Homer could relate . . .

Unfortunately, we're not talking about the author of the Illiad and the Oddysey. I think I just had a Homer Simpson moment . . . (cue sound track)

I recently read a post about Profile Lite advising to keep the little ventilator holes plugged, and it got me thinking. I knew that all masks were 'sposed to ventilate the CO2, and since this mask was given to me with the little holes wide unplugged I "ASS-U-ME d" that this must be their purpose, i.e. to ventilate.

Who knew that the ingenious design engineer had devised a far more stealthy way of venting the carbon dioxide? (The transparent elbow piece has some apertures hiding out, but they were nowhere nearly as obvious.) Who knew the DME folks would give me the mask with the holes unplugged?

Anyhoo, prolly coulda/shoulda figgered it out myself, but you know they throw a lot of new stuff at you with they hand you the machine, the mask, the instructions, etc.

Interesting observation: it does wonders for the leak rate when you actually put the plugs in, as was intended.

Happy ending and moral to story: you can learn a lot by reading these boards. You gotta keep "pluggin' along. Wink

Caveat: if you are perhaps pondering plugging, be SURE you know which holes actually are for venting, as this is a important safety issue. Don't plug willy-nilly!
Wouldn't be prudent.

the exhaust holes should not be all covered on the ProfileLite.

Personally, the ProfileLite is not the best interface in my opinion, the ComfortGel is much better. ProfileLite leaves a nice gouge across the bridge of your nose to wear around all the next day. When that interface first came out it was even worse, they had a manufacturing "seam" going right where the cushion went across the nose, it held the added membrane flap in place that went across the nose bridge area to stop it from leaking so badly. If you search posts here you should find some posts stating the same thing.

The ProfileLite (newer model) uses the same elbow system as the ComfortGel and other Respironics interfaces so they end up all being equally as noisy from the Classic, to the Gel to the Lite. You only know it is noisy when you compare it to others. The ComfortGel seals pretty good if you can get it

There is a difference in CO2 retention levels, the newer generation Respironics interfaces with the tiny digital square pattern exhaust seem to retain more CO2 than the older models.

There is a much better interface than all the Respironics, the Somnotech Soyala is a much better mask, it costs more but has better headgear, better sealing cushion requiring a lot less strap pressure and its exhaust system is completely silent by comparison. The exhaust air is diffused nicely around the elbow retaining ring. The elbow system swivels more than any mask out there. The Soyala has a lower exhaust rate which retains more CO2 which was shown by the Harvard study to assist in reducing SDB events.

A mask that retains more CO2 will feel a bit more stuffy when first trying it out, it may also make you feel like you are hyperventilating but that feeling soon passes.

As a general rule if you use a mask that leaks less, has a lower CO2 exhaust leak rate it will be much quieter mask to use.

https://www.cpap.com/productpage/Soyala ... dgear.html

Here is how the noise level on the Somnotech compares to other interfaces you may have used:

I beleive he is referring to the two little "prongs" on the mask that are covered with white plastic caps. These are not the exhalation ports and should be covered. The exhalation port is on the elbow and. of course, should not be covered.

sleepyWI wrote:I beleive he is referring to the two little "prongs" on the mask that are covered with white plastic caps. These are not the exhalation ports and should be covered. The exhalation port is on the elbow and. of course, should not be covered.

Yes, that's exactly what I was referring to, and thanks for the clarification.

Snoredog wrote:the exhaust holes should not be all covered on the ProfileLite.

Personally, the ProfileLite is not the best interface in my opinion, the ComfortGel is much better. ProfileLite leaves a nice gouge across the bridge of your nose to wear around all the next day. When that interface first came out it was even worse, they had a manufacturing "seam" going right where the cushion went across the nose, it held the added membrane flap in place that went across the nose bridge area to stop it from leaking so badly. If you search posts here you should find some posts stating the same thing.

The ProfileLite (newer model) uses the same elbow system as the ComfortGel and other Respironics interfaces so they end up all being equally as noisy from the Classic, to the Gel to the Lite. You only know it is noisy when you compare it to others. The ComfortGel seals pretty good if you can get it

There is a difference in CO2 retention levels, the newer generation Respironics interfaces with the tiny digital square pattern exhaust seem to retain more CO2 than the older models.

There is a much better interface than all the Respironics, the Somnotech Soyala is a much better mask, it costs more but has better headgear, better sealing cushion requiring a lot less strap pressure and its exhaust system is completely silent by comparison. The exhaust air is diffused nicely around the elbow retaining ring. The elbow system swivels more than any mask out there. The Soyala has a lower exhaust rate which retains more CO2 which was shown by the Harvard study to assist in reducing SDB events.

A mask that retains more CO2 will feel a bit more stuffy when first trying it out, it may also make you feel like you are hyperventilating but that feeling soon passes.

As a general rule if you use a mask that leaks less, has a lower CO2 exhaust leak rate it will be much quieter mask to use.

xcellent information, Snoredog! Wow.
Do you perchance have a reference link for that Harvard study?

Also, regarding the Somnotech Soyala, I am not Bill Gates, but I will gladly pony up extra loot for a better performing mask. I am somewhat familiar with the "popularity" ratings on CPAP.com in regards to the choices in masks. I don't think the Soyala was one of the better sellers, and I am wondering why? People (I think) are willing to spend almost as much as it takes to improve the quality of sleep (and for good reason), so I am wondering why such a superior quality product is not flying off the shelves, despite the higher price tag. Any thoughts on this?
Thanks again for sharing your valuable information, much appreciated.

