Am I too afraid of lung barotrauma? Remedies/Techniques?

[Fexei]

I certified last year for OWSD with SDI and passed without any real problem apart from what you will read below.
Due to CoVid I cant dive as much as i would like to, but soak up every information about diving i can find. My plan is to certify for Advanced Diver and quite possibly Rescue Diver later on.

Now, I can only assume that at some point during one of these courses there will be a deep emergency ascent exercise, from whichever depth but most certainly deeper than the CESA during my OW certification.

And here comes the catch: I really dont feel comfortable during these exercises.
I am so scared of rupturing my lungs that I think I exhale way too much. It distracts quite a chunk of my mind
Why am I so scared?
-After the first practice CESA, when back on the boat I realised I was bleeding from my nose. Until my DI told me what could have caused it, I thought "welp my lung ruptured, byeeee". Which was stupid because i exhaled ( and too much i guess)
-Because it takes only a few feet of "screwing up" to do it.
-Because as I was told, there is no "warning sign" before its too late, no pain or sensation that tells you,you do something wrong with your breath.
-Because I irrationally dont trust the " just keep the airways open (humming etc) and the pressure will make its way out". I always think that I need to give it a little extra "push". Better "safe" than sorry kinda.
Other divers report the sensation of feeling how the one breath they took before ascending just never seemed to end as they ascend. I dont remember feeling that. I just felt the " getting close to having to breath again" sensation.

My concern would be that during a deep CESA or other exercise I would exhale too much and run out of air during the ascent, fail the exercise or inhale during the ascent getting myself hurt.

I would be very thankful for every bit of advice, that would help me to get from "Fear it" to "Be aware of it". Any biology/physics background that helps me understand why my fear is irrational when proper technique is used.

Felix

 

[Rechno]

So you should either overcome your irrational fear or just dont take the advanced courses.

Concerning you fear you obviously already seem to know the "facts" e.g. keeping your airways open.... you know that you tend to exhale too much.. so you already know the solution. Just exhale slowly.
And even if you need to inhale (which will be the case if you do the rescue exercise slowly enough) you just take a breath and exhale again.

 

[Zef]

I am not aware of any training scenario outside of basic open water certification where a CESA is a requirement.

If doing a CESA from deep depth, one could very well exhale to the point that they empty their lungs.

Somethings to consider:

1. Even if your lungs feel empty there is still what is known as "residual volume", so your lungs are never truly empty.

2. A CESA should be conducted with the 2nd stage in the mouth with attempts to draw a breath every so often as one is rising through the water column. As the ambient pressure decreases as one rises in the water column it becomes increasingly likely that the 1st stage will be able to deliver some life sustaining air.

3. In over 25 years of diving I have yet to do a CESA outside of my open water training. I am also from the school of thought that a CESA is a very high risk activity and there are better practices that should be trained and incorporated into one's dive education/repertoire that would negate the need for a CESA in the first place. There are threads on Scuba Board where this has been discussed and debated to great lengths.

The sensations you felt and the things others have told you are very individual and are affected by things such as lung capacity, how deep a breath one took before starting the CESA, how fast/slow the diver exhales, actual rate of ascent, etc.

I think that with experience your fear and anxiety will subside. The fact that you think about the risk is a good thing. Just don't let it paralyze you or otherwise impact you in way that it keeps you out of the water.

Hope that helps.

-Z

 

[Fexei]

So you should either overcome your irrational fear or just dont take the advanced courses.

That is basically the point why I opened this thread..

So tell me, is it even possible to "not exhale enough" during an emergency ascent within the safe speed limits? Apart from holding your breath obviously? Or should i imagine it being a binary thing? Either your airways are closed or even the slightest opening is sufficient?

 

[Zef]

What advanced course are you planning on taking that is requiring you to do a CESA for the purpose of training/certification?

I don't think your fear is irrational...perhaps the concern that you will need to do a CESA in other training courses is a bit, but other than that your concern is not unfounded.

If you make the "Ahhhh" sound like you are have your throat checked at the doctor's office, that sensation you feel is your glottis opening. Practice making that sound and see if you can create the glottis opening sensation even without sound. When your lungs feel empty underwater you want to maintain that sensation of your glottis being open so air can escape as it expands on your way to the surface.

You are not the first diver to be preoccupied with this, and the preoccupation typically subsides with experience.

Plan your dive, dive your plan, keep an eye on your remaining air pressure and arrive at the surface with the planned reserve (typically 300-500 PSI / 30-50 Bar). And most of all, keep asking questions in an effort to increase your knowledge base. A thinking diver is typically a safer diver.

-Z

 

[tmassey]

So tell me, is it even possible to "not exhale enough" during an emergency ascent within the safe speed limits? Apart from holding your breath obviously? Or should i imagine it being a binary thing? Either your airways are closed or even the slightest opening is sufficient?

First, a standard disclaimer: I am not a doctor, I do not play one on television, and I did not stay in a Holiday Inn express. (I see you are from Germany, so I’ll explain that last one: it was a popular commercial in the US sometime ago, where people were magically given the ability to do amazing things because “I did stay at a Holiday Inn express last night”. In other words, I don’t even have a random unexplained ability to be an expert in this topic.)

