My experience with Provent

[SleepingUgly]

The number of times that the Provent directions said "Relax!" made me nervous that there was good reason not to feel relaxed using the product! But surprisingly, it really didn't make me panicky to put it on and I didn't feel like I was suffocating. Night 1 I went to bed feeling unencumbered and I enjoyed having no gear on me besides two stickers on my nose, even though it entailed breathing in through my nose (and mouth, if I wanted) and out through my mouth. I thought I'd be totally focused on my breathing, anxious even, but I was lying in bed thinking of other things, and it was fine. I have no memory of falling asleep, but I must have dozed here and there because there's no way I could have been wide awake for 3'20", when I peeled them off and put on CPAP. I don't know if I was falling asleep and immediately waking, possibly due to a transition from oral to nasal breathing and then experiencing resistance on exhale, or perhaps not transitioning to nasal breathing and just having an uncomfortably dry mouth. But at that point my mouth was very dry and I felt like my nose was "stuffy", I just couldn't get to sleep, and I couldn't spend more time in bed not sleeping.

Night 2 I had the same initial experience, but actually did fall asleep. Somewhere around the 3 hour mark, I woke up and had the dry mouth/stuffy nose feeling and couldn't get back to sleep, so I took it off.

This week I have some unusually early mornings and some cognitive demands, so I'm not sure if I'll keep trying to use it, knowing it will cost me some sleep, or wait until next weekend. For now, I'd say it's possible that I'll adjust, and also possible I may need a chinstrap with it, and of course possible it won't work for me, but I'm not done with it yet and am still hopeful. I'll update here when I have more info on my experience.

[ozij]

How do these first nights of adjusting to ProVent compare to your first nights of adjusting to CPAP?

[LSAT]

SU.....OK...You can sleep with it, but, how do you know that it is doing anything to stop your OSA? No data to check.

[SleepingUgly]

How do these first nights of adjusting to ProVent compare to your first nights of adjusting to CPAP?

Oh boy, it's hard to remember. One thing that's different is that there are less facets of discomfort and adjustment with Provent than with CPAP. With CPAP there's having air blown into you for the first time in your life and trying to breathe against it, being tethered to a hose that you need to get positioned appropriately, then there's the mask with all it's presence on your face, leaks from the mask and/or discomfort, etc. With Provent there's only one dimension of discomfort/adjustment: breathing. This of course doesn't mean that one will adjust better to Provent, only that there's less aspects to have to adjust to....If that makes any sense.

SU.....OK...You can sleep with it, but, how do you know that it is doing anything to stop your OSA? No data to check.

The plan is that IF I can get to sleeping all night with it with minimal interruptions due to it AND I feel less tired in the day, then I will have a sleep study with it.

[SleepingUgly]

Night 3: Fell asleep with it and managed to sleep, off and on. I was waking up with a dry mouth, feeling of a "stuffy" nose, and feeling like it was hard to breathe. I managed to go back to sleep a few times like this, but then called it after about 5-5.5 hours. It was successful in that I'm logging more sleep with it, but I still don't know if my mouth is open the entire time I'm sleeping (leading to ineffective treatment) or just at the tail end, before I wake up. My plan is not to sleep with it this week but to pick it back up next weekend. I hope I'll be able to log more hours over time, and then I'll have to figure out whether I need to add a chinstrap. I really don't want to, for a variety of reasons, including that one of the best things about this is the lack of stuff on my face and I really hate chinstraps. Also I think it will be tough to be awake with a chinstrap and Provent. But we'll see what happens.

[NateS]

…I hope I'll be able to log more hours over time, and then I'll have to figure out whether I need to add a chinstrap. I really don't want to, for a variety of reasons, including that one of the best things about this is the lack of stuff on my face and I really hate chinstraps. Also I think it will be tough to be awake with a chinstrap and Provent. But we'll see what happens.

