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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
Since this is about injury, you need a statement to mitigate fear since this doesn't impact most CPAP (any variety) patients.  State how there "pressures differ from standard treatment or something like that.

Good outline.
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RE: UARS and APAP
I'll just say, we have a wiki editor forum, and once you send a request to be an editor, we can hash that out without disrupting this thread. http://www.apneaboard.com/wiki/index.php...iki_Editor Not trying to be grumpy, but let's do it.
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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, 05:32 PM)slowriter Wrote: So then further, to your first point above, I think it might be valuable for other people who clearly need to increase their TV and MV to experiment with it ..

I mainly posted because I wanted to try to raise the profile of EERS more, given how cheap and simple it is to adapt a mask to provide the additional dead space. Perhaps more people will in time, and Sleeprider can expand that wiki page to incorporate that knowledge.

In sum, though, EERS seems worthy of much more thought, discussion and experimentation as one more tool in the toolbox.

As promised back to the remaining topics. 

Yes, I absolutely agree with all three of these statements.


(10-23-2019, 05:32 PM)slowriter Wrote: Given what you wrote in your post above, it could be that my rough night was a consequence of a too high TV/MV, even if it wasn't obvious to me subjectively.
 
Sorry if I missed it.  I have not seen enough detail about what the rough part of the night was to be able to answer.  

For sure in the past once when I woke up and felt a little almost like a truck somehow ran over my chest in the middle of the night and my pulmonary system was injured as I was trying to be a good patient and force myself to comply with what I can now see as clearly dis-synchronous algorithm therapy.    Took a week of coughing and accepting a higher AHI for softer treatment to give my lungs chance to start to heal.    

A then there are times when poor xPAP response to Leaks seem to have left me very hoarse, a little deeper into my chest than just my throat, etc.  

I read somewhere about constant, unchecked Areography and higher abdominal pressures (ongoing abdominal hypertension) causing injury.  

The list goes on...   


(10-23-2019, 05:32 PM)slowriter Wrote: ... and that I may not be the right guinea pig! 

Well I think as long as we play it safe and we can personally show any change during A/B testing I think we all will make good guinea pigs.  

We just need other/additional guinea pigs at the right time (also playing it safe) to execute the bits of the A/B test scripts we cannot. 

(10-23-2019, 05:32 PM)slowriter Wrote: If you're right about the potential for too high numbers here, it does point out limits to EERS, and also a need for caution for those that do experiment with it.  

I think most everything else needed is sorted except for a testing plan and for sure we need to ensure well thought-out safe testing environments and processes.
  
  • For sure Pulse-Ox nightly that alarms on Desat.  (I believe you already wear one, when I test something I will likely wear two for redundancy.  I am pretty pedantic about working to ensure SpO2 never drops below 92%).  
  • To protect from too much pressure.  We need to see if there is too much pressure and where exactly in the airflow ecosystem that pressure is.  For an entirely different scope of xPAP design improvement experiments I sorted that classic "mid to micro pressure regulation/pressure relief" to releasing pressure above desired levels is not too tough to pull off anywhere in the airflow.  Pressure Modulation that was so non-invasive that it did not disrupt any of the ResMed pressure sensor driven algo process was a whole different story but I think I have that sorted out now as well.  
  • In-line at mouth ETCO2 sensor, with data capture and alarm. Below are two images from the original EERS paper.  They show the addition of CO2 monitoring with lines to an external monitor likely with data capture.  Sure we could just buy that new for $1200 to $5000 but I am looking for an effective lower cost option.    I have seen Mosimo EMMA that appears new for $300 and it has an Alarm but is battery driven, a mite bulky to hang close to the mask and I can not see that there is any data capture card or line options.   I have been thinking an smaller than a pencil inline monitor with the tip slipped through a cut in the hose 1/4 from the mask and line wrapped around the hose running back to a bedside monitor is a better option.  Ebay or medical facility auction is maybe the best way to get high quality Capnography equipment on the cheap.     Further down a snip of a really good thread by mdmardmd is included below.   Unfortunately I have not yet found a more detailed parts list.         

Slowriter, Your thoughts?  Other remaining Gaps?


Everyone, Your thoughts?   Other remaining Gaps?  Rebuttals?  Improvements?   

Has anyone seen a good Capnography solution or seen dmmarmd's parts list?

Thanks,

WillSleep


          

   

(02-24-2019, 07:30 PM)mdmarmd Wrote: ...

To this end, in late 2016, I decided to make a capnograph to measure the CO2 within the P10 tubing.  I acquired a very sensitive carbon dioxide sensor that could measure 0-20% CO2 at 20 times per second. Unfortunately, the software to support this instrument proved faulty and after waiting 6 months for this to be resolved, I lost interest and moved on to other things.

