Two questions which are a source of frustration for me. Can you help ?

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Albatros
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Two questions which are a source of frustration for me. Can you help ?

Post by Albatros » Wed Jun 07, 2023 4:33 am

For 7 months, I believe I have made good progress in the management of my therapy, mainly thanks to the Cpap Forum.

But when I try to understand how it works between the machine and my pharynx, I continue to be unclear.

1: concerning FL's, there are two possible culprits: the nose or the throat.
If the nose is blocked, I understand that there is nothing to do.
If it is the pharynx which is partly blocked, the pressure of the machine will help to fight them. But is it mainly by inhaling or exhaling? Intuitively it looks like both.
Using the EPR is like having a stronger exhale, because my exhale is less reduced by the pressure of the machine. Therefore putting an EPR should logically fight FL's due to the pharynx?

2.concerning the role of the machine in attacking OA's, I have the same question.
I understand that the machine pressure is insufficient to prevent an OA in progress. It is the brain which, by restarting breathing, stops the ongoing OA. On the other hand, the pressure of the machine will keep the throat open after the relaunch of the breath, thus avoiding new OA's. But I have the same question again: is this action mainly Ipap or EPAp? I read that it was done mainly during the exhale, with, therefore, Epap as the first variable.
I try to understand why.

Finally, it is clear that these questions do not prevent making correct adjustments on Pmin, Pmax, EPR by observing their impact on the AHI, mask leakage etc but, for me, they create a little frustration.

Thank you for your appreciated remarks.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by chunkyfrog » Wed Jun 07, 2023 2:48 pm

CPAP= Continuous Positive Air Pressure.
The first devices delivered the same pressure all the time, which held the airway open.
Later on, variations in pressure were introduced for comfort and therapy,
but the principle remains the same to this day.
Cpap does not breathe for you, but it prevents your airway from collapsing between breaths.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by ChicagoGranny » Wed Jun 07, 2023 3:54 pm

Inquiring minds are great until they are allowed to frustrate.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by palerider » Wed Jun 07, 2023 10:41 pm

Albatros wrote:
Wed Jun 07, 2023 4:33 am
questions
1) exhaling is normally done by simply relaxing your diaphragm, though you can force air out. when on CPAP, breathing is pretty much the same as when you're not, with the machine just providing a tiny pressure to hold your airway open. dropping the EPAP increases ventilation by a (relatively) small amount, which makes it feel like it's easier to exhale. Some people feel that increased ventilation can help with FLs.
2) Obstuctives are prevented at EPAP, IPAP has nothing to do with them, because you can't get to IPAP if you don't trigger an inhalation, and not during 'exhale', during the rest period post exhale before the initiation of a new breath.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by lazarus » Wed Jun 07, 2023 11:50 pm

Albatros wrote:
Wed Jun 07, 2023 4:33 am
FL's, there are two possible culprits: the nose or the throat.
It's not an either-or. Blocked sinuses can increase negative pressure in the throat during inhale in a way that can cause narrowing in the throat.
Albatros wrote:
Wed Jun 07, 2023 4:33 am
role of the machine in attacking OA's,
The general idea is not to attack but to prevent.
The people who confuse "entomology" and "etymology" really bug me beyond words.
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Re: Two questions which are a source of frustration for me. Can you help ?

Post by Albatros » Thu Jun 08, 2023 1:43 am

palerider wrote:
Wed Jun 07, 2023 10:41 pm
Obstuctives are prevented at EPAP, IPAP has nothing to do with them, because you can't get to IPAP if you don't trigger an inhalation, and not during 'exhale', during the rest period post exhale before the initiation of a new breath.

It's interesting.
Could you, please, elaborate one each one of your sentences.
The starting point is the moment when the airways have been reopened, and the objective of the machine is to keep it open.
But then, step by step, what happens ?

Thank you

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ozij
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Re: Two questions which are a source of frustration for me. Can you help ?

Post by ozij » Thu Jun 08, 2023 2:16 am

Inhale: Your brain tell you muscles to expand your lugs. That creates negative pressure - like what happen when you suck on a straw. If the Inhale postivie air pressure IPAP from the machine is high enough, you airway remains open and you breathe. If it's not high enough your airway collapses and you an obstructive breathing stoppage, i.e. an obstructive apnes.

Exhale: Your muscles relax. The air start coming out which helps keep you airway open. If the positive air pressure supplied by the machine is too low, your airways collapse. This is especially critical when you switch from exhale to inhale.

CPAP does not work like a ventilator. It only adds positive air pressure to keep you airway open. It does not do the work of breathing for you.

