S9ers Have you changed the EPR Inhale Type?

[rested gal]

"Fast" is without the Easy-Breathe. "Medium" is Easy-Breathe.
see Resmed's EPR with Easy-Breathe, at the very end.

O.

The link in ozi's post goes here:
http://www.resmed.com /assets/documents/technology/epr/fact_sheet/1012764_epr_fact-sheet_row_eng.pdf
I added a space after "resmed.com" so the link can be seen in its entirety. Take out that space to make a long working link.

Here's a screenshot of what ozij was talking about...showing the difference between how "fast or medium" handle going up to full pressure when a person starts to inhale again:


In a nutshell, "fast" means the full pressure happens almost immediately -- the instant you start to breathe in again. That instant jump up to full pressure again can feel abrupt or jarring or "too strong" to some people. Especially if it's a jump up of 3 full cms with EPR set on "3" for a 3 cm drop in pressure each time you exhale.

"Medium" means that when you start to inhale, the machine moves up more gradually to full pressure, instead of jumping to full pressure. Even though it's a gradual move upward, it's gradual in milliseconds...which is still pretty fast. Those milliseconds of "gradual-ness" do feel smoother, though. There's a less sudden return of full pressure with EPR "medium" selected.

I think of ResMed's new "Easy-Breathe" as being like a regular bilevel machine's "Rise" time setting. The Rise time setting in a true bilevel machine does the same thing -- lets you set how fast (or how gradually) you want the full inhale pressure (IPAP) to happen each time you start to inhale.

I also think of "Easy-Breathe" as being somewhat like Respironics' "A-Flex." A smoother feel to breathing in and out with both those features.

Respironics' A-Flex and ResMed's EPR work differently from each other, but A-Flex also smooths out the transitions between inhaling/exhaling.

Respironics' A-Flex lessens the abruptness of how it feels when higher pressure starts coming back in before the exhalation is completely finished.

ResMed's Easy-Breathe lessens the abruptness, too, when a person using EPR starts to inhale.

[DreamOn]

Thanks for that fantastic explanation of EPR Inhale, rested gal! The way you described it is exactly how fast vs. medium feels to me.

[frh]

frh, I believe that if you have your CPAP pressure set at 6 and are using EPR at 3, your EPR is actually at 2 since the lowest the machine pressure can go is 4. In other words, with EPR at 3, your inhale pressure is 6 and your exhale pressure is 4, and if your EPR is at 2, it's the same. That may be why you weren't feeling the difference. I feel a huge difference in EPR between the 1 and 3 settings when used at higher pressures.

I knew that already. I have it set that way right now is so I can show the sleep doc can see I am complying with my sleep study when he sees my ResScan reports.

A couple of months ago I tried APAP with the pressure set from 6 to 12 and EPR set at 3. I gave up on that because my 95% pressure jumped to around 11 and stayed there every night. My AHI was most always around 5, with a fair amount of centrals. I turned EPR off for a few nights, and honestly didn't notice the difference. I think that's because EPR matches my breathing pattern pretty well. I had a chance to try someone's PR System One (while awake, at a pressure of 8 with C-flex at 3), and I definitely noticed C-flex cutting in and out.

Edit: Turns out my EPR was set at 2. I thought I had changed it back to 3.

[Physician]

um, I cant find it.. it has epr one, two, or three, but I dont see an inhale type function on the menu?

I have the s nine autoset..

The med/fast "EPR Inhale" setting is only available in CPAP mode on the S9 Autoset. You won't see it as a menu option if you have the machine set to Auto mode.

That's absolutely correct.

ResMed Tech Support sent me an explanation of this. Will post it later today.

[frh]

...ResMed's Easy-Breathe lessens the abruptness, too, when a person using EPR starts to inhale.

At my sleep study, they put me on CPAP around 1 am. I guess they were done figuring out what they needed to figure out by the time I woke around 4 am to use the restroom. I asked her what BiPAP was like and when I returned to bed she let me try it while I got back to sleep. It abruptly resumed the pressure just before I was finished exhaling. I found it quite annoying. After I woke and was getting ready to go home, the sleep tech told me the abruptness was because it was a PR machine and she said people get used to it.

[kempo]

Would the fast setting help someone who has problems with centrals? This screen shot looks like it might. That's my main problem now. My s9 has done a great job eliminating my obstructives.

[Uncle_Bob]

Thanks for the replies and the detailed explanation Laura.

I'm curious and may try the fast setting out tonight and see if helps with centrals which is all i seem to be getting now. I don't mind the odd one or two but 10-20 throughout the night is too many.

[kempo]

Thanks for the replies and the detailed explanation Laura.

I'm curious and may try the fast setting out tonight and see if helps with centrals which is all i seem to be getting now. I don't mind the odd one or two but 10-20 throughout the night is too many.

Same here Uncle Bob. I have anywhere between a dozen and a couple a dozen centrals every night. I think I'll try it tonight also.

Thanks Laura for that information. I learn something new here every day.

[Uncle_Bob]

Ok i tried it out last night. Friday night is my poor sleep hygiene night and I'm normally over tired going to bed, so getting to sleep with the Inhale set to fast was not much of an issue.

I took a while to figure out how to change the setting, I found out that you have to set the machine to CPAP mode first. So i finally got settled down with CPAP at 7cm with EPR 3.

I got an AHI of 0.5 which is excellent for a poor sleep hygiene night. I had 5 centrals and my AHI graph was much flatter.

I may try this again and see if i can get a trend going. The only downside is more noise, my wife complained that she could hear me breathing when normally she does not.

