I need a way to get higher exhaled pressured relief (EPR)

[Guest two]

In my opinion, the improvements from CPAP are really due to the room being colder and me just having a better night in general. You can see how much I was tossing and turning from my limb movement score in the first study. Central apneas went up with CPAP. I think there is every possibility current use of CPAP at home is just going to make things worse for me.

Most likely. As with about 60% of those who try it (and fail).

[chunkyfrog]

It does take awhile to get used to cpap, apap, or whatever flavor air you get.
Try to increase the time each night; since you are having difficulty going all night--all at once.
The best strategy is to take it slow--but do not allow yourself to backslide.
Keep moving the bar up.
Before you know it, you, too, will be waking up wondering: "Is this thing ON?"

[GrantT]

Before you know it, you, too, will be waking up wondering: "Is this thing ON?"

Unfortunately, in 5 years, I never got to that point with my CPAP machines. Always felt foreign and restrictive before the BiPAP machine.

May I ask inhale and exhale pressure settings you had before and after making the switch from CPAP to BPAP?

Sleep Studies...*sigh*. I lied there for 8 hours, wide awake for most of it, or fitfully dozing off before wires or sensors pulling woke me up. Then they prescribe something which is based on spotty data - doesn't make a lot of sense. I guess they need to start somewhere.

Anyways...S9 in Auto mode I believe was set for 6.6 to 13 when I last used. Tried all EPR levels...I really could not tell much difference. I tried two weeks intervals at other various minimum pressures...as low as 4, as high as 10. Sometimes it would feel like it was working..then start getting worse again. I think my body just hates it in general.

My BiPap is in also in Auto VPAP mode currently set to 8 to 14 with a PS of 3.

Numerically, I am not sure there is much difference in settings as I am still not fully versed on everything, but in practice (better machine or better breathing algorithm?) , it is significantly easier to breath out against the BiPAP machine than it is with the CPAP. I'm not fully understanding why yet, and it is that primary factor which seems to be letting me settle in and sleep better.

[Pugsy]

What was your official diagnosis and why were you put on cpap?
Your pre cpap AHI isn't/wasn't very high

AHI =2.4/hr

[Arlene1963]

What was your official diagnosis and why were you put on cpap?
Your pre cpap AHI isn't/wasn't very high

AHI =2.4/hr

I'm wondering the same thing.

[Pugsy]

Numerically, I am not sure there is much difference in settings

There's not really much difference between your apap with EPR of 3 and the bilevel auto with PS of 3.
Except...maybe a teeny tiny difference in the timing of the reduction.
And I wonder what would have happened if you had used 11 minimum with EPR of 3 on the apap...that's the equivalent of EPAP at 8 with PS of 3.

At any rate I do understand the sleeping better with bilevel and not understanding the why. When I made the change to bilevel some years back it was on a lark really but I quickly realized that I just liked it better and I felt better pretty much immediately. Then I started comparing some numbers after I had been on bilevel a few weeks and while almost everything else was the same the time slept was different. I was averaging approx 45 min to 1 hour more on bilevel than I did on apap. Don't know why but it happened and that 1 hour made a significant difference in how I felt during the day.

Hey...whatever works is fair game in my book. Congrats on finding something that helps you feel better and that's the main important thing and why we do all this stuff.

[metal36]

Ya, I know. My sleep study said "the impression is consistent with obstructive sleep apnea". My doctor verbally used the word "mild". Though I think my sleep issues are a lot more complex than just wanting to prevent a few apnea events. I don't breath deeply, or feel well oxygenated, or sleep deeply. I think all my sleep issues are complications of my infectious disease. Over the years, I have noticed them improve or worsen in tandem with how my overall condition is improving or worsening. If I force myself to take long deep breaths while falling asleep, it makes me feel considerably better, less wired, and more able to sleep. The problem is that doing this requires conscious effort, which is lost the moment you start to doze.

[Pugsy]

Okay. That makes sense. He's stretching the "mild OSA" thing and maybe thinking that the RDI is a factor. The RDI isn't horribly high but it might also be a factor in poor sleep quality.
There might be an underlying UARS (Upper Airway Resistance Syndrome) going on too...and that is also treated with cpap.
Hoping cpap will help you sleep better.

