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Breathing correctly with 02 to get a fast abort. (Read 598 times)
DanAge50
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Breathing correctly with 02 to get a fast abort.
Jul 9th, 2018 at 6:42pm
 
I just got my o2 and have not tried to abort with it yet, I will tonight. I have done a couple brief dry runs to get ready. This might sound stupid but I was wondering how I should breath. Searching found a post from Batch in 2011 on exhaling all the way. (Quoted below) I have a question on the complete exhalation technique batch described and a 15LPM flow. The thing is when I do this it takes me so long (2-3 seconds) to completely exhale, that the bag has been full for a while by the time I breath in, it seems like a waste of 02, since it is just leaking out of the mask in the meantime...lower flow would not work as long as the bag would be full when I'm done exhaling? Or am I just somehow too slow at getting my lungs empty? How do you guys do it? I just want to get it right, because if I don't I'll be reaching for my pen in 15 min right now. Wink

Partial explanation from the post:
The critical part of the respiration cycle during this method of oxygen therapy is exhalation.† You need to stand to give your diaphragm a full range of motion and lean against a wall (you will get dizzy and if you feel too dizzy, sit erect in an upright chair). Open your mouth and drop your jaw like saying the word "Haw" and exhale forcibly until it feels like there's no breath left to exhale...† there is...†

At that point do an abdominal crunch like doing sit-ups and hold the chest and abdominal squeeze until your exhaled breath makes a wheezing sound for a couple seconds.† The crunch will squeeze out another half to a full liter of exhaled breath.†

Then without delay, inhale rapidly until it feels like your lungs can't hold any more... then repeat the forced exhalation with a crunch.† †Repeat this sequence without hesitating between inhalation and exhalation and keep repeating it until the pain is completely gone.

The full post I am referring to in full is here:
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Racer1_NC
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Re: Breathing correctly with 02 to get a fast abort.
Reply #1 - Jul 9th, 2018 at 7:40pm
 
That post is a very good illustration on how I like to utilize O2. That being said I tend to forgo abdominal crunch and just repeat everything else as fast as I can.

I can out run a 25lpm reg doing it that way and I generally abort in 5 minutes.....10 on the outside.

Batch also has a room air / O2 hyperventilating method he uses. I've never had much luck with it so I wouldn't be the one to coach you on how to do it.† Undecided

I tell people to take all the advice they can get and try everything...then use what tends to work the best for them. Everyone is different.

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Re: Breathing correctly with 02 to get a fast abort.
Reply #2 - Jul 9th, 2018 at 8:56pm
 
I use that technique, and it works every time for me.  What I do to conserve O2 is simply turn off the regulator after the reservoir is refilled (while holding my breath). Then I turn it back on as soon as I take my next breath. Doing that, I have been able to get through 3 attacks with a littte D tank with some left over.
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Re: Breathing correctly with 02 to get a fast abort.
Reply #3 - Jul 9th, 2018 at 9:27pm
 
Looks like Iíve been doing it wrong. I couldíve sworn I was told to hold my breath between inhalation and exhalation. That HAS  been working, but Iím sure this way will be better. Iíll make the adjustment tonight.  Thank you for the post.
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Re: Breathing correctly with 02 to get a fast abort.
Reply #4 - Jul 10th, 2018 at 11:10am
 
The idea is simply to get as much 02 into your lungs as quickly as possible, which will constrict the necessary artery to take pressure off the nerve.  All I do is breathe deeply and as long as I got on it soon enough it works in 10 - 15 mins.
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DanAge50
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Re: Breathing correctly with 02 to get a fast abort.
Reply #5 - Jul 10th, 2018 at 8:52pm
 
Thank you for all your insight -- I have aborted successfully 2/3 tries since getting my o2 yesterday, so I dig it. Also it seems as though on the one failed it did not get worse necessarily while on o2, it just stayed where it was which was only a 4 when I started, so why not try every time!

Also, here is Batch again explaining that "3:1 Room Air to 100 O2 breathing sequence" Racer1_NC mentioned. Batch sent me the link last night so is still advocating it. I will try tonight. It would seem one could be going through a lot less O2 and this may get as fast or faster results - worth a try!

