Should I change my minimum pressure and turn on EPR?

I just started using an Airsense 10 Autoset last week and have a couple of questions about the pressure.

The sleep doc prescribed a range of 4-12 and stated that the ramp should be turned on. I haven't downloaded Sleepyhead yet and haven't looked at the data, so this question is just based on how I feel. When I look at the machine's Sleep Report each morning it reports a pressure of somewhere in the range of 10-12.

When I start the machine at night and the pressure is at 4 I feel like I can't breathe due to lack of air. I've shut off the ramp feature, which makes the pressure start to rise a lot sooner, but it is still very uncomfortable until it gets to be around 6 or higher.

Also, in the middle of the night, probably when I'm in deep sleep, I often wake up to find that the pressure is at the maximum of 12 and when it's that high I feel like I can't breathe, not because I'm not getting enough air, but because it's difficult to exhale against that pressure.

I think I need to set the minimum pressure at 6 and turn on the EPR. Does that sound like the correct thing to do? Is it okay for me to do that, or do I have to get the doctor's permission first? I purchased the machine and supplies from cpap.com and am not working with a DME.

The pressure issues are not intolerable, but I would like to optimize the therapy. I have a follow-up with the sleep doc in March, so if I shouldn't mess around with the pressure I'll just wait until then.

As always, thanks very much for your help.

Your story is the same as many of us. I quickly got rid of the ramp on my machine, and now start pressure at 8.5 cmH2O. Like you, I need higher pressures for some stubborn events, and the machine tends to hang around 9 most of the night, ranging up near the max setting of 13.

Obviously, if you're suffocating for air, you can't start at 4, and the machine will be more responsive if you narrow the operating range in Auto. Make it comfortable, and that should be your priority.

yes, go ahead and adjust. I find that 8cm is a fairly comfortable pressure for most people............after awhile I can't even notice 8cm, it seems to be a very neutral pressure, not so low that you feel suffocated, and not so high that you get blown away. I notice that you are using the Airsense machine, so you might try the "Auto Ramp" feature, it works like a regular ramp, but it is supposed to not begin to ramp up until the AirSense senses that you are asleep from the air flow variations.

Using 4cm (the lowest pressure setting on most cpaps) is not the best way to go, most people feel that it is so low they can't get their breath.........if you notice your pressure is mostly around that 10 to 12 range then you definitely want to raise your minimum up closer to your regular operating range. It makes the APAP more capable of responding quickly to impending Apneas or Hypopneas because it doesn't have so far to go to get to an optimal pressure. So you might try 6 or maybe 8cm as a starting ramp pressure if you want to use the ramp and maybe try the Airsense auto ramp. Then have minimum treatment range set from 9 to 12 to tighten up the range a bit. Doesn't hurt with those pressures to experiment a little to find your own personal sweet spot......you want to make things comfortable so you stick with your cpap therapy, that's the important thing.

Also doesn't hurt to experiment with your EPR settings.............first try level one relief, see how that goes........then try two and three to see which one suits you best.

I came from old straight cpap machines, so I did not really get along that well with EPR.............I ended up settling with EPR on 1.......but since you are new to the game you might find two or three more comfortable for you...........the EPR thing is really all about comfort on the cpap, so find your best setting.

As you get more comfortable with everything go ahead and download the SleepyHead software so you can really get a good idea of how your treatment is working out.........lots of experienced peeps on here like Pugsy and others that can help you optimize your settings for best results if they have data to work with from Sleepyhead.

You don't need your doctor's permission. He works for you. Your reasoning is sound and if he's uncomfortable with that then it's time to find another doctor.

After you've raised your minimum pressure and had a few nights to see how it goes, take a look at your sleepyhead data to see if the upper limit needs adjusting. Right now it may just be "chasing" your apnea a because the minimum pressure is too low.

Personally I think it's totally Nutz for a DME or a Doctor to send someone home with a APAP with the starting pressure set at 4cm............just my personal opinion.

I know there might be a medical necessity for someone out there to have such a low starting pressure.........like maybe a frail 90 year old lady, but gee whiz it's so low that most people feel like they are suffocating. I think a DME that sets it up that way is basically incompetent............my personal rant - LOL

TangledHose wrote:Personally I think it's totally Nutz for a DME or a Doctor to send someone home with a APAP with the starting pressure set at 4cm............just my personal opinion.

I know there might be a medical necessity for someone out there to have such a low starting pressure.........like maybe a frail 90 year old lady, but gee whiz it's so low that most people feel like they are suffocating. I think a DME that sets it up that way is basically incompetent............my personal rant - LOL

there are (a very few) people who are successfully treated at very low pressures, even 4. it's reasonable to give someone that for a night and see if they need more, but it's not reasonable (though it is common) to leave the machines set at default for extended periods of time.

What is epr?

Tango wrote:What is epr?

check your manual. also, the airsense doesn't have a separate humidifier.

Tango wrote:What is epr?

