Posts about mechanical breathing assistance

This page contains posts about Mechanical Breathing Assistance.

Subject Re: urgent Information needed (Ventilation/Oxygen/CO2)
From Steve's Account

Ok.. First some things to think about...

Most folks with polio, but without other lung conditions, need
VENTILATION, not oxygen....

Ventilation moves air in and out of the lungs.... When you inhale, you take in oxygen.. When you exhale, you expel carbon dioxide.

If you aren't breathing deeply enough, as can happen with respiratory muscle paralysis, and scoliosis, common in post-polio, you neither get enough oxygen or expel enough carbon dioxide.

Some doctors, not realizing that you have TWO problems (oxygen and CO2) will add inhaled oxygen, solving just the "oxygen" side of the equation. The result is that your oxygen "numbers" look good.. but your CO2 numbers look awful!

What the person with respiratory weakness needs is ventilation.

When folks talk about anything PAP, what they are discussing is a Positive Airway Pressure machine. A Cpap is "continuous" positive airway pressure. A BIpap is a Bi LEVEL positive airway pressure machine.

In both cases they provide positive airway pressure. A bipap will give you a higher pressure on inhale, and a lesser pressure while you exhale.. A CPAP will provide a constant level of pressure, and you must "exhale against that pressure".. Some folks find this difficult, so bipap was created to lower the pressure you are working against on exhale..

The PAP class of machines ARE NOT VENTILATORS. They will NOT deal with a person with respiratory paralysis.

If you have some respiratory weakness, they may help, by keeping your airway open... this is especially true in the case of sleep apnea which is due to "obstructions" in the airway...

There are two kinds of apnea.. obstructive and central. Obstructive is where your airway is blocked, due to lax tissues or being overweight. Central apnea is where your muscles don't exert enough force to cause you to breath.

In respiratory paralysis due to polio, it's your muscles that aren't trying to breath.. This is especially true when you are asleep. When you are awake, you can compensate for a paralyzed diaphragm by using your chest and shoulder muscles. When you are asleep, your autonomic nervous system takes over and your chest and shoulders no longer make up for the weak or paralyzed diaphragm. Under these conditions you can be adequately ventilated while awake... and very underventilated while asleep.

If this is the case, you need a true ventilator, which provides an automatically cycled breathing profile.. there are several types. Some will "start" when they detect you trying to breath in.. synchronizing with your own breathing efforts. Some just run at a preset rate. Some do nothing until they detect that you haven't tried to breath in a reasonable time.. and then will start cycling. (Note that some ventilators also provide PAP support, to help keep airways open.)

The difference between a ventilator and a "pap" is that a ventilator is capable of breathing for you, if you can't. A pap machine will just help keep your airway open so you can breath on your own.

A PAP MACHINE IS NOT A SUBSTITUTE FOR A VENTILATOR IN A PERSON WHO IS UNDERVENTILATED!

A person with respirator paralysis needs to be seen by a respiratory specialist who KNOWS how to deal with underventilation due to neurological conditions.. This is VERY different from what a typical pulmonologist sees.. You need someone who has dealt with either polio or Muscular Dystrophy or ALS (Lou Gherigs disease).

Here is some more info:

<http://www.post-polio.org/ipn/pnn11-4d.html>

Steve

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From Jean

Not all post polios need a bi-pap. Some do very well on c-pap. But "most" do need a bi-pap. This depends on the reason you need a "breathing machine." If you have obstructive apnea, ( and that is all you are dealing with ) you will need enough pressure on EPAP to keep the throat open. But if you have weakened breathing muscles, + obstructive apnea you probably need a bi-pap set so the EPAP is just high enough to keep the throat open and then IPAP to help rest your muscles. It is fairly easy to treat obstructive apnea. It becomes confusing when you need help with both. A good R.T. will work with you until you feel comfortable with your settings. Not all R.T. understand that weak muscles need to be rested at night. And many sleep labs do not understand about neuromuscular problems. A high EPAP will tire your muscles.

