Link: Unvented Mask Improves Centrals/Periodic Breathing?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Todzo
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by Todzo » Mon Jul 21, 2014 2:04 am

I think that they are talking about enhanced expiratory rebreathing space (EERS)[1]. The mask is unvented but a vent is provided further down the circuit maintaining a controlled amount of rebreathed air.

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721
May any shills trolls sockpuppets or astroturfers at cpaptalk.com be like chaff before the wind!

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49er
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by 49er » Mon Jul 21, 2014 2:38 am

Todzo,

Again, what you are advocating is an experimental treatment and thanks to archangle's posts, I realize why I was very concerned you kept posting this advice to people. Just because a doctor is supervising it, doesn't mean it is going to be safe, particularly if it is untested long term.

49er
Todzo wrote:I think that they are talking about enhanced expiratory rebreathing space (EERS)[1]. The mask is unvented but a vent is provided further down the circuit maintaining a controlled amount of rebreathed air.

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

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Todzo
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by Todzo » Mon Jul 21, 2014 4:26 am

49er wrote:Todzo,

Again, what you are advocating is an experimental treatment and thanks to archangle's posts, I realize why I was very concerned you kept posting this advice to people. Just because a doctor is supervising it, doesn't mean it is going to be safe, particularly if it is untested long term.

49er
Todzo wrote:I think that they are talking about enhanced expiratory rebreathing space (EERS)[1]. The mask is unvented but a vent is provided further down the circuit maintaining a controlled amount of rebreathed air.
It was the ASAA web site telling about the available therapy not me.

I was simply reporting not specifically advocating (although I do use EERS[1] with good success myself from time to time).

But indeed!

Perhaps it is high time that they do the research and provide the data regarding the long term objective efficacy of CPAP. That data is certainly lacking (if not, show us the data!!!)!!

Yet they do use CPAP (as the “golden standard” no less).

Talk with your doctors about [1,2].

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721
May any shills trolls sockpuppets or astroturfers at cpaptalk.com be like chaff before the wind!

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Julie
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by Julie » Mon Jul 21, 2014 4:32 am

It's difficult to report (as yet) on long term Cpap because it hasn't been around long term... not in a form that's used routinely by so many people due to lack of comfort and patient education as much as anything, not to mention lack of education and consistency in technical support people, and maybe even doctors for whom a 6 wk course makes them 'sleep pros' but in reality does not really advance anything and often turns patients off. But it'll come... enough has been learned and benefits are obvious, just give it another few years.

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49er
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by 49er » Mon Jul 21, 2014 4:43 am

Julie wrote:It's difficult to report (as yet) on long term Cpap because it hasn't been around long term... not in a form that's used routinely by so many people due to lack of comfort and patient education as much as anything, not to mention lack of education and consistency in technical support people, and maybe even doctors for whom a 6 wk course makes them 'sleep pros' but in reality does not really advance anything and often turns patients off. But it'll come... enough has been learned and benefits are obvious, just give it another few years.
Well said Julie.

As an aside, because a local sleep doctor advertised on her website that she had a particular interest in pap therapy compliance, I decided to call them to see exactly what they meant by that. They seemed more interested in setting me up for an appointment than answering my questions but I persisted. Well, it turned out, it didn't mean didly as according to the person I spoke with, they didn't have the means to let people test out masks and referred them to a local DME. And I sensed there wasn't any true followup.

Until sleep offices really mean what they say about pap therapy compliance which involves letting people extensively test masks and I am not talking about a 30 second trial which the tech is bored to tears and can't wait for you to leave, nothing will change.

Sorry for my off topic rant. Back to regularly scheduled programming.

49er

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Sludge
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by Sludge » Mon Jul 21, 2014 4:58 am

49er wrote:Until sleep offices really mean what they say about pap therapy compliance which involves letting people extensively test masks and I am not talking about a 30 second trial which the tech is bored to tears and can't wait for you to leave, nothing will change.
Then given the present reimbursement milieu, nothing will change.

"Here's your mask and machine, we'll do a D/L in 30 days, if you ain't using it 70% we'll take it back and you can go suck an egg."
You Kids Have Fun!!

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49er
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by 49er » Mon Jul 21, 2014 5:12 am

Sludge wrote:
49er wrote:Until sleep offices really mean what they say about pap therapy compliance which involves letting people extensively test masks and I am not talking about a 30 second trial which the tech is bored to tears and can't wait for you to leave, nothing will change.
Then given the present reimbursement milieu, nothing will change.

"Here's your mask and machine, we'll do a D/L in 30 days, if you ain't using it 70% we'll take it back and you can go suck an egg."
Fair point Sludge.

But I am just getting tired of the patients being blamed for non compliance when this essential service is lacking. And if places have the money to hire psychologists for CBT-I and other services which I am sure doesn't have the greatest insurance reimbursement, I am not sure I understand why they can't place more emphasis on making sure patients get the right mask since this is a crucial part of the process.

49er

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Sludge
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by Sludge » Mon Jul 21, 2014 5:23 am

49er wrote:I am not sure I understand why they can't place more emphasis on making sure patients get the right mask since this is a crucial part of the process.
It's not the heat, it's the humidity.
You Kids Have Fun!!

