Is EPR best avoided?

[Goofproof]

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 started 12 yeats ago, 2 months after a quad by-pass, with a pressure of 15 cm, c-flex 3, NO RAMP, with 2 L of O2. Sure it was painful, took 3 weeks to normalize. O2 levels 90 to 92. Stopped O2 add in 6 months later, O2 levels still 90 to 92 same.

9 years in I set the C-Flex to 1, in a effort to build up lung strength (more effort) it may have helped now my O2 levels reach 95 and drop to 92 at rest, I use 3L of O2 bleed into my CPAP, no HH installed, took it off year 10! Still using my CPAP! Jim

[Pugsy]

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

I give up.

People see what they want to see no matter what is in front of them.
Sometimes Mark did us no favors including information like this that hasn't been thoroughly vetted and there's no way to vet it with Respironics equipment since Encore has elected to not show 2 different pressures. It's not worth worrying about but I will still correct people when they say that the setting of 3 will give them 3 cm reduction because it can't. Then they can believe whatever they want to believe...I don't care. Respironics manual documentation takes precedence over Mark's Beta software calculations that haven't been vetted.

[jtravel]

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

I give up.

People see what they want to see no matter what is in front of them.
Sometimes Mark did us no favors including information like this that hasn't been thoroughly vetted and there's no way to vet it with Respironics equipment since Encore has elected to not show 2 different pressures. It's not worth worrying about but I will still correct people when they say that the setting of 3 will give them 3 cm reduction because it can't. Then they can believe whatever they want to believe...I don't care. Respironics manual documentation takes precedence over Mark's Beta software calculations that haven't been vetted.

Wow, Sorry to upset you like this, not my intention at all. I have always appreciated your help and dedication.
to be fair I never said a Aflex setting of 2 gives you 3 cm reduction.
I just stated that my data showed more than 2 cm and I wanted to understand why.
I want to learn and data plus documentation as well as expert opinion all combine to make that possible.
the sum total of the Respironics manual documentation and graph you posted about Aflex sure seems to indicate that at the beginning of exhalation it can in fact drop more than 2 Cm and it's only at the end of Exhalation that the max of 2 Cm limit comes into play.
That is what i read in the Documentation and have correlated with sleepyhead data.
You obviously disagree and that is fine,peace

[Pugsy]

This would explain why my sleepy head data shows more than 2 cm difference.

No. More likely SleepyHead is wrong in what it is showing.

the sum total of the Respironics manual documentation and graph you posted about Aflex sure seems to indicate that at the beginning of exhalation it can in fact drop more than 2 Cm and it's only at the end of Exhalation that the max of 2 Cm limit comes into play.

No where on the graph does it mention cm...the numbers are all related to the level of Flex chosen. There's no mention of cm on the graph...only the explanation item #3 that I circled mentions cm and it says "by reaching the end of exhalation no more than 2 cm below the high point of inhalation." I don't see cm noted anywhere on that graph. Are you thinking that the wave thing with 1,2 and 3 is cm drop...it isn't..that's just showing the Flex relief setting.

That means a the end of exhalation it can't be more than 2 cm below the high point of inhalation. 2 cm max reduction..pretty plain and simple.

That is what i read in the Documentation and have correlated with sleepyhead data.
You obviously disagree and that is fine,peace

You are assuming what you see reported in SH is what is happening. Ever think maybe SleepyHead might not have it right? This particular little tidbit of data is something Mark came up with and not verified by Respironics software because Respironics software doesn't report this data point at all. Maybe Mark didn't get the scale quite correct.

Believe what you want. Yes, I disagree and when you tell people they can get more than 2 cm reduction using Flex..I will come behind you and show the manual where it plainly says 2 cm max reduction.
The manual trumps SH.

[jtravel]

Believe what you want. Yes, I disagree and when you tell people they can get more than 2 cm reduction using Flex..I will come behind you and show the manual where it plainly says 2 cm max reduction.
The manual trumps SH.

I actually i believe only what the manual shows.
The Manual says that at the END of Exhalation the max relief if 2 Cm. That is the steady state pressure at the end of the Exhalation cycle.
What The manual also says is at the beginning of Exhalation significant pressure relief is provided.
The Graph shows Therapy Pressure on one axis and time on the other. It shows the Line that starts with the Therapy Pressure and then has a note that states "Exhalation starts and pressure level decreases"
You are wrong when you say it does not show pressure drop.
The graph clearly shows that at the beginning of Exhalation the Pressure relief drop is greater based on number selected than the relief pressure at the end of Exhalation.
This is how Aflex works based on PR documentation that you provided.
All I'm saying is You can get more than 2 cm of pressure relief but only at the beginning of Exhalation and then it ramps up to the 2 CM max at the end of exhalation.
It's not a fixed amount of pressure like Remed machines provide.
PR instead smooths the transition from the end of Exhale to the end of inhale.
We will just have to agree to disagree and move on.

