does EPR on ResMed Machines work or make thearpy worse??

[ephskiing377]

Last night I used my ResMed AutoSet II with a pressure range of 11-16cmH2o with EPR @ 1. My data for the night was AHI 10.6 with a leak rate of 0.1l/s with my Mirage Liberty. The week prior, I used the same pressure range of 11-16cmH2o with NO EPR and AHI of 3.2-5.7 with a leak rate of 0.0l/s with my Mirage Liberty. Can anyone tell me if using the EPR affects my total AHI if my constant leak rate is 0.0l/s with my Mirage Liberty. I hope to hear back from you fellow cpapers. Thanks for the help!!

Sincerely,
Chad

[JohnBFisher]

It's likely that you need the full pressure support - even during exhalation to avoid obstructive apneas. So, with EPR enabled, it allowed a little more collapse of your airway and Bingo!

EPR does not work for everyone. Sounds as if that's the case for you. Of course, I would test for a day to two more to be certain it was not just an odd night.

[jmelby]

EPR can affect your therapy... when you have a pressure of 11 with EPR of 1, your exhale pressure is only 10. When you have EPR off, your exhale pressure is 11. But, if you need 11 to avoid apneas, you may want to instead have your pressure set to 12 if you have EPR = 1. That way, your minimum pressure would still be 11, but you'd get the effect of the exhale pressure being lower.

I had a similar issue... when I had my machine set at Auto with a minimum pressure of 9 with no EPR, my AHI was < 5, but turning on EPR of 1 made that jump to around 9. Changing my minimum pressure to 10 with EPR=1, I am back to AHI < 5. The question becomes then... why use EPR at all? It is a personal comfort choice... I had once asked this question of why would you increase pressure just to use EPR? Well, it turns out that even with the higher inhale pressure, the exhale relief is still somewhat more comfortable and makes breathing feel more natural. I also found that having a higher pressure (10 in my case) without EPR, I had very restless nights and felt awful in the morning.

[Tielman]

It can help with aerophagy from what I understand, so yes that might help someone feel better, but I agree with the other two posters that EPR/CFlex can make your AHI numbers higher.

[ephskiing377]

Thanks for your repiles. I really helps. I will try using the EPR a couple of more nights and see what my AHI numbers look like. Maybe I do better with NO EPR vs with EPR at 1. Anymore helpful suggestions on this topic, feel free to leave a post. Thanks fellow cpapers.

Sincerely,
Chad

[dtsm]

EPR can affect your therapy... when you have a pressure of 11 with EPR of 1, your exhale pressure is only 10. When you ha

I had a similar issue... when I had my machine set at Auto with a minimum pressure of 9 with no EPR, my AHI was < 5, but turning on EPR of 1 made that jump to around 9. Changing my minimum pressure to 10 with EPR=1, I am back to AHI < 5. The question becomes then... why use EPR at all? It is a personal comfort choice...

Your AHI data quote above: was there a major difference in the Ai numbers with different EPR settings? I ask because with our S8, other's have written that Hi are often 'artificially' high.

I'm currently on 8.4 to 11.4 range, with ave 9.5 pressure reading, EPR 3 - my AHI remains >10< but my Ai have slowly been dropping to <2. On some nights I get 0 Ai and 12 Hi the first hour of cpap use....

[rosacer]

I just start playing with the EPR. My numbers have definitely been affected by it.

What I can't understand is the following:
I have a pressure of 7, I set EPR2. So I have a median pressure of 5.4 now instead of 7 all the time.

But because a machine is a machine it takes time to go from 7cmH2O to 7-2=5 cmH2O, and to go back from 5 to 7 again. The result is I probably will never be long time (enough time?) at 7 nor at 5.

For my exhale that's great (if my throat doesn't closes in the meant time and make me not be able to exhale), but for my inhale it could be not too good if I really needed 7 to keep open the air ways. But now I have less than 7. Then I say OK I will change the max pressure to 8, so the prefect cpap would give a min pressure of 6 and a max of 8.

But the reality is that now I will have lets say a median of 6.4 instead of 5.4, and we can go like that raising up the max pressure until the real max pressure I get is sufficient to have a good inhale. But because the minimum pressure goes up too WHO KNOWS what is the real decreasing in pressure the minimum I have.

