Can EPR cause apneas?

[ChrisC]

I've been noticing a disturbing amount of apneas on my charts, and a lot of them are clustered together. I'll post a graphic when I get home, but I've had clusters of 10-13 second apneas literally on top of each other for a few minutes. My AHI is usually around 10-13, but has gone as high as 20+ some nights. In these clusters, the HI readings are a blue line instead of individual dots (that's how many I'm having)

Today, I'm absolutely dog tired. I have a headache and feel like I want to crawl under a rock and die. I started EXTREMELY strong at the end of Mar, but now I'm having a lot of challenges with my nasal pillows shifting/coming out during the night and these terrible AI/HI numbers.

Now, when I first started, I had EPR off and never noticed these AI 'clusters'. The only thing I've changed was to turn on my EPR. I now wonder if, with an EPR of 3, the machine isn't recovering quickly enough when I inhale to bring my pressure back up to 10 from 7. Is this a possibility?

[Wulfman]

Yes.
(For whatever reason, the server wasn't letting me post my complete response to your question)


Den

[Slinky]

More likely it is the nasal pillows shifting/coming out during the night causing the terrible AI/HI numbers. What are your reported Leak rates?

ResScan reports hypopneas in their own chart and the more you have the longer they last the higher the graph lines will go.

It is conceivable but less likely that having your EPR reducing your pressure too much on expiration could be causing the high HI. Try reducing EPR to 2 or 1 or even turning it off. Many of us find EPR or C-/A-Flex make it easier to acclimate to xPAP therapy but once we get acclimated to it we don't need it at all or need it at a lesser reduction of pressure than when we first started.

[Froro]

Chris. When I was playing with the noise on my other machine I turned the epr off one night (hated it) but did notice a difference in my numbers. It was originally at 2, I've got it set at 1 now and I'm okay with that and my numbers are better as well. (other than Friday night, I had a cluster like you described but the entire day and night was completely bizarre on the "things that happen in life" side of things so I'm just monitoring for a repeat to see it was extraneous factors...aka stress)

M

[dsm]

I've been noticing a disturbing amount of apneas on my charts, and a lot of them are clustered together. I'll post a graphic when I get home, but I've had clusters of 10-13 second apneas literally on top of each other for a few minutes. My AHI is usually around 10-13, but has gone as high as 20+ some nights. In these clusters, the HI readings are a blue line instead of individual dots (that's how many I'm having)

Today, I'm absolutely dog tired. I have a headache and feel like I want to crawl under a rock and die. I started EXTREMELY strong at the end of Mar, but now I'm having a lot of challenges with my nasal pillows shifting/coming out during the night and these terrible AI/HI numbers.

Now, when I first started, I had EPR off and never noticed these AI 'clusters'. The only thing I've changed was to turn on my EPR. I now wonder if, with an EPR of 3, the machine isn't recovering quickly enough when I inhale to bring my pressure back up to 10 from 7. Is this a possibility?

On a hunch, I would guess you will notice a biiig difference if running EPR (at the pressures you mention) if you change your base pressure from 10 to 11 or 11.4 and run EPR at 2 (then later try 3).

It may well be that EPR is the trigger but because the lower pressure is really just too low for you. This is just a hunch on my part but I am expecting you to say it improves if you try it.

ALSO, you mention your mask giving trouble. Mask problems are possibly the biggest cause of messed up therapy so focus on that problem too.

Good luck

DSM

[bap40]

Using the C-flex on my machine does make a difference in the number of apneas I have. They do increase.. some members suggest that setting the machine up as many numbers as the relief number. So if using it on a setting of 1, then increase pressure up 1. I got used to not using it pretty fast and don't use it at all now. As for the nasal pillows slipping and sliding... when mine do that I know that is a sign that I need new ones. My DME did mention to me that my insurance would pay for a new one every month. At the time I just filed the info away but have since found that it they do seem to start giving me problems at about the 1 month time frame. So maybe that could be a problem for others as well. The pillows don't look old or worn but .......... I use the Swift LT for her.
Just a couple of ideas for you.

Good luck,
Brooke

[JoyD.]