I'll be interested to see how other people do if they try this out.

[frh]

I switched mine to fast last night too. Unlike the medium setting, I noticed it kicking in with each breath. It wasn't particularly annoying, just noticable. Last night my AHI was 1.6. On the detail graph I counted 5 centrals, 6 obstructive apneas, and for the first time ever, no hypopneas.

As I said before, I think I have a lot of shallow-breathing episodes that are not quite shallow enough to be hypopneas. The two images I posted show I was breathing a lot deeper last night.

August 12:


August 13:

[Physician]

Ok i tried it out last night. Friday night is my poor sleep hygiene night and I'm normally over tired going to bed, so getting to sleep with the Inhale set to fast was not much of an issue.

I took a while to figure out how to change the setting, I found out that you have to set the machine to CPAP mode first. So i finally got settled down with CPAP at 7cm with EPR 3.

I got an AHI of 0.5 which is excellent for a poor sleep hygiene night. I had 5 centrals and my AHI graph was much flatter.

I may try this again and see if i can get a trend going. The only downside is more noise, my wife complained that she could hear me breathing when normally she does not.

I'll be interested to see how other people do if they try this out.

Are you indicating that you changed to CPAP mode to change the climb, and then went back to AutoSet and you think the now disabled climb is still effecting the air flow curve ?

[DreamOn]

I switched mine to fast last night too. Unlike the medium setting, I noticed it kicking in with each breath. It wasn't particularly annoying, just noticable. Last night my AHI was 1.6. On the detail graph I counted 5 centrals, 6 obstructive apneas, and for the first time ever, no hypopneas.

As I said before, I think I have a lot of shallow-breathing episodes that are not quite shallow enough to be hypopneas. The two images I posted show I was breathing a lot deeper last night.

frh, thanks for posting your graphs!

I'm just curious, what was your CPAP pressure last night, and what EPR setting did you use with EPR Inhale set to Fast? That night of August 12 you had quite a few more obstructive apneas than you did last night. Was that at the same pressure and EPR level (1, 2 or 3) as last night? If you continue EPR set to Fast for a longer period of time, I'd be interested to know if your results continue to be better. I'd also be interested to know if your sleep quality is better or worse on Fast over time.

I hadn't used EPR at all for many months, but I just switched to EPR 1 a few nights ago. Results have been good (one night was zero AHI -- my fourth AHI 0.0 using this machine). I'm using APAP set to 6-9 right now, so I can't change EPR Inhale to Fast, but I may switch back to CPAP mode to experiment with that. I had tried the Fast setting on my S8 Elite II machine and it was too fast for me, but the S9's EPR seems smoother so it may feel different. Plus, I've been on CPAP therapy for a lot longer now, so I could probably tolerate it better.

Thanks again for sharing your results. And thanks to Uncle_Bob also!

The med/fast "EPR Inhale" setting is only available in CPAP mode on the S9 Autoset. You won't see it as a menu option if you have the machine set to Auto mode.

That's absolutely correct.

ResMed Tech Support sent me an explanation of this. Will post it later today.

Physician, I would be interested to read what ResMed Tech Support sent you regarding "EPR Inhale." I'd like to know why Fast "EPR Inhale" is an option in CPAP mode, but not APAP mode.

[kempo]

I switched my settings last night to CPAP 12cm EPR 3 fast setting. The results AHI 6.1 all centrals. I have been using APAP 10-12 with EPR off and my AHI has been around 1.9- 2.9 the past week. I think I will stick with the APAP settings.

[frh]

frh, thanks for posting your graphs!

I'm just curious, what was your CPAP pressure last night, and what EPR setting did you use with EPR Inhale set to Fast? That night of August 12 you had quite a few more obstructive apneas than you did last night. Was that at the same pressure and EPR level (1, 2 or 3) as last night? If you continue EPR set to Fast for a longer period of time, I'd be interested to know if your results continue to be better. I'd also be interested to know if your sleep quality is better or worse on Fast over time.

The only change I made was setting EPR Inhale from medium to fast. My numbers bounce around a lot, so the change in AHI could have been just because it was a different night. But every night (since that Flow chart showed up about 3 weeks ago) my breathing has stayed in a band between 23 and -37 on the Flow chart. The remarkable difference is last night (with the EPR Inhale set on fast) was the first that it stayed between 38 and -37. I take that to mean I am breathing deeper with it in Fast mode. I still have not installed the software for the CMS 50D plus oximeter, so I can't tell you how much it might affect SO2.

Aug 12th:


Aug 13th:

[DreamOn]

The only change I made was setting EPR Inhale from medium to fast. My numbers bounce around a lot, so the change in AHI could have been just because it was a different night. But every night (since that Flow chart showed up about 3 weeks ago) my breathing has stayed in a band between 23 and -37 on the Flow chart. The remarkable difference is last night (with the EPR Inhale set on fast) was the first that it stayed between 38 and -37. I take that to mean I am breathing deeper with it in Fast mode. I still have not installed the software for the CMS 50D plus oximeter, so I can't tell you how much it might affect SO2.

I know what you mean about the night-to-night variability. Your results with EPR Inhale at Fast are substantially better than the other night, so I hope that trend continues for you! I'd be interested to know if you do see any difference in oximeter results as well, once you get that set up.

Thanks for sharing that information. It may be helpful to some other folks as well. We all have different breathing patterns, so it may be that some who use set CPAP pressure and EPR will benefit from Fast EPR Inhale rather than the default Medium setting.