CPAP algorithm "recoil" mode idea

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metallikat36
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CPAP algorithm "recoil" mode idea

Post by metallikat36 » Mon May 20, 2019 3:45 pm

Take a moment and exhale completely. Then, exhale even further, past the point of complete emptying. Then relax. What you will of course notice is that the lungs "recoil" and some air is sucked into them automatically without any effort. This is because the pressure in the lungs is lower than the outside air and it needs to equalize.

I had a thought about how a new mode of CPAP operation could leverage this. Suppose you are on BIPAP and use EPAP 8 and IPAP 12. Suppose when you take an exhale, instead of the algorithm dropping the pressure to 8, it instead drops the pressure to say 7 for just as long as is needed to fully exhale. The moment this happens, the EPAP ramps back up to 8. Now if 8 was the pressure needed to consistently keep the airway open, exhaling against a 7 may make it close a little bit more. But once the EPAP ramps back up to 8, you now have a relative pressure difference of 1 between the inside and outside of your lungs. This produces a "recoil" effect which makes it easy to inhale.

In other words, a full breathe would consist of up to 3 pressure changes instead of two.

I await Palerider's derision. It's all good.

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Re: CPAP algorithm "recoil" mode idea

Post by palerider » Mon May 20, 2019 4:09 pm

metallikat36 wrote:
Mon May 20, 2019 3:45 pm
Take a moment and exhale completely. Then, exhale even further, past the point of complete emptying. Then relax. What you will of course notice is that the lungs "recoil" and some air is sucked into them automatically without any effort. This is because the pressure in the lungs is lower than the outside air and it needs to equalize.

I had a thought about how a new mode of CPAP operation could leverage this. Suppose you are on BIPAP and use EPAP 8 and IPAP 12. Suppose when you take an exhale, instead of the algorithm dropping the pressure to 8, it instead drops the pressure to say 7 for just as long as is needed to fully exhale. The moment this happens, the EPAP ramps back up to 8. Now if 8 was the pressure needed to consistently keep the airway open, exhaling against a 7 may make it close a little bit more. But once the EPAP ramps back up to 8, you now have a relative pressure difference of 1 between the inside and outside of your lungs. This produces a "recoil" effect which makes it easy to inhale.

In other words, a full breathe would consist of up to 3 pressure changes instead of two.

I await Palerider's derision. It's all good.
What you're talking about is basically *flex on the respironics machines.

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Re: CPAP algorithm "recoil" mode idea

Post by metallikat36 » Mon May 20, 2019 7:07 pm

https://www.sleepapnea.com/downloads/10 ... lesAid.pdf
Oh dang, you are right. I may need to try this out.

Probably would need a new Rx though, and I ain't going back to that patriarchal doc who literally wanted the DME to be faxed an order signed by his office for every single pressure change to have them do it remotely...

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Re: CPAP algorithm "recoil" mode idea

Post by palerider » Mon May 20, 2019 7:17 pm

metallikat36 wrote:
Mon May 20, 2019 7:07 pm
https://www.sleepapnea.com/downloads/10 ... lesAid.pdf
Oh dang, you are right. I may need to try this out.
Sorry to disappoint you about the derision ;)

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Re: CPAP algorithm "recoil" mode idea

Post by CrazyCooter » Mon May 20, 2019 7:45 pm

I was reading the destructions this afternoon for my machine and immediately thought of the "flex" function. Adjusted mine today to 3 after trying the different settings and looking forward to being to empty my lungs for a smoother transition!

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Re: CPAP algorithm "recoil" mode idea

Post by JayDee » Wed May 22, 2019 4:01 pm

metallikat36 wrote:
Mon May 20, 2019 3:45 pm
Take a moment and exhale completely. Then, exhale even further, past the point of complete emptying. Then relax. What you will of course notice is that the lungs "recoil" and some air is sucked into them automatically without any effort. This is because the pressure in the lungs is lower than the outside air and it needs to equalize.
Well, I just sat here for a good minute or more trying my darndest to "recoil" and got nothing but a beet-red face.
Is "recoil" really a thing?
What if mine's busted?

Feeling a bit foolish...
-JD
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Re: CPAP algorithm "recoil" mode idea

Post by palerider » Wed May 22, 2019 4:08 pm

> Is "recoil" really a thing?

I don't think so...

Your machine doesn't have *flex, so you can't play with it... A lot of people don't like the pressure raise flex has, feeling it's rushing them to breathe.

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Re: CPAP algorithm "recoil" mode idea

Post by metallikat36 » Wed May 22, 2019 6:05 pm

I intended for that exercise to be done without a CPAP. Not sure if your being sarcastic about your face being busted. :)

When you take a deep breath and then relax, your lungs will empty to the "neutral" point in order to equalize pressure. In the same way, when you exhale past neutral and then relax, your lungs will have to slightly fill again to regain the neutral relaxed position. That's what I called "recoil".