That's one of the things I'm really puzzled about - is that instruction to breathe through your mouth when awake and then switch to nose breathing after you fall asleep. If anyone had asked me, before I started on xpap, whether I was a mouth breather, I would have absolutely, positively denied it and felt sure I was right. But, as it turned out, after starting xpap, my leak chart was sky high until I tried adding a chinstrap, after which it dropped way down.

So how would the average person using Provent deal with this? Breathe through your mouth when awake and then have someone else put a chinstrap on you after they see that you have fallen asleep? I say this not to mock the product, but to add to the discussion and seek suggestions as to workarounds, if there are any.

And of course, for anyone trying Provent without ever having used a xpap machine, how would they know about whether they mouth breathe when asleep and if so whether or not it affects the effectiveness of therapy with Provent?

Regards, Nate

[SleepingUgly]

That's one of the things I'm really puzzled about - is that instruction to breathe through your mouth when awake and then switch to nose breathing after you fall asleep.

They advise breathing through your mouth (at least exhaling) while awake. It's not an "instruction" to switch to nasal breathing when you fall asleep, but rather, what they've found the vast majority of people do.

If anyone had asked me, before I started on xpap, whether I was a mouth breather, I would have absolutely, positively denied it and felt sure I was right. But, as it turned out, after starting xpap, my leak chart was sky high until I tried adding a chinstrap, after which it dropped way down.

I'm not sure that you can say, "I breathe through my mouth when I have positive pressure blowing in through my nose therefore it's a given that I will using Provent with no air blowing in". I don't know how well those two correlate.

So how would the average person using Provent deal with this? Breathe through your mouth when awake and then have someone else put a chinstrap on you after they see that you have fallen asleep? I say this not to mock the product, but to add to the discussion and seek suggestions as to workarounds, if there are any.

The person would have to put on a chinstrap before they go to sleep and not have it so impossibly tight that they can't breathe even slightly through their mouth while awake.

And of course, for anyone trying Provent without ever having used a xpap machine, how would they know about whether they mouth breathe when asleep and if so whether or not it affects the effectiveness of therapy with Provent?

Again, I don't know that whether someone exhales air out of their mouth on CPAP predicts whether they will exhale using their mouth on Provent.

[NightMonkey]

I think the comment below by NottaTherapist (A comment which seems to have been both overlooked and misunderstood.) is very intriguing, is dead on and points out what was so obvious that there is reluctance to admit I did not think of it.

This sounds like BiPAP in reverse???

10 cm (or 8 ) EPAP and 0 cm IPAP???

Sounds impossible to tolerate.

But what do I know.

The obvious is that BiPap creates an inhalation pressure and lowers this pressure for exhale,

while Provent creates an exhalation pressure and lowers this pressure for inhale (lowers it to zero).

Simple logic would say if one of these processes works well (in general) then the other should work poorly (in general).

But we know the human anatomy is very diverse and the personal human attitude toward any given process is also widely ranging.

Mine is 8-10 IPAP and 4-6 EPAP, so 8/4-->10/6.

So with Provent you transition from 8 - 10 IPAP to zero IPAP and from 4 - 6 EPAP to 8 EPAP.

[-SWS]

Simple logic would say if one of these processes works well (in general) then the other should work poorly (in general). But we know the human anatomy is very diverse and the personal human attitude toward any given process is also widely ranging.

Mine is 8-10 IPAP and 4-6 EPAP, so 8/4-->10/6.

So with Provent you transition from 8 - 10 IPAP to zero IPAP and from 4 - 6 EPAP to 8 EPAP.

Well, let's augment your skepticism with that of Dr. Rapoport's. He has a physics degree from MIT, holds an MD, directs the NYU med school sleep-medicine program, personally practices sleep medicine, holds multiple sleep patents, performs additional medical research, and is generally acknowledged as one of sleep medicine's pioneers and venerable icons.

