New APAP user without sleep study looking for advice

[gadgetmaniah]

I've heard that an EPR of 3 is optimal. So, if I normally have my minimum at 6 cm, would I need to increase the minimum pressure if I set EPR to 3?

Each patient is an individual case. There is no optimal EPR for the patient population, and there is no formula for assigning an EPR. The optimal EPR/Min/Max setting is the one that is effective for the user and doesn't interrupt the user's sleep. For example, some like very much an EPR of 3, and others, like me, don't like the constant up and down cycling of the pressure. I don't use EPR. Others won't do without it.

To find optimal settings, the user can experiment with different settings, make subjective judgments about his sleep quality and energy level the next day, and check the daily data in OSCAR. Trial and error.

As far as turning EPR on and increasing the minimum pressure, some have found they have to do this.

Here is a quote from ResMed.

The ResMed AirSense 10 has built-in sensors that detect a patient’s breathing. As an individual exhales, the CPAP machine responds by reducing the air pressure delivered by a specific amount. When an inhale is detected again, the machine raises the pressure back to the prescribed setting. This is known as EPR, or expiratory pressure relief.

The ResMed AirSense 10 has four EPR settings: 0-3. At 0, pressure relief is turned off. At 3, air pressure is reduced by 3 cm H2O. For example, if a patient’s CPAP is set to 10 cm H2O with an EPR of 3, the air pressure during exhale is lowered to 7 cm H2O. Once an inhale is detected, air pressure increases back to 10.

Note if EPR is set at 3 and minimum pressure is set at 6.0, the machine will not go below 4.0. So, the EPR setting is effectively only 2.

Thank you! So I guess I'll just have to experiment to see which EPR setting suit me best.

Also, just a little update on my CPAP journey- I might be changing machines again and this time I might choose the Philips Dreamstation. I've tried two different Resmed machines (used) from a dealer but I've been experiencing weird noises from the mask when I inhale and I feel like there's some issue with airflow as well. I think that's not a problem with the machine though; probably with the mask only. I will be visiting the dealer's shop tomorrow to check what exactly the issue is and probably get a new, better mask.

But I am thinking of switching to Philips anyways because I think I just got used to it when I was renting the System One machine. I don't like the feel of the Resmed as much as I liked Philips' when breathing. Also the replacement Resmed machine that I got has a lot of hours on it (11,000+) so I need to get it changed anyways.

[Pugsy]

I have a question about my machine settings. I've heard that an EPR of 3 is optimal. So, if I normally have my minimum at 6 cm, would I need to increase the minimum pressure if I set EPR to 3? If so, what should I increase pressure to? As a guess I've set it at 7 cm right now.

Sometimes people have to adjust the minimum when they add more exhale relief...and sometimes they don't.
It all depends at what pressure during exhale that the airway won't stay open well enough to prevent the collapses.

Minimum pressure of 7 with EPR of 3 means inhale of 7 and exhale at 4 cm...and as long as you aren't having a lot of airway collapses during the short time you are at 4 cm then there is no need to compensate for the drop with more minimum.

You can't really go by what was used with the Respironics machine either. Apples and oranges comparison because of the way Respironics does the exhale relief drop and the auto algorithm.
When I was using a Respironics machine I had to use 10 cm minimum with exhale relief at around 2 cm to get good results,
but when I went to a ResMed machine I was able to get same good results with 7 inhale and 4 exhale (EPR at 3).

Doesn't really matter what the settings are as long as they work for you and you are comfortable and getting good results and good sleep and feeling the good numbers.

[zonker]

Note if EPR is set at 3 and minimum pressure is set at 6.0, the machine will not go below 4.0. So, the EPR setting is effectively only 2.

ma'am?

i was told there'd be no math.

[gadgetmaniah]

I have a question about my machine settings. I've heard that an EPR of 3 is optimal. So, if I normally have my minimum at 6 cm, would I need to increase the minimum pressure if I set EPR to 3? If so, what should I increase pressure to? As a guess I've set it at 7 cm right now.

Sometimes people have to adjust the minimum when they add more exhale relief...and sometimes they don't.
It all depends at what pressure during exhale that the airway won't stay open well enough to prevent the collapses.

Minimum pressure of 7 with EPR of 3 means inhale of 7 and exhale at 4 cm...and as long as you aren't having a lot of airway collapses during the short time you are at 4 cm then there is no need to compensate for the drop with more minimum.

You can't really go by what was used with the Respironics machine either. Apples and oranges comparison because of the way Respironics does the exhale relief drop and the auto algorithm.
When I was using a Respironics machine I had to use 10 cm minimum with exhale relief at around 2 cm to get good results,
but when I went to a ResMed machine I was able to get same good results with 7 inhale and 4 exhale (EPR at 3).

Doesn't really matter what the settings are as long as they work for you and you are comfortable and getting good results and good sleep and feeling the good numbers.

Thanks for this; I appreciate your help!

So I visited the dealer today and the issue was indeed in my mask. Apparently that mask was of very low quality. Anyways, he only had a couple of full face masks and I opted to buy the Quattro Air. The newer mask models are hard to find here in Pakistan. This did seem comfortable to me but I am experiencing some leakage from the sides of my nose - there's some air blowing into my eyes. Could I fix this with a cloth liner? I'll have to make one myself though since I don't think there are any commercially available here.

I also exchanged my machine for a Dreamstation which seemed to be in good condition. I did try it in the shop with the Quattro mask and I liked the air flow better than the Resmed's. I guess I'm just a bit used to Philips. Just hoping I don't experience too many leaks with this new mask!

