Rabid1 wrote:I know I've not been kind to Christine on this issue. That is an emotional response to someone...
Well, I guess there's a little "Black Bart" in all of us. But I like your last post, it's a little more in the category of "spirited debate". Once the mudslinging starts, if an issue is already divided, you're going to lose a lot more supporters than you gain.
Does Bret's inline diffuser interfere with the functions of a CPAP, APAP, or BiPAP?
Got me. But it's easy enough to check, and sounds like Bret's doing exactly that.
I want to pose a question to all the experts on this forum: What does an APAP, or BiPAP detect? Answer: CHANGE. Change in pressure, change in flow, change in vibration. Correct?
So, I think we can agree, the diffuser is a static portion of the circuit. It doesn't change.
Not entirely. If you restrict the flow through the circuit, you can alter the basic waveform. And this would not be static in any scenario, because the flow is continually changing, even if your pressure is fixed.
Just as every mask, hose, length of hose, and person's face is a part of that circuit. Does anyone think the geometry of a nasal pillow system is the same as a full-face mask? Of course not; but it doesn't matter, the machine doesn't care. It's only looking for changes within the current configuration. If the machine couldn't do that, we'd have to have a different setting for EVERY variable within that circuit.
I agree, I'll bet there's more restriction in the nares than the diffuser. And as far as this amounting to anything, we're only talking about APAPs and event identification. I don't see where fixed pressure therapy would make a difference.
Nonetheless, one can and should be aware of all these factors. Look at all the threads where machine responses were off the wall because of the variations that you mentioned above, variations that people are basically stuck with?
Some very typical examples of what happens when people make circuit or algorithm changes include:
The IFL1 setting on the 420E whenever you have a flow restriction
anywhere.
The AdaptSV "Learn Circuit" (at the least) if you use flow-restrictive interfaces.
And an interesting exchange between RG and DD when an unknown factor crept into a 420E circuit ("it wasn't the tubing!"):
Why Doesn't The 420 Respond Appropriately
So I'd like to see this thing tested in any machine that looks at flow limitations, regardless of how aggressively it does that.
Maybe they can step in here and provide something other than "it should be FDA approved" as an argument.
OK, fulfilling my reputation as a polysyllabic blatherer (inside joke), my offerings from the other thread were:
StillAnotherGuest wrote:DreamStalker wrote:I had two more zero AHI nights this past week and had my first zero AHI night bit over a month ago shortly after beginning trial use of the diffuser (… and I’m talking about zero AHI over a period of 7 or more hours of uninterrupted sleep here). I cannot say that the EO diffuser is directly correlated to my improved AHI because I have not used it every night and I have not kept a record of which nights I have used it … perhaps I’m just getting really good at making this therapy work? However the coincidence of achieving these recent zero AHIs has given me an incentive to begin tracking my infrequent use of the Pur-Sleep products and my AHI values. Maybe a personal experiment is in order for me?
Snoredog wrote:You mean like is the in-line diffuser device possibly masking your machine's ability to respond to SDB events? That doesn't surprise me.
From what I can tell, this diffuser delivery device is similar to the bacteria filter that installs in-line and has a drop of scented oil on the disc to distribute the scent. Even if it is a low restrictive screen it can impede the ability of the machine to respond to your SDB events.
But a machine like a Resmed Elite with EPR, Remstar with Cflex or autopap/bipap needs that patient airflow "feedback" in order to respond correctly with the exhale relief features offered on these machines.
Another obvious problem with an in-line device like this is when it is used with Autopaps. Autopaps need that patient airflow feedback more than any machine it is how they "listen" to your breathing patterns and respond. When you put a diaphragm in circuit like that, you reduce the sensitivity of the machine to detect SDB events. it is like putting headphones on to hide the outside ambient noise. The machine no longer can respond as sensitive as it did before.
As for your sleeping better as a result? that may very well be only a placebo effect, but I doubt it has very little to do with the actual "smell" and probably more to do with the softer response from the machine with added restriction of the diffuser in the circuit.
Snoredog wrote:The machines we use for OSA are flow-based generators. Flow is the volume of air that flows back and forth as you breathe. While you may have a pressure associated with that flow, it is the flow that the machine uses to determine if you are having a FL, Hypopnea or apnea.
