EPR off?

[Robinjh7]

I've only been on CPAP since 9/19 so please forgive me if I get these terms incorrect. I've looked in the 'our wisdom' section and searched but I can't find a straightforward answer to my question. I'd appreciate any help.

I have a ResMed S8Autoset II, and I also have a Mirage Swift II mask. The pressure the stap puts on my left cheek (sinus) is making me CRAZY. If I loosen it, it leaks. So I tried a Breeze something-or-other. HATED it. So I ordered a ComfortLite 2 from cpap.com since my provider didn't have any other options. Got it yesterday. I like how it feels. No pressure on my face anywhere, but when I used it last night, my legs started tingling and every time I breathed out, it felt like my ears needed to pop. LOTS of pressure. So I switched back to the Swift.

I looked at my settings when I was more awake today. The EPR is turned off. It's set on CPAP. Start at 4.0. My maximum is 6.0. (I know that's pretty low.) Why would the EPR be set to off? Is there a clinical reason for it? I can't change the settings. (And why is THAT? The clinician has disabled that.) Would turning the EPR on get rid of that pressure on exhalation? I can't use the mask this way. I take a million rx for allergies, and my sinuses are clear right now, no congestion, but I stuff up sometimes at night. (I use Nasonex spray every night too.)

Is there anything else I can try?

Robin

[dsm]

Robin,

IIRC EPR will only start to work effectively if your range of pressures allows it to. Slinky may recall this but I am certain EPR can only be activated when max pressure setting is something like 6 CMs or higher. (I am going from memory on this so may not be 100% accurate).

EPR allows pressure to drop on exhale - I use it on my traveling S8 Vantage. The settings 1 2 & 3 represent drops of 1 CMs, 2 CMs and 3 CMs on exhale. So IIRC, the pressure on an S8 must be above 6 before EPR can start to work. i.e. if your EPR setting is set to say 2 & the machine is at a setting of 5 CMs, then EPR can't activate as it would mean the pressure dropping to 3 CMs (5 - 2 = 3) which the machine can't support.

Your settings seem too low to allow EPR to work.

What setting is EPR set to ? if it is at 3 try setting it to 2.

Good luck

DSM

[gailandartie]

Why did your doctor prescribe such a wonderful APAP machine to be used as a straight CPAP?

[ozij]

Hi Robin,
When I started therapy my machine was set at 4-8, and I could really feel the pressure when it went to about 6 and upwards - I was actually scared of it.
However, you do get used to pressure, and 6 is not objectively high. So I suggest you give your CL2 a few more chances. Try it when you're awake too.

PADACHEEK - Karen is a member of this forum who makes pads for mask straps - I've never used them personally, but Swift users are very very happy with them. Her site is http://www.padacheek.com/ - and you can PM her as well.

The reason I've never used cheek pads is that after fighting nasasl masks in the beginning I started using nasal pillows masks. My firs was the Breeze. About 6 months into therapy I bought a Headrest, and then switched back and forth between them for about 2 years, till I deconstructed my Headrest.

I use a cervical tempurpedic pillow, so lying on my back with the Breeze was doable - but I'm a side sleeper..

I liked the Breeze (do you know how to set it up - there are many adjustment points on it). However, here are the reasons I now prefer the Headrest:

1. I couldn't do anything to keep the Breeze's shell from resting on my upper lip - the Headrest's nasal pillows part is softer and lighter
2. The H's vent directions is perfect -- straight up. I'm side sleeper, pull the cover towards my face, and the Breeze forced me to keep my arms/hands and blankets away from its flow - the H does not
3. With the deconstructed Headrest, I use pantyhose straps. I find them far less obtrusive on my head, and they don't leave an unnatural parting in the hair on top of my head (my hair is curly/wavy, and short).
4. I also find the pantyhose straps easier to "set". It's "pull and tie" and there's no problem in getting the tension right.
5. A deconstructed Headrest is much lighter than a Breeze.

Deconstructing the Headrest mean cutting away most of it headgear - one of Rested Gal's many brilliant mask tweaks.
O.

[GuyK]

I have an Auto Set II also -- the DME-R/T also set EPR to off, but I didn't realize that until after he left, so I couldn't ask him why.

In any case, I haven't had much of any problems adjusting (but it seems to be a long process) and things are going well. Last night, for the first time, I had leakage down to 0.36L/s and AHI was 0.9 (AI 0.0, HI 0.9). The only problem is that I wasn't sleeping overly well due to some other issues. But the breathing part was fine

I'm a newbie, so I'll just make this statement without really knowing: as far as I know, machine can be set for different masks (I think it is because different mask designs have different leak/venting rates). It could be that when you're using different masks, the machine doesn't know it, and is "compensating" for the mask in the wrong way.

Now a question from me -- I don't have EPR set, as stated above. But I've noticed that when I start at night, the pressure I feel during exhale is fairly strong. But when I wake in the middle of the night, everything seems very natural and free feeling. I find it very comfortable.

Does the Auto Set II make readings during the night and then make adjustments for exhalation, etc?

