RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
Regarding condensation, other users have found a hose cover over the EERS is needed. Leave the vent uncovered, but protect the EERS tube from exposure to cool air. It has less to do with humidity settings, than the moisture content of warm expired air that used to pass from the mask vents, and is now in the EERS tube downstream of the whisper swivel from the CPAP. This moisture laden air will easily condense, but is also part of the reason you can afford to reduce the humidity setting at the CPAP.
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
(11-29-2019, 10:15 AM)slowriter Wrote: (11-29-2019, 09:59 AM)sherwoga Wrote: Output variables obvious for consideration to be included in that record are:
- CA event index
- Total CA Events
- OA event index
- Total OA events
- Tidal Volume (one or more of Median, 95%, and Maximum)
Do you think you would want all of these and/or others? For example, some attempt to characterize Flow Limits, RERA events, Hypopnea Events, Undeclared Events.....
If we're just trying to assess impact of EERS (before moving on to other aspects that impact your sleep quality), I think (and hope bonjour will correct or confirm) you want to track median TV, MV, RR. So I'd add the latter two. I assume by RR your mean Respiration Rate. If so, there are still four possibilities. Median, 95%, Max, and some kind of a qualitative assessment of the Resp.Rate graph. Don't know exactly how I would do the latter.
11-29-2019, 11:20 AM
(This post was last modified: 11-29-2019, 11:20 AM by slowriter.)
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
(11-29-2019, 11:08 AM)sherwoga Wrote: (11-29-2019, 10:15 AM)slowriter Wrote: (11-29-2019, 09:59 AM)sherwoga Wrote: Output variables obvious for consideration to be included in that record are:
- CA event index
- Total CA Events
- OA event index
- Total OA events
- Tidal Volume (one or more of Median, 95%, and Maximum)
Do you think you would want all of these and/or others? For example, some attempt to characterize Flow Limits, RERA events, Hypopnea Events, Undeclared Events.....
If we're just trying to assess impact of EERS (before moving on to other aspects that impact your sleep quality), I think (and hope bonjour will correct or confirm) you want to track median TV, MV, RR. So I'd add the latter two. I assume by RR your mean Respiration Rate. If so, there are still four possibilities. Median, 95%, Max, and some kind of a qualitative assessment of the Resp.Rate graph. Don't know exactly how I would do the latter.
Right: I did specify "median" (though I recognize that sentence may have been ambiguous).
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
I will defer to your design of experiment experience.
Comments: for new users a 'titration' will be followed which will be a progression of low to high rebreathing volume consisting of 6, 12, then 18 inch EERS extensions. So 6 inches has a good deal of importance because most users going to EERS will at least start there. Thus I would appreciate data here. Filling in after the initial tests is fine with me.
Respiration charts and variables because we saw some notable change
Output variables:
CA event Index
OA event Index
AHI (over all Index)
No need for event totals as they are meaningless without time duration
Tidal Volume - Median/average/ something that is statistically valid
Minute Volume - as above
Respiration Rate - as above
OSCAR charts of the data, including Left margin with settings and stats minus pie and calendar
Events, Flow Rate, Tidal Volume, Minute Volume, Respiration Rate (for detailed breathing overview)
page 2
Events, Flow Rate, Flow Limits, Mask Pressure, Leak Rate, Snores (for context and completeness)
I see no needs for Mins and max, and little for 95%
Humidification and rain out should be not important to the therapeutic effects of EERS, but need to be managed as SleepRider has suggested. I had not considered the fact that exhaled air would be quite humid and causing potential rainout.
This experiment is about the control and management of Central Apnea Events so the concentration of effort is there, The EPR is about demonstrating that EPR and be increased to treat obstructive events with little to no impact/change from central events. Flow Limits, RERA events, Hypopnea Events, Undeclared Events and be noted in observations.
On Max Pressure, I'd set it =18 or 20.
Bathroom Trips are pretty normal for this community, I would tend not to be too worried about them.
I really appreciate your willingness to do this.
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
One more thing. Min pressures need to change along with EPR as follows to keep a constant EPAP. EPAP = Min Pressure - EPR.
This will keep it more apples to apples.
Min Pressure = 5, EPR = 0, EPAP = 5
Min Pressure = 6, EPR = 1, EPAP = 5
Min Pressure = 7, EPR = 2, EPAP = 5
Min Pressure = 8, EPR = 3, EPAP = 5
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
(11-29-2019, 03:19 PM)bonjour Wrote: One more thing. Min pressures need to change along with EPR as follows to keep a constant EPAP. EPAP = Min Pressure - EPR.
This will keep it more apples to apples.
Min Pressure = 5, EPR = 0, EPAP = 5
Min Pressure = 6, EPR = 1, EPAP = 5
Min Pressure = 7, EPR = 2, EPAP = 5
Min Pressure = 8, EPR = 3, EPAP = 5 Four Issues:
Issue 1
I think I understand what you are saying and can see how to set up the design. This could as you say, keep data comparable and I appreciate that refining input. But it also sets up CPAP conditions for which I have no experience. This potentially could cause me to fall off a cliff, i.e. cause me to enter a treatment domain where the treatment just doesn't work as expected. I don't want that to happen in a randomized collection plan after having already collected several nights of data. (Randomization of the combination order is important to generate the most meaningful statistics.)
So what I will do is set up the first two nights of data collection to fall at the extremes of the EPR(Min Pressure), ERRS combinations of 0(5),0 and 3(8),18. I have zero experience (in over 2 years of use) setting the Min Pressure below 8. If all goes well in the first two nights (particularly the first of the two combinations), forcing the first two nights at these combinations does mean the program won't be entirely random, but only in a minimal way. The other 10 combinations that will make up the 12 nights of data collection will be random.