From ResMed:

What is EPR?
EPR™ (expiratory pressure relief) is an effective alternative to standard Continuous Positive Airway Pressure (CPAP) therapy. It offers a more natural breathing experience, enabling reliable and predictable therapy control while delivering a higher level of comfort. EPR is a special inclusion only available on some of our newer flow generators.

How does EPR work?
When you breathe out (exhale), the flow generator device (if EPR is integrated) detects the beginning of exhalation and reduces motor speed to drop treatment pressure. The patient or clinician can select one of three comfort levels:

Setting 1 = mild comfort (1 cm H20)
Setting 2 = medium comfort (2 cm H20)
Setting 3 = maximum comfort (3 cm H20)

palerider wrote:

TangledHose wrote:Personally I think it's totally Nutz for a DME or a Doctor to send someone home with a APAP with the starting pressure set at 4cm............just my personal opinion.

I know there might be a medical necessity for someone out there to have such a low starting pressure.........like maybe a frail 90 year old lady, but gee whiz it's so low that most people feel like they are suffocating. I think a DME that sets it up that way is basically incompetent............my personal rant - LOL

there are (a very few) people who are successfully treated at very low pressures, even 4. it's reasonable to give someone that for a night and see if they need more, but it's not reasonable (though it is common) to leave the machines set at default for extended periods of time.

A pressure range of 4-20 worked well for me last summer. After a few months passed, however, something changed and I was not satisfied with my therapy anymore.

With the airsense, is the epr already on and set at one? Or is this something I turn on? Also,
I've been having some issues with air getting in my stomach.
What could I change that might help air in my stomach?
And

Your idea of starting at 6 cm instead for 4 cm is a sound idea.
Also play with EPR settings and you can't really play with them much until your starting pressure is higher because it can't reduce below 4 cm (which is as low as the machine will go)...so set it at 3 and when the starting pressure is 6 it will reduce to 4 cm and you will get an idea what it feels like. It won't be able to do a full 3 cm reduction until the pressure hits 7 when you are most likely asleep.
You may or may not need to increase that maximum pressure. I have often seen where if the minimum is more optimal that the maximum simply doesn't get reached as often. So wait until you get the software install and up and running and see what it is showing before changing maximum.
Either way EPR should make whatever higher pressures you end up with a lot easier to handle.

If you aren't comfortable changing things on your own...don't but there's no reason that you shouldn't get comfortable with doing so.
EPR is considered a comfort feature and thus considered something within a patient's realm to alter per comfort similarly to the humidity levels or air temp.
Pressure...I look at it this way...6 cm is just different starting point and they already have it set to got from 4 to 12...so I don't see the big deal if starting at 6 and going to 12 (if it wants to go there). It's a tiny change but some docs get all upset if we change things...often I think it is more because we figured out we can change it more than the change itself. The God Complex and all that hogwash.

Minky,
Your story sounds exactly like mine, here is what I did, (My settings are 9 - 15) first thing in did was change the EPR setting mine was on auto 2 so I went to auto 3 which really improved the exhale for me, then I tried to change my start pressure to 9 right at my minimum but I did not like that so I went back to the default 4-20 auto setting but change my Ramp time to 5 minutes instead of auto.(today I think I could shut the ramp off but it's not bothering me so I leave on 5 mins.) Now that worked really good for me for about a week and a half, then I was having trouble on exhale once again...the mask I was using was a Resmed N10 nasal mask ( I liked the mask but was always fiddling with it to keep from leaking ) My DME thought my mask wasn't venting properly so she had me try an F&P Eson nasal mask and WOW what a difference for me , No mess , low leaks (I think they all leak a little) and wonderful AHI , I couldn't be happier, Not saying that is your troubles but you said exactly the same troubles I had so I wanted to share my experience.
I've taken this new therapy real well, just wish I would have started years ago.
Good Luck and sweet dreams!

Tango wrote:With the airsense, is the epr already on and set at one? Or is this something I turn on? Also,
I've been having some issues with air getting in my stomach.
What could I change that might help air in my stomach?
And

Tango,

I believe the default is EPR off, it is possible your DME may have turned it on.....do you see anything in your options/ settings menu that says EPR? If you don't see a setting for it your machine may have been set up so the patient does not have access to that setting. If that is the case you can access the EPR setting in the clinician's menu. If you don't have access to the clinician's menu send me a Private Message and I can get a copy of the Clinician's manual to you, or you can request a copy over at apneaboard.com

As far as air in the stomach or "Aerophagia" it's a somewhat common occurrence with CPAP/APAP pressure. I don't want to tell you to lower your pressure because you Probably need it where it is for proper therapy.....you might try doing a search on the forum for Aerophagia....that subject has been covered extensively and you might find some answers in previous posts, or maybe someone else may chip in here with suggestions for that issue.

Thanks again to everyone for all of your help!!!

I'm going to change the minimum pressure to 6 and try the EPR at 1 tonight.

If the doctor yells at me I'll just play dumb. I'm very good at looking dumb ...