Is EPR best avoided?

[Hannibal 2]

My machine was set to the maximum EPR setting of 3cmH20, I know this is a comfort feature but does it compromise my therapy? I'm trying to edge up my minimum pressure gradually closer to my 95 per cent pressure, within 2cmH20. Am I better off without EPR if I find I can manage without? Maybe drop it gradually and then switch it off?

[Jay Aitchsee]

EPR is a "try it and see" feature. Using EPR will effectively lower your EPAP and, therefore, your average therapy pressure. If you like it, you may have to raise your Min pressure setting slightly to compensate in preventing obstructive events. Some find Central Apneas increase with EPR, others do not. EPR in and of itself does not "compromise" your therapy and could enhance your therapy if it is more comfortable for you. Try it and see, or in this case, turn it off or lower it and see.

[rick blaine]

It is, as Jay sez, a case of suck it and see. Some people find EPR not just more comfortable but getting on for absolutely necessary - to the point where, if 3 cm of relief isn't enough, they might could switch to a bi-level machine (with an up to 6 cm expiration pressure drop). Other people find the effect isn't that much different.

And a few - such as myself, have turned A-flex (the equivalent on my machine to the EPR on yours*) right off. It seems that, with older age, my sleeping resp rate can go above 20, and when it does, the algorithm doesn't quite mesh.

You might - since you're still in the learning/ exploring phase with your new machine - try it with the EPR off. Given normal lung function, breathing out against, say, a pressure of 15 cm is (a) not impossible, and (b) something your chest and diaphragm muscles soon adapt to. So give it try. Find out not the 'text book' answer but the Hannibal 2 answer.

* And, yes, for all you obsessive techno mavens, I do know it is not the exact equivalent.

[DreamStalker]

It was for me. It doesn't take long to get used to breathing under pressure and after that you realize you really don't need exhalation relief. I think I turned mine off after a few months but I could have turned it off after a week or two I think.

[Hannibal 2]

Thank you for your helpful responses.

Rick, Ironically I was re-reading some of the advice you offered when I was about to purchase my first APAP machine a few weeks ago. You suggested trying to set my minimum pressure 0.5 to 2cmH20 below my average 95 per cent. This is what I am attempting to try to optimize my therapy, I will also try then to lower my EPR gradually to see how I cope with that.

I'll also keep watch on how centrals are affected either way.

[palerider]

It is, as Jay sez, a case of suck it and see. Some people find EPR not just more comfortable but getting on for absolutely necessary - to the point where, if 3 cm of relief isn't enough, they might could switch to a bi-level machine (with an up to 6 cm expiration pressure drop). Other people find the effect isn't that much different. * And, yes, for all you obsessive techno mavens, I do know it is not the exact equivalent.

I don't know where you're getting your "information" but, heres a couple of facts.

bilevel machines can have much more than 6cm pressure support. you can set the resmed s machine to an inhalation pressure of 25 and exhalation of 3, giving you an expiration pressure drop of 22cm.

and as for pressure support and epr being different, which of the following is epr, which is pressure support?



the third line doesn't count, that's an experimentation of rise time.

[palerider]

Thank you for your helpful responses.

Rick, Ironically I was re-reading some of the advice you offered when I was about to purchase my first APAP machine a few weeks ago. You suggested trying to set my minimum pressure 0.5 to 2cmH20 below my average 95 per cent. This is what I am attempting to try to optimize my therapy,

that is dumb advice.

[Hannibal 2]

Thank you for your helpful responses.

Rick, Ironically I was re-reading some of the advice you offered when I was about to purchase my first APAP machine a few weeks ago. You suggested trying to set my minimum pressure 0.5 to 2cmH20 below my average 95 per cent. This is what I am attempting to try to optimize my therapy,

that is dumb advice.

Because? ....And what would your advice be?

Edit: should read 0.5 to 2 below the average pressure, sound better?

[Pugsy]

Because? ....And what would your advice be?

Because you will be chasing your tail in terms of pressure and the more you increase the minimum the more the 95% pressure will increase too. There is nothing magical about that 95% number....it's just a number and a number that is easily skewed for any number of reasons. Remember the definition "at OR BELOW that pressure for 95% of the night".
The "or below" part is really important. It is NOT where you spent 95% of the night.

From your Mar 20 report...the 95% number is 14.74. Do you really want to use a 14 cm minimum? You could but it would be way overkill.

If you want to set a target for the minimum...look at the median average..it's a better target for a minimum.

[palerider]

Thank you for your helpful responses.

Rick, Ironically I was re-reading some of the advice you offered when I was about to purchase my first APAP machine a few weeks ago. You suggested trying to set my minimum pressure 0.5 to 2cmH20 below my average 95 per cent. This is what I am attempting to try to optimize my therapy,

that is dumb advice.

Because? ....And what would your advice be?

because it comes from someone that doesn't understand what the 95% number means, all the 95% number represents is a maximum pressure discarding any short term spikes.

like throwing out the highest and lowest judges score in the olympics.

it's a stupid, ignorant shortcut to try and get a minimum pressure without actually understanding anything anything about how the night progresses.

Edit: should read 0.5 to 2 below the average pressure, sound better?

no.

[Oltremare]

Hello to all.
The EPR management (or equivalent) is a subjective thing.
But I don't understand why you have doubts on the use of the EPR?
There are some people who have complications for their CA when they use the EPR, but everyone else, why not use EPR? It 'a prejudice?
EPR for me is a great thing!
I could never do without it.
I tried to go from 3 to 2 but I did not succeed!
After two nights, I had to go to 3 but I have no CA.

Oltremare

[Pugsy]

Edit: should read 0.5 to 2 below the average pressure, sound better?

Are you aware that the "average" shown in SleepyHead defaults to the median average and not an overall normal average that I think you are thinking about.
You can change the median average tor reflect a "normal" average if you wish. Preferences/CPAP tab.

Have you see this?
http://adventures-in-hosehead-land.blog ... de-to.html

FWIW....IF (big IF) I was targeting anything for an APAP minimum pressure setting it would most likely be the median average.

[Hannibal 2]

If you want to set a target for the minimum...look at the median average..it's a better target for a minimum.

Thanks for clarifying, and apologies to Rick for misquoting him - he said average pressure, not average 95 per cent pressure.

So I'll look at my median over the past week and take the average of that.

[Hannibal 2]

Edit: should read 0.5 to 2 below the average pressure, sound better?

Are you aware that the "average" shown in SleepyHead defaults to the median average and not an overall normal average that I think you are thinking about.
You can change the median average tor reflect a "normal" average if you wish. Preferences/CPAP tab.

Have you see this?
http://adventures-in-hosehead-land.blog ... de-to.html

FWIW....IF (big IF) I was targeting anything for an APAP minimum pressure setting it would most likely be the median average.

Will take a look later, thanks

[Hannibal 2]

Hello to all.
The EPR management (or equivalent) is a subjective thing.
But I don't understand why you have doubts on the use of the EPR?
There are some people who have complications for their CA when they use the EPR, but everyone else, why not use EPR? It 'a prejudice?
EPR for me is a great thing!
I could never do without it.
I tried to go from 3 to 2 but I did not succeed!
After two nights, I had to go to 3 but I have no CA.

Oltremare

I don't have doubts, I know it's good for some people, just wondering if it's better to try and adjust to not using it.