[metal36]

My sinuses are trouble. I have done everything imaginable for them, including endonasal balloon adjustments done by a chiropractor. That actually helped, and even improved the symmetry of my whole face. Without CPAP, I sleep with 2 BreatheRight nasal strips on my nose, and also a BreatheRight nostril expander inside my nostrils. I also wear a bite guard.

I would like to share an unusual experience I had in my attempt to treat my breathing issues. So my tongue is obviously lax. Years ago, I was getting prolotherapy for various aches and pains in my body. These are injections that stimulate healing of connective tissue. My infectious disease has made by joints lax throughout my body. I thought about using prolotherapy on the tongue. I looked through anatomy pictures and surmised that the lateral thyrohyoid ligaments may be in large part responsible for keeping the tongue down. I got a doctor to agree to treat these ligaments with prolotherapy. Lo and behold, my tongue snapped down right into position that very night. Could breath with my mouth open, which made me sleep well. It was a miracle. These results however only lasted I think two nights, then the tongue returned to it's original position. I repeated the treatment, and this time only one side of the tongue responded. It seems only of the two ligaments "got the message" this time. This was still enough to enable me to breath through my mouth. Again the results were not permanent. It is generally the case with prolotherapy that results don't seem to be permanent as long as an underlying disease process has not first been resolved.

There are potentially other places the tongue attaches that prolotherapy could treat, such as all along beneath the jaw bone.

Also, I have seen some slight improvement in my tongues position from doing trigger point therapy all along beneath the jaw bone. I stick one finger in the mouth, and one finger below the jaw, then I squeeze the connective tissue together between the tips of these two finger.

In other words, my theory is that there may be ways to directly address/treat connective tissue that could benefit sleep apnea. There is no research on this to the best of my knowledge.

[metal36]

I also experienced similar temporary benefits in tongue laxity from holding DMSO sublingually. It is a solvent and anti-inflammatory. It penetrates right through any tissue you put it in contact with. I reckon it soothed the connective tissues of the tongue. It may burn a little at full strength, and will feel hot, and taste horrible, and will leave you smelling like sulfur for 1 or 2 days in the perception of others. You yourself are not able to smell it though. It must not be combined with anything you wouldn't want to be transported into your bloodstream. Sorry if this is offtopic. I don't think I have any more bizarre experiments to recall.

[Rumbert]

It's the *exhale* pressure that keeps your airway open so you can take another breath.

Why then does the machine bother to create higher pressure on the inhale? I'm not arguing with you, I just want to know. Why don't we just set a single max pressure for whatever works on exhalation and not bother with EPR?

[Rumbert]

It's very common for newbies to come here and say they can't exhale against the pressure. I thought it was very difficult to exhale when I first started with CPAP. After a few weeks of acclimation, I couldn't even tell the machine was producing a pressure. I was thinking about this when I woke up this morning - I couldn't feel anything, but the machine was purring softly so I knew it was working.

Same here. Nowadays I have to hold my hand in front of the mask's relief holes in order to tell whether the machine is on. This is at 13 cm (flat, no APAP) and 1 EPR.

[Pugsy]

Why then does the machine bother to create higher pressure on the inhale? I'm not arguing with you, I just want to know. Why don't we just set a single max pressure for whatever works on exhalation and not bother with EPR?

EPR is a comfort feature. You don't have to use it if you don't want or need to. You can use a single pressure with no variation between inhale and exhale and have it auto adjust as need if you wish.

Some people simply like EPR...that would be me. It simply feels more natural and I like it. I can do without it but I figure why if I can attain desired results and be more comfortable doing it. Plus I found that with 2 distinct pressures (one for inhale and one for exhale) that I actually slept about an hour longer. For me that extra hour made a huge difference in how I felt.

