EPR setting

[trytryagain]

When I started in September my EPR was set at 2, but I switched it to 3. Is there any theraputic reason to turn it back to 2 now that I am getting used to the machine?

[Janknitz]

If it ain't broke, don't fix it!

If you are getting good numbers and feeling well, you can leave it just as it is. The manufacturers and sleep physicians claim that the EPR has no negative effect on AHI and if you are comfortable with it there's no need to change it.

Some people on this forum who have tried everything else when they are having problems find that turning the EPR down or off helps, but it doesn't seem to be necessary in most cases.

[dtsm]

I actually did the reverse; started at 3 and reduced to 1. My understanding is EPR is a 'personal' comfort feature, to help exhalation. Keep in mind if you adjust EPR up or down, your cpap pressure needs to be adjusted by the same incremental setting.

[Breathe Jimbo]

dtsm, as I understand it, a change to EPR (ResMed machines) does NOT require any change to the pressure setting. The EPR is a temporary reduction in pressure at the moment the user begins to exhale. It operates only at the transition from inhalation to exhalation. It has no effect on the pressure during inhalation, and no effect for most of the time that one exhales.

[cwied]

It has no effect on the pressure during inhalation, and no effect for most of the time that one exhales.

Are you sure about this? To me, it definitely feels like it's lowering the pressure for the whole time that I exhale, and then increasing it on the inhale. I actually changed my EPR speed to fast because I felt like it was ramping the pressure up too late on the inhale.

[Breathe Jimbo]

Look at the graphs provided with the explanation of the Easy Breathe with EPR technology. The relief applies only at the beginning of an exhalation, not during the entire exhalation. The latter would be BIPAP.

[sleepymama]

not a dr here but i heard that sometimes if your EPR is too high (so say 3) you could be missing some events cause the machine is taking too much time to adjust the pressure to the pressure you need to stop the events. mine was at 3 and i turned it to 2. my next step would be a 1. not sure i would totally go to no EPR.

[cwied]

Look at the graphs provided with the explanation of the Easy Breathe with EPR technology. The relief applies only at the beginning of an exhalation, not during the entire exhalation. The latter would be BIPAP.

When I look at the graphs it looks to me like the pressure is low until you start to inhale. In fact the example that shows the difference between "fast" and "medium" inhale I think illustrates this pretty well.

As I understand it, Bi-PAP is defined to be at least 4cm pressure difference. I always assumed this is why EPR only goes to 3 cm.

I'm using an EPR of 1 because I find a higher setting makes me feel like the machine is forcing my breathing. My pressure is only 7cm, though, so I imagine if you have a higher pressure the higher EPR settings won't feel as overpowering.

I'm a little uncertain whether therapy pressure should be adjusted for EPR since I've seen a reference that with Bi-PAP the lower pressure is the one that should be set at the fixed CPAP titration value. This seems to be different than what is commonly assumed, so I don't know if it's reliable. If it is accurate, that would imply to me that you would do the same with EPR.

Edit: This is the fact sheet I'm looking at https://88559364175b176f8341-7518c0400f ... 0Sheet.pdf

[chunkyfrog]

It feels to me like EPR runs all the time I'm exhaling--if not, I'd be surprised.

[Breathe Jimbo]

I could be wrong. I sent an email to ResMed in the hope of getting a definitive explanation whether the pressure reduction is transitional only, or during the entire exhalation. I'll let y'all know what ResMed says.

[jmelby]

The answer is "maybe"... I found that with any EPR setting, my AHI was way higher than without (even when adjusting my lower-end pressure setting by a corresponding amount as dtsm suggests). It depends on the individual on whether their breathing pattern is prone to this. My RT said they don't enable EPR at all for patients unless they are having discomfort exhaling. So, I have left the setting off after some experimenting with it early on, and have never felt the need to use it.

[cwied]

So, I have left the setting off after some experimenting with it early on, and have never felt the need to use it.

I agree with you in general. The one thing I'll say is that the breathing assist that EPR gives me did help when I was congested following a cold last week. I turned up the EPR to 3 on the day after I stopped using the OTC nasal spray, and it definitely helped me breathe through the night. During my titration I had a 0 AHI even at 4cm, so I didn't adjust my pressure.

[dtsm]

dtsm, as I understand it, a change to EPR (ResMed machines) does NOT require any change to the pressure setting. The EPR is a temporary reduction in pressure at the moment the user begins to exhale. It operates only at the transition from inhalation to exhalation. It has no effect on the pressure during inhalation, and no effect for most of the time that one exhales.

This was something I learned from our Mother Superior [aka rested gal]. She went into a very detailed explanation for me in a private email back when I first started cpap.

All I can say is from personal experience, it made sense and was true in my case. I was able to validate by using apap rather than straight cpap. My 95th percentile pressure did change [drop} when I reduced my EPR.