Central vs Obstructive Apnea - EERS Device and Trial

[ChadBSr]

Chad, Wondering if we could see an Overview to see how Tidal Volume has changed over time?

Just not sure if it can go too high at this point?

Yes, the EERS simultaneously raises tidal volume and decreases CA due to the increased/stable co2.

In general, yes TV can go too high and it is bad.  Doctors calculate TV with estimated body weight to not overventilate overweight patients.  Basically you don't want to go beyond the volume of your lungs.  
Can EERS cause TV to go to high though?  I haven't seen any evidence.  I have more dead space than the paper says they used in the study.  I would imagine if CO2 raised too much TV would increase but breathing would slow enough to offset it?

   

You can see the median increasing here.  There is a small dip when I went back to 3 sections, then I increased again to 4.

[ChadBSr]

Median Tidal Volume 
Before EERS = 300
Last 30 days = 560
Last 2 weeks = 610

[SeePak]

Chad.

When i say could it go too high, heres my thinking....

Too much CO2 is being washed out, so there is less Oxygen going to blood and cells and brain!

That could cause fatigue etc. etc.

There may be a sweet spot, and i believe there will be for each of us.

As far as the Overview you provide..
The point of the overview, for me and others, is to spot a trend and correlation between events and parameters.

So with your TV, i would add respiration rate, flow limits, AHI, Time in Apnea , pressure.

Also, there is probably a lot of differing opinions on optimal or normal breathing rates and volume.

Patrick McKeown believes  4 to 6 L/min   Minute Ventilation  and  6 breaths per minute, 5 sec inhale  5 sec exhale which seems hard to achieve, the point being we have too many breaths per min. ,  hence  Hyperventilating.

This causes the CO2 to swing up and down and if we have a Low Tolerance for CO2, felt as 'air hunger' or shortness of breath, we take bigger breaths and the cycle of CA events go on and on.

I will be making a thread showing how i just went from 'Crazy Town' events and charts, to  'quiet', low events, no CA really AND amazingly, absolutely no leaks!
I am thinking the NO LEaks stems from having enough pressure to keep my prolapse from happening or something like that. got a few theories...
I do a lot of breath holds as well to get the CO2 tolerance higher.

[ChadBSr]

Yes, too much CO2 was being washed out.  EERS fixed that, and raised my median tidal volume, without increasing respiratory rate.  Normally respiratory rate and tidal volume will balance each other to keep a constant minute vent.

[ChadBSr]

Requested overview charts for the last 3 months.

   
   

[ChadBSr]

   

One thing OSCAR can't show you is my blood pressure dropping 40 points 

[ChadBSr]

My current setup is Airsense 11->heated tube->HME->VCOM->whisper swivel->VCOM->24" flex tube for dead space->F&P Solo pillow with vents sealed

EERS increased tidal volume and eliminated CA, VCOMs lowered and stabilized respiratory rate, increasing tidal volume during the short times it would drop during what I assumed to be REM which may or may not be true.

I'm using 3 EPR which doesn't really make logical sense to do with VCOM but it's working lol

If anyone would like to attempt to make sense of what is actually happening with pressure/flow etc and explain it technically go for it.

[Sleeprider]

Increasing respired CO2 has several effects. It increases the respiratory drive and potentially increases respiration rate, tidal volume and potentially minute vent. I think that increased respiration volume is a generally positive thing until the respiration rate also increases (hyperventilation). As long as respiration remains in the normal range of 12 to 18 breaths per minute, and respiratory volume is comfortable, I don't think there is much risk of CO2 induced hyperventilation. Increased tidal volume ensures that sufficient fresh air is respired, even in an EERS that may be over-sized.

Keep in mind, we are not regulating mechanical ventilation as with a hospital ventilator, but mitigating some of the effects of CPAP assisted spontaneous respiration. In spontaneous respiration, we tend to make unconscious adjustment to increased CO2, and that's what makes EERS work. CPAP is not a normal condition, as it is designed to prevent rebreathing of expired air. It does this by providing a large surplus of air that is vented through the mask and flushing all expired air away through the vent. Without CPAP, we re-breathe a certain amount of expired air that lingers around our face or under bedding. EERS restores a more normal air mix that is slightly warmed and CO2 enriched.

[ChadBSr]

The thing I can't wrap my head around is VCOM and EPR working together, they should be basically cancelling each other out.

[Sleeprider]

i am not a user or believer in Vcom in most applications, and I agree it seems to work to cancel benefits of EPR or pressure support. I don't see how that will benefit you beyond what you're getting with EERS.