EPR making results worse?

[SoccerMan]

A quick overview since I see these questions asked a lot:

1) I'm a CPAP user for just about 1 month
2) My average data for the last 2 weeks (I don't have a card reader yet so I can't give specifics) is:
Pressure: 11.0
Leaks: .15 (0 for my swift LT which I wear most of the time, .22 for my Quatro)
AHI: 2.9
AI: .2
HI 2.8
3) Being tired has not been a problem for me so I don't know if I'm "feeling better"; I got diagnosed because my wife was dealing with my loud snoring and scared due to my "gasping" in the middle of the night.

When I had my last sleep study and I was hooked up to a ResMed mahine, they had EPR turn on though I'm not sure of the setting (I think 2, but I'm not sure why I think that). After receiving a ResMed Escape II (I've since switch to an Elite II... thanks everyone!) I lowered the EPR to 1 to see what it did. It didn't bother me so I left well enough alone until last night

Last night I set the EPR to 3 and went to bed. Two hours later I woke up with anxiety (which has happened 3 or 4 time in my life before CPAP) and I assume that was due to an apnea event. I checked my settings and my AI was .4 (the highest it's been in two weeks, though I realize that only 2 hours may have skewed the result). Figuring the EPR may be at fault, I turned it off and when back to sleep for 5 more hours. The result in the morning was an AI of .1.

It makes sense to me that lowering the pressure by 3 could cause worse results. But then again, I would assume that the Sleep Clinic or my Dr. would have suggested a higher pressure to compensate. I do realize this is a much too small sample of data, but I'm still curious what you all may have found with more extensive testing. Which leads to the following questions:

1) Have you found worse results with EPR and if so did you adjust your maximum pressure?
2) Since I'm comfortable without EPR, would you see any reason to turn it back on?
3) Assuming that EPR is off, do you think it's worth experimenting with a lower pressure (say -1) ?

Thanks for your feedback and advise!

SoccerMan

[ozij]

1) Have you found worse results with EPR and if so did you adjust your maximum pressure?

Yes, I have found my results worse with EPR=3.
No I don't adjust my maximum pressure, since that maximum is good enough for my inhalation (even too much at times), and the EPR, when there is too much of it, causes problems at the end of exhalation. So for me, adding pressure did not help, but actually limiting the auto's maximum pressure and giving myself less Exhale Pressure Relief did make things better. (I realize you use an fixed pressure machine, and I do not recommend changing your pressure. For me the auto goes too high, and I have to limit it).

2) Since I'm comfortable without EPR, would you see any reason to turn it back on?

None at all.

3) Assuming that EPR is off, do you think it's worth experimenting with a lower pressure (say -1) ?

I couldn't say -- my experimentation went from EPR 3 to 2 to 1 -- and it's at 1 presently.

[terrydk]

Years ago before EPR I had a CPAP that was very difficult to exhale against, I found that I was getting less sleep with the machine and stopped using it. When I got my present xpap machine I started out with an EPR setting of 2 with my max pressure set at 15, low pressure was set at 10. That seemed to work pretty good even though I am still adjusting to the entire therapy process. My last visit with the sleep doctor resulted in the max pressure being boosted up to 17 as I was continually bumping up to the 15 max. The very first night during Settling with the pressure set up to 17 and low set at 12 I could definitely feel the pressure difference on start up. So I set the EPR at 3 to help out the 12/17 settings. When I wake up in the night I can tell that the EPR is working very well as it feels like very little exhale resistance. I would have to say for me anyway that EPR is the only way to go.

[billbolton]

I do realize this is a much too small sample of data

Given the overall nightly variability of normal sleep, its not really any sort of data sample.

EPR only impacts exhale pressure and flow resistrictions/apneas rarely occur on exhalation. So generally, EPR should not cause any particular problems.

However, EPR is there only as an option...... if you don't need it, don't use it just because it is there.

Cheers,

Bill

[carbonman]

However, EPR is there only as an option...... don't use it just because it is there.
Cheers,
Bill

...but..but...I must use it...... because it is there.....

and..and....I must change it because I can....change it....

and...and...the pressure....I must change it..... because I can....

I use EPR....there for, I am.
I can change the pressure....there for,
I am free.

These are my God given, inalienable rights.....
guaranteed by the constitution.

Just like gravity, it's not just for fun, it's the law.

I will not be denied.

[KatieW]

Here is a post by Rested Gal (resident expert) on setting pressure, using EPR on Resmed:

viewtopic.php?p=310021#p310021

Hope it's helpful.

