Central vs Obstructive Apnea - EERS Device and Trial

[ChadBSr]

Adding 2 VCOMs with EPR eliminated respiratory rate spikes and lowered respiratory rate and increased tidal volume during those REM? times I was asking about previously.  I would try turning the EPR off to see if VCOM alone has the effect, but I get aerophagia above about 9cm without VCOM, and pressure this high feels uncomfortable without EPR

[SeePak]

chad
VCOM simply reduces Peak Inspiratory Flow, it is a simple physical device.
So if the machine changes pressures for inhale and exhale, VCOM simply reduces flow for whatever pressure is there.

so..

Lets say you have 10 cm pressure on a CPAP setting with EPR 3 ( works the same even in Auto, the machine just increase or lessens the pressure)
On inhale and 10cm, there will be a pressure drop across VCOM depending on how big your breath is, and you will feel that as less FLOW. That pressure drop means the 10 cm becomes effectively less, @ 50 L/minute it would be about 8.3 cm pressure as per VCOM specs.
On exhale and 7cm, there is very little pressure drop, so VCOM will just pass flow that the mask uses for venting, as you breathe out the same vent. There could be a very small amount of drop there, but you would basically have 7cm.

So what has happened with EPR is that the VCOM no longer does what it was built to do, which is have higher Inhale pressure than Exhale pressure. That is a point that Dr. Noah has repeatedly made .
He says originally, when CPAP was invented back in the 80's or so,  Inhale pressure WAS LOWER than Exhale, and i think mostly that was due to the fans not being able to keep up!
So it was kind of by accident i think.

So yes, it kinda cancels it out, but i think if you had a big enough inhale breath or LESS EPR, the Inhale may still drop below exhale pressure.

I dont think it is much more complicated than that.

Sleeprider, the funny thing for me, comparing EPR to VCOM, is that their makers BOTH say they are comfort devices!

And neither claim that the device actually helps therapy, though Dr. Noah says they found out that people stopped mouth breathing, had less leaks and more comfort and cleaned up CA events.

At least i have not heard any official Resmed proclamation of EPR being able to help therapy, though i know here on this site it is almost universally espoused especially for flow limits.

Not sure what the objective data there is for EPR being good? Not saying there is none, just wonder what y'all got on this?

I can show how VCOM tightened up my Respiratory Rate and i think lowered Leak Rates due to mouth breathing,

and how EPR created many more Obstructive Events which in hindsight were due to Pressure NOT being set high enough so that Exhale pressure was Above my personal needs for Apnea, a wider Tidal Volume Flow and Respiration Rate variation with more time at zero flow which i find interesting!

I see many more days , using VCOM, of Minute Vent and Respiratory Rate higher than zero at minimum, much higher. ( i see that in Chad's data as well, last Overview)

That last point of no zero at minimum for Respiratory Rate is very encouraging to me, as it means i kept my breathing under better control, i think!??

[SeePak]

Also, BTW, what i think is lost in the VCOM discussion....

The BIG reason for REDUCING Peak Inspiratory Flow, is the effect of negative suction pressure closing the airway. ( i think i said that right?)

This is a Phenotype, PCRIT i believe.

Results vary due to your Anatomical makeup.

I think that Patrick McKeown makes the best cases and explanation for how to help people with Sleep Apnea, even reversing it!
The scientific papers are all out there.

Unfortunately, there is no consensus among the Professionals, even in light of the evidence and science.

That hurts all of us.

At least here on AB, i was and am hoping for a more unfiltered bias so we can try some of these new findings.

I am hoping Apnea Board will lead the way.

So far i have learned so much here, and i can see how much work goes into hosting and updating this site.
I appreciate that to no end.

But i cannot blindly follow any ideas, that would be a cult.

So hopefully we dont push people away from trying the things that will help them.

EPR is one of those things, so is VCOM.

Also, there is much suggestion when things are not working for AHI, sleep fatigue etc. to just go to Bi-Level!

I can show charts of mine when that would have been surely suggested, but for some reason was not? Maybe it was and i missed it, gotta recheck.

And now i have an almost clean slate for an event chart, < 1 AHI, no leaks, tighter Respiratory Rate and other improvements.

Without Bi-Level !!

I think that is very telling.

[ChadBSr]

SeePak,

I just came to say that I guess what cancels out is pressure, but flow is still reduced. I just spent a while trying to find a gauge I could measure pressure and flow before the mask with and without vcom. That would put things to rest on the technical questions, but those things cost $2000. I may be able to eventually piece some cheaper equipment together.

p.s. I did have bi-pap, asv, etc thrown out as suggestions and more so in another group told to just deal with it and wait.

I may even eventually get an end tidal CO2 meter. It would be good to put numbers on everything and reduce any fears others have for recommending EERS or other solutions. PAP therapy needs help with almost 50% failure. Dr. Thomas, Dr Noah, and others are trying to reduce that.

Maybe manufacturers will eventually add flow adjustments to machines and produce masks that are vented in a way that doesn't allow CO2 washout.

[SeePak]

Chad

Vcom characteristics have already been figured out through extensive testing by Dr Noah and his group.

The differential pressure across the vcom is due to the holes and that is no different than differential restriction that exists anywhere through your Airway due to all kinds of things like lumps and cysts and closing up of the airway etc etc so the whole thing is differential pressure between the machine and your lungs.

You're just going to spend a lot of time for nothing measuring pressures but I get your curiosity it's not a bad thing to have.

[ChadBSr]

Yeah I'm not sure the data tells the flow and pressure from the machine before and after.

My curiosity has more to do with my specific setup of 2 VCOMs, EERS, and EPR. I've also had to put an HME in and probably need a second to resolve the EERS moisture problem.

I have a lot of stuff happening that the CPAP doesn't "see"

[ChadBSr]

@ Seepak - example

I just read through the vcom white paper again and realized the reason it doesn't increase EPAP is because you breathe out the vents... except I had one vcom before my vent.... oops.  So EPR was negating my mistake.