Think of water coming out of a hose. it is possible to increase the pressure without completely closing off the flow. That’s what putting your thumb partially over the hose does to get the water to shoot farther.

But think about what you would have to do to accomplish that: you would have to be intentionally closing down your breathing way. You would have to be directly applying resistance to the flow of gas out of your lungs. And remember: the gas coming out of your lungs is a lot thinner and slipperier than even the water coming out of the hose. That makes it that much harder for you to resist its flow.

On top of which, remember that the volume of gas is not increasing explosively. The most serious part is, say, from 30 feet to the surface, when the *relative* pressure change is the greatest. But even then, if you’re making anything even approaching a reasonable ascent, it’s going to take you tens of seconds to be able to traverse that distance. how much gas can you expel in 30 seconds? The answer is a lot more than the amount of gas in your lungs is going to expand.

That means if you’re exhaling hard enough such that you can empty your lungs in less than, say, 15 seconds, you are exhaling harder than you would need to to be able to vent all of the gas that expands if you were ascending at double the maximum rate you should be ascending at.

So do that sometime. Sit there with a stopwatch and exhale your entire lungs slowly enough to take a full 15 seconds. See how slow that is? if you’re exhaling more than that, you’re actually exhaling too fast.

I think if you do that, and really understand what is going on, you will see that there really is no need to actually, mechanically “exhale”. Between the fact that the gas will escape on its own faster if the pressure increases (physics!), and that with any kind of a controlled ascent, this will be happening slow enough that it won’t present a direct danger.

What does present a problem is if you have completely mechanically closed down airway for the gas to escape — but only when you pair that with a rapid ascent. Of course, a rapid descent has its own dangers, and lung embolism is only one of them.

A better thing to think about might be to focus on your breathing, not to keep you from injury, but to keep you using your gas most efficiently. Slow breath in, gentle transition to exhale, exhale out twice as long as you breathe in, gentle transition to inhale. Pay attention to not closing down your glottis (the back of your throat) as you transition from inhale to exhale and vice versa. Try to carefully inflate your lungs all the way to the bottom, and exhale all the way to the top. That will keep you safe, but more importantly, that will allow you to use a lot less gas and extend your bottom time greatly. Which will allow you to have more fun, which will allow you to worry less about your breathing!

And like others have said, this will come with experience. That idea of keeping your airway open will simply become second nature, and you won’t have to worry about it. In the interim, understanding truly how much time you have, and how little breathing will keep you safe, may help you to be able to put that aside until you develop that experience.

 

[Fexei]

What advanced course are you planning on taking that is requiring you to do a CESA for the purpose of training/certification?

Actually it was just an uneducated guess, that if you would get the "Deep" Specialty and later on the Rescue Diver, the curriculum would have something like a CESA or EBA (if EBA is even taught anymore) to exercise from a depth deeper than in the OW Course.
I only found vague descriptions like "self rescue" in the rescue diver course descriptions.

Thank you for your tip by the way.

 

[johndiver999]

You probably are not going to be asked to do it in training. If you are worried about doing it in an actual emergency then you have good reason to worry. An emergency ascent with no air supply has a track history of being a dangerous practice. It is the last ditch effort when all better options have been exhausted.

Two suggestions.. 1: get a pony bottle so you can drastically reduce the chance of being required to do a "no air" ascent; 2: As mentioned, the most rapid change in pressure is the last several feet of ascent, so if you can calmly exhale from a depth of 5 feet to the surface without injury, then a lung expansion issue should not arise from an ascent at a similar speed from deeper water. If you can acknowledge this, you may be able to retire most of your fears over a lung expansion injury.

 

[boulderjohn]

So tell me, is it even possible to "not exhale enough" during an emergency ascent within the safe speed limits?

Once your airway is open, if any air needs to leave your lungs, it WILL leave your lungs. The only threat is closing the airway. You do not need to worry about letting out too little air. I spoke with two different divers who experienced real CESAs from around 100 feet. They said that once the air started coming out, there was no stopping it.

You should also know something not mentioned in most OW classes--when your tank is out of air, it is not out of air. It just thinks it is out of air. That is because the tank must have enough air in it to deliver it at a greater pressure than the pressure you are under at that depth. When you ascend to a shallower depth, the pressure around you drops, and the regulator will be able to give you some air again.

So can you inhale safely as you ascend? Yes, and thinking about why that is true may help you understand the whole situation. When you inhale, you use the diaphragm to expand chest volume, and this pulls in new air to fill that volume. If your lungs are full enough to risk barotrauma, than you cannot inhale. If you are able to inhale, then it is safe to do so.

 

[Bob DBF]

Having a healthy respect for barotrauma is not a bad thing, but it shouldn't stop you from doing a CESA. What the instructor didn't tell you is that breathing out is to show them that your airway is open so that they can keep you safe on the ascent. They have taught you a trick, but not given you a complete understanding of the process. The two links below have more information, as with any thread, don't believe everything written.

Frequency of advanced divers practicing CESAs ? [Poll]

Performing a CESA After Exhale

I would also suggest that you take the rescue class before deep, before advanced if you have no need for advanced in the near future. PADI has requirements for rescue, some other agencies don't.

Good luck