Thanks,
Guy

[dsm]

Guy,

What you are noticing is normal cpap reaction. Nothing to do with any special S8 action
Even EPR feels different at first but later you notice the classic bilevel 2-pressure response as if it is very natural.

I must admit I don't fully understand why pressure feels so different when hopping into bed as it does later if woken.
The noise of the machines is similar - sometimes noisy when 1st going to bed but in the middle of the night - very quiet.

DSM

[Robinjh7]

Why did your doctor prescribe such a wonderful APAP machine to be used as a straight CPAP?

Good question! It's one I'm going to be asking him when I see him first thing on Monday morning.

Last night, for the first time, I had leakage down to 0.36L/s and AHI was 0.9 (AI 0.0, HI 0.9). The only problem is that I wasn't sleeping overly well due to some other issues. But the breathing part was fine

I'm a newbie, so I'll just make this statement without really knowing: as far as I know, machine can be set for different masks (I think it is because different mask designs have different leak/venting rates). It could be that when you're using different masks, the machine doesn't know it, and is "compensating" for the mask in the wrong way.

I can't see my results! That must be another setting the clinician disabled. (Making list of things to ask the doc....)

I called the clinician to ask about the setting for the mask. Since it's a Respironics mask, and my (machine is a ResMed, it doesn't have a listing for the ComfortLite 2. He said to just use the "Mirage" or "Standard" setting. I was able to wear it for 6.75 hours last night. That's longer than I've been able to wear the Swift II. So I'm going to try it again tonight. I sure wish I could see the results without having to take the card to the provider's office and have them print it out.

PADACHEEK - Karen is a member of this forum who makes pads for mask straps - I've never used them personally, but Swift users are very very happy with them. Her site is http://www.padacheek.com/ - and you can PM her as well.

Thanks for the advice. I might try the Breeze again if I can't get the ComfortLite 2 to work. I didn't like the hardness of the headgear on the , but the biggest problem (besides leaking) was it pushed down on my teeth. My teeth hurt when I woke up in the morning. Maybe it just wasn't adjusted correctly.

I actually put some moleskin on the Swift II until I got some fleece cover thingys with my order from cpap.com. The moleskin helped a lot, and the fleece worked really well, but there is still the pressure pushing against my sinuses. I'm just crossing my fingers that the CL2 will work permanently.

Thanks, everyone!

Robin

[ozij]

Setting up the Breeze

Look especially at the detailed instructions give by WillSucceed.

Female heads are shaped different from male heads - the crown is higher. I used to put a folded tennis sock somwhere between the Breeze and my head. I could set up the Breeze not to hurt my teeth, but the shell always touched the area under my nose.

O.

[gasp]

I've only been on CPAP since 9/19 so please forgive me if I get these terms incorrect. I've looked in the 'our wisdom' section and searched but I can't find a straightforward answer to my question. I'd appreciate any help.

I have a ResMed S8Autoset II, and I also have a Mirage Swift II mask. The pressure the stap puts on my left cheek (sinus) is making me CRAZY. If I loosen it, it leaks. So I tried a Breeze something-or-other. HATED it. So I ordered a ComfortLite 2 from cpap.com since my provider didn't have any other options. Got it yesterday. I like how it feels. No pressure on my face anywhere, but when I used it last night, my legs started tingling and every time I breathed out, it felt like my ears needed to pop. LOTS of pressure. So I switched back to the Swift.

I looked at my settings when I was more awake today. The EPR is turned off. It's set on CPAP. Start at 4.0. My maximum is 6.0. (I know that's pretty low.) Why would the EPR be set to off? Is there a clinical reason for it? I can't change the settings. (And why is THAT? The clinician has disabled that.) Would turning the EPR on get rid of that pressure on exhalation? I can't use the mask this way. I take a million rx for allergies, and my sinuses are clear right now, no congestion, but I stuff up sometimes at night. (I use Nasonex spray every night too.)

Is there anything else I can try?

Robin

Welcome : ) Did you use nasal pillows with your new CL2? Are you using nasal pillows that are large enough to ensure you get enough air and and out? I found it incredibly hard to exhale out of nasal pillows that were too small.

Read through this if you consider changing your pressure settings. our-collective-cpap-wisdom/changing-CPA ... ssure.html

Here is some good advice from an older post by Slinky:

I would STRONGLY suggest that before you go thru that Clinician's Menu you get a long piece of paper and a pencil and you write down EACH menu option BEFORE you push the next button. This will allow you to KNOW exactly how your doctor ORDERED your therapy to be set up.

You, or any other new CPAP user, would do well to get some time on your CPAP under your belt before you jump in and start making any changes.

AND, when you do make a change, make just ONE change at a time (even if it is just the mask you are using), AND STAY w/that ONE change for a week, then collect that AVERAGES for that week before opting to make the next change.

One nice thing about adjusting your own therapy, you have no one but yourself to blame if it doesn't work out.

Once you have some time under your belt w/CPAP therapy more than likely with the advice and suggestions from the experienced PAPpers in the forum you will be able to "tweak" your therapy even better than your doctor.

