Just have to share this!

[SarahB]

8 nights with CPAP and still experimenting but just look at the last two nights graphs. I'm comparing this with an AHI of 45 just a couple of weeks ago before I started all this. Thanks, guys, for all the advice and support so far. I'm getting there!

[Pugsy]

Good job. Looking great.

Be careful though.....seems like the aliens like to mess with us when we brag and they come and visit you during the night and mess with things and you have a "bad" night. They do that to me often.

[freetimecreations]

Yay, Looks good. Seems like the Auto in AutoSet is working out good for you. Did you ever use EPR?

[SarahB]

I had a peep into the clinician's settings and EPR is switched on.

[SarahB]

Good job. Looking great.

Be careful though.....seems like the aliens like to mess with us when we brag and they come and visit you during the night and mess with things and you have a "bad" night. They do that to me often.

Don't spoil it!!!

[Pugsy]

Your EPR may be turned on but it looks like it is set to 0 because your EPAP and IPAP are the same.
Not a big deal. If you are comfortable starting the night at 6 you don't really need exhale relief.
Some people like it but don't necessarily need it (that would be me) and some people don't like it at all and some people actually need it and like it because of whatever.

EPR (or ramp) is personal choice in my book. Whatever it takes to be comfortable so that we can fall asleep because if we aren't comfortable then falling asleep isn't always so easy and we have to get to sleep first before any of this other stuff matters.

[SarahB]

Your EPR may be turned on but it looks like it is set to 0 because your EPAP and IPAP are the same.
Not a big deal. If you are comfortable starting the night at 6 you don't really need exhale relief.
Some people like it but don't necessarily need it (that would be me) and some people don't like it at all and some people actually need it and like it because of whatever.

EPR (or ramp) is personal choice in my book. Whatever it takes to be comfortable so that we can fall asleep because if we aren't comfortable then falling asleep isn't always so easy and we have to get to sleep first before any of this other stuff matters.

Oh, is EPR the same as ramp? Yes, I switched it off and raised the starting pressure from 4 to 6 because I felt a lack of air at 4.

[Pugsy]

No...EPR is not the same as ramp.

2 different setting choices doing 2 different things.

I just added the (or ramp) because some people equate ramp use to training wheels on a bicycle and to me that insinuates that someone who likes ramp is a child and needs to grow up. Annoys the heck out of me when I see that. It's like they make fun of someone using ramp or EPR and think that once we grow a pair we will be big boys and not need childish things.
Don't get me on that soap box.

[SarahB]

So what exactly does EPR do? I thought it was something different to ramp but assumed I must be wrong after reading your reply . And if it's enabled, why is it not on?

[Pugsy]

EPR drops the pressure upon exhale.
See the manual
https://sleep.tnet.com/home/files/resme ... -guide.pdf

It may be "On" but not set to anything but "O"
Choices are 0, 1, 2, or 3 and each number represents a per cm drop from inhale (IPAP) to exhale (EPAP)
The machine can't go below 4 cm...so if you used 6 minimum with EPR set to 3...you would have inhale of 6 and exhale of 4 but if/when your pressure ever went to say 8 cm then you would have 8 inhale and 5 exhale.
Using EPR creates your own little "mini" bilevel machine. I like it just because it feels more natural.

Play with it while awake. Try each setting just to get the sensation of what it feels like. You may or may not prefer it but you will get an idea what it feels like.
I use a 7 minimum and EPR of 3...I like it. Simple as that. Feels like I am breathing normally and not fighting anything to exhale.
I learned a long time ago that if I am more comfortable with anything that I fall asleep easier and stay asleep better and end up feeling better in the long run.

Now I can use a higher minimum and without any exhale relief and be quite successful on paper but I found I slept longer doing it my way....and for me sleeping longer is a critical thing because I have other issues that mess with my sleep. I take every opportunity I can to use or do anything that will improve my sleep quality.
Heck...I once got up to a 13 cm minimum in an experiment and was able to tolerate it without exhale relief.
But nothing changed in terms of AHI, hours of sleep or how I felt so I abandoned that experiment. I could do 13 without exhale relief but it sure wasn't very comfortable and took a bit of effort each night to adjust to it.

[SarahB]

Thanks. I thought it was something like that. I'll give it a try.

[D.H.]

I personally find EPR annoying, and have it off (or set to zero). Of course, I've been using CPAP since 1999, so I got got used to it without (for the most part, that didn't exist back then). Perhaps new users are accustomed to it, so if you like it, that's fine too.

[rick blaine]

Hi SarahB,

Although EPR and ramp are both labelled 'comfort features', they are two separate things.

EPR, you've just had an explanation of.

'Ramp' - or sometimes 'ramp start' - could be called the 'slow and low start with gradual building up to minimum pressure, so you can get off to sleep first' feature.

It suits some people - especially in the beginning. As people get used to the machine, they maybe don't need it quite so much.

You can set the ramp start different ways. You can have it start at 6, for example. It doesn't have to start at 4. And you can pick how long it takes to get the working minimum - on my machine, from 5 to 45 minutes in five-minute increments.

So I have ramp start set as follows: start, 6.5; (target) minimum 10.5; time to get there, 5 minutes.

It's up to you.

There is one small caution. In people with severe sleep apnea - ie, AHI of 30+ - if the slow building up is too long - say, 30 minutes - they might have a few untreated apneas in that first half hour. Might be better to get there quicker.

And, as I also said, after a while some people do without.

[SarahB]

Hi SarahB,

Although EPR and ramp are both labelled 'comfort features', they are two separate things.

EPR, you've just had an explanation of.

'Ramp' - or sometimes 'ramp start' - could be called the 'slow and low start with gradual building up to minimum presure, so you can get off to sleep first' feature.

It suits some people - especially in the beginning. As people get used to the machine, they maybe don't need it quite so much.

You can set the ramp start different ways. You can have it start at 6, for example. It doesn't have to start at 4. And you can pick how long it takes to get the working minimum - on my machine from 5 to 30 minutes in five-minute increments.

So I have ramp start set as follows: start, 6.5; (target) minimum 10.5; time to get there, 5 minutes.

It's up to you.

There is one small caution. In people with severe sleep apnea - ie, AHI of 30+ - if the slow building up is too long - say, 30 minutes - they might have a few untreated apneas in that first half hour. Might be better to get there quicker.

And, as I also said, after a while some people do without.

Ramp was set to Auto when I started but I turned it off after a few days. I prefer to get straight to the starting pressure. As the minimum pressure had been set to 4 there didn't seem much need for the ramp as I could barely detect anything happening at 4 anyway. In fact, I changed the low pressure to 6 as I felt as if there was a lack of air at 4 when using the nasal mask.

[SarahB]

I'm discovering that a low AHI score doesn't mean I won't feel tired!