Do I need to turn off EPR and go CPAP?

Longtime user and feel like I have my therapy pretty much dialed in. AHI's are typically less than 1.0 and leak rates are very low. I read an article mentioned by Lanky Lefty which suggests that EPR is less beneficial for APAP machines (unless titrated with EPR turned on). The article can be read here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773618/

I did a one night experiment where I switched from APAP mode (pressure=16 to 18, EPR=3) to CPAP mode (pressure=16.8 and EPR=off). I am posting links to three SleepHQ reports (first two are APAP and last one is CPAP). Links are fixed.

https://sleephq.com/public/ef73248e-a06 ... c647fb420b
https://sleephq.com/public/540864be-44b ... c734a45c19
https://sleephq.com/public/188ded26-df9 ... c214db3663

To my untrained eyes, there were no benefits to switching to CPAP and turning off EPR. In fact, the situation appears worse given the higher AHI and greater flow limitations. Perhaps I should have selected a higher CPAP pressure? I used 16.8 median pressure with APAP on 3/28.

Should I stick with my APAP settings or give the CPAP settings more nights to see how I respond?

Sleep HQ isn't giving me access to your charts, but given what you've said about them, I see absolutely no reason for you to stick with the changes you've tried out. Your AHI and FLs are worse with these changes, so go back to what was working better for you.

Side note: Often when people turn EPR ON it's a good idea to raise the minimum pressure by a corresponding amount, since their exhale pressure will be dropping lower due to the EPR. But when you turn EPR OFF, there's no reason to raise your minimum, as you did in your experiment.

The study is meaningless for people who have good help with their settings, in my opinion. It compares a fixed pressure with EPR and the SAME pressure without EPR. As I mentioned in the side note above, often it's a good idea to raise the minimum pressure by the same amount as the EPR. This is a very simple step to take -- one that makes the study completely irrelevant for people who know to take it.

MyIdaho wrote: ↑

Thu Apr 04, 2024 2:50 pm

Should I stick with my APAP settings or give the CPAP settings more nights to see how I respond?

stick with apap, in my opinion. just because something works for many people doesn't necessarily mean it will work for you.

i've spent many years on this forum. I've read all kinds of things that people have tried and have recommended. some have worked and i'm grateful for it. but many have not. we are each individuals. we are going react to CPAP or apap or bilevel in our own way.

just my humble opinion.

Hey Zonker! Always appreciate your wisdom! I seem to be trying to fix something that ain't broke! I haven't played with my settings for a very long time so fell for the temptation, newer approach has got to be better! As you well stated, not necessarily so, we are unique individuals! Best!

Miss Emerita wrote

Sorry infrequent poster. Had typed a reply but I don't see it. Weird. Retyping a shorter reply.

Thank you for your informative reply! I had not completely understood the article... oops!

Sorry about the links, corrected ones are shown below that should provide access:
https://sleephq.com/public/7dd7dd94-64f ... dade6d78e9
https://sleephq.com/public/a92e0979-c5e ... a29ac3d75c
https://sleephq.com/public/2ac1a817-dc2 ... f8e3fa9f62

I did set the cpap pressure above the minimum to hedge my bet, figuring the data would show that I could reduce pressure. I was totally surprised to see a significantly higher AHI and higher flow limitations in cpap mode. Based on vandownbytheriver's comments, I will leave apap and EPR settings as is! Zonker would approve, don't mess with success!

At higher pressures EPR (or PS) is needed to blow off CO2... that's why bi-level was invented, that's why bi-level machines go higher. Those clusters of H's look suspicious... verging on CA's? When you turned off EPR and went straight CPAP at almost 17cm you effectively increased your iPap by 3cm.

If you're going to run high pressures by all means use EPR... the proof is in the graphs and events.

MyIdaho wrote: ↑

Thu Apr 04, 2024 8:37 pm

Hey Zonker! Always appreciate your wisdom! I seem to be trying to fix something that ain't broke! I haven't played with my settings for a very long time so fell for the temptation, newer approach has got to be better! As you well stated, not necessarily so, we are unique individuals! Best!

wisdom? me?!?! must have me confused with someone else.

vandownbytheriver wrote: ↑

Thu Apr 04, 2024 9:27 pm

At higher pressures EPR (or PS) is needed to blow off CO2... that's why bi-level was invented, that's why bi-level machines go higher. Those clusters of H's look suspicious... verging on CA's? When you turned off EPR and went straight CPAP at almost 17cm you effectively increased your iPap by 3cm.

If you're going to run high pressures by all means use EPR... the proof is in the graphs and events.

Interesting, thank you for the explanation vandownbytheriver! I did not have any CA's during my sleep study (AHI was 67/hour, yikes!) nor has the Resmed algorithm recorded CA's in the Sleepyhead, Oscar, and SleepHQ reports. But as you said, verging on CA's... Okay, so you're saying I should reduce the cpap pressure to 15 cm if I turn off EPR? Apap pressure did increase to 18 cm multiple times each night. Would be an interesting test!

As an aside, I was never titrated... A tech tracked my sleep data during one night. Sleep Dr read the report and told my family doctor to set cpap pressure at 15 cm but did not comment on EPR. I have always had EPR set at 3. Pugsy saw my report (years ago) and suggested that I increase pressure to reduce flow limitations. I gradually increased to 18 cm on cpap or 16 to 18 cm in apap mode. The sleep Dr was right after adjusting for EPR!

