Lankylefty27

[palerider]

Also it's nice to interact with a youtuber that has some class and ability to interact intelligently, unlike that bogan tosser that soiled the forum recently.

[lazarus]

Don't tell him I said anything nice about him, cuz his head will swell up even more.

Hey YOU'RE the one who got the ringing endorsement! ("Nice guy"? Really? Ya gonna just take that?)

That study lumping various pressure-relief apples and oranges together in the summary/conclusion can be difficult to parse.

I consider EPR as effective as "real" bilevel for me. I was originally prescribed bilevel. I later asked another doc to write me a vanilla CPAP Rx so I could try EPR. I liked the idea of the "suspension" feature of EPR over pure full-time bilevel. I stuck with EPR.

But what makes it all OK (for me) is this forum and self-monitoring AHI. I "get" a tech being insulted by ResMed hiding a virtual 3cm-bilevel inside a "CPAP." It could throw off a non-self-monitoring papper's therapy, in theory, just using a so-called "comfort feature." But for me, I'm sure glad they did it.

[lazarus]

Also it's nice to interact with a youtuber that has some class and ability to interact intelligently . . .

Well put.

[palerider]

Don't tell him I said anything nice about him, cuz his head will swell up even more.

Hey YOU'RE the one who got the ringing endorsement! ("Nice guy"? Really? Ya gonna just take that?)

I haven't decided how to react to that one. I mean, he's correct in that we *have* had direct communications in the past. But "Nice guy" does somewhat sully my reputation, I might have to have speaks with him about that.

That study lumping various pressure-relief apples and oranges together in the summary/conclusion can be difficult to parse.

I consider EPR as effective as "real" bilevel for me. I was originally prescribed bilevel. I later asked another doc to write me a vanilla CPAP Rx so I could try EPR. I liked the idea of the "suspension" feature of EPR over pure full-time bilevel. I stuck with EPR.

But what makes it all OK (for me) is this forum and self-monitoring AHI. I "get" a tech being insulted by ResMed hiding a virtual 3cm-bilevel inside a "CPAP." It could throw off a non-self-monitoring papper's therapy, in theory, just using a so-called "comfort feature." But for me, I'm sure glad they did it.

I think it comes down to "things vary and especially people vary" and trying to put blanket statements on anything to do with CPAP/APAP/Bilevel is liable to cause trouble. Some people find that EPR really is nothing but a comfort feature. Other people can't tolerate any, because the extra ventilation throws them into a state where they start having flagged centrals, and all variations in between, including what TLL27 brought up in the video. The difference in opinion comes were I say "let's try it and let the data determine what works for the individual".

[palerider]

Also it's nice to interact with a youtuber that has some class and ability to interact intelligently . . .

Well put.

Although he might not like my allegation that he has 'class'.

[lazarus]

I haven't decided how to react to that one. . . . "Nice guy" does somewhat sully my reputation,

I think it's time you embrace that you've been revealed as Mr. Apple Pie: Crusty on the outside but all sweet and gooey on the inside.

So there.

[lynninnj]

Like I said, all this has me thinking.

I have had the EPR set on 3 since the beginning.

My apneas register a much greater portion of CA vs OA and H. If you look at the trends, and you look at the AHI line, the green portion is the CA portion of the results.
https://sleephq.com/public/3f45a4f0-62a ... 9bcbce177e

Things are pretty well managed and I am pretty happy with them generally speaking.

Jason was saying that with lower pressures (mine is normally set around 7-14 range and rarely gets above 9 or 10) when you exhale you may be more inclined to start breathing excess CO2 at arousals etc. He mentioned headaches as well. I have seen several doctors and have suspicions that the headache is due to the TMJ that flared up bigtime about 6 weeks ago when I broke a corner of my back molar and needed a root canal (4 hours total with my mouth open and pressure on my lower jaw over the course of two weeks.) so more likely than not my headaches are related to the jaw issue. Different masks that I have tried over the weeks have contributed as well based on strap position.

I may just try it just to see what happens but does anyone else see a value to dropping the EPR from 3 to 2? (and maybe eventually 1?) Not sure how it will feel but I might want to try it to see if it has a beneficial effect on the headaches. (TMJ headaches normally persist for as much as a month and I had a cleaning two or three weeks after root canal and crown so I am within that window. But still....)

[lynninnj]

Also it's nice to interact with a youtuber that has some class and ability to interact intelligently, unlike that bogan tosser that soiled the forum recently.

He seemed to take your criticisms as an opportunity to learn or improve or at least explain.

I have to admit, he impressed me with his willingness to consider. (unlike the tosser as you say)

I am quite impressed too that chunky frog has become a sort of sex symbol. lol

[lynninnj]

I haven't decided how to react to that one. . . . "Nice guy" does somewhat sully my reputation,

I think it's time you embrace that you've been revealed as Mr. Apple Pie: Crusty on the outside but all sweet and gooey on the inside.

So there.

Jeff you big meanie!

(lol)

[chunkyfrog]

I officially apologize for making thelankylefty uncomfortable..
I only meant to compliment him--and congratulate Mrs. Lefty.

[Pugsy]

I may just try it just to see what happens but does anyone else see a value to dropping the EPR from 3 to 2? (and maybe eventually 1?) Not sure how it will feel but I might want to try it to see if it has a beneficial effect on the headaches. (TMJ headaches normally persist for as much as a month and I had a cleaning two or three weeks after root canal and crown so I am within that window. But still....)

