Treating sleep apnea without the mask

[kempo]

I don't understand how this could help.

http://well.blogs.nytimes.com/2012/04/0 ... ef=general

[NightMonkey]

The device contains two pinhole-size valves, one over each nostril. The valves let air in easily — most people breathe through their nostrils while asleep — but there is resistance as the user exhales. That resistance creates a backpressure in the airways, dilating the muscles that would otherwise collapse in the middle of the night.

What do you not understand about this statement?

[kempo]

How would it stop muscles from collapsing on inhales? What would keep them from blowing completly out of your nose?

[tjgriffin]

How would it stop muscles from collapsing on inhales? What would keep them from blowing completly out of your nose?

The back-pressure works the same as positive pressure from a machine. The vents are supposed to let out enough air so as not to overcome the adhesive.

I got a sample, tired one and gave up. They have two levels of resistance. I got the lower one and it was too much. The back-pressure does work, but sitting in a chair, relaxed, I couldn't get enough air without opening my mouth. It was like having really bad congestion. I guess that why I use a full face mask. It may work for some, but not me.

[MaxDarkside]

In what orifice do I stick the SD card to get my data ? Or can I dangle a USB cable from my left nostril ? (GRIN--LOL). I'll stick with my cheaper, data capable, xPAP machine I think.

[Drowsy Dancer]

Interesting device.

(1) It doesn't seem like you could titrate the pressure very accurately.
(2) For an experienced xPAP-er to increased pressure on the inhale and decreased pressure on the exhale, e.g. C-Flex+, it sure would take some getting used to.
(3) To echo Max Darkside--the data! The data! Where's the data kept?

I suppose it would be better than nothing at all if you were desperate, and didn't have a very high AHI to start with.

[chunkyfrog]

Just something to pass around the shelter for the disaster victims.
They'll only be there a couple of nights--then, who cares?
Seriously, I see this as something that disaster managers will stock.
--No way are they going to provide machines, extension cords, distilled water, or even just current.

[BasementDwellingGeek]

It would certainly be easier than carrying enough battery power for a 5 day camping trip in the Grand Canyon, if it works!

[NightMonkey]

How would it stop muscles from collapsing on inhales?

Good question.

Nasal EPAP Mechanism of Action
OSA is traditionally thought of as an inspiratory disease.
However, it is important to note that the closure of the upper
airway has its origins at the end of expiration, when the pressure
in the airway is zero. Morrell et al showed that upper airway
cross sectional area progressively decreased in the four breaths
prior to an obstructive apnea, with this area being smallest
at end-expiration. Their conclusion was that this expiratory
narrowing made it more likely for the airway to completely
collapse during the subsequent inspiration.10 Provent nasal EPAP
creates increased expiratory pressures which are maintained
through the end of expiration and until the start of the
subsequent inspiration [Figure 2].
The exact mechanism through which nasal EPAP treats OSA is
still unclear, but several mechanisms appear most likely:
1) Positive end-expiratory pressure (PEEP) leading to increased
end-expiratory lung volumes (or FRC) that increases
longitudinal traction on the pharynx, rendering it less
collapsible (“tracheal tug”).11 Indeed, the role of increased
lung volumes in decreasing the compliance of the upper
airway has been well described in the literature.12
2) Dilatation of the upper airway by EPAP which carries over
until the start of the next inspiration.13
3) Mild hypercapnia due to hypoventilation which would lead to
increased respiratory drive to the upper airway.13
It is possible that a combination of more than one of these
mechanisms may be responsible for the therapeutic benefit of
nasal EPAP.
The first clinical study intended to help elucidate the mechanism
of Provent nasal EPAP was conducted by Colrain et al.14 This
study demonstrated that the benefits of the Provent device
were due to EPAP, since a similar sham device did not lead to
reductions in either AHI or ODI. In a larger study by Patel et
al, the authors concluded that those patients who were able to
generate and sustain positive end expiratory pressures were
more likely to exhibit a therapeutic response.13 They concluded
that the primary mechanism of action was likely related to
increased FRC (functional residual capacity) leading to a
tracheal traction mechanism, though they cited the possibility
of a carryover effect of pressures from end-expiration into the
subsequent inspiration as well as increased CO2.
A follow up study by the same group15 concluded nasal EPAP
resulted in significant hyperinflation (higher end-expiratory
lung volume) during wakefulness, that there was a trend toward
expiratory upper airway dilatation which appeared to carry over
into inspiration and that there was significant hypoventilation
and hypercapnia induced both while awake and asleep.
Additional mechanistic studies are ongoing and will provide
additional insights into the mechanism of action of Provent nasal
EPAP.
http://www.proventtherapy.com/hcp/asset ... essure.pdf

