Novel idea for a IPAP/"passive" EPAP mode.

[metallikat36]

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.

[palerider]

Since EPAP is what holds you airway open so that you can take another breath, your "novel" idea won't work.

[metallikat36]

There is EPAP. Are you gonna say Provent categorically doesn't work too?

[palerider]

There is EPAP. Are you gonna say Provent categorically doesn't work too?

Provent is a *scam* that separates suckers from their money.

The *instant* you start to inhale, that "EPAP" is *gone*, and there's nothing to hold your throat closed.

[metallikat36]

You are a pseudoskeptic

[palerider]

You are a pseudoskeptic

And you are, to put it simply, a fool.

Wasting everyone's time with your stupid theories, and ideas, as though you were some kind of unique intellect that has figured out things that have eluded researchers the world over.

[ChicagoGranny]

Some people should be banned from using the word "novel".

[chunkyfrog]

Agreed, Granny.
The word "novel" is not an accurate description of an old, STUPID idea.

[zonker]

Some people should be banned from using the word "novel".

but,but,but....

i enjoy reading novels!

why are you so mean to me?

[metallikat36]

What good manners you folks have. Well then I'd love to hear how you all explain away positive meta-analysis that shows EPAP does probably work:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699057/
The throat does not instantaneously collapse after exhalation with EPAP. That is a wrong assumption. It may only partially collapse by the time the inspiration comes in to keep it open.

And PR, explain your categorical rejection of the didgeridoo study while you are at it. Be specific and stop hand-waving.

And yes the addition of IPAP to a "passive" EPAP is to the best of my knowledge novel. Not saying it will work. Just discussing for God's sake.

My preliminary experiments have found that the "valve" that blocks off the IPAP on exhale can actually be made to crack open spontaneously as exhalation approaches completion. This further helps prevent collapse before the full IPAP kicks in.

I have very high residual volume. Walk a mile in my shoes and you will understand the discomfort of breathing at the top of your lungs when further compounded by CPAP which makes you breath even more at the top of your lungs. Then you will understand my search for a more complete exhalation.

[palerider]

What good manners you folks have. Well then I'd love to hear how you all explain away positive meta-analysis that shows EPAP does probably work:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699057/
The throat does not instantaneously collapse after exhalation with EPAP. That is a wrong assumption. It may only partially collapse by the time the inspiration comes in to keep it open.

Inspiration, and the reduced pressure in the throat, is what exacerbates the collapse of the airway.

And PR, explain your categorical rejection of the didgeridoo study while you are at it. Be specific and stop hand-waving.

No. it's stupid, like the rest of your ideas, and I won't waste my time.

And yes the addition of IPAP to a "passive" EPAP is to the best of my knowledge novel. Not saying it will work. Just discussing for God's sake.

discuss with yourself, elsewhere please.

[metallikat36]

Nice dodge. Go write to the journal editor why he should retract the study because clearly you know EPAP can't possibly benefit. Write any of these researchers for that matter and tell them they are idiots. See how smart they think you are. I get it about the inspiration causing collapse, but there is more going on than that. "This high-end-expiratory pressure leads to upper airway dilation with subsequent tracheal traction and increased lung volumes during exhalation, thereby making the upper airway more resistant to ensuing inspiration". That plus I am talking about some machine PAP kicking in in towards the end in time to mitigate the issue more. And even the idea that inspiration has only to do with collapsing the airway is lacking in nuance. When inspiration *immediately follows relatively high EPAP*, the dynamics are changed and that inspiration takes advantage of the situation the EPAP left and things stay more open so long as you don't weirdly take a break in the middle of an inhale. Test it.

Unless you own this forum, I will discuss where I please.

[Pugsy]

Discussions are one thing...even heated discussions but pissing contests are a whole different thing.

Everyone is entitled to their opinion...and to voice that opinion...but if someone thinks that opinion is so far out there...hey, they get to say that also.

Cold hard fact of life...you put it out there you have to be willing to accept what might fly back at you for doing it.

This thread is within a hair breadth of being nothing but a pissing contest and name calling personal attack thread.....and when it crosses the line it will be locked and fade away into oblivion.

Be polite please....I don't like pissing contests. Politely agree to disagree and move on. This is the only warning.