[ChicagoGranny]

This did seem comfortable to me but I am experiencing some leakage from the sides of my nose - there's some air blowing into my eyes. Could I fix this with a cloth liner? I'll have to make one myself though since I don't think there are any commercially available here.

Some people do this successfully. A favorite material is from a 100% cotton T-shirt.

experiencing some leakage

Don't forget to watch some youtube videos on fitting and adjusting - https://www.youtube.com/results?search_ ... +cpap+mask

[gadgetmaniah]

This did seem comfortable to me but I am experiencing some leakage from the sides of my nose - there's some air blowing into my eyes. Could I fix this with a cloth liner? I'll have to make one myself though since I don't think there are any commercially available here.

Some people do this successfully. A favorite material is from a 100% cotton T-shirt.

experiencing some leakage

Don't forget to watch some youtube videos on fitting and adjusting - https://www.youtube.com/results?search_ ... +cpap+mask

Thanks! I did watch one video by Resmed but I'll watch more. I'll also look for some DIY mask liner guides online, hopefully something not too difficult.

[gadgetmaniah]

Ok I thought that I had worn my mask well but after looking at the data it turns out I was experiencing too many leaks. Median leak was 32 cm but it went to a maximum of 154. I think what happens is that the mask slips up my face, causing air to rush from the bottom of the mask. It could be due to my side sleeping habit.

Edit: Also, I wonder if it is normal for having to tighten the mask quite tight to prevent leakage, even though my minimum pressure is low at 6.5 cm only.

Also, the supplier that I got my machine from told me that they disinfect their machines with SoClean. Now I'm a bit paranoid whether the internals of the machine that I got could be damaged. I don't hear any noises from the machine though and it seems to be working fine. And I'm guessing that they would have only disinfected it using SoClean once, so that shouldn't have had much effect on the machine perhaps. Resmed in their statement about SoClean said that repeated and prolonged use of SoClean could damage machines.

But I'm only concerned about whether the pressure that the machine is delivering is accurate (not sure if SoClean could cause any damage to the machine's blower).

Edit 2: Ok I was just testing my mask with different adjustments and lying down in different positions, and I think I realized what could be causing the huge leaks: chin tucking. I'll order a soft cervical collar today and see if that helps with the problem.

[gadgetmaniah]

Good news! I managed my leaks today. Seems like I wasn't properly fitting my mask. I also had to tighten the bottom straps a fair bit - that seemed to have done the trick. I read someone's advice on another thread of trying to tighten the bottom straps and loosen the top straps a bit. Feeling much relieved now.

[ChicagoGranny]

Good news! I managed my leaks today.

[gadgetmaniah]

Good news! I managed my leaks today.

Thanks for recommending watching the fitting videos!

[gadgetmaniah]

Even better today - no large leaks at all. Also, I slept at night and woke up in the morning after such a long time (my sleep apnea really messed up my sleep cycle), and that too feeling fairly refreshed. Just experiencing some lingering sleepiness but I hope that will go away gradually.

[chunkyfrog]

. . .
i was told there'd be no math.

There is ALWAYS MATH.
We were lied to.

[gadgetmaniah]

Just an update. Still managing to manage my leaks. I think I wasn't fitting my mask properly before. One thing I've noticed is that I'm experiencing some light drowsiness throughout the day. I have read that it takes a few months to experience the full benefits of CPAP therapy, so I hope it continues to improve. Right now I would say my symptoms have improved by around 60%-70%. No more extreme tiredness when waking up and the headaches have improved as well.

Today's data - pressure was higher than usual. Mine doesn't usually go till 10 cm but today for some reason it did remain there for about an hour. I can see that it did so after detecting a couple of snores.

[gadgetmaniah]

Ok, I'm having some problems with my mask. The part of the strap with the Resmed logo on it that fits at the back of your head really hurts since I have to tighten my mask to prevent air leaking into my eyes. I even got a Pad a Cheek liner but that doesn't make any difference - I still have to tighten my mask quite well.

Maybe I need to get another mask? My CPAP supplier told me that has the Amara Gel and the Amara View, but I'm not sure whether they'll suit me better or not. The Amara Gel seems similar in shape to my current mask (Quattro Air) so I fear that I would still suffer from air leaking into my eyes. The Amara View mask is going to be a bit of a gamble since I think it fits some people well but for others it does not work at all. Also I have a beard so I'm not sure if the Amara View would work with that, especially if its seal falls further below the lip than regular full face masks. I guess I'll have to read some user reviews on both.

The supplier also has a mask by BMC that seems to be a copy of the Simplus. It looks exactly like it (https://cpapsales.com.au/masks/full-fac ... ews_id=116). However, I have doubts about the quality of this mask.

[gadgetmaniah]

So I went for the BMC (Chinese company's) mask. It's better than I expected and fits me very well. I barely have to tighten it and it doesn't leak. My AHI has gone down from around 2 on the Quattro Air to around 1 on this mask.

One question - is it normal to still be experiencing symptoms of sleep deprivation 5-6 weeks into your CPAP therapy? Much of my symptoms have improved, particularly the fatigue when getting up. Without the CPAP, I would stay in bed for about 10 hours and still wake up feeling terribly fatigued. But now, with the CPAP, I can easily wake up with 4-6 hours of sleep. The mental fatigue/fog has cleared up a lot too. And, if anyone has been following been this thread, my chronic constipation has been relieved as well. However, I still experience a very slight headache and a feeling that I've not had enough sleep, though the severity of these symptoms has reduced. I also experience sleep deprived and dry eyes.