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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
Very impressive. I will link to this from the wiki http://www.apneaboard.com/wiki/index.php...ace_(EERS)

Not only is tidal volume significantly higher, but there is a significant increase in minute vent. We often look for a means to increase minute vent, but normally an increase in tidal volume is offset by a decrease in respiration rate which cancels out any benefit. In this case the respiration drops slightly, but minute vent is higher. That is a nice reduction in CA events as well. Are the therapy breaks a result of the EERS or something else? What is the Sleep Stage chart showing here? I am not familiar with this.
Sleeprider
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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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RE: UARS and APAP
(10-23-2019, 08:50 AM)Sleeprider Wrote: Very impressive.  I will link to this from the wiki http://www.apneaboard.com/wiki/index.php...ace_(EERS)

Not only is tidal volume significantly higher, but there is a significant increase in minute vent.  We often look for a means to increase minute vent, but normally an increase in tidal volume is offset by a decrease in respiration rate which cancels out any benefit.  In this case the respiration drops slightly, but minute vent is higher.  That is a nice reduction in CA events as well.  

So are you saying those respiration numbers indicate, on balance, an improvement? 600 median TV should be better than 480 or 500?

I know TV is related to body size/height. I'm a 6' male.

I don't really understand this area yet.

(10-23-2019, 08:50 AM)Sleeprider Wrote: Are the therapy breaks a result of the EERS or something else?

I don't know. My guess is it's just a random not-great night, but could be related to higher pressure, etc. I was thinking to lower PS again to see, but that may depend on your response to my first question.

I didn't perceive much difference subjectively using EERS.

(10-23-2019, 08:50 AM)Sleeprider Wrote: What is the Sleep Stage chart showing here? I am not familiar with this.

I'm using the Dreem 2 headband (which has EEG sensors which they use to generate the hypnogram), and converting it's CSV data to the Zeo format, which I'm then importing into OSCAR. There's some linked code to do that in this thread.

http://www.apneaboard.com/forums/Thread-...2-CSV-data

PS: in OSCAR, 1=wake, 2=REM, 3=light, 4=Deep
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RE: UARS and APAP
I think what is significant in your results is that tidal volume is not only higher, but thanks to EERS, your respiration rate was not suppressed with higher tidal volume, thereby resulting in higher minute vent. This is a real gain in ventilation without the complication of CA. If the hypothesis that EERS can result in significant increases in ventilation across a larger cohort of individuals and found to be a positive correlation, this could be a valuable tool in treating individuals with low respiratory volumes and/or respiration rates. I suspect people with UARS or even COPD could benefit from such a study. It's a very interesting outcome if it is not simply coincidental.
Sleeprider
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____________________________________________
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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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RE: UARS and APAP
Alright, I'll give it another go tonight or tomorrow night and see if there's a trend there, and if my not-great night was correlated, or a fluke.
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RE: UARS and APAP
(10-23-2019, 08:35 AM)slowriter Wrote: One notable difference in comparison to past few days (aside from waking up more) is higher median TV (usually it's 500, or just under). I assume that's actually not helpful?

What is potentially awesome about finding a way to increase Tidal Volume is finding another dial that people might be able to turn to tune / dial in their therapy.  

Multiple xPAP benchmark papers report that all xPAP brands struggle with measuring and reporting Tidal Volume accurately.  It may just be the VAuto is now sensing different pressures on exhale and inaccurately reporting a change in Tidal Volume.   Or there may be a Tidal Volume change (which is the answer we hope is true).

A good few tests would be with people who have low tidal volume and also nightly average SpO2 lower than they want.   If five of these folks tested EERS and all saw SpO2 improvement and Tidal Volume increase that would signify we might be on to something. 


Where did you locate the parts?  

WillSleep

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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RE: UARS and APAP
(10-23-2019, 01:44 PM)WillSleep Wrote:
(10-23-2019, 08:35 AM)slowriter Wrote: One notable difference in comparison to past few days (aside from waking up more) is higher median TV (usually it's 500, or just under). I assume that's actually not helpful?

What is potentially awesome about finding a way to increase Tidal Volume is finding another dial that people might be able to turn to tune / dial in their therapy.  

Multiple xPAP benchmark papers report that all xPAP brands struggle with measuring and reporting Tidal Volume accurately.  It may just be the VAuto is now sensing different pressures on exhale and inaccurately reporting a change in Tidal Volume.   Or there may be a Tidal Volume change (which is the answer we hope is true).

A good few tests would be with people who have low tidal volume and also nightly average SpO2 lower than they want.   If five of these folks tested EERS and all saw SpO2 improvement and Tidal Volume increase that would signify we might be on to something. 


Where did you locate the parts?  

The interesting thing is, when I first tested it while awake and watching TV, my spo2 rose a few percentage points.

The main part you need is the "Philips Respironics Whisper Swivel II Exhalation Port," which is widely available. I think I got it off eBay.
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RE: UARS and APAP
(10-23-2019, 01:53 PM)slowriter Wrote: 1) The main part you need is the "Philips Respironics Whisper Swivel II Exhalation Port," which is widely available. I think I got it off eBay.

2) The interesting thing is, when I first tested it while awake and watching TV, my spo2 rose a few percentage points.

1) Thanks!


