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Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
#21
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
(11-19-2017, 10:58 PM)Sleepster Wrote:
(11-19-2017, 09:39 PM)Reznik Wrote: Would you also agree that, if you turn on EPR and it doesn't raise your event indices, then your CPAP without EPR should probably not have been set as high as it was in the first place?

No, I wouldn't because it doesn't work that way for me or for a lot of other people. We need the higher (inspiratory) pressure to prevent obstructive events. The exhalation pressure relief provides comfort only.

In my case, I need the lower expiratory pressure to help relieve aerophagia, but I can't set it too far below the inspiratory pressure because then it raises my CA index. But if I lower the inspiratory pressure below my titration pressure it raises my hypopnea and OA indices.

I'm referring to someone who only needs (and uses) CPAP for the control of OSA, and who is using an Airsense 10 with the Expiratory Relief Feature.  Someone who's in a more complex situation, like yours, would be using an Aircurve model, like you are.
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#22
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
(11-19-2017, 10:08 PM)Walla Walla Wrote: Reznik,
            I've never heard of increasing pressure support to erase central apnea. Could you post some before and after charts so I can see this?

Hi Walla Walla,

It'll take some time for me to find them, and then figure out how to cut, paste, and post them. 

In the meantime, you might want to read up on how ASV works.  ASV is designed specifically for CSR and associated CA.  It's primary mode of action is the real-time modulation of IPAP/Pressure Support to prevent CSR and associated CA.  You can read Resmed's explanation of it using the link below (look on page 3, and look for the words "Pressure Support increases" and "Pressure Support decreases" in the graphs):

https://www.resmed.com/us/dam/documents/...er_eng.pdf

And what did they do for CA before the introduction of ASV?  Answer:  Bi-Level.   Timed bi-level is the classic treatment for CSA (prior to ASV) because it can provoke inspiration, but spontaneous Bi-level works in some people as well, which is why you see machines now that work in ST mode.  And now that ASV has shown to be dangerous to patients with certain types of heart failure, I suspect we'll see a return to Bi-level for those types of patients.

Here's a study from 2008 which finds that Bi-pap can be effective at treating CSR and CA, when CPAP is not.  

https://www.ncbi.nlm.nih.gov/pubmed/18577818

And here's a more recent 2017 article that says the same thing...

"Some patients with nonhypercapnic central sleep apnea, such as CSB-CSA, and primary central sleep apnea have been shown to benefit from BIPAP. "  The article goes on to note that if the PS is too high, that can induce CSA as well, which I acknowledge.

https://emedicine.medscape.com/article/304967-treatment

Honestly, I don't understand why you don't believe that shoving a bunch of extra air down someone's throat could help with a disorder in which their brain forgets to breath.  To me, it just seems like common sense.  It's how ventilators work with people who are in comas, right?
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#23
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
I'd still like to see your charts.
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#24
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
(11-19-2017, 11:48 PM)Reznik Wrote: Honestly, I don't understand why you don't believe that shoving a bunch of extra air down someone's throat could help with a disorder in which their brain forgets to breath.  To me, it just seems like common sense.  It's how ventilators work with people who are in comas, right?

Actually, ventilators can do a lot of damage. Too much air is definitely not a good thing. Too much oxygen is not a good thing, either. That would be hyperventilation.

They get you off a ventilator in the hospital as soon as they can. The treatment with ASV, by contrast, is intended to be long-term, and must be sustainable.
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#25
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
Invasive vs non-invasive (ASV) ventilation. Huge difference.
Sleeprider
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#26
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
(11-20-2017, 09:33 AM)HalfAsleep Wrote:
(11-19-2017, 11:48 PM)Reznik Wrote: Honestly, I don't understand why you don't believe that shoving a bunch of extra air down someone's throat could help with a disorder in which their brain forgets to breath.  To me, it just seems like common sense.  It's how ventilators work with people who are in comas, right?

Actually, ventilators can do a lot of damage. Too much air is definitely not a good thing. Too much oxygen is not a good thing, either. That would be hyperventilation.

They get you off a ventilator in the hospital as soon as they can. The treatment with ASV, by contrast, is intended to be long-term, and must be sustainable.

Yes, too much air can be a bad thing whether invasive or not, just as not enough air can be a bad thing...
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#27
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
reznik,
            How about those charts?   Eat-popcorn
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#28
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
(11-20-2017, 04:20 PM)Walla Walla Wrote: reznik,
            How about those charts?   Eat-popcorn

See post #22.  This requires me to learn an entirely new skill, and your request is low on my list of things to do....
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#29
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
It's not that hard! I've got the links just below to show you how. You seem to have the time with all the posts you've made.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#30
RE: Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support??
Walla Walla,

This has been an interesting thread, and I don't want to have to close it.

There is no point in goading someone to post charts.  Let's just leave it be.

If anyone else has something constructive to add on the original topic, please do so.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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