Why not max out EPR and A-Flex?

[FattyMagoo]

Is there any reason you would not want to have as much exhale relief as possible?

I'm actually not sure what exhalation pressure is good for at all. It must required or I guess Bipaps wouldn't set any exhale pressure...

[123.Shawn T.W.]

My ahi goes way up with A-Flex ... I feel miserable ... I turn it all the way OFF!

Try it, see how you like each setting ...

[chunkyfrog]

I have used EPR since day one, first at 3 (max), now at 2.
Some people swallow air (aerophagia) without exhale relief, others have trouble fighting against high pressure all night.
This is especially true for people who need BIPAP.
IMHO, it should be a required feature on all machines, with control left to the patient.

[Francisfromga]

I fought my CPAP for a few weeks before I figured out 2 things. 1) I needed more humidity to keep my nasal passages from swelling shut. 2) EPR was causing AHI. I turned it OFF and have slept much better.

[avi123]

Is there any reason you would not want to have as much exhale relief as possible?

I'm actually not sure what exhalation pressure is good for at all. It must required or I guess Bipaps wouldn't set any exhale pressure...

Reply,

In CPAP mode the maximum exhale pressure is the same as the inhale pressure. For persons with Flow Limitation (including RERA and UARS) a high exhale pressure up to 15 cm is needed to treat it. In some cases, Provent could be used instead of a CPAP to treat this problem.

Those who don't suffer from Flow Limitation and who are uncomfortable exhaling into such pressure on a CPAP at a pressure of 15 cm and above, the American Association for Sleep Medicine suggests a BiPAP whereby the two pressures could be set differently. The EPR or the Flex could do it instead but only to a small degree.

[greatunclebill]

a-flex, humidity and ramp are all personal comfort features. use as much or as little as you feel you need.

[DreamDiver]

Is there any reason you would not want to have as much exhale relief as possible?

I'm actually not sure what exhalation pressure is good for at all. It must required or I guess Bipaps wouldn't set any exhale pressure...

I tried C-Flex on the M-Series Pro and found that it made my breathing race all night, even on the lowest setting, causing a sore diaphragm by morning. I felt like garbage. Once I turned it off, I got better numbers.

I tried the EPR on the S9 and found that I could increase my pressure enough to reduce my AHI to 0.7 monthly average, but still have relatively little aerophagia. I've got the S9's EPR at 3. I could never quite get rid of the aerophagia on the M-Series Pro, but the S9 makes it possible. The algorithm on the S9 feels more natural to my system than the algorithm of the M-Series Pro.

Not having tried the PRS1 Auto, I am unsure how much different it might be from the M-Series with regards to PRS1 A/C/Bi-Flex vs the S9's EPR. If C-Flex on the M-Series Pro is anything like A-Flex on the PRS1 Auto, I'd probably turn it off on that machine too.

The algorithm that each manufacturer uses to shape the breath can really make a difference in the comfort of the user. Each user is different. What doesn't work for me on one machine will be perfect for a different person on the same model. Because it's a user-settable (as opposed to admin-settable) option, it's considered an extra -- but what a difference that little extra variety of settings can make.

We're not all built the same. It's good to have options, eh?

[robysue]

Is there any reason you would not want to have as much exhale relief as possible?

Personal choice. Some folks find the rise in pressure at the end of the exhale annoying---it makes them feel as though the machine is trying to rush their breathing. Some folks find their AHI rises when exhale relief is at it's max and they don't want to raise their overall pressure to compensate.

I'm actually not sure what exhalation pressure is good for at all. It must required or I guess Bipaps wouldn't set any exhale pressure...

We need positive pressure during the exhalation because OAs typically occur when the airway collapses on exhalation. So the exhalation pressure needs to be high enough to splint our airway open during the exhales.

But breathing against constant positive air pressure causes real comfort problems for many people. They find it uncomfortable to breath out against the machine; they feel as though they can't "empty" their lungs sufficiently; they start swallowing what feels like "excess" air that they just can't get out of their nasal and oral cavities.

The drop in pressure at the start of the exhale provided by EPR or Flex makes it easier to exhale against the pressure. For many people it's a major comfort issue: If it feels more "normal" to breathe when using some form of exhalation relief, it makes it easier to get to sleep and stay asleep.

For many folks with serious aerophagia issues, a drop in pressure helps with the aerophagia because it can reduce the swallowing of excess air. For a few people (like me) the main point of being put on BiPAP is that the total, complete drop in presure that lasts for the entire exhalation part of the breath keeps the aerophagia at bearable levels.

[FattyMagoo]

"Can be set differently"

Yes, but if uars/rera is not an issue why wouldn't it always be optimal to max out EPR?

In the same case why would the optimal exhale pressure be zero?

Is there any reason you would not want to have as much exhale relief as possible?

I'm actually not sure what exhalation pressure is good for at all. It must required or I guess Bipaps wouldn't set any exhale pressure...

Those who don't suffer from Flow Limitation and who are uncomfortable exhaling into such pressure on a CPAP at a pressure of 15 cm and above, the American Association for Sleep Medicine suggests a BiPAP whereby the two pressures could be set differently.

[robysue]

"Can be set differently"

Yes, but if uars/rera is not an issue why wouldn't it always be optimal to max out EPR?

If maxing out EPR/Flex is more comfortable than a lower setting or turning it off, then max it out. But if maxing it out causes problems with comfort because you feel as though the machine is rushing your breaths because of the very slight increase in pressure at the end of the exhale, then you'll sleep better without EPR/Flex set at its max setting.

In the same case why would the optimal exhale pressure be zero?

Exhale pressure = 0 is the equivalent of the mask is not on our nose and we all know what that means: We need a positive exhale pressure to keep our airways from collapsing during our exhalations.

OAs tend to start on exhalations. If the airway is not splinted open during the exhale our OSA-plagued airways are prone to collapsing.

When titrating for a BiPAP, the EPAP (exhale positive airway pressure) is adjusted upwards until it is sufficient to prevent the OAs from happening and to eliminate the snoring, which typically occurs on exhales. The IPAP (inhale positive airway pressure) is adjusted upwards until it is sufficient to prevent the Hs, the RERAs, and FLs from occurring. The usual minimum spread between the IPAP and EPAP on a BiPAP is 4cm, but it can be set as low as 2cm and as high as something like 8 or 10cm.