ResMed EPR: Could it be worsening my sleep?

[Sleep Celebrity]

I'm a newbie, please be gentle.

I've been using CPAP for about a year and a half. I was diagnosed with moderate to severe apnea, about 60 AHI. I'm below 5 most nights with my CPAP, and I feel absolutely terrible on the rare occasions that I'm without it. It's definitely made a positive difference.

However, I've become increasingly convinced that EPR (http://www.resmed.com/int/patients_and_ ... c=patients) is affecting the quality of sleep I get. When I was in the process of tracking down my breathing issues, I was examined by an allergist. She gave me a test to determine my lung capacity and airflow, and while I've got normal lung capacity, my airflow's pretty limited. I breathe much more slowly than most people.

With my device, when I wake up, I feel like I'm hyperventilating, and the EPR feels like it's rushing my breathing. Sometimes my chest hurts a little.

Here's a screenshot from SleepyHead that seems to correlate with what I'm feeling: . My breathing rate slows and tidal volume increases dramatically around 6 am, when my girlfriend wakes up. I usually wake up and try to doze a while, since she goes to work before I do, so this represents my waking breathing rate and volume.

Should I just turn EPR off? Is there a way to slow it down? I like the idea of the feature, but need it slower, to suit my body.

[Wulfman...]

I'm a newbie, please be gentle.

I've been using CPAP for about a year and a half. I was diagnosed with moderate to severe apnea, about 60 AHI. I'm below 5 most nights with my CPAP, and I feel absolutely terrible on the rare occasions that I'm without it. It's definitely made a positive difference.

However, I've become increasingly convinced that EPR (http://www.resmed.com/int/patients_and_ ... c=patients) is affecting the quality of sleep I get. When I was in the process of tracking down my breathing issues, I was examined by an allergist. She gave me a test to determine my lung capacity and airflow, and while I've got normal lung capacity, my airflow's pretty limited. I breathe much more slowly than most people.

With my device, when I wake up, I feel like I'm hyperventilating, and the EPR feels like it's rushing my breathing. Sometimes my chest hurts a little.

Here's a screenshot from SleepyHead that seems to correlate with what I'm feeling: . My breathing rate slows and tidal volume increases dramatically around 6 am, when my girlfriend wakes up. I usually wake up and try to doze a while, since she goes to work before I do, so this represents my waking breathing rate and volume.

Should I just turn EPR off? Is there a way to slow it down? I like the idea of the feature, but need it slower, to suit my body.

You haven't mentioned what your pressure settings are or what your EPR setting is.

Try it and see. It's mostly for "comfort" anyway. Some people need it and some people have apnea events at the point where the exhale cycle ends and the inhale cycle begins. Everybody's different.

By the way, an AHI of about 60 is SEVERE. (over 30 is in the severe range)

Den

.

[Pugsy]

You can turn EPR off and see how things go.
You can also choose to use EPR only during ramp...so use it while awake and falling asleep and after ramp time EPR turns itself off.
There is a choice between Med and fast speed in cpap mode only I think. Medium is the default setting though.
See the provider manual for full details.

[palerider]

Should I just turn EPR off? Is there a way to slow it down? I like the idea of the feature, but need it slower, to suit my body.

EPR is totally and completely controlled by your breathing, there's no 'timing' involved in it. when you start to inhale, it increases the pressure and when you stop inhaling, it drops the pressure, unless you're really slow on inhaling, then it may drop it before you're done.

you can turn adjust how much it drops the pressure, from nothing, to 3cm, but that's all you can do with it.

to have any more control, you have to upgrade to a vpap (bi-level).

even so, most of them are still triggered purely by your starting an inhale, though you can configure how sensitive they are to that, and how long they'll stay at the higher pressure before dropping back to the lower (epap) pressure.

[Sleep Celebrity]

You haven't mentioned what your pressure settings are or what your EPR setting is.

Try it and see. It's mostly for "comfort" anyway. Some people need it and some people have apnea events at the point where the exhale cycle ends and the inhale cycle begins. Everybody's different.

By the way, an AHI of about 60 is SEVERE. (over 30 is in the severe range)

Den

.