Issue 2
Your list of output variables from your first response included:
Quote:Output variables:
CA event Index
OA event Index
AHI (over all Index)
No need for event totals as they are meaningless without time duration
Tidal Volume - Median/average/ something that is statistically valid
Minute Volume - as above
Respiration Rate - as above
OSCAR charts of the data, including Left margin with settings and stats minus pie and calendar
Events, Flow Rate, Tidal Volume, Minute Volume, Respiration Rate (for detailed breathing overview)
page 2
Events, Flow Rate, Flow Limits, Mask Pressure, Leak Rate, Snores (for context and completeness)
As far as I've determined, OSCAR does not report the averages for any of the outputs, but does report the medians. Am I missing something? The medians should be meaningful statistically, but I would prefer averages. Can they be extracted?
Issue 3
Supplying the charts as defined is doable; however, the statistical analysis can only be applied to variables with discreet numerical values. But I don't object to supplying the charts as having another pair of eyes (especially experienced eyes) looking at the charts will help me avoid making mistakes or missing important observations outside of the original set of outputs. Is there a limit to the total number of these charts I can have displayed in my forum account at any one time? If so, I would have to find an alternative way to share that much data. I guess I need more definition from you about what you want. I should think sharing the original raw data files would be preferable to sharing the divided screen shots. While I have gotten a bit better at using the tools available in OSCAR for screen shot sharing, posting pictures, and referencing earlier posts, I have not yet solved my problems sharing the original raw data files. Will I have to?
Issue 4
I will set up my Design and Data Collection Plan in an Excel workbook. I could share the same with you so that you could monitor the project. I would have to be able to send you a link and you would have to have Excel running on your computer. You would be opening the file from my Cloud account and you will not have to have anything but the link and a functional version of the Excel software. I could probably send the link to you in a PM. Do you have access to Excel? Would this help?
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
(11-29-2019, 04:31 PM)sherwoga Wrote: (11-29-2019, 03:19 PM)bonjour Wrote: One more thing. Min pressures need to change along with EPR as follows to keep a constant EPAP. EPAP = Min Pressure - EPR.
This will keep it more apples to apples.
Min Pressure = 5, EPR = 0, EPAP = 5
Min Pressure = 6, EPR = 1, EPAP = 5
Min Pressure = 7, EPR = 2, EPAP = 5
Min Pressure = 8, EPR = 3, EPAP = 5 Four Issues:
Issue 1
I think I understand what you are saying and can see how to set up the design. This could as you say, keep data comparable and I appreciate that refining input. But it also sets up CPAP conditions for which I have no experience. This potentially could cause me to fall off a cliff, i.e. cause me to enter a treatment domain where the treatment just doesn't work as expected. I don't want that to happen in a randomized collection plan after having already collected several nights of data. (Randomization of the combination order is important to generate the most meaningful statistics.)
If I understand right, bonjour is just saying you want to keep EPAP constant, whatever you do; it doesn't have to be that precise min pressure setting range. This would also keep EPAP constant:
Min Pressure = 8, EPR = 0, EPAP = 8
Min Pressure = 9, EPR = 1, EPAP = 8
Min Pressure = 10, EPR = 2, EPAP = 8
Min Pressure = 11, EPR = 3, EPAP = 8
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
(11-29-2019, 04:57 PM)slowriter Wrote: (11-29-2019, 04:31 PM)sherwoga Wrote: (11-29-2019, 03:19 PM)bonjour Wrote: One more thing. Min pressures need to change along with EPR as follows to keep a constant EPAP. EPAP = Min Pressure - EPR.
This will keep it more apples to apples.
Min Pressure = 5, EPR = 0, EPAP = 5
Min Pressure = 6, EPR = 1, EPAP = 5
Min Pressure = 7, EPR = 2, EPAP = 5
Min Pressure = 8, EPR = 3, EPAP = 5 Four Issues:
Issue 1
I think I understand what you are saying and can see how to set up the design. This could as you say, keep data comparable and I appreciate that refining input. But it also sets up CPAP conditions for which I have no experience. This potentially could cause me to fall off a cliff, i.e. cause me to enter a treatment domain where the treatment just doesn't work as expected. I don't want that to happen in a randomized collection plan after having already collected several nights of data. (Randomization of the combination order is important to generate the most meaningful statistics.)
If I understand right, bonjour is just saying you want to keep EPAP constant, whatever you do; it doesn't have to be that precise min pressure setting range. This would also keep EPAP constant:
Min Pressure = 8, EPR = 0, EPAP = 8
Min Pressure = 9, EPR = 1, EPAP = 8
Min Pressure = 10, EPR = 2, EPAP = 8
Min Pressure = 11, EPR = 3, EPAP = 8 Good point. We'll see if Bonjour agrees. If so, that might allow me to stay within the treatment domain for which I have some experience.
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
The chart you posted 23 Nov shows a min pressure of 8, EPR = 3, EPAP = 5. This means I chose this because it is a thearaputic range you are currently using. The proposed values, EPAP =8, are 3 cmw higher than you are currently using. Look
I figured to center around that. And yes the important part is the constant EPAP. EPAP is the pressure that manages obstructive apnea
I don't want this to go where you are uncomfortable either in range of pressure or physically.
Randomized order, as I said I defer your expertize there.
RE: Fabrication of an Enhanced Expiratory Rebreathing Space (EERS)
Issue 2: means vs average. You are right. I sure Averages could be calculated, but they are not currently. L
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