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buran
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by buran » Mon Jul 21, 2014 5:25 am

JDS74 wrote:
buran wrote: I guess you confuse CO2 washout vent with Anti Asphyxia Valve (AAV). Since your mask has “a swivel that lets in a little air” it is a vented mask (it allows CO2 washout). However, many nasal masks and all nasal pillows do not have AAV. So, yes, “you can't breathe through the thing if the hose connection if blocked”. In case of power failure you are expected to breath through your mouth. It can be dangerous only for people who do "mouth taping" to prevent leaks. However, in this case one can use DIY standalone AAV.
Sorry. I examined the mask very closely. There is no vent. The swivel only allows air in around the surface of the two pieces that make up the swivel perhaps a 0.001 inch gap. Close the hose end and there is no air flow. If a vent were there, some air flow would occur.
I am completely familiar with the difference between the vent and the anti-asphyxia valve. My mask has both. Close the AAV and the hose end and there is still air flow possible.

The mask is still in the trash.
JDS74,
OK, I misunderstood your initial description of the mask. I do not use nasal masks, but I still do not like your idea to destroy the mask. It is very difficult to find a non-vented mask, even with a prescription (I could not find them online. It requires “special order” for local DMEs and takes long time).

_________________
Mask: Simplus Full Face CPAP Mask with Headgear
Additional Comments: Non Vented Mask + EERS (Enhanced Expiratory Rebreathing Space). Software: SleepyHead, ResScan, SpO2 Review
Nov.2012: 1st sleep study OSA AHI=105
Feb.2013: Started APAP 10-20cm
May.2013: 2nd sleep study. CPAP 12cm + Non Vented Mask + EERS
Oct.2013: S9 VPAP Adapt 36037
May.2014: 3rd sleep study.
Experimenting with acetazolamide (diamox) 250mg

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buran
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by buran » Mon Jul 21, 2014 5:42 am

cuyahogaguy,
Periodic breathing (especially if it is not cheyne-stokes, that is without central apnea) is not necessary related to any heart problems. This breathing instability could be due to chemoreflex problems.
There are several methods to treat periodic breathing. See this short paper, “Single vs. Multi-Modality Treatment of Central Apnea Syndromes”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413795
1. Adaptive Servo Ventilation CPAP – standard treatment
2. Non-vented mask (in addition to CPAP). This is an experimental treatment. I posted a short description and link to the original paper in this topic:
viewtopic/t98904/Unvented-Masks-and-Acc ... -Data.html
3. Pharmacological treatment (acetazolamide) in addition to CPAP, also experimental.
There are other methods, but they are not used even as “experimental” (for example, adding CO2, somewhat similar to adding O2 to CPAP).

_________________
Mask: Simplus Full Face CPAP Mask with Headgear
Additional Comments: Non Vented Mask + EERS (Enhanced Expiratory Rebreathing Space). Software: SleepyHead, ResScan, SpO2 Review
Nov.2012: 1st sleep study OSA AHI=105
Feb.2013: Started APAP 10-20cm
May.2013: 2nd sleep study. CPAP 12cm + Non Vented Mask + EERS
Oct.2013: S9 VPAP Adapt 36037
May.2014: 3rd sleep study.
Experimenting with acetazolamide (diamox) 250mg

JDS74
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by JDS74 » Mon Jul 21, 2014 7:51 am

archangle wrote:
JDS74 wrote:It is a Respironics Contour Deluxe single use mask.
Although the user manual shows an exhalation port attached, what I came home with has no such port.
The exhalation port attaches at the bottom of the blue device on the front of the mask.
Its still going in the trash!!!
Wow, that's scary. It looks like it's intended to be used with a "disposable circuit," which is apparently a tube with an exhalation port (vent).

I agree it looks like an unvented mask. Break it and throw it in the trash.
Indeed, the user manual makes explicit reference to a disposable circuit and also to it not being suitable for an incapacitated person. My guess is this is intended for hospital use only. Home users should avoid this and similar masks.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
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Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
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KillingMe
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by KillingMe » Mon Jul 21, 2014 9:18 am

"Do NOT use an unvented mask!!!!
You could die.

[/quote]

Would this be a good way to commit suicide?

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Bill44133
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by Bill44133 » Mon Jul 21, 2014 1:53 pm

KillingMe wrote:"Do NOT use an unvented mask!!!!
You could die.

Would this be a good way to commit suicide?[/quote]

Might be horrible death...

_________________
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Mask: Zzz-Mask Full Face CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Settings are IPap 23 EPap 19

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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by palerider » Mon Jul 21, 2014 2:03 pm

KillingMe wrote:"Do NOT use an unvented mask!!!!
You could die.


Would this be a good way to commit suicide?
sorry, the suicide assistance hotline is that away =----->

we're more in the business of prevention of premature death.

_________________
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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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cuyahogaguy
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Re: Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by cuyahogaguy » Mon Jul 21, 2014 6:17 pm

THANKS, THIS IS WHAT IM TRYING TO GET AT. IVE BEEN ON CPAP FOR 3 YEARS AND ABOUT EVERY 8 MONTHS THE IDENTICAL THERAPY TURNS NONCOMPLIANT AND ITS TIME TO FIND OUT WHY
buran wrote:cuyahogaguy,
Periodic breathing (especially if it is not cheyne-stokes, that is without central apnea) is not necessary related to any heart problems. This breathing instability could be due to chemoreflex problems.
There are several methods to treat periodic breathing. See this short paper, “Single vs. Multi-Modality Treatment of Central Apnea Syndromes”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413795
1. Adaptive Servo Ventilation CPAP – standard treatment
2. Non-vented mask (in addition to CPAP). This is an experimental treatment. I posted a short description and link to the original paper in this topic:
viewtopic/t98904/Unvented-Masks-and-Acc ... -Data.html
3. Pharmacological treatment (acetazolamide) in addition to CPAP, also experimental.
There are other methods, but they are not used even as “experimental” (for example, adding CO2, somewhat similar to adding O2 to CPAP).