But in 2018, I was spurred on to renew my efforts with the onset of winter, since I knew that this phenomenon most likely occurred in cooler weather when the P10 was more susceptible to rainout conditions.  I also read of additional reports of blocked P10s in the sleep apnea forum in a recent thread started by Hulk, with very inciteful comments by DaveResmedP10 who persevered in pushing back on those who dismissed his concerns:

Rebreathing causing Hypercapnia (CO2 – Carbon Dioxide Poisoning)

I already had all the components for the capnograph: 
1              thin anesthesia gas sampling line             6          Nafion dryer tube
2              water trap                                                   7          Air pump
3              particulate filter                                           8          CO2 sensor and housing
4              hydrophobic filter
 
It is, however, a simplified instrument, and I don’t suggest it has the precision of a medically approved device.  It does respond almost instantaneously to changes in CO2, and I do believe it is sufficiently sensitive for the intended purpose.
... 
I believe that this data proves the P10 vents can occlude resulting in rebreathing of very high levels of expired CO2.  I also believe it dispels the notions that significant hypercapnia would always provoke awakening or that the natural safety valve, namely one’s mouth, would always come to one’s defense.
... 

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
(10-24-2019, 12:09 AM)WillSleep Wrote: ...
(10-23-2019, 05:32 PM)slowriter Wrote: Given what you wrote in your post above, it could be that my rough night was a consequence of a too high TV/MV, even if it wasn't obvious to me subjectively.
 
Sorry if I missed it.  I have not seen enough detail about what the rough part of the night was to be able to answer.  

Nothing dramatic. Just more fragmented sleep (awakenings) than has been typical for past couple weeks, and Sleeprider was asking why.

I slept better last night (the next night) without EERS and at lower PS, but still more fragmented than I like. I'll just assume a not ideal couple/few nights.

... snipping discussion of testing design ...

Quote:Slowriter, Your thoughts?  Other remaining Gaps?

I'm a bit out of my depth, but it seems sensible.
.
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RE: UARS and APAP
So in comparison, here's PS 5.2, EPAP 6.2. 

TV 480, MV 7.13, which appears "normal." Unlike Sleeprider, I think my lungs are pretty normal.

At this point, I'm fine-tuning, but can someone explain what's going on with this wake up event? Is this breathing related that might suggest any settings tweak(s)?

In REM for about 10 minutes (which this shows tail end of), then light, then wake.

The Dreem is telling me I changed position at end of REM, so maybe just that?

       
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RE: UARS and APAP
IDK that larger breaths necessarily indicate waking up so I'm not entirely sure what I"m looking for. the only obvious wake up in the full night shot is later than 1:45, 1.5 - 2 minutes after the end of the zoomed in screenshot.

however, fwiw, the first minute or so of that flow still looks like my flow when I'm having plm.
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RE: UARS and APAP
(10-24-2019, 02:58 PM)sheepless Wrote: IDK that larger breaths necessarily indicate waking up so I'm not entirely sure what I"m looking for.  the only obvious wake up in the full night shot is later than 1:45, 1.5 - 2 minutes after the end of the zoomed in screenshot.  

however, fwiw, the first minute or so of that flow still looks like my flow when I'm having plm.

I'm assuming the sleep staging is accurate, and is what I'm basing this on, but it's possible it's not.

The other issue is syncing the two graphs.

On the PLM point, maybe we should be more specific? What actually causes that pattern? Is it movement itself; body shifting positions?
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RE: UARS and APAP
being unaware of plm, I have no firsthand knowledge. movement can only be inferred from the flow rate. what I see in my flow is my respiratory response to the movement. what I think happens to me starts with a jerk/spasm. my wife thinks it originates in legs or feet but the movement is often transmitted throughout most of my body. in any event, the first indication of a kick in my flow is a sharp inhale, often accompanied by a moan/groan and followed by a more or less regular number of relatively flow limited breaths (whether abbreviated or flat-, m-shaped- or slant- topped) until it repeats. I'm not adding anything new to my previous descriptions so let me know if there's something I'm missing in your question and I'll try to address it if I can.
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RE: UARS and APAP
I completely overlooked the sleep stage graph. to my knowledge most apps use movement to infer sleep stage but looking back in this thread I see this one is based on EEG which should be more accurate? stage 3 is light sleep which makes sense to me. not a full awakening but maybe enough movement / arousal to move up to light sleep?
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RE: UARS and APAP
(10-24-2019, 03:36 PM)sheepless Wrote: I completely overlooked the sleep stage graph.  to my knowledge most apps use movement to infer sleep stage but looking back in this thread I see this one is based on EEG which should be more accurate?  stage 3 is light sleep which makes sense to me.  not a full awakening but maybe enough movement / arousal to move up to light sleep?

That's what I was thinking is one possibility.
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