Is EPR best avoided?

[palerider]

Last time I saw the doc, he said I could try changing the EPR to see if I got improved results. He sets his own to off and says that helps prevent his airway from collapsing during exhales. Aside from comfort issues are you saying there could be a downside to no or reduced EPR in the form of increased Central or Complex Apneas?

Just saying/thinking that if EPR is lowering pressure, the machine may be slightly less effective in hitting the required pressure in time to deal with events, but clearly if EPR helps someone to sleep better, then even with a slightly raised but 'treated' AHI you're going to feel better. As Pugsy says, sleep quality is far more important than the Math, it's just getting the balance right.

to *properly* use EPR, one should raise the minimum pressure for each point of EPR that's added... thus keeping the baseiline (epap) pressure the same, since it's EPAP that holds the airway open so you can take a breath.

[Guest]

to *properly* use EPR, one should raise the minimum pressure for each point of EPR that's added... thus keeping the baseiline (epap) pressure the same, since it's EPAP that holds the airway open so you can take a breath.

*waves hands* +1
+1
+1
+1 *waves hands*
*smiling faces*

[Hannibal 2]

to *properly* use EPR, one should raise the minimum pressure for each point of EPR that's added... thus keeping the baseiline (epap) pressure the same, since it's EPAP that holds the airway open so you can take a breath.

So where you may find some comfort in ease of exhalation, you could conversely find some discomfort with raising the pressure to compensate, increased risk of mask leaks and aerophagia. Just about getting the balance right I guess.

[Pugsy]

So where you may find some comfort in ease of exhalation, you could conversely find some discomfort with raising the pressure to compensate, increased risk of mask leaks and aerophagia. Just about getting the balance right I guess.

Yeah but often the comfort of the exhale offers more benefits than the slight increase in the minimum pressure might offer in discomfort.

You would just have to play with it and decide what feels the best for you in your situation.
When I was first using a bilevel machine....coming from APAP with minimum set to 10 and maybe getting 2 cm in Flex relief (that's the max Respironics will give) I set the EPAP to 10 and IPAP to 14 and I actually felt much more comfortable with 10/14 than with the 10 and maybe 8 (that 2 cm Flex max).
I know it sounds weird but it's the difference that offers the comfort and at least for me the comfort was dramatic.
10 EPAP and 14 IPAP was much more comfortable than 10/8.

When you use EPR it sets up a bilevel pressure situation...EPAP and IPAP being distinctly different.
Flex exhale relief on the Respironics machines is similar in that it creates a bilevel situation but the most most reduction that Respironics Flex relief will offer is 2 cm and that's based on flow rate so if a person is a shallow breather they may not even get 2 at the max setting of 3.

[Okie bipap]

I set my bipap with a max IPAP of 20 and a min EPAP of 17 with a pressure support of 3. This essentially gives me a fixed pressure with 3 cm pressure support but still allows me to track my flow restrictions.

[Hannibal 2]

Thanks for your observations, currently I am on a minimum of 9cm with EPR set at 3cm. I was thinking of dropping to 8cm and 2cm as I the only thing that seems to wake me is mask leak or vent noise. I think I'm doing ok apart from this but I won't make the changes just yet as I have a Mask Review appointment tomorrow, I'm more interested in first trying a different mask, see how it works for me regarding comfort, leaks and vent noise for a few days, then I may experiment with the EPR settings.

[jtravel]

Flex exhale relief on the Respironics machines is similar in that it creates a bilevel situation but the most most reduction that Respironics Flex relief will offer is 2 cm and that's based on flow rate so if a person is a shallow breather they may not even get 2 at the max setting of 3.

That has not exactly been my experience with my PR 60 series Apap.
The Aflex setting of 1-3 is not an exact amount of pressure relief and actually varies how much pressure refile it provides based on the specific IPAP pressure used to treat you.
I have seen mine vary between 1.9 and 2.5 at the aflex setting of 3 with my actual max Ipap pressure of 15.40
I found At higher pressures you get more Epap pressure relief. I suspect it will Max out at 3 when you Hit a max Ipap of 20 but I have never gone that high in my actual treatment pressure to say for sure.
I like the Resmed better because if you select 1-3 that is the exact amount of Epap pressure relief you get.

[palerider]

Flex exhale relief on the Respironics machines is similar in that it creates a bilevel situation but the most most reduction that Respironics Flex relief will offer is 2 cm and that's based on flow rate so if a person is a shallow breather they may not even get 2 at the max setting of 3.

That has not exactly been my experience with my PR 60 series Apap.
The Aflex setting of 1-3 is not an exact amount of pressure relief and actually varies how much pressure refile it provides based on the specific IPAP pressure used to treat you.
I have seen mine vary between 1.9 and 2.5 at the aflex setting of 3 with my actual max Ipap pressure of 15.40

unless you've got a high rate logging manometer attached to the machine, you don't know that, since the machines don't accurately log measured pressure.

mostly you just repeated what Pugsy said.

[Pugsy]

I suspect it will Max out at 3 when you Hit a max Ipap of 20 but I have never gone that high in my actual treatment pressure to say for sure.

Not according to what Respironics says. Please note the comments I have circled. "No more than 2 cm below the high point of the inspiration". That means the most reduction a person can get is 2 cm and that of course is flow based. Not everyone will get that at the setting of 3.

From Respironics....