SleepGuy wrote:In answer to your specific question, the diffuser has not yet been tested by an independent lab "to determine if there is any effect on xpap machines ability to sense SDB more specifically is the sensitivity of the machine to respond to events changed in any way." I think that is certainly a fair question and one that will take a bit of time and effort to answer definitively. I am presently working with an independent underwriting lab to develop a testing protocol to accomplish that but expect it to take several months to get to the end of that process.
In the meantime, I have tested the diffuser's performance in comparison to the in-line hepa filter presently on the market and can state that the diffuser's bi-directional airflow is better than the hepa filter.
Everything you have said here about demonstrating that the diffuser has any effect on xpap machines' ability to sense SDB can and should be said about the in-line hepa filter product. I have asked about and looked for independent testing of the in-line hepa filter (in order to assist in the development of testing protocols) but have found none.
I'd be appreciative of any feedback/comments you may be able to pass my way in that regard.
Sure, I'm here to help!
A lot of good points were made in the other thread, so lemme make sure those points are noted here.
Overall, as far as all this goes, I think the only EO you can really talk about if you want to talk about sleep quality is lavender. That's the only substance on the list that has had any documentation whatsoever.
In response to your comment, DS, I would offer the following:
1. If you're not using lavender, the effect is entirely placebo.
2. I see your AHI in your sig hovers around 0.1 to 0.4, as well as occasional 0.0, so this new 0.0 is statistically insignificant.
3. If the Goel study is correct on lavender (and again,
lavender, not anything else, and you don't need to do it with a diffuser), an increase in SWS is claimed. SWS is a very stable sleep stage, so the likelihood of having events there is quite small regardless of the instability of light NREM (Stage 1/2). I still gotta get that percentage, but it can't be much more than some minutes worth, so it's contribution to AHI would be negligible.
4. Do we really know if the xPAPs are measuring respiratory events or artifact from sleep fragmentation. If people are claiming they sleep better (there is probably some placebo effect as well, but if part of sleep hygiene is to go to bed in the right frame of mind, then placebo is not really placebo here, that's the desired effect). So perhaps reduced sleep fragmentation makes the "AHI" drop.
5. Does the diffuser change the flow characteristics of the aPAP. Does it create a flow limitation, which now causes the machine to overall increase pressure.
6. Has the ability of the xPAP to recognize events changed.
7. What I find interesting is the example on his website of the diffuser "in action":
Putting the diffuser on a machine that measures proximal airway pressure (pressure measured at the patient vs within the machine) puts out a whole new set of variables.
8. On that same subject, yeah, stick it in an AdaptSV and watch the fun.
9. Comparison to a HEPA filter is inappropriate. That rationale simply says "See, there could be worse things." BTW, a plug for what happens with HEPA filters (and I don't think he's talking about HEPA either, I think he's talking "bacterial", but we can review that at some point if necessary) when they mess up is at
Fun With Bacterial Filters
9. As snoredog suggests, perhaps a less aggressive approach by APAP (which differs from SAG #5, which offers more aggressive approach. Certainly, we gotta say "different", cause something's stuck in there that shouldn't be there.)
10. That effect probably changes the flow by way of the Bernoulli Principle, creating a venturi effect:
A Venturi meter is shown in a diagram, the pressure in "1" conditions is higher than "2", and the relationship between the fluid speed in "2" and "1" respectively, is the same as for pressure.
One other thing that's been largely ignored in this thread, is how people using Bret's system FEEL. By far, the vast majority of those people, who like the scents, report better sleep, or at a minimum, a more pleasant CPAP experience.
Not me, certainly at least as far as lavender goes. There's seems to be a lot of stuff out there supporting lavender in re: improving sleep quality.
And meanwhile, there are a lot of ways you can take advantage of that other than this in-line device, such as using lavender by:
Taking a few inhalations before bedtime (this medically-documented reference was offered by SleepGuy himself).
Simply aromatherapizing the room.
Sprinkling on pillow, mattress or use sachet if you're not on a machine.
Placing the EO near the intake (assuming the EO won't dissolve the impeller. But anybody who offers that argument better explain to me how if it does that, then what must it be doing to lung tissue).
Taking a bath with lavender in it (warm bath adds to the calming effect, that's Sleep Hygiene 101).
Lavender EO massage. Saaaaayyyy,,,you could even have a smoke afterwards.
And have I got a blend for you.
SAG