20 sec. Room Air to 30 sec 100 O2 breathing sequence: (Scroll down)
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« Last Edit: Jul 11th, 2018 at 12:04pm by DanAge50 »  
 
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Batch
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Re: Breathing correctly with 02 to get a fast abort.
Reply #6 - Jul 11th, 2018 at 1:07pm
 
Oxygen therapy with hyperventilation may be easier to explain and understand if you start with the underlying respiratory physiology.  We upload oxygen and offload CO2 with every inhalation - exhalation cycle...  This brain stem controlled function keeps us alive as our bodies need a balance in oxygen and CO2 blood gasses.

Our bodies are much like the gas driven engine in a car.  If we increase our physical activity we burn (metabolize) more glucose (blood sugar) and in the process generate more heat, energy and CO2.  In comparison, when you step on the gas peddle, your car goes faster as you burn more gas and the carburetor intakes more air.  As a result the engine develops more energy, the engine generates more heat and exhausts more CO2.

As we increase our physical activity we need to breathe faster to inhale the additional  oxygen needed to support the increased metabolism and exhale the additional CO2 generated by the physical activity. Again, this happens without thinking about it.  All you had to do was intentionally increase your physical activity.

The primary physiological function that regulates this process is called a homeostatic process.  The chemoreceptors of the cardiovascular system are located in two places. The carotid bodies are located in the carotid arteries that run through the neck to the brain, and the aortic bodies are found in the aortic arch, an arterial feature near the heart. 

These chemoreceptors sense blood CO2 concentrations and blood pH (a measure of acidity/alkalinity based on hydrogen ion concentrations). These chemorecepters in turn signal control centers in the brain stem that control the rate of heart beat and respiration.  They also control vascular constriction and relaxation to regulate the flow of blood.

When we hyperventilate, (breathe faster than we need to breathe to maintain the homeostatic balance of CO2 and oxygen), we pump more CO2 from the cardiovascular system than normal so blood pH rises (becomes more alkaline).  The chemoreceptors sense these conditions and signal the control centers in the brain stem.  They in turn signal the lungs to breath more slowly, the heart to beat more slowly and the vascular system to constrict.  All these actions slow the flow of blood through the lungs and that slows the release of CO2 in exhaled breath. In short, these homeostatic processes work to lower pH and increase blood CO2 concentrations back to normal.

However, as we are intentionally hyperventilating, we continue to pump CO2 from the blood with each exhalation, we override the control signals to slow the heart beat and rate of respiration.  The only thing we can't override is the vasoconstriction so arteries, arterioles and capillaries continue to constrict.  This is one of the basic cluster headache abort mechanisms.

The other part of the cluster headache abort mechanisms occurs when blood pH rises.  How did that happen?  When CO2 dissolves in water (blood serum) it becomes carbonic acid (more hydrogen ions) so pH drops.  When CO2 is removed from blood serum, the hydrogen ion concentration drops (less acid) so blood pH rises (becomes more alkaline).

When blood pH rises, blood hemoglobin molecules have a greater affinity for oxygen so upload up to 14% more oxygen and offload CO2 more rapidly. This results in oxygenated blood flowing to the brain and body and the returning venous blood carries the CO2 back to the lungs to be exhaled. This is happening every second of every day as long as we're alive. If we're breathing 100% oxygen at this point, we super-oxygenate the blood flowing to the brain and body. This then becomes another important CH abort mechanism.

Now lets look at the breathing procedures I suggest while trying to abort a CH with oxygen.  If we hyperventilate for 30 seconds using maximum forced lung tidal volumes by doing an abdominal crunch at the end of each exhalation cycle, we pump out more CO2 than normal so blood CO2 levels drop and blood pH rises.  If we continue hyperventilating at forced vital capacity tidal volumes for 30 seconds then inhale a lungful of oxygen and hold it for 30 seconds what have we accomplished?  We've lowered the CO2 concentration dissolved in our blood, raised the pH and super-oxygenated the flow of blood to the body and brain...  trigeminovascular system in particular.

Now watch the youtube video of my dear friend Chuck Setzco at the following link.  He's trying to abort a CH with oxygen therapy at an oxygen flow rate of 7 to 9 liters/minute with a non-rebreathing oxygen mask.

