These charts are only from EPR 3 nights.
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EERS Experiment Data (sherwoga)
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12-04-2019, 01:51 PM
(This post was last modified: 12-04-2019, 01:52 PM by JoeyWallaby.)
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.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
12-04-2019, 02:44 PM
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!
12-04-2019, 03:06 PM
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? 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.
12-04-2019, 03:27 PM
RE: [split] EERS Experiment Data (sherwoga)
(12-04-2019, 03:06 PM)slowriter Wrote:(12-04-2019, 02:44 PM)sherwoga Wrote:My comments/answers inserted directly into the quote of your post in bold.(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?
12-04-2019, 03:47 PM
(This post was last modified: 12-04-2019, 03:49 PM by JoeyWallaby.)
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?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.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
12-04-2019, 04:26 PM
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?My comments inserted in bold in the quote of your last post. See bold inserts.
12-04-2019, 05:13 PM
(This post was last modified: 12-04-2019, 05:21 PM by JoeyWallaby.)
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.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
12-05-2019, 06:57 AM
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:
RE: EERS Experiment Data - Seq #6 Design #11
(12-05-2019, 06:57 AM)sherwoga Wrote: My initial observations: 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.
12-05-2019, 09:43 AM
RE: EERS Experiment Data (sherwoga)
Yes, flow limitations are bad.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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