Is EPR best avoided?

[palerider]

From Respironics....

Interesting that it does not agree with the actual data I see on sleepyhead with my 60 series Apap.
makes me wonder if I can really trust any of the pressure data reported by the machine in sleepyhead?

Resmed machines report *actual high rate measured pressure with calculated offsets* to represent what is present at the mask.

your machine DOES NOT DO THIS.

there is a low res extra pressure line that was recently discovered in the data, and that is *experimentally* shown on the latest version of sleepyhead.

given that this data IS NOT SHOWN on encore, there is no way to know how accurate it is.

do you understand?

[tan]

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Your opinion of which you are certainly entitled to share and have but it isn't my opinion.
Those of you who have this sort of opinion and compare anything related to "comfort" as being silly or childish and once we "grow up" we will have bigger balls and not need such childish things really make my ass want to dip snuff.
What the hell is wrong with wanting to be comfortable? Why are people who want to be comfortable looked down upon...because your balls are bigger and you are all grown up and we aren't?
Your therapy is "better" than mine because I happen to like a little comfort?

You are associating my use of the word "maturity" with adulthood or manhood. Not my intent. I was referring to when a period may end, in this case with regards to learning to adjust to xPAP therapy, that is all. You can go through years of posts here from many people who recommend working towards not using EPR & ramp based on experience, I'm not exactly sure exactly why you chose to single out me for your reaction. But i have my suspicions.

Oh...what pressure do you use? If I remember right it's a really low pressure

Yes its low (7cm) so I wasn't prescribed a BiPAP or any other machine.

pffft, maturity... you are just a baby, my exhale is 8, inhale is 13

[Uncle_Bob]

You old timers

I'm not an old timer, I never claimed to be, I'm simply attempting to pass on a bit of advice (no graphs required) based on my own experience on this wonderful forum. Old timers or training wheels, whatever, you take what you need and leave what you don't right?

I say more power to you but don't talk down to me

I didn't talk down to you.

I do have a confesssion to make, I had surgery last month and found the EPR to be of great comfort

[Jay Aitchsee]

EPR is a comfort feature. Not all xPAP machines even have it. I've would personally question my doctor if he wrote out an Rx with an EPR setting unless he could specifically explain to me why I needed one following a titration study. People here on the forums will will be telling you what to do with your standard pressure setting(s) if you use EPR until they are blue in the face.

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Good luck
~UB

Bob, I think you're way off base, here. I have 9 years of therapy maturity and I have concluded that an EPR of 3 yields the most effective therapy for me! On the other hand, I don't believe it would for everyone.

[Arlene1963]

I've experimented with turning EPR off and on.

At first, I had no problem with EPR off, but a few months later I began to notice that I was having difficulty, and would sleep half the night without CPAP just to take a "break". My respiratory rate was a bit faster with EPR off, and maybe this was the reason.

....so I turned EPR back on again and it made a BIG difference.

I'm now a convert to EPR. Quite simply, I need EPR to use CPAP, even at a fairly low pressure, its just the way I'm built and the way I breathe.

[LSAT]

EPR is a comfort feature. Not all xPAP machines even have it. I've would personally question my doctor if he wrote out an Rx with an EPR setting unless he could specifically explain to me why I needed one following a titration study. People here on the forums will will be telling you what to do with your standard pressure setting(s) if you use EPR until they are blue in the face.

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Good luck
~UB

Bob, I think you're way off base, here. I have 9 years of therapy maturity and I have concluded that an EPR of 3 yields the most effective therapy for me! On the other hand, I don't believe it would for everyone.

I agree!!..I have used EPR 2 with my therapy for 4 years. That yields the best therapy for me. I discontinued the use of ramp the second week of therapy 8+ years ago.

[Attila]

In this, as in most things in life what works for one person will not work for another. I too have found the EPR makes a big difference in my comfort level and how I sleep. As a new CPAP user I've found that one of the best pieces of advice I was ever given was to focus on how I slept and how I felt in the morning instead of the pure numbers. The numbers are only a tool to get you to feeling the best you can with this machine. Ultimately that is the goal. Thanks to everyone supporting us in that goal. No matter what our settings are.

[Hannibal 2]

In this, as in most things in life what works for one person will not work for another. I too have found the EPR makes a big difference in my comfort level and how I sleep. As a new CPAP user I've found that one of the best pieces of advice I was ever given was to focus on how I slept and how I felt in the morning instead of the pure numbers. The numbers are only a tool to get you to feeling the best you can with this machine. Ultimately that is the goal. Thanks to everyone supporting us in that goal. No matter what our settings are.

Agreed, this is the point that Pugsy keeps trying to get people to take on board, don't get obsessed with chasing numbers, if you're feeling good with an AHI of 5 be content with that.