Best, thanks my friend!

That's awesome your AHI is so low, sounds like you've got your therapy dialed in well. Interesting about the EPR article, thanks for sharing the link [link removed]!

Looking at your SleepHQ reports (thanks for fixing the links!), it's tough to say definitively without your doctor's input. While the AHI is slightly higher on CPAP, it's still very low overall. The flow limitations could be due to a number of factors, so a CPAP pressure adjustment might be worth exploring.

Here's what I'd suggest:

Discuss the article and your experiment with your sleep doctor. They can give you the best advice based on your specific needs.

If they're open to trying CPAP further, they might recommend a titration study with EPR off to find the optimal pressure.

If sticking with APAP, it might be worth keeping an eye on leaks or mask fit issues that could explain the higher flow limitations you saw with CPAP.

Hope this helps!

SonopaalFounik wrote: ↑

Thu Apr 04, 2024 10:16 pm

Discuss the article and your experiment with your sleep doctor. They can give you the best advice based on your specific needs.

and yet you've come in here before, wanting to get a CPAP machine without a prescription.

what you are saying here is the exact opposite of the spirit of this forum, which you'd realize if you were to spend some time reading posts here. here, we are trying to go our own way in our sleep apnea journeys, with the help and support of folks who pretty much know more than the average sleep doctor.

you might want to consider just what it is you're doing here.

what you are saying here is the exact opposite of the spirit of this forum

Gosh, that seemed harsh!

I personally am still very much in the early experimental phase of dealing with my sleep apnea, and making good progress (at least in my understanding) thanks to folks on here and similar forums. Are you telling me I am no longer allowed to discuss my progress with my sleep doctor (if I had one)?

MyIdaho wrote: ↑

Thu Apr 04, 2024 10:01 pm

vandownbytheriver wrote: ↑

Thu Apr 04, 2024 9:27 pm

At higher pressures EPR (or PS) is needed to blow off CO2... that's why bi-level was invented, that's why bi-level machines go higher. Those clusters of H's look suspicious... verging on CA's? When you turned off EPR and went straight CPAP at almost 17cm you effectively increased your iPap by 3cm.

If you're going to run high pressures by all means use EPR... the proof is in the graphs and events.

Interesting, thank you for the explanation vandownbytheriver! I did not have any CA's during my sleep study (AHI was 67/hour, yikes!) nor has the Resmed algorithm recorded CA's in the Sleepyhead, Oscar, and SleepHQ reports. But as you said, verging on CA's... Okay, so you're saying I should reduce the cpap pressure to 15 cm if I turn off EPR? Apap pressure did increase to 18 cm multiple times each night. Would be an interesting test!

As an aside, I was never titrated... A tech tracked my sleep data during one night. Sleep Dr read the report and told my family doctor to set cpap pressure at 15 cm but did not comment on EPR. I have always had EPR set at 3. Pugsy saw my report (years ago) and suggested that I increase pressure to reduce flow limitations. I gradually increased to 18 cm on cpap or 16 to 18 cm in apap mode. The sleep Dr was right after adjusting for EPR!

Best, thanks my friend!

Glad to help. Once you get over 16cm you're verging on bi-level territory... consider a bi-level titration, just had one, sleeping much better at 17-21 PS4.

Best as I can tell, EPR is a matter of personal preference. I've been using CPAP since 1999. I find it very annoying, as if the machine was breathing for me. I know that's no literally happening, but is ure feels like it.

BigWing wrote: ↑

Fri Apr 05, 2024 7:59 am

what you are saying here is the exact opposite of the spirit of this forum

Gosh, that seemed harsh!

I personally am still very much in the early experimental phase of dealing with my sleep apnea, and making good progress (at least in my understanding) thanks to folks on here and similar forums. Are you telling me I am no longer allowed to discuss my progress with my sleep doctor (if I had one)?

You're free to discuss your sleep apnea journey with whomever you choose! No questions asked, obviously no demerits, and hope you find the information your looking for. I enjoy reading the stories of fellow sleep apnea travelers and occasionally discussing issues on this forum. My therapy is dialed in, I've gone from a AHI of 67 in my sleep study to less than 1.5 based on the resmed algorithm. Any changes could only result in a small improvement if any. I am careful with changes that I make and do monitor/evaluate results using Oscar or SleepHQ.

In my case, my family doctor is the go between the sleep doctor and me. I would not have set it up that way but I understand that our sleep doctor's schedule is very difficult to get on. I have classical obstructive sleep apnea that is easily corrected with a cpap machine. No real need to see the sleep specialist and would not be a good use of his time. IMO, his time is better spent helping those who are not dialed in... Family doctor is pleased with my success.

D.H. wrote: ↑

Fri Apr 05, 2024 9:18 am

Best as I can tell, EPR is a matter of personal preference. I've been using CPAP since 1999. I find it very annoying, as if the machine was breathing for me. I know that's no literally happening, but is ure feels like it.

I agree, definitely a personal preference. My DME suggested that I use EPR when starting therapy 10+ years ago. I didn't notice the EPR but sure noticed the low pressure (apap mode set 4 to 15). The low level was not enough (felt air starved) and 15 seemed too strong but I adapted quickly to the higher pressure. Was sleeping through the night almost immediately (after adjusting start pressure to 7). Based on my recent little experiment, I will stick with EPR and current apap range (16 to 18 cm).