Effect of EPR=3 vs. EPR=1 on S9 Autoset
- Slartybartfast
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Effect of EPR=3 vs. EPR=1 on S9 Autoset
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.
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.
Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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!
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!
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Ray
Diagnosed in 1997
Diagnosed in 1997
- Slartybartfast
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
Ok, here's what I'm talking about. With and without EPR set to 3:
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."
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."
Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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
Weezy
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- Lizistired
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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?
But why does your machine think it's December 2010?
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- Slartybartfast
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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?
Interesting. If your AHIs went down when you turned EPR off were you running in straight CPAP mode at the time?
Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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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- Jay Aitchsee
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
Bump for PR
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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
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.fdw wrote:Interesting topic. Im trying to figure out the benefits of same.
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.
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
I knew you couldn't resistpalerider 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.
viewtopic/p886641/Complex-sleep-apnea-a ... ml#p886641palerider 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.
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.
Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
troublemaker!!! *mutters* where's my pitchfork *stab*Jay Aitchsee wrote:I knew you couldn't resistpalerider 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.
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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
- Jay Aitchsee
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
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
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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- Wulfman...
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
Now, now........we'll have NONE of that kind of talk around here!!!palerider wrote:well, since jay is trying to throw me to the wolves,
Den
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Re: Effect of EPR=3 vs. EPR=1 on S9 Autoset
lions?Wulfman... wrote:Now, now........we'll have NONE of that kind of talk around here!!!palerider wrote:well, since jay is trying to throw me to the wolves,
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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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.