Novel idea for a IPAP/"passive" EPAP mode.
Posted: Thu Aug 20, 2020 7:11 pm
I have a concept for an apnea therapy. It goes like this:
1. On the inhale, you have some IPAP pressure, as usual.
2. On the exhale, a valve blocks off the IPAP pressure. The exhaled air then exits into the ambient room through an exhalation vent. But the vent itself has a variable dial that lets you set a "resisitance".
3. On the inhale, the valve once again opens to provide IPAP pressure.
How is this different than regular CPAP?:
1. Well, on the exhale, you still get some would-be EPAP from the resistance in the exhalation vent. This would keep the airway open, but further allows you to more fully empty your lungs than if you were exhaling against the machine's EPAP pressure. (Maybe this and other things like Provent could be called "passive" EPAP versus "active" EPAP that a machine provides?) [If you doubt this, do the following test. Inhale, then close your mouth and plug your nostrils with your fingers. Then totally relax your lungs, ever so slightly let an opening appear in one nostril, and then let the air our of your nostril really slowly against this finger-generated EPAP (like you would let air out of a tire). Wait until no more air leaks out and the pressures have been equalized . Then remove your fingers suddenly and verify that no more air comes out despite the sudden removal of the partial obstruction created by your fingers. Ergo, the lungs have fully emptied.]
2. If you have more fully emptied your lungs, when you start the next inhalation, the relative pressure difference will be greater than had you exhaled against the CPAP's pressure (since your lungs would not have fully emptied). This would make the inhalation easier and require less pressure.
3. The above two factors may allow greater comfort and compliance and less aerophagia due lower pressure needed and allowing people to breath from the more comfortable "bottom" of their lungs as nature intended.
4. Though this proposed benefit would be offset by the fact that "passive" EPAP may still somewhat allow collapse of the airway at the moment of transition between exhalation and inhalation, just as other EPAP therapies like Provent might. However, if trigger sensitivity if very high and the IPAP pressure quicks in promptly, this could be mitigated.
- In this would-be "passive" EPAP mode, if you have inhalation pressure set to zero, that would in effect be identical to EPAP therapy through something like Provent. In other words, a mask could be made that is a resusable standalone EPAP device. This could be added to the other such options like Optipillows and Bongo.
- So at worst, this option is as good as other EPAP therapies. But with the additional ability to have a little IPAP help things along, this idea seems superior to existing EPAP therapies.
- I would suspect when compared to regular CPAP mode it would be worse for some people, but better for a larger number of people
- I use a FitLife total face mask. It already has such a valve in it. If I use the mask with the CPAP off, then this valve functions just as desired. It opens on the inhale, and is blown shut in the exhale. I will be experimenting to see if I can implement this proposed mode with my mask. Not sure if any other masks have this same type of valve.
I await the eye-rolling and identification of a fallacy.
1. On the inhale, you have some IPAP pressure, as usual.
2. On the exhale, a valve blocks off the IPAP pressure. The exhaled air then exits into the ambient room through an exhalation vent. But the vent itself has a variable dial that lets you set a "resisitance".
3. On the inhale, the valve once again opens to provide IPAP pressure.
How is this different than regular CPAP?:
1. Well, on the exhale, you still get some would-be EPAP from the resistance in the exhalation vent. This would keep the airway open, but further allows you to more fully empty your lungs than if you were exhaling against the machine's EPAP pressure. (Maybe this and other things like Provent could be called "passive" EPAP versus "active" EPAP that a machine provides?) [If you doubt this, do the following test. Inhale, then close your mouth and plug your nostrils with your fingers. Then totally relax your lungs, ever so slightly let an opening appear in one nostril, and then let the air our of your nostril really slowly against this finger-generated EPAP (like you would let air out of a tire). Wait until no more air leaks out and the pressures have been equalized . Then remove your fingers suddenly and verify that no more air comes out despite the sudden removal of the partial obstruction created by your fingers. Ergo, the lungs have fully emptied.]
2. If you have more fully emptied your lungs, when you start the next inhalation, the relative pressure difference will be greater than had you exhaled against the CPAP's pressure (since your lungs would not have fully emptied). This would make the inhalation easier and require less pressure.
3. The above two factors may allow greater comfort and compliance and less aerophagia due lower pressure needed and allowing people to breath from the more comfortable "bottom" of their lungs as nature intended.
4. Though this proposed benefit would be offset by the fact that "passive" EPAP may still somewhat allow collapse of the airway at the moment of transition between exhalation and inhalation, just as other EPAP therapies like Provent might. However, if trigger sensitivity if very high and the IPAP pressure quicks in promptly, this could be mitigated.
- In this would-be "passive" EPAP mode, if you have inhalation pressure set to zero, that would in effect be identical to EPAP therapy through something like Provent. In other words, a mask could be made that is a resusable standalone EPAP device. This could be added to the other such options like Optipillows and Bongo.
- So at worst, this option is as good as other EPAP therapies. But with the additional ability to have a little IPAP help things along, this idea seems superior to existing EPAP therapies.
- I would suspect when compared to regular CPAP mode it would be worse for some people, but better for a larger number of people
- I use a FitLife total face mask. It already has such a valve in it. If I use the mask with the CPAP off, then this valve functions just as desired. It opens on the inhale, and is blown shut in the exhale. I will be experimenting to see if I can implement this proposed mode with my mask. Not sure if any other masks have this same type of valve.
I await the eye-rolling and identification of a fallacy.