[palerider]

if you're feeling good with an AHI of 5 be content with that.

I'd agree, except I'd say "2".

of course, not everybody is the same, but I feel about the same if my AHI is under around 2, and worse if it's higher.

[Pugsy]

Agreed, this is the point that Pugsy keeps trying to get people to take on board, don't get obsessed with chasing numbers, if you're feeling good with an AHI of 5 be content with that.

Yeah...to a point but I can tell you that if I was consistently getting AHI of 5 I would most likely chase the numbers just a little. I would at least investigate whether getting it lower made any difference in how I felt so that I could make an educated decision on how to proceed.
For some people getting the AHI lower causes more problems than the AHI might cause...and if they are feeling good and sleeping well...maybe 5 is the best they can do and that's okay.
Now maybe they are like PR and can noticeably feel a difference between less than 2.0 and over 2.0 AHI...then by all means work towards feeling better and if that means killing OAs with more pressure then killing OAs is what we do.

What I really want people to do is look at the whole picture and not just a tiny corner of the picture which is a number.
Numbers don't mean squat without feeling the results and they don't always guarantee good results even when extremely low.
Learn your own body and how it feels and how it responds...not base your therapy on what someone else does or feels.
You need to figure out what works best for you and the numbers be damned...no matter if it is AHI or EPR or leak or what.

I could get a really low AHI all the time...simply use 18 cm pressure in cpap mode...pretty much would kill all the obstructive stuff but using 18 all the time sure isn't high on my want list and I long ago discovered that for me that low AHI doesn't mean anything more than a low number.
Now if I felt like super woman every day with AHI below 1.0...sure I would go for that but I don't. I am still a grouch old bitch in the mornings. I used to think that cpap would make me into a morning person....it didn't...but then I realized that I have never ever been a morning person and why I expected cpap to turn a pig's ear into a silk purse I don't know what I was thinking.

Use the numbers as a guide along with how you feel and how you sleep and what makes you happy. Make educated choices as to how you want to proceed and what you are happy with in terms of your own therapy.
Numbers have their place in the grand scheme of things but numbers alone don't really mean much except we get to break our arms patting ourselves on the back.

[HoseCrusher]

I use ramp and EPR and find sleeping very comfortable...

[Uncle_Bob]

if you're feeling good with an AHI of 5 be content with that.

I'd agree, except I'd say "2".

of course, not everybody is the same, but I feel about the same if my AHI is under around 2, and worse if it's higher.

5 - Good
2 - better
0 - best

its your choice.

Said no one on this forum "I feel crap at 0 and I want to go back to 5"

[Uncle_Bob]

EPR is a comfort feature. Not all xPAP machines even have it. I've would personally question my doctor if he wrote out an Rx with an EPR setting unless he could specifically explain to me why I needed one following a titration study. People here on the forums will will be telling you what to do with your standard pressure setting(s) if you use EPR until they are blue in the face.

Getting off ramp and EPR is a sign of xPAP therapy maturity without having to juggle around with your pressure

Good luck
~UB

Bob, I think you're way off base, here. I have 9 years of therapy maturity and I have concluded that an EPR of 3 yields the most effective therapy for me! On the other hand, I don't believe it would for everyone.

Good for you. I wonder if you are itching to try an EPR of 4, 5 or 6?

I don't think I'm off base, what I've suggested works well for many people and that was the general gist of conversation here on this forum on this topic when I started out. I understand everyone is different.

My thinking was that I was prescribed Constant Positive Airway Pressure to keep my airway open (note NOT BiPAP). So why take away pressure on the exhale and increase the potential for my throat to collapse?

[jtravel]

I suspect it will Max out at 3 when you Hit a max Ipap of 20 but I have never gone that high in my actual treatment pressure to say for sure.

Not according to what Respironics says. Please note the comments I have circled. "No more than 2 cm below the high point of the inspiration". That means the most reduction a person can get is 2 cm and that of course is flow based. Not everyone will get that at the setting of 3.

From Respironics....

Ok, I think I understand this now.
The information and diagram you posted states at the Beginning of exhalation significant pressure relief is provided. Based on the diagram it shows that the pressure drops lower than the 2 cm and then rebounds back up to the 2 CM difference from inhalation pressure at the end of exhalation.
This would explain why my sleepy head data shows more than 2 cm difference.
If the Diagram is correct then selecting 1-3 all result in 2 cm lower at the end of Exhalation.
The difference in the settings is the initial pressure drop at the beginning of Exhalation.

[palerider]

This would explain why my sleepy head data shows more than 2 cm difference.
If the Diagram is correct then selecting 1-3 all result in 2 cm lower at the end of Exhalation.
The difference in the settings is the initial pressure drop at the beginning of Exhalation.

this one's thick as a brick. :shaking head: