Expiratory Flow Limitations

[Rubicon]

If we were to calculate inspiratory volume and expiratory volume with ASB's .04 Waveform Slicer, the expiration looks to have simply disappeared!

IOWs, the area above the line has to equal the area below the line. If it don't then a leak has occurred.

Using a cran:



In the first breath of color I pretty much = E.

In the second, most of it is gone.

[Rubicon]

OTOH, does this mean that there's definitely NO PP?

[imposterdroids]

Rubicon,

I've tried all the aforementioned. Full face masks, every chin strap known to man (and some not), and mouth taping. I even tried nasal trumpets (or nasopharangeal airways, or NPAs) but they are horridly uncomfortable. Most relief I ever got was from nastent - which improved the expiratory flow line dramatically, but sadly they kink and clog and are not available in the United States.

Will have a phone interview with the alaxostent people tomorrow to talk things over.

[Rubicon]

Most relief I ever got was from nastent - which improved the expiratory flow line dramatically, but sadly they kink and clog and are not available in the United States.

That may change:

https://clinicaltrials.gov/ct2/show/study/NCT04305964

So whatever happened to yrnkrn?

[Rubicon]

OTOH, does this mean that there's definitely NO PP?

Cause I mean, although it appears in many breaths that the entire exhalation came flying out of his mouth, there might have been a good reason for that.

In general, I wonder how many EFLs are dismissed as CB?

[dataq1]

I've been lurking this thread for a bit, and I'd like to understand if palatal prolapse (PP) is a condition that normally requires treatment?
( My question is conditioned on my (very rudimentary) understanding that PP is demonstrated by nasal inhalation and oral exhalation).

[imposterdroids]

I've been lurking this thread for a bit, and I'd like to understand if palatal prolapse (PP) is a condition that normally requires treatment?
( My question is conditioned on my (very rudimentary) understanding that PP is demonstrated by nasal inhalation and oral exhalation).

I'm guessing that you're thinking that it shouldn't matter, since your oxygen saturation isn't affected if you're just breathing out through your mouth. But you CAN have apneas on the exhale and your mouth just doesn't open and that would affect your oxygen saturation. But for me personally, its the arousal that occurs when the prolapse occurs. Waking up hundreds of times a night won't leave you feeling great the next day.

[imposterdroids]

That may change:

https://clinicaltrials.gov/ct2/show/study/NCT04305964

So whatever happened to yrnkrn?

They been trying to get nastent approved in the U.S. for years. Then seven dreamers, the company that makes the device, filed for bankruptcy. They've just recently rebounded as a company focusing on just the nastent device. But they've had trials that were supposed to end before the pandemic, then it was March of this year, and now it's been moved once again. And that's just the trials - FDA approval is still way down the road.

And I dunno - haven't seen yrnkrn post for a while. Hope he's well. Think he was from outside the U.S.?

[dataq1]

But for me personally, its the arousal that occurs when the prolapse occurs.

Please don't take this as a challenge, as it's not meant to be. But what what would be helpful (for me) to understand is how those arousals evidence themselves. (for example choking ? or suffocating ? or some other feeling?).

Referring to the flowrate curve )from earlier in this thread):

prolapse.jpg (30.77 KiB) Viewed 1721 times

Would the breathing seen at time 04:29:40 through 04:29:50 be indicative of the arousal that you speak? If so how, does that breathing event cause a physical response (such as choking, or what ever).

I'm just trying to understand, as I have lots of "arousals" (sighing, disturbing dreams, repositioning, figgiting) and the PAP software does not seem to consider those to be significant enough to report or classify).

[Rubicon]

Would the breathing seen at time 04:29:40 through 04:29:50 be indicative of the arousal that you speak? If so how, does that breathing event cause a physical response (such as choking, or what ever).

My interpretation of this waveform is that this person is on a nasal device breathing entirely through their nose; transition occurs until they are inhaling through their nose and exhaling through their mouth; then suddenly the arousal occurs, they close their mouth and exhalation reappears.

Could this be PP? Sure.

Is this diagnostic of PP?

Absolutely not.

That said. I would look at the whole night, including body position when they occur (gonna be a long night for the little woman!). If there was only a couple of these, then why bother. If there's a lot (like >5 per hour)(and we can certainly debate what the significant number would be)(like if an event like that happened and you ended up awake for an hour) then look at options to fix floppy palates.

[imposterdroids]

Please don't take this as a challenge, as it's not meant to be. But what what would be helpful (for me) to understand is how those arousals evidence themselves. (for example choking ? or suffocating ? or some other feeling?).

Referring to the flowrate curve )from earlier in this thread):
prolapse.jpg

Would the breathing seen at time 04:29:40 through 04:29:50 be indicative of the arousal that you speak? If so how, does that breathing event cause a physical response (such as choking, or what ever).

I'm just trying to understand, as I have lots of "arousals" (sighing, disturbing dreams, repositioning, figgiting) and the PAP software does not seem to consider those to be significant enough to report or classify).

Theres no scientific way of identifying arousals from the flow graph. I've seen articles on people attempting to make correlations, but they never line up with actual sleep study data. So when I say arousals, I'm referring to my own personal sleep studies (3 of them) where my arousal index is through the roof. You'd have to be hooked up to something other than a CPAP/BiPAP machine to get an accurate recording of arousals.

[dataq1]

Would the breathing seen at time 04:29:40 through 04:29:50 be indicative of the arousal that you speak? If so how, does that breathing event cause a physical response (such as choking, or what ever).

My interpretation of this waveform is that this person is on a nasal device breathing entirely through their nose; transition occurs until they are inhaling through their nose and exhaling through their mouth; then suddenly the arousal occurs, they close their mouth and exhalation reappears.

1) Does that arousal (that we both seem to agree is an arousal) cause a physical response (such as choking, suffocating etc)?

and while I did not originally ask this:
2) I have observed my own flow pattern, what appears to be a low volume of air being exhaled, with a graph that looks similar to the one above, followed by a large volume exhalation similar to 04:29:39. However, I am using a full face mask (capturing both oral and nasal) AND there is no reported leakage.
Now, It does not cause me to awaken (however I can not say that my EEG would not reflect an brain awakening).

Can't understand how this happens? Where did the exhaled air go???

[imposterdroids]

dataq1,

Care to post your own flow pattern from OSCAR? I've done the full face mask too but still get a graph similar to the one Rubicon posted - so it's definitely not mouth breathing.

[Rubicon]

I've done the full face mask too but still get a graph similar to the one Rubicon posted - so it's definitely not mouth breathing.

But if you have palatal prolapse, it has to be mouth exhalation, otherwise there'd be no exhalation at all.

Frankly, I find that "classic" PP waveform a little confusing. Why, when PP supposedly starts, does tidal volume drop? PP is a one-way valve so inhalation shouldn't be affected. Or has baseline -0- dropped because of an LL?

[SleepyCPAP]

Frankly, I find that "classic" PP waveform a little confusing.

I was always confused too. I tape my mouth and have zero leaks, so I could not figure out how this was working. But it was causing arousals, and higher AHI as severe stretches of PP looked like apneas or Hypopneas to the machine. So I just wanted it gone, whether I could explain it or not. I figured if it is my soft palate doing this, I can stent that and see if it works. The 6” AlaxoStent worked, instantly. The first night I used the stent I had hints of mild (partial) PP, but once I got used to the proper placement of the stent my VAuto no longer showed expiratory Palatal Prolapse patterns.

- SleepyCPAP