Look for videos, by ResMed for example, explaining how sleep apnea and how Continuous Positive Air Pressure works.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by lazarus » Thu Jun 08, 2023 2:26 am

Albatros wrote:
Thu Jun 08, 2023 1:43 am
step by step, what happens ?
In the words of the ResMed dudes describing their APAPs:
"By constantly measuring how much resistance is present in your breathing on a breath-by-breath level, APAP technology knows whether to decrease pressure when your upper airway is stable, and increase pressure when it senses an airway event (such as an apnea, a hypopnea, flow limitation or snoring). Unlike a CPAP device, APAP machines only deliver the amount of pressure that’s necessary at any given moment."--https://www.resmed.com/en-us/sleep-apne ... than-cpap/
But it is important, in my opinion, to understand that standard APAPs aren't so much designed to wait for events so that they can attack those events mid-event. The idea is for an APAP to use its algorithm to notice indications of the need for more pressure so that further future events can proactively be prevented from occurring at all. The goal of standard APAPs, as stated above, is airway stability.
The people who confuse "entomology" and "etymology" really bug me beyond words.
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Re: Two questions which are a source of frustration for me. Can you help ?

Post by palerider » Thu Jun 08, 2023 10:57 am

Albatros wrote:
Thu Jun 08, 2023 1:43 am
palerider wrote:
Wed Jun 07, 2023 10:41 pm
Obstuctives are prevented at EPAP, IPAP has nothing to do with them, because you can't get to IPAP if you don't trigger an inhalation, and not during 'exhale', during the rest period post exhale before the initiation of a new breath.

It's interesting.
Could you, please, elaborate one each one of your sentences.
The starting point is the moment when the airways have been reopened, and the objective of the machine is to keep it open.
But then, step by step, what happens ?

Thank you
Not really, it's all explained elsewhere.

You seem to want to look at things strangely, like putting the "starting point" when the airways have been 'reopened", which doesn't make sense.

posit a normal non-obstructed breath, the 'starting point' is when one starts an inhalation, with an open airway. The *point* of CPAP is just to keep that airway open.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by palerider » Thu Jun 08, 2023 11:00 am

lazarus wrote:
Thu Jun 08, 2023 2:26 am
But it is important, in my opinion, to understand that standard APAPs aren't so much designed to wait for events so that they can attack those events mid-event. The idea is for an APAP to use its algorithm to notice indications of the need for more pressure so that further future events can proactively be prevented from occurring at all.
Which it does by waiting for an event, described as snoring, flow limitations, hypopneas and apneas.

Unfortunately, there's nothing in the algorithms that can integrate anything else, (yet).

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by lazarus » Thu Jun 08, 2023 11:22 am

I consider change in flow shape often to be less than an event, although I understand the position of those who may consider anything less than a perfect breath to be something that could be labeled an IFL "event," since some can provoke an algorithm response in a home-treatment machine. Medically speaking, however, many changes that provoke machine response are subclinical changes that would NOT be considered actual events in
the context of a sleep study when sleep itself is not disturbed or O2 sufficiently affected.

As the Resporonics people once worded their material, the idea is to "manage a respiratory event in the early stages rather than waiting for it to occur. The primary function of the algorithm is to conduct a proactive analysis of the patient’s upper airway and its potential to collapse. It makes subtle, programmed CPAP pressure adjustments in response to detected changes in flow."--https://sleepreviewmag.com/sleep-diagno ... -pressure/

Marketing hype? Maybe.

But my point is that what a home-treatment machine considers an "event" in the context of its proprietary algorithm (because it is something it reacts to in choosing treatment pressure) is often not an actual clinical event as defined in sleep medicine.
The people who confuse "entomology" and "etymology" really bug me beyond words.
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Re: Two questions which are a source of frustration for me. Can you help ?

Post by palerider » Thu Jun 08, 2023 12:31 pm

lazarus wrote:
Thu Jun 08, 2023 11:22 am
As the Resporonics people once worded their material, the idea is to "manage a respiratory event in the early stages rather than waiting for it to occur. The primary function of the algorithm is to conduct a proactive analysis of the patient’s upper airway and its potential to collapse. It makes subtle, programmed CPAP pressure adjustments in response to detected changes in flow."--https://sleepreviewmag.com/sleep-diagno ... -pressure/

Marketing hype? Maybe.
From them, yes, because their algorithm absolutely does none of that. Maybe they were channelling Resmed.
lazarus wrote:
Thu Jun 08, 2023 11:22 am
But my point is that what a home-treatment machine considers an "event" in the context of its proprietary algorithm (because it is something it reacts to in choosing treatment pressure) is often not an actual clinical event as defined in sleep medicine.
Flow Limitations and Snores are defined, and that's the other things the machines react to.

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Re: Two questions which are a source of frustration for me. Can you help ?

Post by lazarus » Thu Jun 08, 2023 1:41 pm

Which definitions differ from NPSG and even from one generation of machine to the next.

But what do I know? I've been breathing in the remains of Quebec's trees for days now.
The people who confuse "entomology" and "etymology" really bug me beyond words.
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Re: Two questions which are a source of frustration for me. Can you help ?

Post by Albatros » Fri Jun 09, 2023 4:49 am

Thank you all, for your remarks and your different ways to help the understanding.

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chunkyfrog
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Re: Two questions which are a source of frustration for me. Can you help ?

Post by chunkyfrog » Fri Jun 09, 2023 9:49 am

It is better not to think of "events", per se, but a condition, where floppy bits hang down
where they get in the way when you need to breathe.
Positive air pressure pushes the loose tissue out of the way, so you can breathe.
The concept of events is used by sleep labs to measure the severity of apnea.
(Something to count, like periods of impeded airflow)

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