Everest Aura & CO2 clearance

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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rested gal
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Post by rested gal » Tue Jan 10, 2006 11:10 pm

john5757 wrote:The 30 ml volume of the Aura nasal seal will never get refreshed until you stop exhaling and some of that exhale can be re-breathed.
Maybe its just me, but at the end of breathing out, I pause briefly before inhaling again. Perhaps that short pause is enough time for cpap pressure to whisk out all/most of the exhaled air from any mask, including the Aura. The only way I can imagine a person not pausing between breaths is if he/she were panting. Considering how fast the air is coming in, surely that natural slight pause during respiration is enough to clear the CO2 out. No?

Like ozij, I don't think the FDA would approve an interface unless the CO2 washout during cpap operation were safe. The "Headrest with nasal seal" (crazy new name for our beloved Aura! LOL) obviously passed FDA scrutiny. Not that I think the FDA is foolproof, but I think how the exhaust on a mask performs would be pretty easy for the FDA to check.

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deltadave
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Mask Dead Space

Post by deltadave » Wed Jan 11, 2006 6:37 am

You know, I'm a little surprised that the calculating dead space exercise wasn't picked up and done on other mask types, especially those with exhalation ports that are not particularly close to the nares, and/or full face masks. See what kinda volumes those guys get. Don't forget to account for the "nose volume", which in some cases will... oops, better not go there.
If you really wanna go crazy, the way to do it is fill it up with salt, mash your nose in there (don't inhale) then measure the displaced salt.
Then you also have to account for turbulence in the mask, and the admixture (the rebreathed air is never really "purely" rebreathed air).
And 30 ml is only 2 tablespoons. And your naturally occurring dead space is already about 150 ml. And since your body breathes according to CO2 levels, and not a fixed tidal volume, you probably just breathe that tiny bit deeper anyway. Except if you're on BiPAP, then your tidal volumes are increased anyway. And the BiPAP-like modes such as EPR. This is like endless.
I think I'll just go back to "get a CO2 monitor."
deltadave


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Jerry69
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Call to Aeiomed

Post by Jerry69 » Wed Jan 11, 2006 12:33 pm

I called Aeiomed to discuss this topic with them: 866-722-2507. I selected option 1 and spoke to a sales person. When I told her what I was calling about she quickly forwarded the call to Holly Larkin, Sr. Director of Clinical Affairs and Steve Bordewick, President and CEO of Aeiomed, in a conference. Was I impressed!

I explained that there was a topic on this forum that questioned the proper CO2 elimination from the Aura nasal seal due to the relatively long distance to the vent.

First, Steve cited the fact that the FDA 'tightly constrains' the dead space and the vent distance to insure adequate ventilation. [So, this is something that the FDA looks closely at.]

I explained that there were still people posting that accepted the fact that the Aura had FDA approval, but still had doubts about the CO2 clearance. I asked if they had anything on a web site that I could reference that would be convincing. They said that the FDA has a site that can be queried for specific products. [I will do this.]

Steve added that the dead space on the Aura was very small compared to a nasal or full-face mask and that the Aura was much more likely to clear CO2 than either of these mask types, in general. Further, he said, our exhale is not entirely CO2, or something to that effect. [Keep in mind that I am trying to recall what was said from the brief notes I made and my recollection.] He said, we actually expel more CO2 through our skin than by exhaling. And, that people are likely to breath more CO2 when they bury their face in a pillow or cover their heads with bed covers than when using a CPAP interface of any type.

Holly asked for my phone number and email address and gave me hers. One of them said how much they appreciated my call and that they liked to keep in touch with the people using their products. They wanted to know in what state and area I lived.

Holly volunteered that she had been on PAP since 1988 and encouraged me to hang in there. "You will make it." [I had explained that I had just completed 2 months and had three masks: Swift, Breeze, and Aura.]

Then, I offered that the posts on this forum indicate that the Aura headgear runs large. I described my head size: 7-1/4 and the fact that I was bald. I said that I had to take the straps all the way up and close the two sliding adjustments, entirely. They said they were looking at that and in the meantime, they had provided adapter straps to provide for the needs of people with smaller heads. They said these were available from their suppliers. Holly said she would email me to get my address and send me two sets of adapter straps.

Steve added that if I had the sliders closed entirely, maybe I was wearing the headgear too far forward. He suggested I hold the interface so that the top bars were horizontal and note the way the staps hang. He said, "This is the way you should wear it." [I'll try that.]

How much nicer could their response have been?

