Central vs Obstructive Apnea - EERS Device and Trial

[ChadBSr]

Sneak peek of O2 stats 

[SeePak]

Hey Chad

That was interesting about the airway collapsing when you stop breathing I never heard that before and the one thing that makes me wonder about that is being that you still have pressure that's supposed to be keeping the airway open I'm wondering why it would collapse?

[ChadBSr]

Maybe its collapsing during the hyperventilation that follows?  I'll read through that section of the book again and see if I can get a better understanding.

[ChadBSr]

@Seepak

4.1.2 Mixed Apnea

Mixed apnea is a combination of central apnea events and obstructive apnea events. Because the device cannot tell whether there is a chest wall motion, it cannot rule out the possibility of closed central apneas (mixed apneas). It only sees that the airway is closed and treats these events like obstructive apnea. Thus, generally mixed apneas are categorized as obstructive respiratory events by the PAP algorithm.
event [3]. We must bear in mind that in mixed apnea, the very cessation of respiratory flow, due to central apnea, destabilizes and prevents the maintenance of airway permeability, culminating in the closure of the upper airways [4, 5]. Many researchers believe that the upper airway obstruction occurs as a consequence of the lung volume decrease with the breathing cessation (so, an UA obstruction takes place because of the loss of the tracheal traction) (Fig. 4.5) [6, 7].

[jlm255]

Well I can certainly start a thread on ASV, but I'm not sure that that is the answer for me or my sons. The way I got here is that I was extremely frustrated because all my boys are using BIPAP and the machine shows after each breath the tidal volume and you can see the waveform. So I can watch it real time. I noticed that sometimes when they need oxygen the most, their breaths are shallow and wimpy, and even if not throwing central apneas, their time between breaths were uncomfortably long.

If I lower pressure support very low then central apneas and "near" central apneas lessen, but their oxygen sucks. It will sometimes be in the 80s for long stretches and can dip down to the 70s for a few seconds. So in my researching I figured that they were blowing off too much carbon dioxide on exhalation especially when pressure support is high.

I bought a used ASV machine in desperation and while their stats didn't really get worse, it wasn't demonstrably better either. Obviously it could because not titrated well. Not anywhere near the results that Chad is getting (super jealous, congrats!). So they are back on the Resvent BiPap as am I and the ASV currently in the closet.

So I searched "how to prevent blowing off too much carbon dioxide sleep apnea" or something like that, found a Dr Thomas article, and once I knew a possible name (EERS) I searched that up and found this thread. Thanks to all for contributing.

As for me, I've used 200ml of EERS a couple nights, don't really notice any difference yet, subjectively or in the stats. For my kids I have noticed what I believe is a definite increase in their tidal volumes, minute ventilation up. Just 90ml so far. A little scared to increase on the kids (quite young), so testing on myself. I've been testing with the oxygen concentrator hooked up so that if I happen to overdo it a little, the extra oxygen should help.

My sons and I don't have any other health problems, our bodies just regulate breathing extremely poorly when asleep.

[Sleeprider]

Increasing the FiO2 in combination with EERS is an interesting concept and addresses two issues simultaneously. You still increase CO2, but the oxygen bleed should result in consistently higher blood oxygen, while the CO2 is not depleted by a ventilator. Makes more sense than you know. I would still use an ASV if central apnea breathing pauses are evident without the backup rate. ASV is actually not the right tool for increasing tidal volume, that would be a volume assured positive air pressure device like he ST-A iVAPS

[ChadBSr]

Dr. Thomas sometimes adds O2 or acetazolamide to lessen loop gain.

"Supplemental Oxygen
Supplemental oxygen was added to the positive airway pressure circuit proximal to the rebreathing space, and not the mask side port (to prevent washout of rebreathing space). Oxygen was used if one or more of the following conditions occurred: (1) baseline oxygen saturation ≤ 90%while awake; (2) sleep oxygen saturation ≤ 90% after optimal positive pressure and ERRS; (3) persistent periodic breathing despite use of recommended strategies for EERS, regardless of the oxygen saturation. Typically, oxygen was added during the second half of the titration. After adequate control of disordered breathing, oxygen was down titrated and discontinued if possible."

[jlm255]

Thanks for those replies, the RESVENT iBREEZE has iVAPS capability, and I tried it for like 9 months, I found it incredibly difficult. The backup breathing rate did improve oxygenation, but at least according to my fitbit it was incredibly disruptive of both REM and deep sleep. It was very common for my percentage spontaneous to be in the 50-70% range. And also I was gaining weight very quickly, I went from 170 pounds to 200 pounds in 5-6 months, the fastest I have ever gained weight. I think spontaneous breathing is better if I can figure out a way.

The volume assured component is interesting, and I did try it--I'm sure I did it all wrong. What I found is that my pressure support would be zero because my tidal volume was higher than the number and then when I really needed it it would deliver but it would be pumping me full of air so hard it would wake me up. So I found it very hard to find the magic number.

As for Chad's comment, I did read that part as well, and I have had the oxygen coming in through a "bleed-in" adapter at the start, but I was able to move that just in front of the P10 mask.

I'm going to try this EERS because to me it seems like my breathing drive is just not high enough when asleep. If it doesn't I'll read more about iVAPS or Ti control and if necessary start a thread there. Thanks so much for the comments.

[ChadBSr]

jlm,

Are you saying the resvent displays the flow pattern in real time?? That's pretty awesome