[palerider]

All I'm saying is ....

all I'm saying is you're a nutjob and talking out your ass... 'course, that's what you've always done.

[prodigyplace]

All I'm saying is ....

all I'm saying is you're a nutjob and talking out your ass... 'course, that's what you've always done.

Don't sugar coat it, they'll them what you really think.

[Hannibal 2]

Geez! ....Just went off to sleep for a few hours, come back and all hell has broken loose!

So, last few nights I've maintained a minimum pressure of 9cm with EPR of 3. AHI went 4.9, 3.7, 2.7, 6.0 and 2.1. I couldn't say I felt much different on any of the following days, I have felt better and I have felt worse. Maybe 2 IS the magic number for me, or it's other variables at play, sleep hygiene etc.

Had another wasted journey to the hospital yesterday, re mask review, long story short he measured me for an AirFit F20 and gave me a medium, I double checked it when I got home and I clearly need a large! I think he didn't have a large so just palmed me off with the wrong size! Shocking!

[Jay Aitchsee]

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 would, as a matter of fact, but I don't have a bi-level machine.

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?

It's a little more complex than that, depending on the nature, type, and cause of the Sleep Disordered Breathing and type of machine one has. Generally speaking, EPR lowers the average pressure applied during therapy and, again generally speaking and in my opinion, the lower the pressure that needs to be applied to maintain effectiveness, the better. That is not to say that using EPR will always be more effective than not, but in some cases it might. Again, there are many factors involved.

[Guest]

At low pressures EPR may not be needed. At high pressures it can be the diff between being able to exhale or not - if you can't exhale you aren't blowing off your CO and will feel like you aren't getting enuff air = like you are suffocating. If your cpap doesn't allow for enuff EPR for you to breath then you need a diff cpap to have successful cpap therapy.

[palerider]

Bob, I think you're way off base,

My thinking

"thinking"? is that what he calls it?

what would be the appropriate word to connote "swirling cesspit of ignorance and stupidity?'

[Lucyhere]

Bob, I think you're way off base,

My thinking

"thinking"? is that what he calls it?


what would be the appropriate word to connote "swirling cesspit of ignorance and stupidity?'

Oh yeah... the swirling cesspool of nasty, Paleface, is at it again. Anyone notice this kind of utter nasty in about every third thread? Oh darn... he won't even see this... I'm on his foe list.

[DreamStalker]

Bob, I think you're way off base,

My thinking

"thinking"? is that what he calls it?


what would be the appropriate word to connote "swirling cesspit of ignorance and stupidity?'

Oh yeah... the swirling cesspool of nasty, Paleface, is at it again. Anyone notice this kind of utter nasty in about every third thread? Oh darn... he won't even see this... I'm on his foe list.

Yeah ... but I did and that's all that matters.

[Uncle_Bob]

It's a little more complex than that, depending on the nature, type, and cause of the Sleep Disordered Breathing and type of machine one has. Generally speaking

I was just referring to my own situation (words such as "I" and "my" etc) basic obstructive sleep apnea with prescribed CPAP.

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

I would, as a matter of fact, but I don't have a bi-level machine.

To me that does not matter because a BiPAP is not the same as EPR. EPR is a limited bi level function, so you would not be comparing apples with apples. EPR uses a slower pressure change (more chance for an obstruction to occur ) whereas a BiPAP is a ventilatory device providing a faster response to expand and contract lung volume.

EPR also turns itself off during an apnea (which you possibly allowed to happen by turning ON EPR in the first place), in doing so its reacting to an apnea rather than preventing it. Not good.

[Pugsy]

To me that does not matter because a BiPAP is not the same as EPR. EPR is a limited bi level function, so you would not be comparing apples with apples. EPR uses a slower pressure change (more chance for an obstruction to occur ) whereas a BiPAP is a ventilatory device providing a faster response to expand and contract lung volume.

Really now?
Okay, here's a little test for you.
Spot EPR here...EPR is 3 and PS from a bilevel device is set at 3. Using your rationale find the EPR flow rate.
And BTW not all bilevel devices work like ventilators. In fact most do not.