Some people need some form of exhale relief because pressures are quite high and they simply can't exhale comfortable against those pressures. Some people need some form of relief even at lower pressures (that some of us would consider quite low) for any number of reasons and in my book whatever reason they have is a good enough reason. This isn't some sort of macho contest where my balls are bigger than your balls because I can exhale at my inhale pressure just fine and your balls must be smaller since you have to use some sort of exhale relief.

The whole goal with the therapy is to get good sleep and keep the airway open...whatever it takes to fall asleep and get the good sleep is fair game. You have to get to sleep first and foremost for the therapy to work its magic. Not much help if a person is uncomfortable with exhaling and takes forever to fall asleep.

It's the difference between inhale and exhale that offers the comfort for most people. The bigger the difference the easier to breathe.
I know it sounds weird but inhale of 9 and exhale of 6 can be more comfortable than using 7 with no exhale relief.

I am currently using 7 minimum with 3 EPR. Now I can quite comfortable exhale against 7 without EPR but I wanted to test things with my new AirSense 10 AutoSet to see if I could use lower pressures with it and get the same results as I would get with Respironics minimum of 10 and Flex relief of 2 (with Respironics the max drop during exhale is 2 cm even at a setting of 3 due to the way they do the exhale results).
So I found out that I can get nice low AHI numbers and sleep quite well at these settings.
For me using EPR (or even a bilevel device with similar PS) simply lets the breathing feel more natural...more like not using pressure at all. Yeah, I could do it without EPR but why do it when using it simply feels better and I don't have to "work" at exhaling at all.

For some people using no relief means aerophagia issues due to the constant higher pressure...and sometimes using exhale relief will keep the aerophagia monster away. Aerophagia can be a lot more than a big burp or some farts...it can cause severe pain lasting all day as well as nausea or vomiting. It can disturb sleep too...and anything that disturbs sleep is unwanted.

So some people need some form of relief for various reasons and so me people just like how it feels...and any reason for using exhale relief is a good enough reason in my book. Anything that lets us get that precious good sleep is worth doing.

Now for those of you who don't particularly need exhale relief or care...hey, more power to you but there's nothing wrong with those of us who do like it and there's certainly nothing small about the size of our balls.
Some people who don't use exhale relief have likened it to training wheels and that just irritates the hell out of me when they do that.
They think that because they are comfortable exhaling at so and so pressure that anyone else who isn't must be needing to "grow a pair".
They forget that big sticker that comes with any cpap stuff...YMMV.

Sometimes I want to tell those people saying "I am using 9 cm and don't need any relief" to go try 15 cm and see how well they like it...or 18 or 22....it's not much fun for anyone exhaling at those higher pressures.

So exhale relief is a comfort feature....and in my book we need to be comfortable to sleep and if exhale relief helps us fall asleep faster...that's the goal of the therapy...sleep. Anything that helps us attain that goal is fair game to do or use.
Some people actually need it. They simply can't exhale against the pressure and they can't go to sleep fighting the pressure.

Some people think that if something is "only a comfort" feature that it isn't part of the therapy but I don't feel that way. Being comfortable is a necessary part of therapy IMHO.

[ChicagoGranny]

It's very common for newbies to come here and say they can't exhale against the pressure. I thought it was very difficult to exhale when I first started with CPAP. After a few weeks of acclimation, I couldn't even tell the machine was producing a pressure. I was thinking about this when I woke up this morning - I couldn't feel anything, but the machine was purring softly so I knew it was working.

Same here. Nowadays I have to hold my hand in front of the mask's relief holes in order to tell whether the machine is on. This is at 13 cm (flat, no APAP) and 1 EPR.

+1

I tried EPR and didn't like it. I would rather have a steady pressure and not have the machine cycling pressure up and down on every breath. That cycling is very distracting. My pressure is 10 - 20 and it hits 14 -16 during REM. (Without cervical collar, it was going as high as 20, and there were still events.)

On another subject, what caused your N24HSWD? Which drugs have you tried?

[ChicagoGranny]

Some people who don't use exhale relief have likened it to training wheels and that just irritates the hell out of me when they do that.

You should turn this around on them. "One steady pressure is training wheels. When you become skilled at riding CPAP, you can stay upright on the bicycle in fluctuating winds."