[terrydk]

Here is a post by Rested Gal (resident expert) on setting pressure, using EPR on Resmed:

viewtopic.php?p=310021#p310021

Hope it's helpful.

Rested Gal is making a very good point in that message that I hadn't thought of when it comes to EPR settings. Now that my sleep doctor bumped my max pressure up a bit to 17 from 15 I am going to try lowering my EPR from 3 to 2 and see if that lowers my HI's as they have been consistently higher than the AI's. If I can tolerate that I might even try it on the 1 setting.

[rosacer]

Hi Soccerman

Only to tell you when I get my machine the technician didn't want to activate the EPR. She told me they where told by the Resmed representative to don't activate it at least the patient really can't live without it. She said Resmed told them the EPR affects the treatment, she didn't elaborate in the subject.

I know your pressure is pretty high (I'm at 7 and I find that high ), but a person at the forum told me the people who need high pressure what they do is they take a couple of deep breaths and they keep them a bit before exhale, she told in this way they get adjusted to pressure without using the ramp or EPR. Maybe you can give it a try, maybe somebody out there can corroborate my saying.

[Maryland_Mike]

I actually get improved numbers with EPR on, and at 3. I have mostly central hypopneas. I suspect that the the sudden jump in pressure at the beginning of a breath helps me to follow through with a fuller breath.

[jmelby]

My sleep tech also told me that they don't set patients up to use EPR unless they report problems exhaling... and that it can affect the effectiveness of the treatment for some people. Exhalation pressure has never been a problem for me, so I don't use it.

[SoccerMan]

I have a short update for anyone this might help.

Since turning off EPR, this is my data:

AHI: 2.7
AI: 0.0
HI 2.7


I was never able to achieve AI of 0 with EPR on at 1 (though the average was quite good at .2 as I mentioned in my original post). Looks like no EPR for me is a good thing.

-SoccerMan

[terrydk]

I have a short update for anyone this might help.

Since turning off EPR, this is my data:

AHI: 2.7
AI: 0.0
HI 2.7


I was never able to achieve AI of 0 with EPR on at 1 (though the average was quite good at .2 as I mentioned in my original post). Looks like no EPR for me is a good thing.

-SoccerMan

After my sleep doctor raised my pressure from 15 to 17 and reading some posts here I lowered my EPR from 3 to 2 and last night had the best results so far. AHI = 3.8, HI = 3.4 and AI = .4. Now we will see if that trend continues. Pretty good change I believe considering I had an AHI of 126 during my sleep study in late November.

[terrydk]

[/quote]

After my sleep doctor raised my pressure from 15 to 17 and reading some posts here I lowered my EPR from 3 to 2 and last night had the best results so far. AHI = 3.8, HI = 3.4 and AI = .4. Now we will see if that trend continues. Pretty good change I believe considering I had an AHI of 126 during my sleep study in late November.[/quote]

Well after changing my EPR from 3 to 2 along with a new Forma mask I am getting some pretty good numbers...last night's AI was .1 and that apnea happened right at the end of my settling time, my HI was 5.8 for an AHI of 5.9. So now I need to consider lowering that settling time and see if I can get a 0.0 I assume that since my low setting is at 12 and my high is at 17 I had that single apnea because the pressure won't go above the low setting of 12 during 'settling'...is that correct?

[rested gal]

EPR only impacts exhale pressure and flow resistrictions/apneas rarely occur on exhalation.

I agree that apneas probably rarely occur during exhalation. However, I believe there's a pause (no matter how short) that is going to occur each time, AFTER exhalation has finished and BEFORE an attempt to breathe in begins.

I can sit here right now, wide awake, relaxing my throat as completely as possible during being awake, and can feel the back of throat close completely during the pause before I start to breathe in again. If that can happen to me during deliberate "awake" relaxation, I can only imagine how much more easily it could happen during the fuller relaxation of sleep.

So generally, EPR should not cause any particular problems.

I'm an anecdote of one. I have no idea how many other people could experience the same thing (if throat becomes extremely relaxed) during the pause in the respiratory cycle. I suspect EPR generally could cause a problem for quite a few people -- the problem being sub-therapeutic pressure allowing enough collapse of the airway during the pause that they were not able to get the next inhalation started when ready to start breathing in again.

Fortunately EPR has a safety measure built in to suspend EPR operation and resume the prescribed pressure after so many seconds of no flow detected from the person.

However, EPR is there only as an option...... if you don't need it, don't use it just because it is there.

Right.