EPR is at 2. I was at a starting pressure of 4, with a 4 min/9 max until last week, when my new sleep doc changed my pressure settings to 6 start/8 min/18 max. I wasn't feeling very comfortable with how he made that call, which is partly why I'm posting here. He didn't look at the CPAP data at all, he just glanced at my report and said "you should double your pressure" and did so. So far, I am seeing an improvement, but it's led me to want to take my therapy more seriously and try to understand and improve.

My original sleep test AHI was pretty bad. They stopped me midway through the first night to fit me with a device once they saw my numbers. I've emailed the sleep center and asked for a copy of the results, so hopefully I'll have something more accurate than "about 60" soon.

[Wulfman...]

OK. With an EPR setting of 2, that drops the "effective" pressure by 2 whole centimeters. So, if you were using straight pressure (for illustrative purposes), and your fixed pressure was at 10 cm., at the point where you finished your exhale, your pressure would be at 8 cm. If that isn't enough to prevent apneas, one would need to either increase the pressure above 10 or decrease the EPR setting (to 1 or turn it off).......or, both.

Welcome to the forum. The sooner you can comprehend some of this and take your therapy into your own hands, the better off you'll be.


Den

.

[Sleep Celebrity]

Should I just turn EPR off? Is there a way to slow it down? I like the idea of the feature, but need it slower, to suit my body.

EPR is totally and completely controlled by your breathing, there's no 'timing' involved in it. when you start to inhale, it increases the pressure and when you stop inhaling, it drops the pressure, unless you're really slow on inhaling, then it may drop it before you're done.

you can turn adjust how much it drops the pressure, from nothing, to 3cm, but that's all you can do with it.

to have any more control, you have to upgrade to a vpap (bi-level).

even so, most of them are still triggered purely by your starting an inhale, though you can configure how sensitive they are to that, and how long they'll stay at the higher pressure before dropping back to the lower (epap) pressure.

Is it possible that my breathing is responding to the pressure changes or something? Could there be some other factor causing me to breathe more rapidly while using CPAP? Looking at my graph, the steady number I show at night is around 15 breaths per minute, which some Googling tells me is in the normal adult sleeping breathing range.

However, I found a quote in this thread that I thought was interesting: viewtopic/t58897/breathing-rate.html

However, most xPAP units that included a "Timed" mode will - by default - shift to inhalation pressure if you do not achieve 12 breaths per minute.

It looks like my awake resting rate bounces between 5 and 12. Maybe this device includes a similar 12 minimum and steers me up towards 15ish, which is causing the feeling of rapid breathing?

I'm going turn off EPR tonight and see how I do.

[palerider]

Is it possible that my breathing is responding to the pressure changes or something? Could there be some other factor causing me to breathe more rapidly while using CPAP? Looking at my graph, the steady number I show at night is around 15 breaths per minute, which some Googling tells me is in the normal adult sleeping breathing range.

However, I found a quote in this thread that I thought was interesting: viewtopic/t58897/breathing-rate.html

However, most xPAP units that included a "Timed" mode will - by default - shift to inhalation pressure if you do not achieve 12 breaths per minute.

It looks like my awake resting rate bounces between 5 and 12. Maybe this device includes a similar 12 minimum and steers me up towards 15ish, which is causing the feeling of rapid breathing?

I'm going turn off EPR tonight and see how I do.

1) awake breathing and sleep breathing are two totally different things. awake breathing is often all over the charts, whereas sleep breathing is typically much more regular.

2) the machines are designed for sleep, you can't pay attention to what they do while you're awake

3) JohnBF is talking about high end machines, that are designed for people with severe central sleep apnea, or other severe respiratory problems, where they don't *try* to breath on their own regularly, these machines cost *much much much* more than what you have, (in the 3-5 thousand dollar range), so what he's talking about, (timed mode) is inapplicable to your case.

4) turn it off if you want, it's purely a comfort feature, there's little, if any theraputic value to it.

[Sleep Celebrity]

4) turn it off if you want, it's purely a comfort feature, there's little, if any theraputic value to it.

