Does EPR truly lower Central Apnea?

[ozij]

Why no EPAP line when she's at less than 7, and EPR is presumably functioning at less than 3? Is that an OSCAR issue?

I don't know.
EPAP could be at 4 cm so we can't see the green EPAP line when it is on the baseline number. I think that is probably why we can't "see" it...but it's probably there at the baseline.
But obviously there are times where EPR can kick in but we don't see it in action at these settings.

Got it. Thanks.

[palerider]

Essentially you get the amount of reduction available within the constraints of the machine itself.
You don't have to be using the 7 cm to get any exhale reduction...it's just you have to be using at least 7 to get the full 3 cm drop.
If using 7 cm minimum and setting of 3 EPR then you can get the full 3 cm drop
If using 6 cm minimum and setting of 3 EPR then you will only get a 2 cm drop while at 6 cm.
If using 5 cm minimum and setting of 3 EPR then you will only get a 1 cm drop while at 5 cm.

Something I don't understand:
When using EPR at higher pressures, I get a red line for IPAP in the Pressure chart, and a green one for the EPAP, the green line being an EPR's distance below the red.

RES9372 has EPR set to 3, full time. The Pressure chart only shows a minimal blip of a green EPAP line at about 06:15, when she reaches IPAP 7.

Why no EPAP line when she's at less than 7, and EPR is presumably functioning at less than 3? Is that an OSCAR issue?

It's hidden behind the baseline of the chart at 4. If the chart minimum was set to 3, you'd see the EPAP at 4.

[lazarus]

Re: Does EPR truly lower Central Apnea?

"In our experience, EPR may be beneficial for some patients and prevents the need to convert to BPAP for tolerance. Some patients only need EPR during the ramp period. In other patients, the drop in pressure may induce more treatment-emergent central events and intolerance, so we recommend that the patient be treated with and without EPR on setup to determine what is most comfortable rather than be set for all patients. Similarly, some patients find starting at low pressures suffocating (often elicited by asking if they feel they have to suck in air) and prefer to start with no ramp or a higher start ramp setting, which can be tested on setup."--Kryger's Principles and Practice of Sleep Medicine, p. 1262. Meir H. Kryger, Thomas Roth, Cathy A Goldstein
Elsevier Health Sciences, Dec 16, 2021. https://books.google.com/books?id=yDVVE ... ea&f=false

[dataq1]

going back to the very beginning of this topic.....
Did your doctor prescribe the constant 4 cm that you showed in your first post?
If not, what did he prescribe?

[RES9372]

going back to the very beginning of this topic.....
Did your doctor prescribe the constant 4 cm that you showed in your first post?
If not, what did he prescribe?

They prescribed a fixed pressure of 7. But my AHI was even higher on that.

[Captain_Midnight]

I'm a rare visitor hereabouts, however this is a topic of interest to me.

I recall reading, maybe from here, that when one uses APAP, the lower pressure needs to be increased (I think) 1 cm for each level of EPR.

I use an EPR of 1, and I did increase my lower APAP setting by one from my original titrated pressure (don't set your lower pressure at zero). My AHI stays at a consistent 0.4, if that's an indicator.

Just my observation, not a recommendation. As always, do your own DD.

Regards all - Capt Midnight

[dataq1]

going back to the very beginning of this topic.....
Did your doctor prescribe the constant 4 cm that you showed in your first post?
If not, what did he prescribe?

They prescribed a fixed pressure of 7. But my AHI was even higher on that.

Ok, so you started at 7 cm constant, but to achieve a lower AHI, you changed to 4 cm constant.
Then you began to experiment with EPR settings.
Now (8-13-23) your settings are on Auto (5.0 to 9.2) , Full time EPR of 3 and your seeing Clear Airway Index of 6.4 and Obstructive Index of 0.0
Is that a fair summary?

[RES9372]

going back to the very beginning of this topic.....
Did your doctor prescribe the constant 4 cm that you showed in your first post?
If not, what did he prescribe?

They prescribed a fixed pressure of 7. But my AHI was even higher on that.

Ok, so you started at 7 cm constant, but to achieve a lower AHI, you changed to 4 cm constant.
Then you began to experiment with EPR settings.
Now (8-13-23) your settings are on Auto (5.0 to 9.2) , Full time EPR of 3 and your seeing Clear Airway Index of 6.4 and Obstructive Index of 0.0
Is that a fair summary?

Yep exactly.

[RES9372]

Here is the latest screen shot from last night. I am wondering if I should raise the minimum pressure?

[dataq1]

Here is the latest screen shot from last night. I am wondering if I should raise the minimum pressure?

Not responsive to you question, but could you change the Y-axis on your pressure curve to 0-15, makes it easier to see the EPR.

It is my personal preference to avoid changing parameters (pressure/epr settings) every day. Again, it's just what I do, but I'd very leery of trying to draw conclusions from one or two days. Again, it's just my preference, but unless some setting is very very bad, I (personally) would leave conditions alone for a week before considering further jiggering.

That said, are you certain that the clear airway events you are experiencing are NOT a result of sleep-wake-junk?

[ozij]

Not responsive to you question, but could you change the Y-axis on your pressure curve to 0-15, makes it easier to see the EPR.

If the machine does not go beneath a pressure of 4, changing the axis show anything underneath 4 is unnecessary and will not teach you anything about your therapy.

Here is the latest screen shot from last night. I am wondering if I should raise the minimum pressure?

How long have you been on this setting?
Stick to it for a few day - your body has to get used to it

[dataq1]

If the machine does not go beneath a pressure of 4, changing the axis show anything underneath 4 is unnecessary and will not teach you anything about your therapy.

True, but it would avoid people having to ask ‘where is the EPR curve ?’

[palerider]

A minimum pressure of 7, maybe 8 would give you less breathing issues that disturb sleep.