EPR settings

ozij wrote:In humans, exhalation is the result of muscular relaxation, and not of muscular effort. Therefore, it's the difference between inhale pressure and exhale pressure that makes exhalation easier.

Right. The "relative difference" in two pressures (higher for breathing in, lower for breathing out) feels more comfortable and natural to me.

ozij wrote:And that's why as far as exhale relief is concerned, it does make sense to increase your pressure by your EPR.

Right. I want a pressure that absolutely keeps my airway OPEN during exhalation....so, when I'm ready to breathe in again, my airway is open enough to allow me to get a new breath started.

If the CPAP titration pressure from the sleep study is the pressure a person really NEEDS to keep the airway open during breathing out, and especially during the pause before breathing in starts again, dropping that prescribed pressure with EPR may let the airway collapse shut when it's time to breathe in again. If the airway collapses at the end of exhalation, the person cannot even begin to draw in a new breath in a timely manner. EPR will suspend (stop holding the pressure down) if a person doesn't start to breathe in again after so many seconds. But I don't really want any delay if I'm trying to inhale again.

So... when using EPR, I set the pressure higher by the same number of cms as my EPR setting. I do that simply to insure that my airway will be held open nicely to allow inhaling again when I'm ready to breathe in, while still getting the comfortable feeling of a relative difference in pressures for breathing in and out.

If I'd been prescribed "CPAP @ 10 cm H2O" and I intended to use EPR for pressure relief when breathing out, I'd raise my CPAP pressure accordingly, like this:

EPR off or during ramp only: I'd leave the CPAP pressure set at 10.

EPR full time "1" (for a 1 cm drop when exhaling): I'd set the CPAP pressure at 11 (so I'm still getting "10" while breathing out.)

EPR full time "2" (for a 2 cm drop when exhaling): I'd set the CPAP pressure at 12 (so I'm still getting "10" while breathing out.)

EPR full time "3" (for a 3 cm drop when exhaling): I'd set the CPAP pressure at 13. (so I'm still getting "10" while breathing out.)

Higher-than-needed-pressure being delivered for inhaling is probably not a problem for most people on CPAP. But "same" pressure (even a fairly low steady pressure) can be unnatural feeling or difficult for some people to exhale against.

I'm not a doctor or anything in the health care field. That's just the way I always raise my CPAP pressure when I use EPR...and why I do that. Works well for me.

archangle wrote:You tend to notice the pressure less and less as you get used to it.

Right. That's very common. It's not unusual for a pressure (single straight pressure) to feel like "a lot," or to feel like "work" breathing out against, when the CPAP machine is first started each night. Yet the person can wake up during the night (or in the morning) breathing easily and feeling like there's practically no pressure at all. Can even make the person wonder if the machine has stopped blowing at all! But, put your hand up near the exhaust vent, and you can feel the air still flowing just like when you started.

Rested Gal is right on this one from my own observations. If you need 7cm to keep your airway open and like a pressure change of 1,2 or 3 for comfort then you have to increase your base pressure otherwise the EPR drops your pressure lower than whats needed to keep your airway open.

Can someone explain how this is not accurate?

Cuda wrote:Rested Gal is right on this one from my own observations. If you need 7cm to keep your airway open and like a pressure change of 1,2 or 3 for comfort then you have to increase your base pressure otherwise the EPR drops your pressure lower than whats needed to keep your airway open.

Can someone explain how this is not accurate?

So I'm titrated at 7. Should I go 10 with EPR of 3? Or 7 with 0 EPR?

scottjf8 wrote:So I'm titrated at 7. Should I go 10 with EPR of 3? Or 7 with 0 EPR?

My opinion? I would go 7cm with no EPR from those two choices. I am running 2cms lower on base pressure after dropping EPR from 3 to 1 with fantastic results. I believe Rested Gal has the correct explanation for the results I am seeing.

I am curious as well.
When I got my machine my pressure was at the prescribed 12 CmH2O. The C=Flex or EPR was at 3. My inspiration pressure was the same as my prescribed pressure.
My machine is a Respironics and I know that the C-Clex is not a 1 for each 1 cmH20 but I think the basics are the same.
I was under the impression that the inspiration pressure was what really mattered, but now I am not sure.

pap4life wrote:Mark.. the EPR is a comfort setting, to assist you with your exhaling. . . . .The setting of (1) gives a small amount of exhale relief, maybe (depending on your equip) drops the constant pressure down about 1 -2cm (2) middle of the road, drops the pressure down 2-3 and (3) the most EPR relief, drops the pressure down maybe 3-4cm during your exhalation.