[Uncle_Bob]

EPR is a comfort feature. Not all xPAP machines even have it. I've would personally question my doctor if he wrote out an Rx with an EPR setting unless he could specifically explain to me why I needed one following a titration study. People here on the forums will will be telling you what to do with your standard pressure setting(s) if you use EPR until they are blue in the face.

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Good luck
~UB

[Pugsy]

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Your opinion of which you are certainly entitled to share and have but it isn't my opinion.
Those of you who have this sort of opinion and compare anything related to "comfort" as being silly or childish and once we "grow up" we will have bigger balls and not need such childish things really make my ass want to dip snuff.
What the hell is wrong with wanting to be comfortable? Why are people who want to be comfortable looked down upon...because your balls are bigger and you are all grown up and we aren't?
Your therapy is "better" than mine because I happen to like a little comfort?

Oh...what pressure do you use? If I remember right it's a really low pressure.

[Uncle_Bob]

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Your opinion of which you are certainly entitled to share and have but it isn't my opinion.
Those of you who have this sort of opinion and compare anything related to "comfort" as being silly or childish and once we "grow up" we will have bigger balls and not need such childish things really make my ass want to dip snuff.
What the hell is wrong with wanting to be comfortable? Why are people who want to be comfortable looked down upon...because your balls are bigger and you are all grown up and we aren't?
Your therapy is "better" than mine because I happen to like a little comfort?

You are associating my use of the word "maturity" with adulthood or manhood. Not my intent. I was referring to when a period may end, in this case with regards to learning to adjust to xPAP therapy, that is all. You can go through years of posts here from many people who recommend working towards not using EPR & ramp based on experience, I'm not exactly sure exactly why you chose to single out me for your reaction. But i have my suspicions.

Oh...what pressure do you use? If I remember right it's a really low pressure

Yes its low (7cm) so I wasn't prescribed a BiPAP or any other machine.

[Pugsy]

I'm not exactly sure exactly why you chose to single out me for your reaction. But i have my suspicions.

Probably not the reason you suspect. It had nothing to do with a feud you may be having with someone if that is what your suspicion is..

It's always been a pet peeve of mine that people compare using a comfort feature to training wheels and blatantly tell people that when they grow up they won't need the training wheels. It's like saying someone is childish and hasn't grown up or they wouldn't need training wheels.

You just happened to get square in the middle of my crosshairs tonight. So I took aim and fired.

And yes...I equated "maturity" to being grown up....which is just something that irritates the hell out of me when people do it and most of the time I just bite my fingers bloody and don't say anything. It's already been inferred in this thread that wanting comfort is somehow a sign of weakness and I think that is the wrong impression to give newbies.
You old timers who want to brag about how tough you are and don't need any "comfort" anything...hell, I don't care but I just hate it when newbies are talked to in such a way to infer that "when you grow up you won't need" whatever.
People brag how they don't "need" ramp or don't "need" exhale relief like it's a special badge to wear.

I say more power to you but don't talk down to me because I like something that makes me comfortable.
It's just another one of the many cpap things that have that really big YMMV sticker on it.
What does it matter if someone wants to use a comfort feature or not? I don't know about you but if I ain't comfortable I don't sleep so good and sleeping is the name of the game here...not how tough or grown up or how big their balls are.
And you know very well that some people here mention the "training wheels" analogy...and that just makes me see red.

So I picked on you because you were handy and in my face this time and I saw red. That's the only reason.

[jtravel]

From Respironics....

Interesting that it does not agree with the actual data I see on sleepyhead with my 60 series Apap.
makes me wonder if I can really trust any of the pressure data reported by the machine in sleepyhead?
I the end I guess it does not really matter.
I use Alex setting of 3 on my Pr 60 series and EPR of 3 on my Resmed and can tell no difference in how I actually feel.
I found aflex/EPR a great value as it was hard to exhale sometimes against the full inhale pressure.
Before using the relief setting my sleepyhead data showed i was having Centrals. They went totally away after I started using it.
It work wonders in my situation and prevented me having to go directly to a Bi-level machine that would have been my next step.

[Pugsy]

Your Quoted information From Respironics did not have a date when that information was released by PR. Any possibility it was released for the 50 series before the 60 series came out and they changed it?

I don't remember the date. It was from a Respironics manual and either the 50 or 60 series. I remember the pictures
I will look to see if I can find the direct link to that manual and check date. I had the whole manual on another computer and that's where I got the image of that page...but that computer died and I can't retrieve anything from it.

The 50 series and 60 series machines didn't change the way Flex relief was delivered. The basic functions of the machines haven't changed in years. Flex wasn't changed...and I don't think it was changed with the DreamStation either.
The algorithms and basic functions haven't been redone since that changed from the M series to the PR S1 and added clear airway flagged.

Now if you think SH is showing something different...I don't know what to tell you except maybe you want to verify with Encore software.
Is it possible that SH is not getting the calculations spot on....sure it's possible. I don't know how SH does the 2 separate graphs for inhale and exhale when Flex is involved. Encore doesn't do them at all so it's something Mark came up with and it might not be perfect. It is Beta software after all and there are some known bugs in it.

Flex is exhale relief..EPR is exhale relief...but after that they are 2 different animals. I just wanted people to understand that it's a flow based drop and not a per cm drop like ResMed...and per the manual the most drop you can get is 2 cm.
They feel different...I have used both...and both are quite nice but they feel different. They both get the job done..they just go about getting there in different ways.