S9 and EPR

[msradar65]

I have been playing with the EPR it was set to 3 and I reduced it to 2. I have been sleeping much better and waking feeling wonderful. I am going to leave it at 2 until sunday night and then reduce it again to 1.

So we shall see if that is any better. my leak rate has stated normal. But I am still getting 1-8 apneas a night..some as long as 45 secs still. So I am hoping by reducing the EPR I want to see if it will improve the number of events I have a night.

Any suggestions?

[DocWeezy]

I think you're doing the right thing by experimenting and then giving it several nights to see how it goes. EPR is very personal. I know for me, I discovered that my AHI was lower when I set it to 3; fortunately, I also discovered that I slept pretty much the same no matter what the setting.

Are you running cpap or apap?

Weezy

[msradar65]

I'm running in CPAP mode. I am beginning to think that I need to bump to 9 but I am going to wait and see what the numbers say in a week. I am also waiting to see if I have anymore night terrors. My doc increased my elavil for sleep.

[tschultz]

I think that, at least for some people, the ERP does influence the frequency or ease at which an apnea event can occur at a given pressure. When I first started at a pressure of 14 I had EPR ON and at a setting of 3, the first 3 nights my AHI varied between 16 to 43, then simply turning EPR OFF my AHI then dropped to between 4.1 and 6.9 over the next four nights. After carefully reviewing the data I switched to Auto mode to try and auto-titrate over a few nights to determine what the pressure should be to adequately control things, this pressure has turned out to be around 18, but with EPR ON and at a setting of 2, which works well for me. As I increased the pressure the impacts of the EPR on the ease of breathing became quickly evident and although once I determine what pressure I needed if I turned EPR OFF I found I did not awaken as rested even though the numbers showed no difference.

I would not be surprised to heat that other people have found the same thing, the EPR can affect the required pressure to adequately control the apnea events. I like to take data over at least 5 night to get a good idea of how well any given change makes. I am keeping a spreadsheet with my settings, index numbers, oxygen and pulse data when I wear my oximiter and make notes each morning summarizing how I felt upon awakening. I have now also added blood pressure and pulse information taken approx 30 minutes after getting up and setting idle just before breakfast.

My index numbers show almost no difference between 16 and EPR OFF vs 18 and EPR ON at level 2, however how I feel after a nights sleep is very different. I believe that although the EPR does make breathing more natural the decrease in pressure during exhale allows the airway to close easier. Even though the algorithm is supposed to turn off EPR during such an event it may actually take even more pressure to force the airway open so the apnea event continues until the brain kicks things and forces a very strong inhale to open the airway. At least this what I have seen looking closely at some of my apnea events when zooming into a 1 minute or even 30 second time scale.

So don't be afraid to experiment with both the EPR and the pressure settings to find the combination that works best for you, they can affect each other.

[Big Daddy RRT,RPSGT]

I have noticed on my S9 that using it as straight CPAP of lets say 12 cmH2O felt less comfortable than Auto set 12 to 12 cmH2O. That is Auto that is not allowed to adjust. Why? I'm not sure. Something to do with easy breath? I noticed there is a flow setting available in straight CPAP that is not avaliable when set it to Auto? I think it is "normal or Fast" but when you use Auto it is not there? Auto is more comfortable than straight CPAP even when set to the same pressure. Maybe I'm just weird. Anyone else notice this difference?

[DreamDiver]

I have been playing with the EPR it was set to 3 and I reduced it to 2. I have been sleeping much better and waking feeling wonderful. I am going to leave it at 2 until sunday night and then reduce it again to 1.

So we shall see if that is any better. my leak rate has stated normal. But I am still getting 1-8 apneas a night..some as long as 45 secs still. So I am hoping by reducing the EPR I want to see if it will improve the number of events I have a night.

Any suggestions?

My guess is that any control the manufacturer puts in the hands of patients are considered less likely to affect therapy and are provided more for comfort. Yet, when I turned off C-Flex on the M-Series, my AHI shot down three points lower. With EPR, I find I do better with it set to 3, but it doesn't affect AHI as much as it reduces aerophagia. Our airways are relatively unique. Perhaps it affects us each differently.

I have noticed on my S9 that using it as straight CPAP of lets say 12 cmH2O felt less comfortable than Auto set 12 to 12 cmH2O. That is Auto that is not allowed to adjust. Why? I'm not sure. Something to do with easy breath? I noticed there is a flow setting available in straight CPAP that is not avaliable when set it to Auto? I think it is "normal or Fast" but when you use Auto it is not there? Auto is more comfortable than straight CPAP even when set to the same pressure. Maybe I'm just weird. Anyone else notice this difference?

One way to find out if there is something testably different: have you tested it with a manometer in CPAP mode and then in Auto mode emulating the same pressure?

[jmelby]

EPR negatively affected my AHI even compensating for the drop in pressure on the low end of my pressure range (e.g., normally have 9 as the minimum, set it to 10 with EPR of 1). Since I don't find I need EPR, I don't use it at all.

[AirBreather]

I don't use EPR either. After extensive experimentation it was clear that my AHI averages lower and I sleep better with EPR off regardless of other settings.

[Big Daddy RRT,RPSGT]

Maybe a manometer would show something. It feels like the same pressure but in straight cpap it doesn't seem to meet my inspiratory demand then when I adjust the flow setting it seems like too much flow.

For me it isn't a problem as now I use an Auto range set 13-20cmH2O but I thought others might benefit if they are using a set pressure. Try it. Set your S9 to straight CPAP mode at a given pressure and then set to Auto with that pressure as the high and low. Maybe it's just me but Auto feels more comfortable. (I do use an expiratory relief of 1.)