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This is painful to watch, but look closely at the 1-liter reservoir bag on the disposable non-rebreathing oxygen mask he's using.  It's collapsed most of the time.  Chuck is trying to breathe faster but the mask and oxygen flow rate will not permit this to happen. 

Although Chuck is receiving an adequate supply of oxygen, the amount of lung ventilation is insufficient to expel the excess CO2 generated through his physical activity fast enough so his blood CO2 levels rise.  This is the worse case scenario and just the opposite of what is needed to abort a CH so the CH pain gets worse rather than better.  This happens as the increased blood CO2 concentration (way above normal) triggers vasodilation which contributes to CH pain and makes an abort with oxygen therapy take much longer than needed.

Chuck was the first CHer to try the oxygen demand valve method of aborting a CH we developed in November of 2007.  This method of oxygen therapy allowed Chuck to hyperventilate with 100% oxygen breathing as fast and as deeply as desired as the oxygen demand valve delivers oxygen on demand much the same as a SCUBA diver's regulator.

Chuck was also the first of seven CHers to take part in a pilot study of the oxygen demand valve method of aborting CH.  We asked him to log his abort times and pain levels using a 15 liter/minute oxygen regulator and the standard disposable non-rebreathing oxygen mask.  The results of that pilot study are illustrated in the following graphic.  In all, the seven CHers collected abort times and pain levels for 8 weeks each resulting in data on 366 aborts with the oxygen demand valve.

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Chuck's aborts with a 15 liter/minute regulator are shown in red.  As you can see his average abort time using an oxygen regulator at a flow rate of 15 liters/minute was over 30 minutes.  Now look at the abort times with the oxygen demand valve that allowed users to hyperventilate with 100% oxygen.  The average abort time was 7 minutes for pain levels 3 through 9 on the Kip Pain Scale.

The latest method of aborting CH by hyperventilating with room air at forced vital capacity tidal volumes for 30 second followed by inhaling a lungful of oxygen and holding it for 30 seconds is just as effective with nearly the same abort times as with the oxygen demand valve.  The biggest benefit of this new method is in the amount of oxygen consumed per abort.  Where this new method results in an average CH abort time of 7 minutes, it consumes roughly 28 liters of oxygen, the demand valve method consumes roughly 280 liters of oxygen per abort.

I hope all this makes sense.

Take care,

V/R, Batch
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Mike NZ
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Re: Breathing correctly with 02 to get a fast abort.
Reply #7 - Jul 12th, 2018 at 4:12am
 
Using the approach from Batch, minus the abdominal crunch bit which was added after D3 started its magic, I was able to abort a CH in about 3 minutes using 25lpm flow rate (about 12 min at 15lpm).

And Dan, practicing before you get a CH is a great way to learn how to use your O2, so much easier than when you're mid-CH by far.

You're doing a lot of things right. Any update on seeing a headache specialist yet?
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Re: Breathing correctly with 02 to get a fast abort.
Reply #8 - Sep 2nd, 2018 at 3:29am
 
Good morning all,
I had thought I had got away with it this year, no headaches at all in my usual spring time.  So I find myself back here updating at the start of September.  I am trying the approach to O2 here, however no matter how hard I try I canít hyperventilate.  I stand, deeply inhale, exhale at the end of the inhale as hard as I can, then crunch and expel and wheeze, then repeat this for about 5 cycles, then take a full 3 litre bag of 100% O2 as quickly as is possible, then hold for 30 seconds and exhale.  I never get that feeling of tingling lips and dizziness.  When I did the spirometer test a little while ago I kept blowing the device off the scale.
My HAs do abort after about 15 to 20 mins, I am struggling to see a way to hyperventilation.  Any advice please?
Thank you as always to Batch and all who help on here.
Ian
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Batch
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Re: Breathing correctly with 02 to get a fast abort.
Reply #9 - Sep 3rd, 2018 at 1:26pm
 
Hey Radar,

Try 10 to 15 cycles with room air before the lungful of oxygen.† Five is not enough...

Take care,

V/A, Batch
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« Last Edit: Sep 3rd, 2018 at 1:26pm by Batch »  

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