[Health] Interpreting sleep study results, EERS enhanced expiratory rebreathing space

[slowriter]

Not sure about influence or not of EERS; however, my first hyphotesis you perfectely go on without it. 
It would be invaluable hearing our other fellows involved in your case, and has more expertise than me on this tool.

I think if he removes the EERS, his CAs go up significantly.

It can't really hurt to try, but I don't see the point. I think the progress he is seeing is based on the EERS, and the freedom to experiment with a wider range of pressures and pressure support.

Just a reminder: at the most basic, what we are seeing with EERS is dramatic decrease in CAs, and significant (in my case, 20%) increase in TV.

It could have other positive impacts, though that's yet unclear.

I suggest Joey stays right where he is for awhile, and see how it goes.

[slowriter]

Just a reminder: at the most basic, what we are seeing with EERS is dramatic decrease in CAs, and significant (in my case, 20%) increase in TV.

I just checked back to the beginning of this thread, and while I can't view most of the attachments, the earliest one I can shows a median TV of 320.

So the above patterns holds for Joey as well; his median TV is up more than 50% with EERS and current pressure settings!

[JoeyWallaby]

Same as last night (cervical collar, EERS, chin strap) but messed with PS and EPAP min. Feel tired today.

[JoeyWallaby]

[mper6794]

_Hi, Joey,

Not good……”Inspiration is like a spike at some points. IPAP too high?”…you asked last night. Yes, indeed, your respiration was very unstable this night, because an anomalous increase in Inspiration time, and consequent decrease to an anomalous E:I: 1.5. You experience same tendence to decrease during your first cycle of using the EERS, under constant EPR (1.0) (see attached historic). I don’t think EPAPmin and PS would provoke such great variarions.

_maybe only this buffered respiration could account for your bad night.

_on the other hand, there is strong suggestion the setting of this night were able to bring your flagged FL to absolute zero, as it should be, thus indicating, EPAPmin/P.S wise, you would not be very far from your fine-tuned parameters;

_I am afraid I has been a little difficult keep trying to help while your experiencing with EERS. Please, I am not dismissing the value of this experience; far from this. I just don’t know much about EERS, other than being a tool to increase a bit pCO2 and avoid CA’s, which in your case, I think are fake events due to still not balanced EPAPmin/PS and, arousal/sleep transition, and toss and turning.

_Yet, I think I would better waiting you finish your attempts with the EERS. However, even under this cloud environment, you could go better with EPAPmin:6.0 and P.S: 5.6, to begin a cycle of fine-tuning, should you decide to.

All the best

 P.S: unfortunately, could not attached your updated historic...limits. I will send it by e-mail

[slowriter]

Why did you change the settings? I thought you said you felt good at the previous one?

[JoeyWallaby]

snip

Thank you for the feedback.

Why did you change the settings? I thought you said you felt good at the previous one?

I don't know, just experimenting.

I tried the settings that worked before, this time with replacement mask and without EERS. I wore cervical collar and chinstrap plus taped mouth.

I received my night vision camera in the mail and set it up, these are my observations...

1. I move a lot more in my sleep than I thought
2. I spend more time on my back than I thought
3. I tried to tuck my chin at least twice but the cervical collar prevented it

6:50:00-6:51:30
Moved around a bit, touched face and mask. Stayed on side.

7:41:40-7:42:00
Rolled further over. On side.

8:13:20-8:13:40
Rolled back over. On side.

8:36:30-8:41:00
Rolled onto right side, then back to left side

8:53:30-8:59:00
Rolled WAY over so my head was actually hanging off the side of my bed. On stomach.

9:28:44
Rolled back onto bed and onto back.

9:45:50
Moved over, still on back.

10:24:25
Moved over, still on back.

10:37:21
Rolled over, head hanging off the side of my bed. On stomach.

10:47:21
Rolled back onto bed and onto back.

11:11:00
Moved over, still on back.

11:14:30
Moved over. Still on back.

