically.  I no longer (and this is for over a year) am a mouth breather.  The appliance isn't terribly comfortable, but I'm used to it.  It was designed to help with OSA, but now it does both that and holds my mouth closed.  

I feel most nights by the time I put the dental appliance in my mouth, mount an oximeter on my wrist and finger, and put on my CPAP mask (which now can include the EERS with it's quilted wrap) that I am properly armored to do my "KNIGHTLY" battle to get some sleep.  
It's interesting that you're using a MAD and CPAP at the same time. 

Let me explain how EERS works. It increases the amount of CO2 rebreathed, increasing CO2 levels which increases respiratory drive. This will increase tidal volume, reduce hypocapnia-induced CAs and maybe increase SPo2. Last night you had no CAs marked in the whole seven hour night and already have a high tidal volume. Increasing EERS further would be interesting experimentally but I don't see how it would help you.

These are the charts from last night. While some parts are OK, it's mostly bad. Look at the mask pressure chart compared to the flow rate. Despite the mask pressure increasing when you breathe in, the top of your inspiratory curve plateaus which indicates flow limitation (or it has the weird jagged look). This is more obvious in the last three images where I haven't messed with the Y-value settings.

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Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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#36
RE: [split] EERS Experiment Data (sherwoga)
(12-04-2019, 03:47 PM)JoeyWallaby Wrote:
(12-04-2019, 02:44 PM)sherwoga Wrote: I'm aware that Tidal Volume might be an issue, but I don't yet know what makes it an issue.  Tonight will be the first time I will have used any EERS at a min pressure below 8.  Tonight min pressure will be 5, EPR will be off or at 0, and the EERS will be 18 inches long.  Will lower min pressure exacerbate your concerns about Tidal Volume?

I often start out trying to sleep on my back, but invariably move to my side.  And it usually happens before drifting off as sleep doesn't come easily when I'm on my back.  I do return from the bathroom trip in the middle of the night and sometimes spend a long time asleep on my back.  If shallow breathing is occuring between about 12 midnight and 4 AM, it might reflect that sleeping position.  

I use a dental appliance every night that draws my lower jaw forward.  

....
My comments inserted in bold in the quote of your last post.

It's interesting that you're using a MAD and CPAP at the same time. 
CPAP initially appeared, based on AHI numbers only (that's all I was getting feedback on), to NOT be working.  I went to the dentist to get an alternative therapy approach that has now turned into an adjunct therapy.  (In the US, Medicare would not pay for both CPAP and MAD.  The MAD cost me out-of-pocket US$2,500.00).  Now I believe that the AHI numbers were probably inflated by CA events, perhaps induced by the treatment and perhaps having been there all along.  If I use the MAD alone, I don't get any feedback on sleep performance except for how I feel.  At some point I will test using the CPAP alone, but that is one too many variables for now.  

Let me explain how EERS works. It increases the amount of CO2 rebreathed, increasing CO2 levels which increases respiratory drive. I understand the explanation up to this point and could have written it myself, but perhaps not so concisely.  This will increase tidal volume why?, reduce hypocapnia-induced CAs and maybe increase SPo2. I do wear the oximeter and the record last night was one of the best I've seen.  I can share the output, but I don't know how to directly interface it with OSCAR output. I don't think I can.   Last night you had no CAs marked in the whole seven hour night and already have a high tidal volume. Increasing EERS further would be interesting experimentally but I don't see how it would help you. It is not my intent to increase EERS volume further, but to test it at 6 and 12 inches after the designed experiment is complete.  

These are the charts from last night. While some parts are OK, it's mostly bad. Look at the mask pressure chart compared to the flow rate. Despite the mask pressure increasing when you breathe in, the top of your inspiratory curve plateaus which indicates flow limitation (or it has the weird jagged look). This is more obvious in the last three images where I haven't messed with the Y-value settings. Your explanation of what can be seen in the graphs is appreciated as is the effort you put into assembling those graphs, but you are making some mental jumps that I'm not keeping up with.  The paper Slowriter put me onto yesterday helped me understand a lot about the flow rate patterns.  But relation to mask pressure is still a question for me.  

See bold inserts.
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#37
RE: [split] EERS Experiment Data (sherwoga)
I think the increased respiratory drive increases tidal volume. Everybody that has tried EERS and posted data that I've seen, had increased tidal volume (including myself and you).

Basically your flow limitation problem is because you have resistance in your upper airway when you breathe in (likely caused by airway anatomy), this resistance can be overcome by additional IPAP pressure. IPAP is the pressure when you inhale, EPAP is the pressure when you exhale. The difference between those two values is set by EPR on your machine to a maximum of 3 and PS (pressure support) on BiLevel machines which can go far past 3. EPR and PS are very similar.

You can increase the min pressure (IPAP) on your machine but since EPR maximum is 3, your EPAP will be IPAP-EPR (for example min pressure is 10, EPR is 3, 10-3, EPAP is 7). Basically, if you want more IPAP (which you do), you need more EPAP (which you may not, as too high of an EPAP can cause various issues) with your current machine.

This first image is your data from last night, second image is mine. My PS is a lot higher than yours (5.4 vs 3), look at how despite increasing mask pressure, your flow rate doesn't increase. Whereas in my chart, it matches pretty well.
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Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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#38
EERS Experiment Data - Seq #6 Design #11
12/04/2019 EPR(Min Pressure),EERS pair = 0(5),18 Sequence #6 Design #11

           

See Link for Raw Data.  [I'm still learning about sharing my files.  If you can't see data for 12/4/2019 and want to, please advise and I will investigate/fix.]

SD Flash Card

My initial observations:
  • Slowriter was right in his speculation that Tidal Volume might come down.  But I was aware several times in the night of very deep breathing.  It was almost like working at it.  
  • Flow limitations are perhaps the worst I've ever seen, but still only 1 CA event.  I'd appreciate other's articulation of what this means.
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#39
RE: EERS Experiment Data - Seq #6 Design #11
(12-05-2019, 06:57 AM)sherwoga Wrote: My initial observations:
  • Slowriter was right in his speculation that Tidal Volume might come down.  But I was aware several times in the night of very deep breathing.  It was almost like working at it.  
  • Flow limitations are perhaps the worst I've ever seen, but still only 1 CA event.  I'd appreciate other's articulation of what this means.

I think that makes total sense.

The EERS is addressing the CAs, but such a low pressure without EPR is going to expose the kind of FLs that we'd expect.

This is the benefit of EERS: since it basically eliminates the CAs, you then have the flexibility to treat those FLs with either max EPR or, maybe more likely, bilevel pressure support.

Not sure about the deep breathing. That may be the thing that's increasing the TV so much? I assume EERS of 18 is too much.
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#40
RE: EERS Experiment Data (sherwoga)
Yes, flow limitations are bad.
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Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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