[Robinjh7]

Welcome : ) Did you use nasal pillows with your new CL2? Are you using nasal pillows that are large enough to ensure you get enough air and and out? I found it incredibly hard to exhale out of nasal pillows that were too small.

Ohhhhhhhhh. That's an interesting suggestion! I will try the medium size tonight. I've been using the small. I think they're pillows? It calls them 'direct seal cushion' on the cpap.com Web site.

I'm going to not mess with anything else. I see the doctor on Monday morning, so I'll ask him what he thinks. Thanks for the help!

Robin

[gasp]

Welcome : ) Did you use nasal pillows with your new CL2? Are you using nasal pillows that are large enough to ensure you get enough air and and out? I found it incredibly hard to exhale out of nasal pillows that were too small.

Ohhhhhhhhh. That's an interesting suggestion! I will try the medium size tonight. I've been using the small. I think they're pillows? It calls them 'direct seal cushion' on the cpap.com Web site.

I'm going to not mess with anything else. I see the doctor on Monday morning, so I'll ask him what he thinks. Thanks for the help!

Robin

Here is a picture of my nasal pillows: viewtopic/t35145/Little-jacket-for-CL2-Nasal-Piece.html to help you identify if you're using them. Best wishes on increasing the size. Don't forget to adjust all the setting so the pillows don't push too hard on your nose, either too hard in or up.

[Robinjh7]

Here is a picture of my nasal pillows: viewtopic/t35145/Little-jacket-for-CL2-Nasal-Piece.html to help you identify if you're using them. Best wishes on increasing the size. Don't forget to adjust all the setting so the pillows don't push too hard on your nose, either too hard in or up.

I tried the medium size pillows last night. (And, yes, those are the very ones I'm using.) They were much better except for one thing. I rolled over about 2am and had water run up my nose. It burned! So I changed to the Swift II.

I've got fleece around the hose, but I guess I need to do that little jacket thing you linked to as well. I'm also thinking I might need to put fleece around the hose on the headgear too. I live in the desert, and it's quite dry. The Nasonex I use for allergies also dries out my nose, plus I take a diruetic that contributes to dryness everywhere, so I like the humidity quite high. I don't, however, like that water up my nose! (And I don't have that problem with the Swift II.) I really prefer the ComfortLite 2, if I can just debug it. Thanks for your help.

Robin

[gasp]

Here is a picture of my nasal pillows: viewtopic/t35145/Little-jacket-for-CL2-Nasal-Piece.html to help you identify if you're using them. Best wishes on increasing the size. Don't forget to adjust all the setting so the pillows don't push too hard on your nose, either too hard in or up.

I tried the medium size pillows last night. (And, yes, those are the very ones I'm using.) They were much better except for one thing. I rolled over about 2am and had water run up my nose. It burned! So I changed to the Swift II.

I've got fleece around the hose, but I guess I need to do that little jacket thing you linked to as well. I'm also thinking I might need to put fleece around the hose on the headgear too. I live in the desert, and it's quite dry. The Nasonex I use for allergies also dries out my nose, plus I take a diruetic that contributes to dryness everywhere, so I like the humidity quite high. I don't, however, like that water up my nose! (And I don't have that problem with the Swift II.) I really prefer the ComfortLite 2, if I can just debug it. Thanks for your help.

Robin

The jacket only decreases the condensation by 1/2. Gerald has a quicker and easier fix for this:
viewtopic.php?f=1&t=34883&st=0&sk=t&sd= ... erald+wick

I haven't tried it yet, but will. I used to use products such as Nasonex but found the ingredients themselves exacerbated the problem of nasal congestion. When I stopped using them I had worse than ever congestion, but then after a time my passages returned to normal. I wish at that time I would have known about using the Neli Med product. I use the blue Neti Pot but there also have other delivery products. http://www.neilmed.com/usa/netipot_adwo ... awod9FWGFA

I highly recommend it! It helps return the normal moisture balance to the nasal passages. Another bonus is when you know you gotten into something such as pollen, dust, desert bloom, or other irritant, you can just rinse your nasal passages and they won't swell in response to the allergens. A wonderful natural way to go.

[GuyK]

I can't see my results! That must be another setting the clinician disabled. (Making list of things to ask the doc....)

Please forgive me if you already know some of this: the results are in a separate menu that is only accessible by a special key press. You'd then see "Efficacy Data" and "Usage" menus, along with the ability to change a few other settings. This is shown in the Clinical Guide (if you don't have that, send me a PM with your regular email address).

To get to the special menus, you hold down the <- and -> (left and right menu buttons) simultaneously for about 3 seconds. You'll see when the menu changes. The first thing that pops up is "Review", I think. Select that, and then keep negotiating the menu until you see the "Efficacy Data" and "Usage" menu items.

Should I post a standard warning? Please...I don't condone changing any settings unless you absolutely know what you're doing (I don't, and I haven't changed any settings yet). Also, please write down the configured settings before making any changes, so you can get back to your starting point if need be.

[GuyK]

(sorry, I just realized that I had in fact sent you a copy of the clinical guide!)