EERS using Resmed AirFit P30i Mask

[GrantT]

So I have been getting pretty well nothing but CA's in my AHI reading these days, usually large clusters around 4:00am.  Anyways, one of the things mentioned as a possible resolution (thanks for all your help so far on this Sleeprider!) is the EERS option.

Perhaps this is just an incorrect and oversimplification, but from what I have read so far, EERS seems to be just moving a vent 6" (or another set distance) away to increase carbon dioxide reinhalation. Yes?

Now, when looking at my current mask (Resmed P30i) there is a vent right near the nasal area, and another vent on the back/top of the back.  Now, this might be where I type something stupid...but would blocking the nasal vent not be almost the same thing as the EERS modifications I have seen in the WIKI etc?  Or, perhaps blocking the nasal vent AND then slightly modifying (compensating) with the rear vent by just slightly increasing the little holes with a tiny drill bit to compensate for the loss of the front vent?

What I am missing?  Why would I not want to do this? i.e.  suffocating in my sleep?

They say there is no such thing as a stupid question, right?      I can't help to think this mask was almost IDEAL for EERS modification...

Grant

[Sleeprider]

I'm not sure what portion of the venting is accomplished at the mask and top of the headgear, so the safest approach would be to install the Respironics Whisper Swivel II vent available at Supplier #1, and block both mask vents. Alternatively, you could try blocking the nasal pillow vent and use the mask while awake for a half hour to make sure you get adequate venting. I don't think there will be a problem, but I don't know. Since it is a nasal pillows mask you don't need an emergency valve, just open your mouth. It's not a stupid question. If possible, start with an older mask you can discard if it doesn't work out.

[austinweathers29]

Any update on how the expirement worked? I am looking to do the exact same thing!

[Sleepy Quixote]

@GrantT

I did exactly as you are planning, I used porous tape to cover the vents in the nasal mask, using an extra layer each night over portions of the mask vents until I got the desired EERS effect. It knocked my central apneas to near zero but was just a bit humid and not to so comfortable. I just live with my CAs now, about a third are sleep disturbance related anyway. 
Make sure and zoom in tight on those CA events and confirm are they central apneas? or are they just a clear airway event? What is the ratio? Is it worth it? Another thing that reduced my centrals quite a bit was reducing EPR to 1 or 2 both offered a modest reduction but my Flow Limitations balloon and I start having OAs. I'm not willing to go any higher on the pressure to compensate because pressure around 9 wakes me up constantly. So my EPR is back to 3 for flow limits and comfort, I just live with the CAs, had twenty last night, did not really effect sleep quality much, not like flow limits, OAs, Hs, and UAs.

Another trick to reduce CAs is to sleep with the cover over your head, making a well around your face that retains co2 rich expiration, using EPR of three allows just enough of that expired air to re-enter upon inhalation, if you put your fingers over the vents you can feel the warmer air start to re-enter slightly on inhalation. Keep in mind I run a min of 7.6 so this may not work at higher pressures. The hardest part is staying that way, never fails sometime in the night I pull the covers down and the CAs start right up.

The Whisper Swivel II vent Sleeprider suggests may improve the comfort of the P30i EERS configuration, haven't tried it but certainly am eyeballing that as a possible second run at it.

[Too Sleepy]

I private messaged Sleepy Quixote  about his P30i setup as I was interested. He recommended that I comment here so the public can see it. I'm going to add an EERS setup to my P30i. I'm planning on putting silicone over the nasal pillow vent and also the elbow vent at the top. I'm just waiting for my EERS supplies to arrive tomorrow and I'll set it all up. I'll update on how it goes.

[Sleepy Quixote]

@Too Sleepy

Just in case... unless you plan to use the Whisper Swivel II vent Sleeprider suggested do not plug the elbow vent at the top. Otherwise carry on. Silicone is fairly permanent and leaves you no adjustment to how much vents out of the mask, porous medical tape works great because you can reduce the venting in stages by layering and find a spot that is comfortable and still has EERS functionality. If you don't like the results just peel off the tape. Make sure you have a couple of the P30i masks on hand for experimentation if going with silicone. Also I'd think it would smell quite strong for a few days before fully curing and off gassing... unless you are using a silicone putty like those ear moldable ear plugs? 

It took me a couple of weeks to find the right combo, then only ran it for about a week because rebreathing the air in the frame gets a little humid and stuffy. I'd suggest turning off or way down the humidity if you use it.

Good luck! Looking forward to hearing how the experiment goes. 

[Too Sleepy]

I'm planning on using the whisper swivel vent. It was quite hard to source it in the UK, so if anybody needs help with that let me know. I also found a UK equivalent of corr-a-flex tubing.

In terms of silicone I used gasket silicone, it cures in 24 hours.

[Humancyclone7]

Hey Sleepy Quixote,

Do you have any updates regarding the use of porous tape over the vents as an alternative to EERS?
Would 3M Micropore Surgical Tape work for this? https://www.amazon.co.uk/3M-Micropore-Su...9MLV8?th=1

I seem to benefit from a PS of 9-10 to treat flow limitations but I'm getting very significant CA events even at a PS of 5. I firmly believe by now that things like backup rate, trigger sensitivity and chemoreceptor adaptation are actually unhealthy since they don't address the root problem of hypocapnia (and probably exacerbate it too by promoting overbreathing), which is why I'm keen to fix TECSA by reducing CO2 washout instead i.e. EERS.
However by now I'm mentally exhausted and worried that I'd mess up the EERS construction, so your method sounds much better.

I'm also going to experiment with combining NEPAP (Nasal EPAP) devices like Zeebud with my BIPAP therapy, since that also leads to CO2 retention but without causing inspiratory flow limitations like a training mask would.

[Sleepy Quixote]

Hey Humancyclone7,

No updates, the porous tape worked for me. I'm not familiar with the 3m micro pore tape, unfortunately the tape I used is generic and doesn't have any markings to identify it. It's a cloth bandage type tape, very breathable.

Good luck, keep at it, that's how we get good at it.  

[mintjberry]

Hey Humancyclone7,

No updates, the porous tape worked for me. I'm not familiar with the 3m micro pore tape, unfortunately the tape I used is generic and doesn't have any markings to identify it. It's a cloth bandage type tape, very breathable.

Good luck, keep at it, that's how we get good at it.  

Hey, just to confirm, did you only block the nasal vent? Or did you also partially block the vent at the top?

Thanks