If anyone can answer the following it would be greatly appreciated:
I have an elite s8 on which I just started using the epr setting. I was recently titrated at 12 cm which is what my machine is now set to. I set the epr to 2cm. When I check the results in the morning it says my pressure for the night was 11.4. Should I increase my pressure before I go to bed to try to hit that "12.0" # when I check my results? I've heard mention on this board that the results # is the 90% pressure????
Please help!!!!
Resmed S8 EPR
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DreamStalker
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Your titrated or prescribed CPAP pressure is constant for inhalation. EPR basically decreases the pressure by 2 cm from what ever CPAP pressure is set to for exhalation relief.
The Respironics machines give 90 percentile efficacy data whereas the ResMed machines provide 95 percentile data. The 95 percentile data reading means that 95 percent of all the data values for that period were at or below the 95 percentile value.
In other words, … for you, 5 percent of the values were above 11.4 and 95 percent of the pressure values sampled were at or below 11.4 --- Here is what happens: you spend about half of the time exhaling at 10 cm and the other half inhaling at 12 cm which averages to 11 cm. The machine is always slightly behind on the pressure relief so the data is skewed to a little above the average or 11.4 in your case.
The Respironics machines give 90 percentile efficacy data whereas the ResMed machines provide 95 percentile data. The 95 percentile data reading means that 95 percent of all the data values for that period were at or below the 95 percentile value.
In other words, … for you, 5 percent of the values were above 11.4 and 95 percent of the pressure values sampled were at or below 11.4 --- Here is what happens: you spend about half of the time exhaling at 10 cm and the other half inhaling at 12 cm which averages to 11 cm. The machine is always slightly behind on the pressure relief so the data is skewed to a little above the average or 11.4 in your case.
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Some thoughts on this.
The main point of the sleep study is to determine the cms setting that keeps your airway open most effectively during sleep. The number chosen is what is best for a full nights sleep so tends to be optimal.
Some professionals will say (mine does to me ) that in any bilevel environment (which is essentially what EPR is) the lower pressure (EPAP) should be the same as your titration. Applied to your titration this would mean setting cms to 14 and EPR to 2. So when you Inhale (IPAP) it is at 14 and when you exhale (EPAP) it drops to 12. That is not what I would want to put up with (why set our Inhale to more than is needed ?).
Speaking for myself, I have chosen to run my own machine with the titration cms set as IPAP or inhale pressure & whan I exhale (EPAP) I allow it to drop 3 cms. My titration is 13 cms (I set IPAP to this), thus my EPAP becomes 10. I get *excellent* AHI numbers with this set up.
Here is a suggested compromise for you to try.
Set your cms to 13 and your epr to 3 & see how it works !.
Or
Set leave your cms at 12 & EPR at 2 (but for me, 2 cms just isn't enough & I also find that on my Bilevel 4 cms seems too much).
Good luck with your setting up.
DSM
The main point of the sleep study is to determine the cms setting that keeps your airway open most effectively during sleep. The number chosen is what is best for a full nights sleep so tends to be optimal.
Some professionals will say (mine does to me ) that in any bilevel environment (which is essentially what EPR is) the lower pressure (EPAP) should be the same as your titration. Applied to your titration this would mean setting cms to 14 and EPR to 2. So when you Inhale (IPAP) it is at 14 and when you exhale (EPAP) it drops to 12. That is not what I would want to put up with (why set our Inhale to more than is needed ?).
Speaking for myself, I have chosen to run my own machine with the titration cms set as IPAP or inhale pressure & whan I exhale (EPAP) I allow it to drop 3 cms. My titration is 13 cms (I set IPAP to this), thus my EPAP becomes 10. I get *excellent* AHI numbers with this set up.
Here is a suggested compromise for you to try.
Set your cms to 13 and your epr to 3 & see how it works !.
Or
Set leave your cms at 12 & EPR at 2 (but for me, 2 cms just isn't enough & I also find that on my Bilevel 4 cms seems too much).
Good luck with your setting up.
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
that must be aussie logicdsm wrote:Some thoughts on this.
The main point of the sleep study is to determine the cms setting that keeps your airway open most effectively during sleep. The number chosen is what is best for a full nights sleep so tends to be optimal.
Some professionals will say (mine does to me ) that in any bilevel environment (which is essentially what EPR is) the lower pressure (EPAP) should be the same as your titration. Applied to your titration this would mean setting cms to 14 and EPR to 2. So when you Inhale (IPAP) it is at 14 and when you exhale (EPAP) it drops to 12. That is not what I would want to put up with (why set our Inhale to more than is needed ?).
Speaking for myself, I have chosen to run my own machine with the titration cms set as IPAP or inhale pressure & whan I exhale (EPAP) I allow it to drop 3 cms. My titration is 13 cms (I set IPAP to this), thus my EPAP becomes 10. I get *excellent* AHI numbers with this set up.
Here is a suggested compromise for you to try.
Set your cms to 13 and your epr to 3 & see how it works !.
