Link: Unvented Mask Improves Centrals/Periodic Breathing?

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cuyahogaguy
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Link: Unvented Mask Improves Centrals/Periodic Breathing?

Post by cuyahogaguy » Sun Jul 20, 2014 9:52 am

http://www.sleepapnea.org/learn/sleep-a ... apnea.html UNVENTED MASK?

Very very impressive forum, well organized, and above all its obvious people are being helped with real-life medical issues of survival and quality of life. ME: was on cpap for appx 2 years, good AHI, but sleepyhead revealed a severe vibratory issue (upon exhalation I think). Switched by sleepdoc to PR Bipap Pro (didnt know enough to demand auto) and settings in the range of 13/9. Instant elimination of vibratory and a good solid 6 months of blissful compliance.

NOW/HELP Dont worry, i wont be one of those here today gone tomorrow posters, my periodic breathing has gone out of control up over 11 percent and i feel exhausted and dizzy at times. Have been tinkering with pressures and masks but cannot solve PB. ANY AND ALL HELP appreciated. I will post sleepyhead data tomorrow on this thread and if ok ask for more advice---I do NOT trust sleepdocs, they play hit or miss for dollars.

1. what is exactly is an unventilated mask to increase c02 and signal breathe response?
2. How can i determine if im entering into cheynes stokes? Heart had checked out healthy few years ago
3. I have an extreme deviated septum, getting worse causing problems?
4. Switch back to cpap and deal with snoring better than continueing with bipap for now?
5. Buy a servo off Craigs and see if i can get anywhere?

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

Post by Pugsy » Sun Jul 20, 2014 9:57 am

When you post your detailed daily graph tomorrow can you also include a zoomed in section of the green flagged PB that you are worried about? So that we can more or less see the breath by breath air flow of what your machine is calling PB.
Not all PB is Cheyene Stokes respiration. CSR is just one of many forms of PB.

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

Post by cuyahogaguy » Sun Jul 20, 2014 10:04 am

Yes Pugsy, thats exactly what i will attempt to do. I am not a strong technical person but i'll try to get the information you need up there. I dont want to screw around with this, we all know going into air-hunger mode and twitchy fingers and headache that we basically disabled until problem corrected. Im very baffled how identical therapy can be good for six months and suddenly turn quite bad suddenly.

My air hunger is debilitating when im not compliant. I can deal with fatigue. But im one of those who feel light headed, have this ache inside my brain for 02, shaky twitching fingers.

Im very interested to try the unventilated mask, but obviously safely. The article i posted listed a general brain stem issue that requires more c02 to signal. Complicated.

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

Post by archangle » Sun Jul 20, 2014 11:34 am

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


With normal CPAP equipment, with an unvented mask, you will die, just like you would if you breathed into a large plastic bag for long enough. As the O2 levels drop, you might lose consciousness and never wake up.

Without a vent in the system at the mask, the CO2 builds up and there's no way for fresh oxygen to come in.

If you use an unvented mask, you need to have a separate vent. This article is probably talking about a technique where you use an unvented mask, then a short (12 inch or so) hose and then you put a vent on the end of that hose. You end up rebreathing the exhaled air in that "dead air" space for the hose. CO2 builds up to a varying degree depending on the length of the hose and other factors. CO2 increases the urge to breathe, so this may help with central apnea.

This is dangerous to experiment with on your own. If someone ends up not having a proper "inline" vent, the O2 levels could drop to dangerous levels.

This is an interesting technique that may be a boon to those with central apnea. However, if you try it on your own and get it wrong, you could die. If you screw up one night and hook the hose up to the unvented mask without the swivel, you could suffocate.

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

Post by chunkyfrog » Sun Jul 20, 2014 11:44 am

Please pay attention to Archangle's post.
It sounds extreme, but an unvented ff mask should only be used under the advice of a physician.

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

Post by cuyahogaguy » Sun Jul 20, 2014 1:30 pm

Yeah, i certainly wouldnt use any mask that wasnt completely safe. What they mean by unvented is what im trying to discover. If a centrals/PB issue can be corrected by mask configuration rather than more lengthy solution then all the better. Im just in the explore phase of correcting this problem. We all know AHI is the holy grail to most sleepdocs, unfortunately.

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

Post by JDS74 » Sun Jul 20, 2014 2:06 pm

Look at your mask. Just below the head support is the vent for the mask. This allows the exhaled air and the incoming air to mingle and exit the mask. That process makes sure that the CO2 you exhale doesn't get re-inhaled on the next breath.
If this same mask were designed as unvented, the vent would not be there.
For it to be safe to use, another vent would be added. Typically this would be at the end of the short hose.
The effect would be to increase the amount of exhaled CO2 that is re-inhaled by the user. The effect is to increase the mask dead space. In the large size, the Quattro has dead space of 242 mL already. Closing the on-mask vent and moving it 10 inches down to the end of the mask hose would add another 250+ mL to the dead space.