2) Excellent!  Nice.  Good point.  Anyone/everyone who could see SpO2 rise and fall in A/B testing could contribute to the testing process.  

I have an itching to join you in that. 

I am a bold BioHacker & seasoned Innovator but with a process and safety streak so I have not explored attempting to adjust CO2 at the mask because I have not found a way to baseline and measure change in CO2.  

Have you found or seen any reasonable home lab ETCO2 monitoring and Capnography analysis solution?   

WillSleep

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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RE: UARS and APAP
(10-23-2019, 02:26 PM)WillSleep Wrote: Have you found or seen any reasonable home lab ETCO2 monitoring and Capnography analysis solution?   

No. I just use a Garmin vivosmart band for this. I don't care too much about extreme accuracy, so much as whether it can measure relative change.
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RE: UARS and APAP
(10-23-2019, 09:08 AM)slowriter Wrote: So are you saying those respiration numbers indicate, on balance, an improvement? 600 median TV should be better than 480 or 500?

I know TV is related to body size/height. I'm a 6' male.
 


When I started typing this reply I had no idea it would get this long.   Well it is here now.  I hope you find it of some value.   Lol.  

At 6' tall a median Minute Volume of 9.13 and median Tidal Volume of 600mL on an ongoing basis are considered undesirably high and puts you at higher risk of Ventilator Induced Lung Injury (VILI).  

So what should Minute Ventilation and Tidal Volume be?

Theoretically attaining, monitoring and maintaining of balance of ideal SpO2 and ETCO2 levels would be the method to determine the exact proper Minute Ventilation needs for each person.  

In the absence of a means to measure ETCO2 we assume general 'normals' until we learn a reason to deviate.  

Normal Tidal Volume for a 6' male:
A generally accepted default goal TV seems to 6mL/Kg * Predicted Body Weight (PBW).    

For in hospital ventilation and long term xPAPs the most common current view I see is for a Protective Lung Ventilation strategy using Minute Ventilation of 6mL/Kg per minute for health people, and sometimes 4mL/Kg for restricted lung patients and examples even down to 2mL/Kg + 100% Oxygen for use during surgeries where TV is set very low to keep reduce lung movement.  

Below is a handy dandy table to identify your Predicted Body Weight and recommended Tidal Volume at 6mL/Kg.   I really like this version of the table because it up top it includes a nicely simple presentation of the ARDSNet Ventilation implementation protocol.  Step by step.  Those steps do not directly tie to home xPAP use and in no way replace any of the existing titration guides.  I like visibility of the ARDSNet protocol as a tool to better understand the overall dynamics of what we are trying to achieve.    

At 6' tall your PBW is 78 Kg and your ideal Low Tidal Volume Lung Protective value that provides for a healthy balance of both enough not too much airflow is 466mL (TV=466mL/breath).

[attachment=16470]  ... for some reason the cool handy-dandy Predicted Body Weight & Tidal Volume lookup table attachment appears at the bottom of the message.


Normal Minute Ventilation for a 6' male:   MV = Reps Rate * Tidal Volume 
Most often I see 6L/min listed at the norm for health patients and the acceptable population range 5-8L/min.  The common printed example is (TV=500mL) * (RR=12) = 6L/min.    

At the expected norm of 12 breaths per minute this gives you baseline target sleeping Minute Ventilation of 5.6L/min (12 breaths a min * TV of 466ml).    

If a Minute Vent of 5.6L/min seems a bit low that is because it is.   The HHS/NIH and ARDSNet protocols are published with expected short term, 28 days of use.  It is accepted that these recommended TV values are known to not be enough volume to flush out enough CO2 for long term use.   

Ok, so what should is my ideal Minute Ventilation Value:
 
We know some studies report an average healthy ~35 year old male has a Tidal Volume at rest during the day of 7.3L/min and at night 7.15L/min.  So if I was 6' tall to create my real MV target I would personally just adopt the 466mL per breath as the Tidal Volume currently recommended as the best number/value to protect and preserve my pulmonary system and mate it to my rough average Respiratory Rate of 15.   

This will give me a baseline ideal of Minute Volume of 7 L/min (MV 6.99L/min = (RR 15bpm * TV 466ml)) which quite nicely maps to commonly published normal MV around 7L/min.   

So we have our pragmatic working baseline ideals: 
  • Minute Volume of 7 L/min (6.99L/min) (RR 15bpm * TV 466ml)
  • Tidal Volume of 466mL per breath
  • Respiratory Rate of 15 breaths per min       
At 6' I would use a Minute Volume (MV) of 7 L/min as an anchor value everything adjusts around.  When Respiratory Rate increases or decreases I will seek to adjust (as much as I can) my Tidal Volume up or down to always maintain 7 L/ min of MV (MV 7L/min = RR & TV).


WillSleep


Attached Files Thumbnail(s)
   

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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RE: UARS and APAP
This is interesting WillSleep!

It also seems to conflict with what Sleeprider was saying. Curious how he would respond.

So if you're right, how to bottomline this then?

Conclude that PS 6 is too high and EERS is not necessary for me?

E.g. what would you do tonight if you were me?

My initial impulse was to go back to the initial setting that reduced AHI to 0, which was min EPAP 6.2 and PS 5.2. At those settings, TV varied from 460-500, and MV was a bit over 7.
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