You should however be able to notice an effect using a CPAP as well. Exhaling ever so slightly past neutral in turn makes initiating the next inhalation less laborious as it is assisted by that slight recoil. I'm not saying you can sleep like that. I'm just trying to show proof of concept. A flex feature would be needed to see how it actually works in reality.

I see what Palerider means about that sharp pressure raise in the Flex documentation. I find ResMed EasyBreathe waveform comfortable. Maybe if Resmed and Respironics combined the best of both worlds, we could have EasyFlex or some such.

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Re: CPAP algorithm "recoil" mode idea

Post by JayDee » Thu May 23, 2019 10:26 am

metallikat36 wrote:
Wed May 22, 2019 6:05 pm
I intended for that exercise to be done without a CPAP. Not sure if your being sarcastic about your face being busted. :)

When you take a deep breath and then relax, your lungs will empty to the "neutral" point in order to equalize pressure. In the same way, when you exhale past neutral and then relax, your lungs will have to slightly fill again to regain the neutral relaxed position. That's what I called "recoil".
Yeah, no... When I forcibly exhaust everything out of my lungs until there's nothing left, nothing happens until I intentionally inhale. So, either my lung's "recoiler" is busted or I'm doing it wrong.

Thanks,
-JD
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Re: CPAP algorithm "recoil" mode idea

Post by jimbud » Thu May 23, 2019 11:00 am

JayDee wrote:
Thu May 23, 2019 10:26 am
metallikat36 wrote:
Wed May 22, 2019 6:05 pm
I intended for that exercise to be done without a CPAP. Not sure if your being sarcastic about your face being busted. :)

When you take a deep breath and then relax, your lungs will empty to the "neutral" point in order to equalize pressure. In the same way, when you exhale past neutral and then relax, your lungs will have to slightly fill again to regain the neutral relaxed position. That's what I called "recoil".
Yeah, no... When I forcibly exhaust everything out of my lungs until there's nothing left, nothing happens until I intentionally inhale. So, either my lung's "recoiler" is busted or I'm doing it wrong.

Thanks,
-JD
What JD said. Me to.
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Re: CPAP algorithm "recoil" mode idea

Post by palerider » Thu May 23, 2019 11:46 am

JayDee wrote:
Thu May 23, 2019 10:26 am
metallikat36 wrote:
Wed May 22, 2019 6:05 pm
I intended for that exercise to be done without a CPAP. Not sure if your being sarcastic about your face being busted. :)

When you take a deep breath and then relax, your lungs will empty to the "neutral" point in order to equalize pressure. In the same way, when you exhale past neutral and then relax, your lungs will have to slightly fill again to regain the neutral relaxed position. That's what I called "recoil".
Yeah, no... When I forcibly exhaust everything out of my lungs until there's nothing left, nothing happens until I intentionally inhale. So, either my lung's "recoiler" is busted or I'm doing it wrong.

Thanks,
-JD
Or... it's not busted, and you're not doing anything wrong.

think of it like straightening your arm, as much as you can... when you relax, it'll pretty much just lay there, it won't 'spring back' to any particular spot without some external effect.

The original idea of some sort of 'recoil' in a pressure delivery algorithm is essentially what *flex does on Respironics, a drop *below* (for want of a better term, epap) during exhalation, then going back up to epap to prepare for the next breath.

But, saying that if you compress your interstitial muscles to force a bit more air out of your lungs under normal respiration that they 'spring back, pulling in more than an insignificant amount of air... not so much. I think, for most people, it's a tiny fraction of lung volume, perhaps not even a noticeable amount.... without measurements though, that's just a guess.

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Re: CPAP algorithm "recoil" mode idea

Post by metallikat36 » Thu May 23, 2019 2:31 pm

I very definitely experience this recoil effect. I don't know what is going on with you guys, but in general, I think people have become very disconnected from abdominal breathing and general awareness of abdominal muscles. I'm also very thin, and perhaps mechanics would be different if I were heavier.

Exhaling past neutral requires conscious contraction of the abdominal muscles. If one is limited only to chest muscles, it would not be possible to exhale past neutral.

The benefit I am purposing about a recoil effect is not about increasing tidal volume, which it would only do very slightly. It is about that momentary recoil forcing the airway upon, thereby easing the initiation of the next inhale.

Though in my case, I just experimented inflating a ziploc bag over my mouth, and my maximum recoil sucks like a 1/3rd of a quart of air out of it I would guess.

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Re: CPAP algorithm "recoil" mode idea

Post by palerider » Thu May 23, 2019 7:22 pm

metallikat36 wrote:
Thu May 23, 2019 2:31 pm
It is about that momentary recoil forcing the airway upon, thereby easing the initiation of the next inhale.
I can't see how that would work any more than provent does(n't).

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