11:44:00
Rolled onto side.

11:59:00
Rolled onto back.

12:08:00
Moved over, still on back.

12:19:00
Moved over, still on back.

12:23:00
Blockage of airway? Rolled over with head off side of bed. On stomach.

12:58:00
Moved over. On stomach.

13:06:30
Rolled onto back.

12:48:00-13:34:00
Visible observations… seems like struggling to breath? Weird noises.

13:33:00
Rolled over, tried to tuck my chin but cervical collar prevented it. Still on back.

13:50:00
Visible distress, moving eyebrows.

13:53:00
Moved over, still on back.

14:00:37
Moved over, slightly on side, slightly on back

14:11
Ran out of battery

[JoeyWallaby]

[JoeyWallaby]

Think I'll go back to EERS tonight.

[mper6794]

Hi, Joey,

having in mind your sleep study, and a revision on all posts, just to save time, I would have these observations

Together with your sleep study, and revising all posts here, I would have the following observations, interpretations and suggestions (just in case you decide to for starting all over again, on much lower pressures, after finishing the experience with the EERS):

_your sleep study came in line with my suspicion: because so many arousals/supine position 100%, you did not have REM in the sleep study, and, in consequence, pretty much no CA. Therefore, your CA’s (fake and true) would be concentrated in REM. Therefore, for now, also, there would be no way to know whether you would be acting out or not during REM;

_your leaks appear concentrate in REM, likewise. For both, monitoring leaks and acting out or not, I would suggest you, the soonest as you can, you camera-record/better (or just audio-record, as I sometimes did with very low highly sensitive device) your sleep.

_I suspect your leaks would be occurring on account of chin retraction/tucking (loosing mask stripes), when you enter atony/relax deep, while entering in REM. One post you said you tighten the mask and leaks subside. You may perform one experiment and prove increasing leaks, laying down and chin-retracting/stretching head;

_are your in benzo’s or similar sedating’s anytime? (this detonate leaks, from recurrent experience, when I used it);

_you said you would have been a side-sleeper. You would have to assure this; may have great implications on EPAPmin and CA’s. Part of CA’s and quasi-H/H may be provoked by instability during leaks (I experiment this many sometimes);

_a trick for forcing sleep on your back (I used it sometimes), if camera suggest, would be sawing one or two tennis ball on a sleep-shirt;

_and for the chin move, of course, the soft collar, could help a lot (I started use 1 month ago and appears has been adding something on residual RERA I had);
 
Because all of this, once you take measures for leaks, chin retraction, and assure side position, I would suggest you started with even lower EPAPmin: just 5.6, P.S: zero.
 
All the best.

Hi, Joey

_ First, I think would be worth going back to these my observations above.  You have taken measures, and are taking your therapy on your hands: this is great! 

_Your night above came in line with your diagnostic: you are an UARS sufferer. To treat this, as pretty much by protocol of great ENT's,  first thing would be take measures (position, mainly; collar, second; no sedating if possible, third; and, then, fourth: fine-tuned, balanced, EPAPmin x PS;

_Your EPAPmin x PS seesaw, pivoted on normal RR, are not balanced yet;

_Repeating myself: absolute majority of your CA's, if no all of them, in my opinion, are fake events on account of arousal/awakening-sleep transition, as well as unbalance EPAmin x PS. 

_For instance, your semi-quantitative plots and my interpretations suggest you would be on too high EPAPmin, and too low PS. A fine-tuning cycle could start at EPAPmin: 6.0 and P.S: 5.6, as I mentioned above.

_your respiration are going out of track with the EERS, as on the historic I sent you yesterday by e-mail (not possible to post here, limits....don't like go out of jus posting here). It backed perfectely on tracks this last night (as by e-mail I have just sent to you).

_However, as said before, I would not like to interfere on your experience with the EERS; I think could be of great value for others, eventually, in special cases of true serious drawbacks on Periodic Breathing, etc.

all the best