Switched from ASV to CPAP, finally getting some sleep.

[sleeplover69]

How could you safely omit the safety valve from nasal/pillow masks?

[pholynyk]

If you are using a nasal or pillows mask, you can just open your mouth - unless you are taping it shut. AFAIK, with a collar or chin strap you can still open your mouth. Possibly not with the "Ultimate Chin Strap", but I think that one is overkill (so to speak).

[tedvpap]

This is great info.
I like to have a simple summary that can be easily communicated to non-physicians.
How is this: If PAP causes a CO2 issue, fix the CO2 issue by increased rebreathing instead of forcing ventilation via ASV???

[Sleeprider]

I mentioned it in another thread; I am pretty excited to see this approach being developed. At this time, the use of a rebreathing circuit is extremely logical and may work for many individuals. It is not an FDA approved therapy for complex, mixed or central apnea, and what we actually have is like pharmacy compounding. An EERS circuit can be assembled, and the volumes and results can be calculated and observed. It is not a part of any recognized protocol, but is being advocated by a physician as an alternative to traditional, expensive and disruptive therapies (ASV/ ST). It has a long way to go to become mainstream.

I will use this information to develop some Wiki articles and may recommend some members experiment with the EERS assembly. It's not very hard to put together, and like CPAP, may involve some trial and error to optimize efficacy. In my opinion it is inherently safe, as increased CO2 above the user's needs will trigger hyper-ventilation through normal feed-back loops, but when properly implemented should reduce or eliminate the symptoms of therapy onset complex apnea centrals and periodic breathing. It is not likely a solution for primary central apnea. If the medical community gets behind this, I can see it being adopted as a new therapeutic solution, but for now, we are making up custom EERS circuits and observing results. We're on our own unless you have one of the few enlightened doctors that are even aware of it and researching the applicability.

[tedvpap]

I mentioned it in another thread; I am pretty excited to see this approach being developed. At this time, the use of a rebreathing circuit is extremely logical and may work for many individuals.  It is not an FDA approved therapy for complex, mixed or central apnea, and what we actually have is like pharmacy compounding.  An EERS circuit can be assembled, and the volumes and results can be calculated and observed.  It is not a part of any recognized protocol, but is being advocated by a physician as an alternative to traditional, expensive and disruptive therapies (ASV/ ST). It has a long way to go to become mainstream.

I will use this information to develop some Wiki articles and may recommend some members experiment with the EERS assembly.  It's not very hard to put together, and like CPAP, may involve some trial and error to optimize efficacy.  In my opinion it is inherently safe, as increased CO2 above the user's needs will trigger hyper-ventilation through normal feed-back loops, but when properly implemented should reduce or eliminate the symptoms of therapy onset complex apnea centrals and periodic breathing.  It is not likely a solution for primary central apnea.  If the medical community gets behind this, I can see it being adopted as a new therapeutic solution, but for now, we are making up custom EERS circuits and observing results.  We're on our own unless you have one of the few enlightened doctors that are even aware of it and researching the applicability.

Any thoughts as to when one should try EERS?  I have no personal experience but IIRC some people who exhibit PAP treatment induced CA will resolve with time.  Is this true?  If so, how much time?

[Stom]

Any thoughts as to when one should try EERS?  I have no personal experience but IIRC some people who exhibit PAP treatment induced CA will resolve with time.  Is this true?  If so, how much time?

I'm new to this, but here is what a big data study of a sample of all ResMed Airsense and Aircurve 10 devices set to CPAP or APAP (since these machines all report to ResMed's AirView system).

Trajectories of Emergent Central Sleep Apnea During CPAP Therapy by Dongquan Liu et al that found:

"The proportion of patients with CSA in week 1 or week 13 was 3.5%; of these, CSA was transient, persistent, or emergent in 55.1%, 25.2%, and 19.7%, respectively. Patients with vs without treatment-emergent CSA were older, had higher residual apnea-hypopnea index and CAI at week 13, and more leaks (all P < .001). Patients with any treatment-emergent CSA were at higher risk of therapy termination vs those who did not develop CSA (all P < .001). "

It's a bit surprising that only 3.5% of new machine users had greater than or equal to 5 CSAI on average in week 1 and/or week 13 of treatment, but the sample size is huge, and the machine detection of CSAs is the same we are all using in here to to talk about our results using sleepyhead.

The main problem with the study that stands out to me is (unless I've misread the study) they don't know the sleep study data on any of these users, so they can't say that the CSAs are treatment emergent since they could predate treatment, but they still call them treatment emergent CSAs.

[Sleeprider]

The reason your RT is telling you to just make minor adjustments to pressure and that your events are a figment of your imagination is the condition is not particularly common, and most that experience complex apnea quit therapy. You're a rare bird indeed, and will be more unusual if you stick it out. There is a reason that most doctors view all apnea as obstructive, and treat everything with higher pressure. They just do don't see anything else by the second appointment.

[sleeplover69]

If you are using a nasal or pillows mask, you can just open your mouth - unless you are taping it shut. AFAIK, with a collar or chin strap you can still open your mouth. Possibly not with the "Ultimate Chin Strap", but I think that one is overkill (so to speak).

That was my first thought, but wouldn't opening your mouth to exhale cause leaks and compromise therapy? But apparently that's the setup that OP is using.

[pholynyk]

In a regular full-face mask, the anti-asphyxiation (safety) valve is closed by the machine flow during both inhale and exhale. It only opens when the machine is not running. Any time you need the safety valve your therapy is already compromised, but you can still breathe.

[Walla Walla]

Maybe it's just me, but I don't think People should be trying EER's without medical supervision. It could end up being fatal due to an overdose of CO2.