The need to sit up while sleeping seems to say you do need a machine. But only a good sleep lab can determine the right setting for EPAP and IPAP.

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Subject Re "Sleep Apnea"
From Judith

OK... "Sleep apnea" is a clinical condition. It is also a generic term
for ANY sleep/breathing disorders and is such is very much MIS-used,
even by polio drs. The big probelm with calling everything "sleep apnea"
is that it generates the wrong treatment modality for us.

Sleep Apnea is a condition where the airway collapses during sleep and
breathing actually stops. There are 2 kinds of apnea - central (brain
signal cause) and the other I cannot remember, but it is a mechanical
problem, as opposed to neural. Apnea is frequently found in heavy
smokers, people with lung damage, obese people, etc..

One other sleep/breathing problem is hypopneas. This is where the
breathing slows or becomes too shallow to maintain a healthy blood
oxygen level.

There can be many causes for this. In many polio survivors it is caused
by weakened neuro-musculature of the oblique abdominal muscles,
sometimes compounded with weak diaphragms or intercostal muscles (those
that expand & contract the ribs).

The big difference is the treatment modality. apnea is treated with
drugs and/or a CPAP machine (Constant Positive Airway Pressure). The
purpose of the CPAP is to prevent the airway from closing during sleep.
It is ALWAYS blowing air into your lungs at a more or less steady rate.

The reason this is a problem for us is those weak abdominal muscles.
When we lie down, the oblique abdominal muscles take over for much of
the function of the diaphragm (diaphragm works with gravity when we are
upright). These muscles were one of the first to go when we had polio,
especially for those who had Bulbar type polio. As a result we do not
breathe deeply enough often enough and our O2 levels drop. But having
air forced into our lungs at a steady rate can suffocate us because we
do not have the strength to breathe out against this force. Breathing
out is crucial because this is how we get rid of CO2. Our bodies take
the O from the O2 and expel the CO2.

The treatment modality that most of us need is a BiPAP (Bi-level
Positive Airway Pressure) machine. This machine assists our inhalations
with air pressure, similar to the CPAP, but then it drops the pressure
to a negligible level to allow us to comfortable exhale. This must be a
comfortable level so that our muscles will work when we are asleep -
mine is set at "3" for exhalation ("expiration") and at 13.5 for
"inspiration", but everyone's levels can vary.

- JB

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Subject Re: Web site (C-Pap)
From Judith

Check out www.cpaptalk.com

There are veterans there who will help you out with whatever questions you might have. Great site!!!! (they even will teach you how to adjust your machine yourself!)

- JB

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From Rod

Hi
For those that use cpap or bipap machines I found cpap.com a good site to visit. When I first started with my bipap machine I was always getting sinus infections site mentioned above gave me the answers to solve the situation.
Rod

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Subject Mechanical breathing assistance and the use of oxygen
From Richard Daggett

In the past couple of weeks there have been posts relating to mechanical breathing assistance and the use of oxygen. We have posted a compilation of articles on this subject on our website. You can access them at:

http://www.polioassociation.org/newsletters.html

I hope this is helpful. If you have specific questions I will try to get the answers for you.

Richard Daggett, President, Polio Survivors Association
12720 La Reina Avenue
Downey, CA 90242-4243
Richard@polioassociation.org
www.polioassociation.org

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Subject APAP
From Richard

Pat asked about an "APAP" breathing machine. APAP is an acronym
for "automatically titrated positive airway pressure". It is basically a CPAP machine. The Standards of Practice Committee of the American Academy of Sleep Medicine states that an APAP of machine is not recommended for any condition other than obstructive sleep apnea. Obstructive sleep apnea is a relatively common condition BUT it is NOT the same as hypoventilation from pulmonary muscle weakness. I don't know Pat personally, and I don't know her pulmonary history, but I hope she is confident in her doctor AND that he knows the difference between the two diagnoses. Most pulmonologists with knowledge of hypoventilation caused by pulmonary muscle weakness recommend the use of BiPAP rather than CPAP.

Richard

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