Effect of EPR=3 vs. EPR=1 on S9 Autoset

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Slartybartfast
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Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Slartybartfast » Thu Apr 21, 2011 9:37 am

Just for grins I decided to reset the EPR on my S9 from 3, where it's been since I got the machine last August, to 1. I wondered whether I'd be able to see any effect on my AHI and I also wanted to see what effect the increased exhalation resistance might have on the flow trace.

I set it to 1 on Sunday night and downloaded the data this morning. To my surprise, there was a significant difference in my data. With EPR = 3 AHIs usually range from 0.2 to 0.5. One or two hypopneas, maybe a short OA. Some nights, no events. Pressure usually lies against my lower limit of 9 (my official titrated pressure from the lab was 11) until some event, or perceived event, kicks it up a little.

But with EPR set to 1, I noticed a consistent pattern of probably a dozen hypopneas and maybe a "central" or three were recorded each night. The "snore" trace is elevated, as are the "flow limitation" and "leaks" traces. And the mean pressure is up about 2 cm, which I suppose is to be expected since 2 cm is how much EPR I removed.

Feeling especially daring, last night I threw all caution to the wind and turned EPR off completely and had the worst night yet. AHI was 1.9. Nothing to complain about, I know, but it showed me that even though EPR is considered a patient comfort feature, it DOES affect the numbers.

I recall awakening a number of times during the night with little leaks and several times I felt the S9 pressure pulsing, checking my airway with the "forced oscillation thingy" (FOT, I think they call it). I feel fine today, but I am aware that my sleep was distrubed the past few nights. And, come to think of it, I had a hard time keeping my eyes open in an especially boring meeting I attended yesterday.

So tonight, I'm going to set EPR back to 3. No time now to post graphs. I'll see if I can get a few minutes later today.

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by BernieRay » Thu Apr 21, 2011 10:28 am

I've thought about doing this a few times, but I fall asleep so much easier with EPR=3 when compared to straight CPAP, that I never got around to trying it.

Given how the medical community tends to measure success solely on AHI being less than 5, I can see why they consider it a comfort feature. Like you, though, I don't consider good sleep (vs adequate sleep) a comfort but a necessity.

Thanks for posting this!
Ray
Diagnosed in 1997

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Slartybartfast
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Slartybartfast » Mon Apr 25, 2011 8:45 am

Ok, here's what I'm talking about. With and without EPR set to 3:

Image

So evidently the higher pressure opposing your exhalation without EPR can cause your AHI to be higher by causing an increase in hypopneas and "centrals."

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by DocWeezy » Mon Apr 25, 2011 9:03 am

I didn't discover this quite as scientifically as you, SB, but I discovered that my AHI and overall pressure was lower when I was at EPR3. It was a very noticeable difference between 0, 1, 2, and 3. I don't remember how wide the AHI variance was, but it was noticeably better at each higher level. Haven't messed with it since. I was surprised at the differences, so it does seem to be a bit more than "just" a comfort feature.

Weezy

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Lizistired » Mon Apr 25, 2011 9:39 am

Works just the opposite for me. My AHI dropped in half when I turned off EPR. We are all wired a little differently.

But why does your machine think it's December 2010?

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Slartybartfast » Mon Apr 25, 2011 3:33 pm

Oh, that was data I collected a while ago and never bothered to post to the forum. Since it was already there, I used it, Photobucket being as fast as a glacier in January.

Interesting. If your AHIs went down when you turned EPR off were you running in straight CPAP mode at the time?

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Otter » Tue Apr 26, 2011 2:36 pm

If you the call of your inner lab rat is strong, you might try turning EPR off and lowering your pressures. Because with EPR you'll be below "therapy pressure" for the bulk of each minute, you might get a similar AHI at a lower pressure with EPR off.

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Jay Aitchsee » Mon Sep 15, 2014 3:55 pm

Bump for PR

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by fdw » Tue Sep 16, 2014 3:15 pm

Interesting topic. Im trying to figure out the benefits of same.
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by palerider » Tue Sep 16, 2014 3:46 pm

fdw wrote:Interesting topic. Im trying to figure out the benefits of same.
well, since jay is trying to throw me to the wolves, I'll just offer something he pm'd me earlier today on the subject.

viewtopic.php?f=1&t=4514&p=38022&hilit= ... ave#p38022

and, do click through to the two links in sludge's post above.

in essence, epr lowers your baseline pressure, and makes your autoset into a vpap auto, though with limited range and configurability. so a pressure of 10, epr3 gives you a pressure of 7 with boosts to 10 when it detects you starting to inhale.

if your airway closes at 7, then there's no signal to the unit to boost pressure back up to 10, so you'll likely have more hypops and apneas, if you *need* 10 to keep your airway open, then turning up epr will probably result in more ah events.

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Last edited by palerider on Tue Sep 16, 2014 4:12 pm, edited 1 time in total.
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Jay Aitchsee
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Jay Aitchsee » Tue Sep 16, 2014 3:58 pm

palerider wrote:well, since jay is trying to throw me to the wolves, I'll just offer something he pm'd me earlier today on the subject.
I knew you couldn't resist
palerider wrote:
fdw wrote:Interesting topic. Im trying to figure out the benefits of same.

viewtopic.php?f=1&t=4514&p=38022&hilit=application+epr+deltadave#p38022

and, do click through to the two links in sludge's post above.

in essence, epr lowers your baseline pressure, and makes your autoset into a vpap auto, though with limited range and configurability. so a pressure of 10, epr3 gives you a pressure of 7 with boosts to 10 when it detects you starting to inhale.

if your airway closes at 7, then there's no signal to the unit to boost pressure back up to 10, so you'll likely have more hypops and apneas, if you *need* 10 to keep your airway open, then turning up epr will probably result in more ah events.
viewtopic/p886641/Complex-sleep-apnea-a ... ml#p886641
edit to add the link contained in the PM referenced above.

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Last edited by Jay Aitchsee on Wed Sep 17, 2014 8:30 am, edited 2 times in total.

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by palerider » Tue Sep 16, 2014 4:13 pm

Jay Aitchsee wrote:
palerider wrote:well, since jay is trying to throw me to the wolves, I'll just offer something he pm'd me earlier today on the subject.
I knew you couldn't resist
troublemaker!!! *mutters* where's my pitchfork *stab*

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Jay Aitchsee » Tue Sep 16, 2014 5:25 pm

It seems this post from 2005 is still relevant today. (My highlight)

viewtopic.php?f=1&t=4514&st=0&sk=t&sd=a ... =45#p45271
deltadave wrote:Hmmm, seems like the discussion on the ResMed EPR tailed off somewhat.

However, if anyone is still interested, I did create a few waveform analyses on how it works:

ResMed EPR

The overall point is, while this is a very comfortable adjunct, you could be changing your therapy utilizing it. And I'm not sure if anything short of PSG could say for sure if if it is addressing your events (particularly arousals).

However, certainly using this in the ramp mode only would have no issues that I could see.
deltadave

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by Wulfman... » Tue Sep 16, 2014 6:11 pm

palerider wrote:well, since jay is trying to throw me to the wolves,
Now, now........we'll have NONE of that kind of talk around here!!!


Den

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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset

Post by palerider » Tue Sep 16, 2014 6:53 pm

Wulfman... wrote:
palerider wrote:well, since jay is trying to throw me to the wolves,
Now, now........we'll have NONE of that kind of talk around here!!!
lions?

I know there's a few sweet folks here that would love to see me have a starring role in some sort of ritual sacrifice

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