Dr. Rapoport believes that Provent offers three potentially beneficial mechanisms, despite his initial skepticism about the Provent devices:
1) Increased lung functional residual capacity (FRC) at the beginning of inspiration- This benefit improves tracheal traction at the beginning of inspiration
2) Slightly elevated CO2- This benefit stimulates respiratory drive.
3) Increased upper-airway diameter at the beginning of inspiration- This benefit yields less flow resistance inside the airway---and helps avoid Starling Resistor collapse dynamics.

http://www.sleepdt.com/provent-nasal-ep ... -believer/

[NightMonkey]

(Dr. Rapoport) has a physics degree from MIT, holds an MD, directs the NYU med school sleep-medicine program, personally practices sleep medicine, holds multiple sleep patents, performs additional medical research, and is generally acknowledged as one of sleep medicine's pioneers and venerable icons.

Dr. Rapoport believes that Provent offers three potentially beneficial mechanisms, despite his initial skepticism about the Provent devices:
1) Increased lung functional residual capacity (FRC) at the beginning of inspiration- This benefit improves tracheal traction at the beginning of inspiration
2) Slightly elevated CO2- This benefit stimulates respiratory drive.
3) Increased upper-airway diameter at the beginning of inspiration- This benefit yields less flow resistance inside the airway---and helps avoid Starling Resistor collapse dynamics.

Did Dr. Rapoport use that MIT physics degree, his MD, his patents, his venerable iconny, and his practice of sleep medicine to develop his belief about the "three potentially beneficial mechanisms"?????

Or did he just watch the same two-minute cartoon containing them on the Provent site that I watched? http://www.proventtherapy.com/hcp/patient-selection.php

Well, let's augment your skepticism

Thank you, but my skepticism needs no augmentation. The data on the Provent website is quite sufficient for my level of skepticism:

[-SWS]

You are very welcome...

That graph is extremely encouraging for anyone who can't use CPAP. That graph tells me that when I can't tolerate CPAP or a dental appliance during excruciating trigeminal neuralgia flareups, that Provent might be vastly superior to no treatment. BTW, I resonated with one of Dr. Rapoport's critical comments----that using Provent in tandem with other adjunct treatments (eg dental appliances) might improve efficacy even more. If so, that's a godsend for people who cannot tolerate CPAP.

Rapoport's open-mindedness and positive comment about dental appliances reminded me of what Rooster once said about oral appliances:

Oral appliances do work for some limited amount of patients...

...cpaptalk members who aggressively treat their condition with CPAP are in a rare group, so I don't begrudge anyone who gets some therapy from a dental appliance.

viewtopic.php?f=1&t=52181&p=505665&hili ... al#p505665

I can't help but think Rooster's open-minded spirit and logic about the dental-appliance alternative translates to the Provent alternative...

Did Dr. Rapoport use that MIT physics degree, his MD, his patents, his venerable iconny, and his practice of sleep medicine to develop his belief about the "three potentially beneficial mechanisms"?????

Or did he just watch the same two-minute cartoon containing them on the Provent site that I watched? http://www.proventtherapy.com/hcp/patient-selection.php

Since Provent incorporated Dr. Rapoport's analysis elsewhere on their web site, they have the same incentive to incorporate his analysis in their video. Wouldn't ya think? Candidly, it appears Dr. Rapoport spent more time analyzing Provent than vocal opponents on this message board have.

[SleepingUgly]

I think the comment below by NottaTherapist (A comment which seems to have been both overlooked and misunderstood.) is very intriguing, is dead on and points out what was so obvious that there is reluctance to admit I did not think of it.

Therapist, what say you about NightMonkey's comment that your comment was "intriguing" and "dead on", so much so he wishes he'd thought of it himself?

[NightMonkey]

He has a physics degree from MIT, holds an MD, directs the NYU med school sleep-medicine program, personally practices sleep medicine, holds multiple sleep patents, performs additional medical research, and is generally acknowledged as one of sleep medicine's pioneers and venerable icons.

kudos on the great attempt to nuke me with credentials. Hahaha

Since Provent incorporated Dr. Rapoport's analysis elsewhere on their web site, they have the same incentive to incorporate his analysis in their video. Wouldn't ya think?