And PS, thanks for confirming that the exhaust ports should be covered as you noted.

drbandage wrote:Do you perchance have a reference link for that Harvard study?

Think he's referring to:
Recognition and Management of Complex Sleep-Disordered Breathing
Geoffrey S Gilmartin; Robert W Daly; Robert J Thomas
Curr Opin Pulm Med. 2005;11(6):485-493. ©2005 Lippincott Williams & Wilkins
Posted 10/27/2005

The paper acknowledges Complex SDB as a third sleep-apnea phenotype (in addition to obstructive and central). The paper also mentions CO2 rebreathing as a possible therapeutic approach----but very specifically for the narrow percentage of sleep apnea patients experiencing this hypocapnic complex disease discussed in the Gilmartin, et al paper.

Some admittedly wild message board discussions, with many of us very clearly grappling to get a grasp on Complex SDB:
http://www.talkaboutsleep.com/message-b ... hp?p=89686
viewtopic.php?t=10545
viewtopic.php?t=11458

-SWS wrote:

drbandage wrote:Do you perchance have a reference link for that Harvard study?

Think he's referring to:
Recognition and Management of Complex Sleep-Disordered Breathing
Geoffrey S Gilmartin; Robert W Daly; Robert J Thomas
Curr Opin Pulm Med. 2005;11(6):485-493. ©2005 Lippincott Williams & Wilkins
Posted 10/27/2005

The paper acknowledges Complex SDB as a third sleep-apnea phenotype (in addition to obstructive and central). The paper also mentions CO2 rebreathing as a possible therapeutic approach----but very specifically for the narrow percentage of sleep apnea patients experiencing this hypocapnic complex disease discussed in the Gilmartin, et al paper.

Some admittedly wild message board discussions, with many of us very clearly grappling to get a grasp on Complex SDB:
http://www.talkaboutsleep.com/message-b ... hp?p=89686
viewtopic.php?t=10545
viewtopic.php?t=11458

-SWS

Thank you for your thoughtful response. I had heard of the Complex SDB, but my uninformed first take was that it was just a woeful overlap of two separate disorders, i.e. Central and OSA. I previously mentioned that I had sleep problems with severe PLMD, and now newly diagnosed with OSA, so I could relate to the misfortune of having a second unrelated condition.

I will be interested to read the article with a critical eye (peer reviewed, randomized, prospective study), as the idea of rebreathing CO2 therapeutically is fascinating. Elevated CO2 levels are one of the body's warning systems that you'd better get some oxygen on board, and do in fact stimulate the respiratory drive, so there is possibly some merit to it in limited situations.
Thanks for the help.

drbandage wrote:

And PS, thanks for confirming that the exhaust ports should be covered as you noted.

Please re-read my first sentence, I think you left out the word "NOT".

Under most circumstances the "exhaust" ports should not be covered. On the ProfileLite the exhaust port comes out the swivel elbow.

Once should not confuse the exhaust ports with the "capped" supplemental oxygen ports (most masks I have used come with 2 "capped" ports). The supplemental oxygen ports are only used (uncapped) when you are prescribed supplemental oxygen as described in the Owners manual.

The Harvard study mentioned discusses (amongst other things) how manipulation of the retained CO2 can impact therapy in CSDB cases by using non-vented masks and masks with greater dead space.

I have since gone to using an interface (Soyala) which appears to retain much more CO2 than other interfaces I have used and have never slept better. This higher retention rate also seems to directly impact how noisy the interface will be as shown in the chart. However, some people cannot tolerate these higher rates, I know when I first tried the Soyala which has this higher CO2 retention rate I nearly hyperventilated but that went away after a few minutes now it is not a problem at all. In fact the rate was so different I contacted the distributor to make sure I didn't get the non-vented version. I was assured the one I was using was the vented version (non-vented version has a blue elbow).

Snoredog wrote:drbandage wrote:

And PS, thanks for confirming that the exhaust ports should be covered as you noted.

Please re-read my first sentence, I think you left out the word "NOT".

Under most circumstances the "exhaust" ports should not be covered. On the ProfileLite the exhaust port comes out the swivel elbow.

You're so right, Snoredog. Sorry, my first post noted that the elbow was the actual site for exhaust ports. The supplemental O2 ports are what should be covered, and I initially had mistaken them for exhaust ports. Thanks for the valuable input.

drbandage wrote: I had heard of the Complex SDB, but my uninformed first take was that it was just a woeful overlap of two separate disorders, i.e. Central and OSA.

I'm not so certain your first take was off the mark, drbandage. My own "under informed" take is that Complex SDB is an observable phenotype. I'm under the layperson's impression (right or wrong) that there just may be several possible complex SDB etiologies occurring in the patient population. But I also happen to think the overlap of two independent apneas, just as you mentioned, may be happening as well. Who knows, at this early stage of sleep science, just how many discoveries are waiting to be made by the way of SDB complexities?

The complex sleep disorder Gilmartin, et al focus on, however, entails PAP-machine induced central apneas---which in turn can be mitigated in many cases by CO2 retention.