Or
Set leave your cms at 12 & EPR at 2 (but for me, 2 cms just isn't enough & I also find that on my Bilevel 4 cms seems too much).
Good luck with your setting up.
DSM
cause it doesn't make any sense. If you are at 12cm pressure and you have to increase it to 14cm in order to make use 2cm relief pressure you are essentially getting zero (0cm) relief on exhale from the pressure where you were before.
Or are you saying that feature doesn't really work anyway?
I'm with Mary, if my titration pressure was 12cm, I'd set the cpap pressure to 12cm and EPR to 2 and hope like heck that it drops to 10cm on exhale or get a machine that did.
I tried a setting of 13 cm's last night w/ an EPR of 3. My #'s were worse than usual but for some reason I feel better than usual this morning????
I woke up about 45 min. before the alarm went off & so far feel great & that hasn't happened in quite some time (however it's still early).How I feel for the rest (rest - what an operative word) of today will determine my course of action tonight.
Thanks for all of your input so far & PLEASE add more if you any more thoughts on the subject. Having people to talk to about CPAP has been a blessing!
I woke up about 45 min. before the alarm went off & so far feel great & that hasn't happened in quite some time (however it's still early).How I feel for the rest (rest - what an operative word) of today will determine my course of action tonight.
Thanks for all of your input so far & PLEASE add more if you any more thoughts on the subject. Having people to talk to about CPAP has been a blessing!
That's no Aussie logic, Snoredog. It's a BiLevel efficacy caveat driven by airway biophysics. That caveat specifically has to do with the fact that in many patients, heavy apneas are incipient during the expiratory phase itself. This means some patients simply cannot get away with EPAP being anything less than what would have been their titrated CPAP pressure. But that caveat DSM mentioned is for traditional BiLevel, and not necessarily for Resmed's EPR.
DSM, Resmed's EPR algorithmically attempts to avoid this particular BiLevel caveat by suspending the lowering of EPAP pressures when/if they become problematic. That is why many patients who cannot get away with EPAP=CPAP minus 3 cm using traditional BiLevel can presumably get away with EPAP set at 3 cm under CPAP using Resmed's EPR algorithm. There is no such EPR safety technique algorithmically employed with traditional BiLevel. Bottom line: patients should feel comfortable using EPR in conjunction with their titrated CPAP pressures----unless their overnight data (residual AI/HI) or daytime symptoms indicate otherwise.
We very recently touched on this exact difference between traditional BiLevel and "event-handling" EPR in this thread:
viewtopic.php?t=15559&postdays=0&postorder=asc&start=0
DSM, Resmed's EPR algorithmically attempts to avoid this particular BiLevel caveat by suspending the lowering of EPAP pressures when/if they become problematic. That is why many patients who cannot get away with EPAP=CPAP minus 3 cm using traditional BiLevel can presumably get away with EPAP set at 3 cm under CPAP using Resmed's EPR algorithm. There is no such EPR safety technique algorithmically employed with traditional BiLevel. Bottom line: patients should feel comfortable using EPR in conjunction with their titrated CPAP pressures----unless their overnight data (residual AI/HI) or daytime symptoms indicate otherwise.
We very recently touched on this exact difference between traditional BiLevel and "event-handling" EPR in this thread:
viewtopic.php?t=15559&postdays=0&postorder=asc&start=0
Great explanation, DreamStalker! That slight skewing will occur more because of rise and fall times---yet negligibly because of phase lag itself. Additionally, when/if EPR decides to algorithmically suspend the lowering of EPAP pressures, then that too will skew the pressure average upwards. And it will skew the average pressure to varying degrees in that upwards direction on a patient-by-patient basis (depending on each patient's phase-distribution of sleep events).DreamStalker wrote: The machine is always slightly behind on the pressure relief so the data is skewed to a little above the average or 11.4 in your case.
Sorry, Archoliva. On this message board we've got all levels of discussion occurring in various threads. Most newcomers just ignore the ones they find unsuitable. DSM is an engineer by profession and Dreamstalker is a scientist.Archoliva wrote:Huh? Can someone please translate that into English?!?!?!
My above post translated: EPR should be a-okay to run at your titrated CPAP pressure. Again, I apologize about some of the topics that seem either too technical or too esoteric. However, there are some people who come to these message boards looking for just those kinds of discussions pertaining to their therapy.
Good luck with your therapy and welcome to the message board! .
SWS,
Many thanks for that link - a very well explained and easy to follow set of points. Both your and RG's posts have clarified that the EPR gap gets reduced if the machine perceives problems during the EPAP breathing phase.
(#2 Explanation: When in EPR mode, the machine is set to a standard cms (say titration cms of 12), and then an EPR level is chosen. The EPR levels can be 1 cms below, 2 cms below or 3 cms below the 12 cms that was set as the standard pressure). So when breathing in (IPAP) the pressure is 12, on EPR 3, when breathing out (EPAP) the pressure drops to 9, for EPR=2 the epap would be 10, etc: ).
