Method and apparatus for treating hyperarousal disorders
Methods and apparatus provide automated controls for a respiratory pressure therapy device, such as a servo-ventilator. For example, a controller of a respiratory pressure therapy device may control application of pressure support ventilation therapy to an airway of a patient. The controller may control the respiratory pressure therapy device to auto-titrate an expiratory positive airway pressure (EPAP) of a pressure support ventilation therapy so as to maintain airway patency of the patient. The EPAP may be bounded below by a floor pressure limit. The controller may control the respiratory pressure therapy device to repeatedly adjust the floor pressure limit depending on events of interest during the auto-titration of the EPAP. Such methodologies may improve treatment for patients such as those suffering from sleep disordered breathing-comorbid hyperarousal disorders.
1 . An apparatus comprising:
a transducer to sense a voluntary respiration manoeuvre by a patient;
a pressure generator configured to deliver a flow of air at a controllable treatment pressure above atmospheric to an airway of the patient via a patient interface over an air circuit; and
a controller configured to:
control the treatment pressure of the flow of air so as to apply paced breathing to the airway of the patient, wherein a therapy parameter determination algorithm determines therapy parameters comprising a plurality of interim breathing rate targets for a therapy control algorithm that controls the pressure generator to generate a pressure support ventilation therapy with the paced breathing according to the plurality of interim breathing rate targets;
providing of biofeedback to the patient, wherein the biofeedback is controlled by the therapy control algorithm so that the biofeedback is matched to a paced breathing interim breathing rate target, the paced breathing interim breathing rate target being one of the plurality of interim breathing rate targets from the therapy parameter determination algorithm, such that the biofeedback changes as the paced breathing interim breathing rate target changes according to breathing rates of the patient;
generate a confirmation signal when the patient's breathing rate slows to an optimal breathing rate target, wherein the confirmation signal controls the pressure generator to provide a transient modification to a treatment pressure; and
terminate the biofeedback in response to the sensing of the voluntary respiration manoeuvre by the patient.
2 . The apparatus according to claim 1 , wherein the transient modification comprises a pressure oscillation at a sub-acoustic frequency.
3 . The apparatus according to claim 1 , wherein the controller is configured to terminate the paced breathing in response to the sensing of the voluntary respiration manoeuvre by the patient.
4 . The apparatus according to claim 1 , wherein a magnitude of the treatment pressure is a function of a difference between a respective interim breathing rate target and a current breathing rate.
5 . The apparatus according to claim 1 , wherein the controller is further configured to periodically reduce a interim breathing rate target in response to a current breathing rate slowing down toward the interim breathing rate target until the optimal breathing rate is achieved.
6 . The apparatus according to claim 1 , further comprising a user input device comprising a manual control.
7 . The apparatus according to claim 6 , wherein the controller is further configured to terminate the paced breathing and the biofeedback on activation of the manual control.
8 . The apparatus according to claim 1 , further comprising an audio sensor.
9 . The apparatus according to claim 8 , wherein the controller is further configured to terminate the paced breathing and the biofeedback upon the audio sensor detecting a predetermined sound.
10 . The apparatus according to claim 1 , further comprising a data communication interface through which the controller is configured to communicate with a local external device.
11 . The apparatus according to claim 10 , wherein the controller is configured to control the local external device to provide the biofeedback to the patient.
12 . The apparatus according to claim 10 , wherein the controller is further configured to receive an audio signal from the local external device.
13 . The apparatus according to claim 12 , wherein the controller is further configured to terminate the paced breathing and the biofeedback upon detecting a predetermined sound in the audio signal.
14 . A method of acclimatising a patient to pressure support ventilation therapy, the method comprising:
controlling, by a controller, a pressure generator of a respiratory pressure therapy device to apply paced breathing to an airway of the patient, wherein a therapy parameter determination algorithm determines therapy parameters comprising a plurality of interim breathing rate targets for a therapy control algorithm that controls the pressure generator to generate the pressure support ventilation therapy with the paced breathing according to the plurality of interim breathing rate targets, wherein the interim breathing rate targets change according to breathing rates of the patient;
causing, by the controller, biofeedback to be provided to the patient, wherein the biofeedback is controlled by the therapy control algorithm so that the biofeedback is matched to a paced breathing interim breathing rate target, the paced breathing interim breathing rate target being one of the plurality of interim breathing rate targets from the therapy parameter determination algorithm, such that the biofeedback changes as the paced breathing interim breathing rate target changes according to the breathing rates of the patient;
generating, by the controller, a confirmation signal when the patient's breathing rate slows to an optimal breathing rate target, wherein the confirmation signal controls the pressure generator to provide a transient modification to a treatment pressure; and
terminating, by the controller, the biofeedback in response to sensing of a voluntary respiration manoeuvre by the patient.
15 . The method according to claim 14 , wherein the biofeedback is in one or more of acoustic or visual form.
16 . The method according to claim 14 , further comprising terminating the paced breathing on receiving a command from the patient.
17 . The method according to claim 16 , wherein the command is activation of a manual control.
18 . The method according to claim 16 , wherein the command is a sound emitted by the patient.
19 . The method according to claim 16 , wherein the command is a voluntary respiratory manoeuvre by the patient.