O2PTIMASK Techniques, Tips and Procedures

The following are a number of tips, techniques, and procedures I've learned over the last 5 years using the Clustermasx™ and O2PTIMASK™ configured with a 3-liter reservoir bag.  In general, inhaling and exhaling through the mask is simple and easy to do. 

However, a small amount of condensation and CO2 will collect in the mask and green "T" manifold.  There should be no condensation in the reservoir bag.  If there is, the check valve in the lower portion of the "T" manifold is faulty.

I don't use a "bubbler" or humidifier as they force moisture into the reservoir bag.  This moisture will eventually collect bacteria and grow some nasty stuff you're not going to like at all.

Humidifiers also don't work very well at the flow rates that support hyperventilation as this high a flow rate the humidifier produces a mist as opposed to humidifying the oxygen and inhaling the mist forces too much fluid into the lungs.

Some of us have allodynia (skin on the hit side of the face is painful to touch) during our cluster headaches so we use the mouthpiece as the mask aggravates the additional pain caused by allodynia.  The mouthpiece is also less restrictive if you start feeling smothered or have anxiety pangs.

Tip:  For the purists... (like me and many others), exhaling away from the mask or mouthpiece is an alternative to exhaling through them.  Rationale:  A few cubic centimeters of exhaled breath remains in the mask and "T" manifold after each exhalation and this residual breath is sucked back into the lungs during the next inhalation. 

As this residual breath at the end of the exhale cyclecontains the highest concentrations of CO2, a.k.a. End Tidal CO2 (ETCO2), and CO2 is more powerful as a vasodilator than oxygen is as a vasoconstrictor, inhaling it can lessen the effectiveness of the oxygen therapy. 

Exhaling away from the mask or mouthpiece also eliminates any condensation in the mask or mouthpiece and "T" manifold.

The technique of breathing away from the mask or mouthpiece requires a bit more coordination and it's possible to inhale a small amount of room air through the nose when using the mouthpiece. 

If you're stuck with a regulator that delivers less than 15 liters/minute, this is likely an advantage as 7 to 9 liters/minute oxygen flow is sufficient to oxygenate hemoglobin to 100% and the higher respiration rate can help prevent CO2 buildup.  Having said that, the soft pallet usually prevents this from happening for most of us.

Tip: When exhaling away from the mouthpiece while using higher flow rates of 15 liters/minute and higher, it's best to press the opening of the mouthpiece to the lower lip to seal the manifold to prevent oxygen from leaking out while the reservoir bag fills.

Technique: Some of us breathe directly from the 22mm opening on the green "T" manifold or the 22mm nipple on a demand valve as this technique has the least flow resistance during inhalation at the higher flow rates.  It's also a bit more difficult blocking the 22mm opening to prevent oxygen from leaking while exhaling, but it can be done with a little practice. 

Tip: I press the "T" manifold opening lightly against my chin, cheek, or lower lip while exhaling to prevent oxygen from escaping as the reservoir bag fills.

Procedure:  Free-cycling oxygen through the mouth and out the nose is a procedure I use with the mouthpiece or straight from the "T" manifold 22mm opening.  I do this to rest for 15 to 20 seconds after using oxygen at very higher flow rates. 

I also do this procedure as it generates an evaporative cooling effect on the sphenopalatine ganglia that's located on both sides of the back nasal passage.  The sphenopalatine ganglia is also that thing that starts to sting as you sneeze or sniff the fumes from from a hot pepper like a fresh cut jalapeño.

Free-cycling oxygen out the nose produces a sensation similar to a mini-brain freeze except the cooling effect is in the back of the nasal passage and not the roof of the mouth.  The sphenopalatine ganglia is also connected directly to the nasal branch of the trigeminal nerve through a short nerve segment.

The thinking here is the cooling effect triggers vasoconstriction in the sphenopalatine ganglia and that can cascade over this short link to the trigeminal nerve.

Cooling the sphenopalatine ganglion will not make the abort happen faster, but it does have a soothing effect similar to a sphenopalatine ganglion block with lidocaine.  The big difference is this procedure is far easier than hanging upside down trying to drip lidocaine into the nose.  Even better, your nose doesn't go numb and you can still smell things when you're through.

In order to free-cycle you'll need cap or block the exhaust end of the "T" manifold in order to force the oxygen in the mouth, through the back nasal passage, and out the nose. 