Mine goes from settings; 1, 2, 3, Patient. So what is the "Patient" setting? That is where mine is set at now and it was set before they (Apria) delivered it per my sleep doctors orders.

Roger

Roger2 wrote:

pap4life wrote:Mark.. the EPR is a comfort setting, to assist you with your exhaling. . . . .The setting of (1) gives a small amount of exhale relief, maybe (depending on your equip) drops the constant pressure down about 1 -2cm (2) middle of the road, drops the pressure down 2-3 and (3) the most EPR relief, drops the pressure down maybe 3-4cm during your exhalation.

Mine goes from settings; 1, 2, 3, Patient. So what is the "Patient" setting? That is where mine is set at now and it was set before they (Apria) delivered it per my sleep doctors orders.

Roger

"Patient" is so you can change it in "Settings". That's the double check mark button. Look in the settings and see what they set it at. Probably 2 or 3 to make it more comfortable for you getting started. I would try turning it off to see if you need it. Then if you do, go up from 0.
Notice the sudden drop in AHI in my avatar. That's Feb 7th, when I turned OFF the EPR. Something I would like to have known to try in December, January...

ronbien wrote:I am curious as well.
When I got my machine my pressure was at the prescribed 12 CmH2O. The C=Flex or EPR was at 3. My inspiration pressure was the same as my prescribed pressure.
My machine is a Respironics and I know that the C-Clex is not a 1 for each 1 cmH20 but I think the basics are the same.
I was under the impression that the inspiration pressure was what really mattered, but now I am not sure.

You're right about C-Flex not giving an exact number of cms for reducing pressure when exhaling. EPR (in ResMed machines) does give an exact number of cms for dropping pressure when EPR is turned on. C-Flex (at any setting) in Respironics (and Philips Respironics) machines works quite differently during exhaling.

There's no need at all to raise the prescribed CPAP pressure when using a Respironics (or Philips Respironics) machine with any kind of "flex" (C-Flex, A-Flex, or C-Flex+) turned on.

This linked post might help explain the difference in how ResMed's EPR works, compared to how Respironics (Philips Respironics)'s "C-Flex" (and A-Flex, since A-Flex uses "C-Flex" during breathing out:)
viewtopic.php?p=436054#p436054

So I turned mine totally off last night and slept just fine... in fact, I don't think I woke up once during the night.

Gonna check my stats soon in Resscan and I'll post.

Lizistired wrote:

"Patient" is so you can change it in "Settings". That's the double check mark button. Look in the settings and see what they set it at.

OK, since I am relatively new at this, I just checked again. This is a Resmed S9 Elite and is only three days old since Apria replaced the other due to problems with it. The new one does have some settings that I don't think were available on the old one but as I said, I am relatively new at this so maybe I just missed it on the replaced unit.

This how it reads as being set now;
Settings:

EPR Inhale ---> has 2 settings, Fast and Medium and was already on Medium
SMART START ----> has 2 settings, On and Patient and was already set on Patient
EPR ----> which has 3 settings, Off, Ramp Only and Full Time and was already set on Full Time
EPR Level ----> and has 4 settings, 1, 2, 3, and Patient and was already set at Patient

These settings were supposedly set per my sleep doctors instructions. Do these seem correct or should I be making some more inquires?

Roger

I have those on my one year old Autoset S9.

Whereever is says patient, that mean you can change the setting throught the patient's setup menu, you don't have to to go into the clinician's.

EPR inhale has an older mode (FAST) and a newer, smoother mode (MEDIUM). MEDIUM is the defautl on S9 machines.

Since you're using a full face mask, you should set smartstart to "OFF" those are ResMed's instructions - you can do that using the patient setup button.

Can't see any reason for making inquiries.

Check the patient settings to see what those functions are actually set to. The only thing you should need to go into the clinician's menu for would be to change your pressure.

Is 4cm the lowest working pressure with EPR enabled?

e.g If i have a base pressure of 5cm and EPR of 3 will the machine drop to 2cm on exhale?

My guess is it does because when i tried to use a pressure of 4 cm with EPR turned ON, i felt like i was not get enough air, I couldn't do it.

Now i am running at 4cm to 6cm with EPR OFF and 4cm seems OK. In fact the machine now runs at a flat 4cm for almost 50% of my sleep. And my numbers are better too so far.

RIP EPR

RIP EPR indeed.