Chris,
Your problem may have to do with your pillows (or mask itself). I use three masks: the Swift LT(for her), the ComfortLite 2, and the Aeiomed Headrest (modified). Of the three, I get the highest AHI with the Swift LT. It is the only one of the three that has part of the headgear on the cheeks that can move when you toss & turn. At some point you might want to try a different mask . . . like the two others I use or the Breeze. The sides of the face are entirely clear. All have nasal pillows.

As Brooke pointed out pillows could just be old, but another thing to consider before you change masks is to be sure you are using the best size pillows for you - IMO it is better to have them a bit large than a bit small. I was using the small Swift pillow and thought for sure it was my size. Then Kenny (tattooyu) mentioned that he ended up with better results going to a larger pillow size. So, I tried that and it worked! I went from a Small to a Medium . . . and I definitely got fewer leaks and the AHI's (now 3 - 4 AHI) improved even though the AHI isn't as low as my other two masks. NOTE: I have to use Lansinoh Lanolin with the Swift LT nasal pillows, however, and need to be sure the straps aren't too tight . . . tightening the back strap first (but not too tight), then adjusting the top strap so it's "just a bit" loose).

Hope this helps.

Joy

[tattooyu]

Absolutely EPR can make a difference. A while back, I lowered my EPR from 3 to 2, and my numbers got a lot better. Last night was a little crazy. My AI was 0.9 (I had 7 apneas), and it's usually 0.1-0.3. I am in a bad digestive cycle (IBS), so I attribute it to that. I can feel the difference today a bit.

Anyway, I agree with JoyD. that a little too big is better than too small. I started with small but forced myself to get used to the medium, which fits fine and is no longer uncomfortable.

Also, worn out pillows (at least for the Swift LT) can definitely cause problems for me. I'm due to get a new set soon, and I can tell they are starting to need it. I wish they were a little stiffer.

[ChrisC]

Thanks for the suggestions, guys. Just wanted to update!

Turning OFF the EPR has made *ALL* the difference in the world for me. I actually had a 0.0 AI the other night!! I noticed an IMMEDIATE drop in my AHI after turning the EPR feature off. I went from having AHI between 10-20 to a AHI between 3 and 5 (with the vast majority still being those HI numbers). My AI numbers have never looked better!!!

[DreamStalker]

Thanks for the suggestions, guys. Just wanted to update!

Turning OFF the EPR has made *ALL* the difference in the world for me. I actually had a 0.0 AI the other night!! I noticed an IMMEDIATE drop in my AHI after turning the EPR feature off. I went from having AHI between 10-20 to a AHI between 3 and 5 (with the vast majority still being those HI numbers). My AI numbers have never looked better!!!

You can still get great results with EPR if you set the machine up right ... but your body does get use to the unusual experience of breathing against pressure (w/o EPR) after a few days.

So ...

If you like the natural breathing experience provided by EPR option, you need to increase your pressure settings by 1 or 2 cm to compensate ... otherwise turn it off and get used to breathing against pressure.

[ChrisC]

Oh, I'm completely fine with breathing with the EPR off. My pressure is only 10cm.. I think if I was contending with 15+, it'd be a much more necessary feature.

[DebbieDeb]

It certainly does for me. While I haven't been checking numbers, etc. I know the Autoset S8 didn't seem as effective as my S7. Because I couldn't get in the clinical menu at first, I didn't even know about the EPR setting. All I knew was I felt like the machine wasn't helping. That was compounded by the fact the original starting pressure was set at 4 even though I told her my pressure was 15. After months of struggling with the machine, I saw another rep who confirmed the pressure was too low. I also said I didn't think it worked as well as my old machine. He said he'd heard a lot of people say that too but he had no suggestions. I tried to use it for a few more weeks at the higher pressure but on the nights I didn't fall asleep quickly, I could tell my throat was closing at the end of each breath. I gave up and have been using my S7 99% of the time. But it's 9 years old and I'm worried it'll finally give out so I'm back to trying the S8. Even with EPR off, the easy breathe technology is still is a problem for me. If I hold my breath after exhaling, the machine does nothing. It may finally kick in at some point (longer than I'm comfortable holding my breath) but that means I'll have apneas after each exhale!! Considering the way I felt the other morning, that's likely what happened. I believe the S8 is discontinued so I may be able to get another machine. Does the S9 have the easy breathe technology? If so, I think I'll have to look into another brand. It just seems illogical to keep the pressure low until I inhale. If I could inhale on my own, would I need CPAP?