Tip:  The easy way to block the exhaust port is to grip the "T" manifold like a pistol pointing the mouthpiece toward your mouth while pressing the exhaust end of the "T" manifold against the palm of the hand just below the index finger.  I also grip the reservoir bag fitting that attaches to the "T" manifold with my little finger to keep it from being forced loose when the bag fills tightly and the pressure builds.

Once you've blocked the exhaust port and the reservoir bag is full, inhale then try to exhale from both your mouth and nose.  As the the exhaust port is now blocked the exhaled breath will start flowing out your nose.  At that point, just relax and let the oxygen continue to flow in your mouth and out your nose.

Most of us start having a runny nose on the hit side around Kip-6 to Kip-7 so free-cycling oxygen out the nose is best accomplished early while the hit side nostril is clear.  If you do try this technique while your nose is running, have some Kleenex handy as this procedure can blow snot all over the place.

Of all the techniques tips and procedures, the following breathing technique is by far the most effective I've found over the last five years in achieving the fastest aborts possible at just about any flow rate up to 40 liters/minute.

This technique is called Breathing at Forced Vital Capacity (FVC).  Vital capacity (VC) is the maximum amount of air a person can expel from the lungs after a maximum inspiration. It is equal to the inspiratory reserve volume plus the tidal volume plus the expiratory reserve volume.

A normal adult has a vital capacity between 3 and 5 litres. After the age of 20 the vitalcapacity decreases approximatley 250 cc per ten years.

Forced Vital Capacity is the volume of air exhaled with maximum effort and speed after a full inspiration.  In practice, if I exhale fully after a maximum inhalation, there is still some residual volume left in my lungs that I can expel by doing an abdominal crunch, like done in sit-ups, except I hold the abdominal and chest squeeze for a couple seconds.  This will squeeze out another half liter or more of residual breath.

This exhalation maneuver will also produce a wheezing sound so when I coach folks on the use of this breathing technique, the mantra is "Squeeze 'till you Wheeze."

This breathing technique is best accomplished in a standing position to give the diaphragm full range of motion and to better ventilate the lungs.  If done properly at a high enough respiration rate and the pain level is low, I can feel the effects of paresthesia after 4 to 5 of cycles. If the pain is level 6 or higher, this may take up to a minute and sometimes longer.

The symptoms of paresthesia include a slight tingling or prickling of the fingertips, lips, and back of the neck sometimes accompanied with a slight sensation of dizziness.

You can practice the FVC breathing technique with air after reading this post.  In the absence of a cluster headache, you should start feeling the symptoms of paresthesia after three to four cycles if you use this technique at a fast enough respiration rate.  The tip here to increase the respiration rate is to inhale as rapidly and fully as possible after a couple seconds of the squeeze.  In other words, there's no delay between the end of the squeeze and start of the inhale cycle.  The inhale part of this cycle should take a half second.

Paresthesia is the best indication you're casting off CO2 faster than your body is producing it through normal metabolism and also that you've cast off enough CO2 to push your respiratory and circulatory systems into respiratory alkalosis.

I usually lean against a wall while while using this breathing technique more for comfort than anything else as I've never gotten so dizzy I needed to sit down.

Breathing at FVC works best with oxygen flow rates from 25 liters/minute up to 40 liters/minute.  At a flow rate of 60 liters/minute there's not enough time to squeeze for more than a second so you're really breathing close to vital capacity at this flow rate.

It's also possible to use the FVC breathing technique at flow rates between 10 and 15 liters/minute to shorten abort times. 

The tip here is a bit controversial.  As oxygen flow rates this low will not support hyperventilation, you'll need to use the FVC breathing technique with room air for three cycles while the reservoir bag fills then use it with 100% oxygen from the O2PTIMASK™ for one cycle then repeat.

This 3:1 Air to Oxygen breathing ratio is more than sufficient to keep the blood oxygen hemoglobin saturated at 100%.  And, if you're able to hyperventilate with the FVC breathing technique and feel the effects of paresthesia, the CO2 level will be lower than normal, the arterial pH will be higher than normal, and this will increase hemoglobin's affinity for oxygen so it can carry even more oxygen to the brain.

I hope you find these O2PTIMASK™ Techniques, Tips, and Procedures helpful.

Take care,

V/R, Batch