The theory, as I understand it, is that this will increase the serum CO2 level. During sleep the serum CO2 level controls breathing and defects there are the cause of central apneas. Increasing serum CO2 is thought to reduce the incidence of central apneas by getting it to the breathing trigger point sooner.

As previously stated, trying this at home may be dangerous.

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

Post by archangle » Sun Jul 20, 2014 4:03 pm

cuyahogaguy wrote:Yeah, i certainly wouldnt use any mask that wasnt completely safe. What they mean by unvented is what im trying to discover. If a centrals/PB issue can be corrected by mask configuration rather than more lengthy solution then all the better. Im just in the explore phase of correcting this problem. We all know AHI is the holy grail to most sleepdocs, unfortunately.
Some "hospital" masks don't have built in vents. These masks are partially for more complicated breathing setups, ventilators, etc. They are designed to be hooked up with some sort of valve or vent right at the mask that allows CO2 to escape and fresh O2 to enter the mask. Without this external vent, you could suffocate from rebreathing your exhaled air.

BTW, occasionally someone buys an unvented "hospital" mask online somewhere or takes one home from a hospital visit. This is dangerous, too.

We tend to be skeptical because of all the DME/doctor/medical mafia BS about "tampering with your CPAP could kill you." An unvented mask is one case where it really could kill you.

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

Post by JDS74 » Sun Jul 20, 2014 4:44 pm

archangel wrote:BTW, occasionally someone buys an unvented "hospital" mask online somewhere or takes one home from a hospital visit. This is dangerous, too.

We tend to be skeptical because of all the DME/doctor/medical mafia BS about "tampering with your CPAP could kill you." An unvented mask is one case where it really could kill you.


Lordy, lordy I brought home from the Mayo Clinic a nasal mask they used for me in the ER since I didn't have my machine with me. Just got it out to take a close look - NO VENT - and you can't breathe through the thing if the hose connection if blocked. It does have a swivel that lets in a little air but not enough to do the job in a power failure. There must have been a vent piece I didn't get when I left.

Next stop the trash bin. The thing is too dangerous to keep around.
Thanks for the heads up about hospital masks.

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

Post by buran » Sun Jul 20, 2014 6:19 pm

JDS74,
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.

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

Post by cuyahogaguy » Sun Jul 20, 2014 6:52 pm

True story. When i first got sick my doc thought maybe i had MS. Prescribed an 02 concentrator for home use.

I wore that thing out, sucking 02 constantly.

Came to find out you can kill yourself pretty easy overdosing on 02. Surprised I didnt off myself, because i was
sleeping with the thing turned on full blast a lot of nights.

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

Post by JDS74 » Sun Jul 20, 2014 7:59 pm

buran wrote:JDS74,
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.

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

Post by archangle » Sun Jul 20, 2014 8:37 pm

JDS74 wrote:
buran wrote:JDS74,
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.
Put it on, turn on the CPAP and see if there's an air stream coming out of it. Your PRS1 machine plus SleepyHead will tell you the actual leak rate of your mask, so you can get a number to see if it's truly unvented.

The "gap in the swivel" sounds a bit like how the old ComfortGel masks worked. There was sort of a slit that was hard to see, but it leaked a lot of air. Just looking at it, you might conclude there's no vent.

BTW, even with a proper exhaust vent, it's hard to get enough air to breathe through the vent holes. The holes are designed to vent air when you're under pressure not normal breathing.

However, you may have an unvented mask. If you do determine it's an unvented mask, see if there's any kind of label on it. Maybe take a picture. And break it before you take the trash out so no one else picks it up and uses it. Although if someone is getting CPAP masks from the trash, they've got problems anyway. However, given the price DME's charge for masks.....

If really is an unvented mask, you might want to warn the clinic that sending home unvented masks for CPAP patients is a bad idea. The next person might not be so lucky.

Way back when, someone on this board discovered that the hospital had set up their unconscious mom on a hospital CPAP/ventilator machine and didn't have a vent. They had to pitch a fit to get the numbskull nurses to call the pulmonologist. Supposedly, the pulmonologist turned white when they saw that. If there hadn't been mask leaks and a savvy relative, the patient could have died and probably no one would have figured out why.

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

Post by JDS74 » Mon Jul 21, 2014 12:37 am

It is a Respironics Contour Deluxe single use mask.
Image

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!!!

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

Post by archangle » Mon Jul 21, 2014 1:12 am

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.

It's scary to look it up on the web. There are a number of sites that seem to be selling it with no clear warning that you need a separate exhalation port. It looks like an innocent CPAP user could easily harm themselves with one of these, although hopefully they'd get uncomfortable enough while still awake to take it off. Heaven help someone who uses one of these on someone who's incapacitated.

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