What would keep them from blowing completly out of your nose?

They have an adhesive backing. (They are not in your nose. Provent adheres to the outside of the nostrils.)

[NightMonkey]

The back-pressure does work, but sitting in a chair, relaxed, I couldn't get enough air without opening my mouth.

Somebody should have explained this to you. Provent claims most patients using the device breathe through their mouth until they fall asleep and the mouth (of most) closes reflexively.

If this is true and Provent is letting the devices be sold without educating the customer then the product will be a failure.

[NightMonkey]

Any AHI above 2.0 is not good for me!

[MaxDarkside]

Any AHI above 2.0 is not good for me!

OK, so I would go from SEVERE to merely moderate. Thanks for posting that graph.

[NightMonkey]

OK, so I would go from SEVERE to merely moderate. Thanks for posting that graph.

Not necessarily. Those are median numbers.

You might be an outlier. You could stay at severe or go to "normal".

The studies show some treated fully and some not treated at all. But, IMO, these are crude and small studies.

Like you, I won't drop CPAP treatment without a method to evaluate my at-home treatment on an ongoing basis. Data is important for achieving, verifying and maintaining gains in any process. Provent provides no data.

[NightMonkey]

The back-pressure does work, but sitting in a chair, relaxed, I couldn't get enough air without opening my mouth.

Here it is on the Provent website:

"Breathe out through the mouth while awake. The patient will naturally shift to nasal breathing when asleep."

http://www.proventtherapy.com/hcp/patient-selection.php

So not knowing how to use the device you were doomed from the start to failure.

A general comment, I certainly would not want to have to breathe through my mouth every night while waiting to fall asleep.

The work that was done on this device and the science behind it impresses me. However the practical application leaves a lot to be desired compared to my CPAP.

[avi123]

I just posted this post in the other thread:

But Provent works for many:

HEALTH | April 09, 2012
Well: Treating Sleep Apnea Without the Mask
By ANAHAD O'CONNOR
An alternative form of C.P.A.P. is gaining popularity for sleep apnea patients: a patch that fits over the nostrils.

Link:

http ://well.blogs.nytimes.com/2012/04/09/treating-sleep-apnea-without-the-mask/?emc=eta1

take the space out after the http

The Provent device is nothing more than a simple PEEP creator (PEEP = Positive End Exhalation Pressure). For years, Anesthesiologists and Respiration Therapists, have been using this technique on certain patients in operating rooms and in surgical intensive care units.

See here how PEEP works:

http://www.ccmtutorials.com/rs/mv/page14.htm

I could create a PEEP in an XPAP mask by plugging SOME of the intentional vent holes, or using a ventless mask and installing a PEEP valve at the inlet to the mask. The valve creates 2 to 3 cm of exhaling pressure above athmosferic pressure.

A BiLevel machine allows setting the exhale pressure and thus creating PEEP, besides lowering the pressure then from CPAP, for comfort.

The Provent air resistance creates a "backpressure in the airways, and thus dilating the muscles that would otherwise collapse". This is what Provent company says. But I don't know if this is correct or not, and suitable to to all levels of OSAs.

The following recent article in the NY Times indicates that the Provent is gaining success:

http://well.blogs.nytimes.com/2012/04/0 ... /?emc=eta1