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CPAPopedia Keywords Contained In This Post (Click For Definition): breeze, swift, CPAP, Aura, AEIOmed, seal


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MachineMask
Last edited by Jerry69 on Wed Jan 11, 2006 4:24 pm, edited 1 time in total.
Un-treated AHI = 9.5
Titrated prssure: 6 cm
Ave. AHI after therapy = 0.5
Ave. Snore Index = <10
Current pressure = 9 cm

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wading thru the muck!
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Re: Call to Aeiomed

Post by wading thru the muck! » Wed Jan 11, 2006 1:44 pm

Jerry69 wrote: How much nicer could their response have been?
It's no wonder how they came to make such a great interface.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!

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Jerry69
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FDA Record

Post by Jerry69 » Wed Jan 11, 2006 5:14 pm

All I could find on the FDA site is the approval certificate: http://www.accessdata.fda.gov/scripts/c ... T&ID=88149

If someone could tell me where to find a 'smoke puffer', a squeeze bottle that would emit a puff of colored smoke, I would test the interface. I would insert the squeeze bottle nozzle into a pillow and stop up the other pillow, turn on the machine and observe the dissipation of the colored smoke.

That would be the convincing evidence for me. Until then, I'm going to enjoy the Aura. I sleep with her 9-10 hours every night.

Jerry


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MachineMask
Un-treated AHI = 9.5
Titrated prssure: 6 cm
Ave. AHI after therapy = 0.5
Ave. Snore Index = <10
Current pressure = 9 cm

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Jerry69
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Re: Mask Dead Space

Post by Jerry69 » Wed Jan 11, 2006 5:16 pm

deltadave wrote:You know, I'm a little surprised that the calculating dead space exercise wasn't picked up and done on other mask types, especially those with exhalation ports that are not particularly close to the nares, and/or full face masks. See what kinda volumes those guys get. Don't forget to account for the "nose volume", which in some cases will... oops, better not go there.
If you really wanna go crazy, the way to do it is fill it up with salt, mash your nose in there (don't inhale) then measure the displaced salt.
Then you also have to account for turbulence in the mask, and the admixture (the rebreathed air is never really "purely" rebreathed air).
And 30 ml is only 2 tablespoons. And your naturally occurring dead space is already about 150 ml. And since your body breathes according to CO2 levels, and not a fixed tidal volume, you probably just breathe that tiny bit deeper anyway. Except if you're on BiPAP, then your tidal volumes are increased anyway. And the BiPAP-like modes such as EPR. This is like endless.
I think I'll just go back to "get a CO2 monitor."
deltadave
Dave, you are 'right on'.


_________________
MachineMask
Un-treated AHI = 9.5
Titrated prssure: 6 cm
Ave. AHI after therapy = 0.5
Ave. Snore Index = <10
Current pressure = 9 cm

Smokey the Bandit

Smoke Puffer

Post by Smokey the Bandit » Wed Jan 11, 2006 5:36 pm

If someone could tell me where to find a 'smoke puffer', a squeeze bottle that would emit a puff of colored smoke, I would test the interface.
Oh, okay.... I guess I'll share my smoke puffer source:
http://www.infiltec.com/inf-catr.htm#Smoke



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Jerry69
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Re: Smoke Puffer

Post by Jerry69 » Wed Jan 11, 2006 6:45 pm

Smokey the Bandit wrote:
If someone could tell me where to find a 'smoke puffer', a squeeze bottle that would emit a puff of colored smoke, I would test the interface.
Oh, okay.... I guess I'll share my smoke puffer source:
http://www.infiltec.com/inf-catr.htm#Smoke

Smokey,

Da-am, as Gomer Pyle would have said if allowed to say 'damn' in 1960. You found one! But, I don't see paying $65 for it, as I'm already satisfied that the Aura is a good interface and I'm not going to suffer from CO2 accumulation. I would like to see for myself, however.

Thanks,

Jerry


_________________
MachineMask
Un-treated AHI = 9.5
Titrated prssure: 6 cm
Ave. AHI after therapy = 0.5
Ave. Snore Index = <10
Current pressure = 9 cm

john5757
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Joined: Fri Jun 10, 2005 7:48 pm

Post by john5757 » Wed Jan 11, 2006 7:54 pm

Jerry69

The key thing what works for you is what counts. I know that a few of the other masks I tired does tend to make me hyperventilate when I am wide awake before sleep. There is also other masks that I feel more comfortable breathing in even at a low pressure setting. Yes I do think the differences is going to be much smaller when you go to sleep. The Dreamfit by the way has a leak rate of 20L/min at a pressure of 6cm H2O.
Jerry, is does appears that you follow your mind on how your treatment goes because I noticed that your Titrated prssure is 6 cm but your current pressure is 9 cm. Right now I have a bunch of individuals telling how dangerous is the chin strap I am wearing. My goal is to reach the "Mental Zest" stage.