That is very logical but if you read the studies you will find that analysis was written into them by people other than Dr. Rapoport and the dates indicate their analysis predated Dr. Rapoport's comments. So was Dr. Rapoport whispering in their ears all along or did he watch the cartoon later? I will let you research that.

Candidly, it appears Dr. Rapoport spent more time analyzing Provent than vocal opponents on this message board have.

You are showing your sensitivity to the issue by inferring I have been an opponent of Provent. I am only an opponent of the idea that Provent is a good replacement for CPAP or a first course of treatment without being titrated for CPAP and making a determined try.

I am quite intrigued by Provent and its possibilities and have stated before I will ask for a prescription (if I ever see a doctor again) and try Provent for short naps. Like you I have thought of it as possibly viable for some people in a combination therapy with dental appliances or positional therapy or both. I would definitely combine it with positional treatment for my experimenting with naps.

You like to research old posts so you may want to find the ones where I have pointed out that some patients in the studies were fully treated by Provent. But that might erode the strawman that you are building up in this thread. Donchew think?

That graph is extremely encouraging for anyone who can't use CPAP.

Extremely encouraging? I would expect that someone who could not use CPAP would be "extremely encouraged" by a graph that showed Provent was 90+% effective for 90+% of trial participants. But you may just be engaging in hyperbole and our positions may be close. In any case I would be optimistic for any one individual, not because of the graph, but because the study claims some outliers were treated to normal.

As are my wishes for SU, I hope you find yourself to be one of the outliers that is treated with Provent to a perfectly healthy level.

[-SWS]

kudos on the great attempt to nuke me with credentials. Hahaha

Dr. Rapoport's credentials really weren't aimed at you. They were aimed at qualifying why he's a highly credible source of relevant opinion.

Since Provent incorporated Dr. Rapoport's analysis elsewhere on their web site, they have the same incentive to incorporate his analysis in their video. Wouldn't ya think?

That is very logical but if you read the studies you will find that analysis was written into them by people other than Dr. Rapoport and the dates indicate their analysis predated Dr. Rapoport's comments. So was Dr. Rapoport whispering in their ears all along? I will let you research that.

That is very logical as well. But if you read Dr. Rapoport's research papers and patent descriptions, you'll see he had been offering expert analysis in those same Starling Resistor dynamics (mechanisms 1 and 3) as well as CO2 dynamics (mechanism 2) for many years before Provent was invented. I'll let you research that.

You haven't established Dr. Rapoport's first consult with Provent. Regardless, the years Dr. Rapoport spent carefully documenting his work in those very same CO2, FRC, and Starling Resistor dynamics lend a direct answer to your previous question:

Did Dr. Rapoport use that MIT physics degree, his MD, his patents, his venerable iconny, and his practice of sleep medicine to develop his belief about the "three potentially beneficial mechanisms"?????

Or did he just watch the same two-minute cartoon containing them on the Provent site that I watched? http://www.proventtherapy.com/hcp/patient-selection.php

Dr. Rapoport's white papers prove he did not merely watch the same cartoon you have. Kudos to you for watching the cartoon. No Kudos to you for insinuating a respected researcher did nothing more.

Extremely encouraging?

Let's see... When I am involuntarily forced off CPAP and untreated, my mortality risks will be associated with twice as many untreated apneas than successful Provent use. If I can find another adjunct treatment to use in tandem, it's conceivable my mortaility risk will get even better. So the answer to your question above is most definitely.

[avi123]

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 the 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 a regular mask by plugging SOME of the intentional vent holes while CPAPing, or using a ventless mask and install a PEEP valve at the inlet to the mask. The valve creates 2 to 3 cm of exhaling pressure above athmospheric pressure.

A PEEP Valve:



In light of above comments it seems to me that the Provant should be used in combination with a chinstrap to prevent mouthleak.