At the end of the story how much worth the EPR? I think it depends of each person, for me (because I have a low pressure of 7)I'm not sure it worth something to use that. Maybe somebody with 12 or more will appreciate it more I really don't know I'm a bit skeptic.

rosacer

[ephskiing377]

Fellow cpapers,
EPR really dose seem to impact our ahi numbers. Anyone else have any input on this topic? I would like some type odf answer to why EPR increases our ahi. My ai has been under 0.5 with no EPR and last night with EPR @ 1 my ai was 0.5. A,y help would be greatly appreciated. Thanks everyone!

Chad

[KatieW]

Here is a recent thread:

viewtopic/t48002/Cflex-13-Levels.html

If you do a search, you will find many more discussions on this.

[DreamStalker]

Fellow cpapers,
EPR really dose seem to impact our ahi numbers. Anyone else have any input on this topic? I would like some type odf answer to why EPR increases our ahi. My ai has been under 0.5 with no EPR and last night with EPR @ 1 my ai was 0.5. A,y help would be greatly appreciated. Thanks everyone!

Chad

John already answered your question. EPR reduces pressure on exhalation. It is at the end of an exhalation that one needs the pressure most to stent and prevent collapse of airway.

Look at the orientation of the epiglottis ... used to shut airway off when swallowing food or water (also for speech too I suppose ... dunno, not a doctor).

Anyway, when you are exhaling, the air flow can easily force open the airway at the epiglottis. If it collpases at end of exhale, then when you inhale, the air "flow" reverses and will actually make it harder to open the airway at the epiglottis junction. So the idea is to have sufficient pressure to stent it open throughout entire exhalation cycle so that when you inhale, the airway is open. This also contributes to positional OSA too IMO (with much help from tongue and gravity).

Here is an animated version of epiglottis in action while eating/drinking ...


It does not take the body that long to adapt to the pressure. Better to do without the exhalation relief IMO and allow your body to adapt.

[dtsm]

Here is a recent thread:

viewtopic/t48002/Cflex-13-Levels.html

If you do a search, you will find many more discussions on this.

Katie - You're the best, just like resident research librarian - always gets us the exact source, thanks.

I now remember reading about how ResMed's EPR mode of action differs from Respironics C-Flex, and the so-called advantages of the latter. I'm still tweaking my ranges and will include the EPR settings when comparing Ai results.

Thursday morning update: dropped EPR from 3 to 2 last night. Wow, Ai fell to earth, 0.9, AHI of course dropped dramatically.....
Let's see what happens next few nights.
Friday morning update: leakage slightly up, same excellent Ai and AHI numbers, and best of all, slept from 11:30 pm to 6:30 pm without waking up - first time in 3 years! Still not with that 're-freshing feeling' but i'm sure it's slowly working. Seems that last little tweak with EPR might be the trick.

[sarki]

I have been using EPR setting of 2 on my S8, which i found to be really comfortable.
My AHI range from 40 - 78, so because i have central apnea and high hypopnea scores i have been told that i have to turn the EPR off.
I tried it on epr 1 but the noise in my head was so horrific i ended up with a bad headache after only 2 hrs use, i found there seems to be "air everywhere" my throat was so dry, even with the humidifier and after 2 hrs use i was also so bloated.
My cpap and i were becoming as 1 and very comfortable, i am now faced with the shocking noise that even EPR level 1 has in my head .
I have to wonder what the noise level in my head will be with it turned off.
I have just had an oxiometre connected to my machine for the last 2 weeks to see what the data from that shows.
I have been using cpap now for 4 mths and was very happy with it but of course my AHI keeps going up, instead of down.

I have to wonder how on earth others cope with the epr off, does anyone else have that shocking head noise with it turned off ?

[rested gal]

sarki, what is the full name of your S8 machine? Which of these is it... Escape? Elite? Elite II? Autoset? Autoset II?

If it is a CPAP (Escape or Elite) what is your prescribed pressure?

If it's an autopap (Autoset) what is your prescribed range... the minimum/maximum pressures it's set for?

[linagee]

Even if EPR doesn't work that well for therapy, if it's more comfortable you might put EPR on ramp only.

[dtsm]

sarki, what is the full name of your S8 machine? Which of these is it... Escape? Elite? Elite II? Autoset? Autoset II?
If it is a CPAP (Escape or Elite) what is your prescribed pressure?
If it's an autopap (Autoset) what is your prescribed range... the minimum/maximum pressures it's set for?

Rested gal is right on...go to:
>control panel link on top left, right below cpaptalk.com
>profiles
>edit equipment

Then post your set-up, i.e. prescribed pressure, whether you're on cpap, or apap. If you do have the software, put up images. Then folks have better chance to help you.

Good luck....