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Jerry69
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Too Concerned?

Post by Jerry69 » Wed Jan 11, 2006 8:03 pm

john5757 wrote:Jerry69

The key thing what works for you is what counts. I know that a few of the other masks I tired does tend to make me hyperventilate when I am wide awake before sleep. There is also other masks that I feel more comfortable breathing in even at a low pressure setting. Yes I do think the differences is going to be much smaller when you go to sleep. The Dreamfit by the way has a leak rate of 20L/min at a pressure of 6cm H2O.
Jerry, is does appears that you follow your mind on how your treatment goes because I noticed that your Titrated prssure is 6 cm but your current pressure is 9 cm. Right now I have a bunch of individuals telling how dangerous is the chin strap I am wearing. My goal is to reach the "Mental Zest" stage.
I wish you the best, John. I don't know how a chin strap could be dangerous, however. Could it be that we on the Forum are a little too 'concerned' about everything?

Jerry

_________________
MachineMask
Un-treated AHI = 9.5
Titrated prssure: 6 cm
Ave. AHI after therapy = 0.5
Ave. Snore Index = <10
Current pressure = 9 cm

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LDuyer
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Re: Call to Aeiomed

Post by LDuyer » Wed Jan 11, 2006 9:28 pm

Jerry69 wrote:I called Aeiomed to discuss this topic with them: 866-722-2507. I selected option 1 and spoke to a sales person. When I told her what I was calling about she quickly forwarded the call to Holly Larkin, Sr. Director of Clinical Affairs and Steve Bordewick, President and CEO of Aeiomed, in a conference. Was I impressed!
I think it's wonderful that you were able to get the ear of the top people at Aeiomed and that you shared their insights with us here. I truly appreciate you taking the time and effort to do this. I know you didn't expect to be so fortunate as to get Larkin and Bordewick on the phone. You made the effort and look what happened. It pays to ask, doesn't it?

What's particularly special about this is that you were able to share this information and their insights with a large audience, countless invisible people who come to read and who might not post. As I write this, this forum shows that there were 716 views of this topic. Thanks, Jerry!


Linda


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Jere
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Post by Jere » Wed Jan 11, 2006 9:51 pm

Wow! Something like that could make me less cynical about the corporate world .... nah, not enough. However, in this case I am impressed that you got the answers straight from the "Man" himself.

I will cherish my Aeiomed/Aura and wash it every day.

.

"First rule of holes: when you are in one, stop digging"

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Kemosabe
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Re: smoke puffer

Post by Kemosabe » Thu Jan 12, 2006 2:18 am

I would only test with that smoke puffer on a mask that you don't plan to use again. It puts out HCl (hydrochloric acid) which would likely damage your mask.

gracie97
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Post by gracie97 » Thu Jan 12, 2006 10:04 pm

Also, what are the long term effects of heavy chest breathing? Can an increase of forced breathing over a long term cause any kind of strain on your heart? My chest sometimes hurts after wearing the Aura, which is a great concern to me. I think it is a perfect design, just needs some more professional tweaking.
Geez, Snoozie! Now I'm even more worried! My chest has been hurting too after a couple weeks on the Aura. And I notice that sometimes when waking up or dropping to sleep with the Aura, I'll start grabbing really deep breaths as if I'm starved for air even though I feel no difficulty breathing at the time -- not enough oxygen?

I'd sure like to talk or correspond with someone from AIEOMED about these matters. But my experience is that such manufacturers expect us to get all our info for DME's (and I don't even have one).

In about the same place you are with the Aura: I love the comfort. Love the lack of leaks. But having to admit I just felt better when I used the Swift even though the leaks woke me up repeatedly in night.

BTW have had NO rain-out with the Aura despite having the humidifier jacked up a ways to deal with a cough. Maybe all the old socks I'm uising the cover the hose really are helping. Also could be due to the fact that I didn't have to bend the Aura wires.

Grace

Started CPAP on 7/1/2005
Mild apnea
Plus upper airway resistance syndrome with severe alpha intrusion

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Jerry69
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Contacting Aeiomed

Post by Jerry69 » Fri Jan 13, 2006 7:47 am

gracie97 wrote:I'd sure like to talk or correspond with someone from AIEOMED about these matters. But my experience is that such manufacturers expect us to get all our info for DME's (and I don't even have one).
Grace, did you read my post on your topic? I contacted Aeiomed? They were very responsive.

Jerry

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, AEIOmed


_________________
MachineMask
Un-treated AHI = 9.5
Titrated prssure: 6 cm
Ave. AHI after therapy = 0.5
Ave. Snore Index = <10
Current pressure = 9 cm