I just got my hands on a VPAP III ST and a Bipap Auto last night (they had been with a friend for several weeks after I purchased them)
The VPAP III ST does have the equal best set of adjustments I have seen for a BiLevel (But IMHO the PB330 still rates as the best for tuning the various rise & fall times & bpm rates etc: etc: ).
Naturally I had the Bipap AUTO apart in minutes & was surprised to see it is nearly identical in all aspects (incl motherboard), to a Bipap Pro 2. Seems the major difference is software control ?. A Bipap S/T (grey model) has a quite different motherboard and different controls and a different LCD display.
The point about the VPAP III ST adjustments, is of course to put into perspective the point you make about how with EPR there are few adjustments as these aspects are controlled in the machine software.
I do find the need to adjust rise times plus ipap/epep ratios & really like those machines that allow doing this by varying the time in ms rather than 1-3 or 1-5 settings.
Apart from the not being able to adjust risetimes issue with EPR, I am impressed with what they set out to achieve.
I am looking forward to trying the Bipap Auto - conceptually that machine is a great innovation and by using an air-valve to do the pressure regulation, it solves one very annoying aspect that the VPAP IIIs have - fan speed fluctuation. The Bipaps all run their fan at a constant speed and that is so much easier to get used to than the changing of the fan speed in the VPAP IIIs, although, my PB330 doesn't seem to exhibit that VPAP III characteristic. In the PB330, there is a change in noise between ipap & epap but it seems to be air noise rather than motor hum or whine. I now want to find out if Resmed have solved this issue in the Vpap Adapt (am cynical enough to say I will believe it when I hear it but from what I have gathered from other people's comments re the Vpap Adapt, the new dual impeller blower isindeed very quiet)
DSM
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, auto
Many thanks for that link - a very well explained and easy to follow set of points. Both your and RG's posts have clarified that the EPR gap gets reduced if the machine perceives problems during the EPAP breathing phase.
(#2 Explanation: When in EPR mode, the machine is set to a standard cms (say titration cms of 12), and then an EPR level is chosen. The EPR levels can be 1 cms below, 2 cms below or 3 cms below the 12 cms that was set as the standard pressure). So when breathing in (IPAP) the pressure is 12, on EPR 3, when breathing out (EPAP) the pressure drops to 9, for EPR=2 the epap would be 10, etc: ).
I just got my hands on a VPAP III ST and a Bipap Auto last night (they had been with a friend for several weeks after I purchased them)
The VPAP III ST does have the equal best set of adjustments I have seen for a BiLevel (But IMHO the PB330 still rates as the best for tuning the various rise & fall times & bpm rates etc: etc: ).
Naturally I had the Bipap AUTO apart in minutes & was surprised to see it is nearly identical in all aspects (incl motherboard), to a Bipap Pro 2. Seems the major difference is software control ?. A Bipap S/T (grey model) has a quite different motherboard and different controls and a different LCD display.
The point about the VPAP III ST adjustments, is of course to put into perspective the point you make about how with EPR there are few adjustments as these aspects are controlled in the machine software.
I do find the need to adjust rise times plus ipap/epep ratios & really like those machines that allow doing this by varying the time in ms rather than 1-3 or 1-5 settings.
Apart from the not being able to adjust risetimes issue with EPR, I am impressed with what they set out to achieve.
I am looking forward to trying the Bipap Auto - conceptually that machine is a great innovation and by using an air-valve to do the pressure regulation, it solves one very annoying aspect that the VPAP IIIs have - fan speed fluctuation. The Bipaps all run their fan at a constant speed and that is so much easier to get used to than the changing of the fan speed in the VPAP IIIs, although, my PB330 doesn't seem to exhibit that VPAP III characteristic. In the PB330, there is a change in noise between ipap & epap but it seems to be air noise rather than motor hum or whine. I now want to find out if Resmed have solved this issue in the Vpap Adapt (am cynical enough to say I will believe it when I hear it but from what I have gathered from other people's comments re the Vpap Adapt, the new dual impeller blower isindeed very quiet)
DSM
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, auto
Last edited by dsm on Tue Dec 12, 2006 6:53 pm, edited 2 times in total.
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
[quote="Snoredog"]
that must be aussie logic
cause it doesn't make any sense. If you are at 12cm pressure and you have to increase it to 14cm in order to make use 2cm relief pressure you are essentially getting zero (0cm) relief on exhale from the pressure where you were before.
Or are you saying that feature doesn't really work anyway?
I'm with Mary, if my titration pressure was 12cm, I'd set the cpap pressure to 12cm and EPR to 2 and hope like heck that it drops to 10cm on exhale or get a machine that did.
that must be aussie logic
cause it doesn't make any sense. If you are at 12cm pressure and you have to increase it to 14cm in order to make use 2cm relief pressure you are essentially getting zero (0cm) relief on exhale from the pressure where you were before.
Or are you saying that feature doesn't really work anyway?
I'm with Mary, if my titration pressure was 12cm, I'd set the cpap pressure to 12cm and EPR to 2 and hope like heck that it drops to 10cm on exhale or get a machine that did.
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)