The potential issue with EPR causing excess blow off of carbon dioxide and centrals to happen is actually quite rare. A very small percentage of an already small percentage of people put on cpap/apap that have centrals develop.
I hate to see people not use EPR if it would benefit them just because a few people have a problem with it.
Why punish someone just because someone else has a problem????
Heck...I have been using either EPR of 3 with the AutoSet or PS of 4 with the bilevel for years and years and I have yet to have one real asleep central. I get a few false positive awake/arousal centrals every now and then but that's because of crappy sleep secondary to waking up hurting.

I doubt your headaches are central related or even related to any respiratory imbalance but it hurts absolutely nothing to experiment with reducing EPR or even eliminating it and see what happens...if anything..in terms of how you sleep or feel.
Back when I first started therapy I used a Respironics apap and didn't use the Flex option because I really couldn't tell it felt any better and I just didn't use it.
Then I got my first ResMed machine with EPR and used it and fell in love...then deeper in love when I got a chance to use a bilevel and learned about PS.

Is there value in trying? You will learn something one way or the other and there's always value in learning anything.
I have done LOTS of experiments with settings over the years...even used ASV for a couple of years just because I liked how it felt.
I always learned something. Now sometimes that something was "I hate this setting" or "this change makes zero difference"...but I learned something.

You never know until you try.

Give it a try....ideally for a week at each trial or reduction if you are comfortable with less EPR or no EPR.

[lynninnj]

I may just try it just to see what happens but does anyone else see a value to dropping the EPR from 3 to 2? (and maybe eventually 1?) Not sure how it will feel but I might want to try it to see if it has a beneficial effect on the headaches. (TMJ headaches normally persist for as much as a month and I had a cleaning two or three weeks after root canal and crown so I am within that window. But still....)

The potential issue with EPR causing excess blow off of carbon dioxide and centrals to happen is actually quite rare. A very small percentage of an already small percentage of people put on cpap/apap that have centrals develop.
I hate to see people not use EPR if it would benefit them just because a few people have a problem with it.
Why punish someone just because someone else has a problem????
Heck...I have been using either EPR of 3 with the AutoSet or PS of 4 with the bilevel for years and years and I have yet to have one real asleep central. I get a few false positive awake/arousal centrals every now and then but that's because of crappy sleep secondary to waking up hurting.

I doubt your headaches are central related or even related to any respiratory imbalance but it hurts absolutely nothing to experiment with reducing EPR or even eliminating it and see what happens...if anything..in terms of how you sleep or feel.
Back when I first started therapy I used a Respironics apap and didn't use the Flex option because I really couldn't tell it felt any better and I just didn't use it.
Then I got my first ResMed machine with EPR and used it and fell in love...then deeper in love when I got a chance to use a bilevel and learned about PS.

Is there value in trying? You will learn something one way or the other and there's always value in learning anything.
I have done LOTS of experiments with settings over the years...even used ASV for a couple of years just because I liked how it felt.
I always learned something. Now sometimes that something was "I hate this setting" or "this change makes zero difference"...but I learned something.

You never know until you try.

Give it a try....ideally for a week at each trial or reduction if you are comfortable with less EPR or no EPR.

Thanks. I might just try it tomorrow night. (busy day tomorrow so want to wait a day).

I don’t have a clue what it’s like at a lower epr because I never tried. Seems like a strange experiment I look forward to.

This was a tough day. Most were CAs and I may be reading incorrectly but there seems to be a deep breath followed by a CA. Is this what he refers to as an arousal ca?

https://sleephq.com/public/157c4d48-49b ... 665958c67e

Some weirdness that wasn’t flagged at 537. The CAs directly before and after 537 weirdness were maybe the real deal but were the early ones with a big breath arousal CAs in your opinion?

Thanks for any insights.

edit: I don’t know if time zone issue still exists but I went to bed just before 11.

[zonker]

Also it's nice to interact with a youtuber that has some class and ability to interact intelligently, unlike that bogan tosser that soiled the forum recently.

"bogan"!?!?

had to look that up, had never heard it. thanks for making me learn stuff.

[Pugsy]

Most were CAs and I may be reading incorrectly but there seems to be a deep breath followed by a CA. Is this what he refers to as an arousal ca?

If the bulk of your centrals flags look like the very first flagged central...that's an arousal central for sure.
We don't take big breaths/gulps of air like that when asleep....awake or half awake or maybe a turn over in bed take a breath and hold it briefly while turning.

The weird looking stuff shortly after 5:30 .....I think all of that is arousal related. There's a lot of stuff there that is irregular and doesn't look like nice normal rhythmic asleep breathing. I also think the OA flagged at the end of that time frame is most likely arousal related.
Again we just don't take big gulps of air PRIOR to a flagged event...now maybe afterwards which would be an recovery breath but not before the event.

Remember that it is normal and to be expected to have a real asleep central...sleep onset central...normal to see and no big deal.

At any rate even if all your flagged centrals were real asleep centrals (which they aren't) you don't have enough of them to worry about.

I think your flagged centrals are primarily a symptom of just not sleeping soundly. Certainly not EPR related and I would bet my last dollar on that fact.

You need to reduce the arousal/awake stuff and then your central numbers will also reduce...and that's easier said than done.

[palerider]

I haven't decided how to react to that one. . . . "Nice guy" does somewhat sully my reputation,

I think it's time you embrace that you've been revealed as Mr. Apple Pie: Crusty on the outside but all sweet and gooey on the inside.

So there.

People that know me, outside of the forum, have accused me of such things. (pugsy, chunkyfrog, tatooedlady to name a few), so as much as I'd like to argue, I can't really, or maybe it's just because I'm really tired after my radio club's monthly meeting, I might be more argumentative tomorrow