Okay, thanks. Sounds like you both feel pretty strongly that this won't be the culprit. I'll turn it off tonight anyway, because the risk seems low. It's disappointing, though. I guess I've got to keep reading and learning.

[palerider]

4) turn it off if you want, it's purely a comfort feature, there's little, if any theraputic value to it.

Okay, thanks. Sounds like you both feel pretty strongly that this won't be the culprit. I'll turn it off tonight anyway, because the risk seems low. It's disappointing, though. I guess I've got to keep reading and learning.

feel free to play with it

if you THINK the machine is hurrying your breathing, then what's happening is that you're hurrying your breathing because of something you think the machine is doing, even though it's not. the pressure changes could be confusing, but really, the autoset is controlled by you, not the other way around.

[zoocrewphoto]

4) turn it off if you want, it's purely a comfort feature, there's little, if any theraputic value to it.

Okay, thanks. Sounds like you both feel pretty strongly that this won't be the culprit. I'll turn it off tonight anyway, because the risk seems low. It's disappointing, though. I guess I've got to keep reading and learning.

feel free to play with it

if you THINK the machine is hurrying your breathing, then what's happening is that you're hurrying your breathing because of something you think the machine is doing, even though it's not. the pressure changes could be confusing, but really, the autoset is controlled by you, not the other way around.

When I first started cpap, I felt like I was trying to keep up with the machine. I had to remind myself that the machine was keeping up with me. If I hold my breath, I can tell the machine is waiting on me. Once I got over that feeling, I was able to breathe normally and trust the machine to do its thing.

It sounds like your data overnight is showing you breathing normally and regularly. So, the rushed feeling may only be when you are awake and aware of it. A lot of people do not need the EPR, so it is worth giving it a try without it and see if that is more comfortable for you.

It does seem a bit odd to change the settings without reviewing the data, but the changes themselves don't sound too odd. The original starting pressure of 4 was rather low and often gives a feeling of suffocation. So, he may have been trying to eliminate that as an issue.

[tortoisegirl]

Starting CPAP I quickly learned the APAP mode & EPR was not a good fit for me. I sleep much more soundly with a constant pressure without EPR. I started low and planned to increase the pressure a bit every few days as seemed appropriate per the data. However it turns out my AHI was lower with a lower constant pressure than the APAP mode was putting out. When I had asked my doctor after the first week to try a constant pressure, she instead asked me to first try a tightened up range in APAP mode (higher min pressure and lower max pressure).

That made my sleep quality and AHI even worse, so I went ahead and took things into my own hands. In the end she wasn't happy but understood it wasn't realistic to wait at least a month between appointments and making one adjustment at a time, especially when I had knowledge from here about how to look at the data. If your doctor isn't going to be helpful with specific setting changes to improve your sleep quality, you may also have to take things into your own hands. Best wishes.

[Sleep Celebrity]

I woke today without the hurried-breathing feeling, but the steady pressure seemed to cause me to open my mouth more than normal. My AHI was under 2 and I didn't have any leaking above 24 L/min, so I don't think it caused any serious issues. I'd like to keep at it with steady pressure, but I've got to fix the open-mouth thing, because it made me pretty noisy. I've also had dry mouth for several months now, so maybe it'll help with that. I just ordered a chin strap off Amazon. Can't wait to try it out.

However it turns out my AHI was lower with a lower constant pressure than the APAP mode was putting out. When I had asked my doctor after the first week to try a constant pressure, she instead asked me to first try a tightened up range in APAP mode (higher min pressure and lower max pressure).

That made my sleep quality and AHI even worse, so I went ahead and took things into my own hands.

I don't feel quite ready to adjust my own pressure yet, but it's really interesting to hear that. I'm going to look around for a new doctor, because I'm not crazy about the one I've got, but maybe it'll come to that for me, too. I definitely know there's a lot of room to improve in my sleep.

[TangledHose]

I started out years ago with straight CPAP and got used to it. When I switched to Auto PAP with EPR on highest setting (3) it did not work well for me at all, so I experimented with all three settings as well as "off". I ended up with it on the lowest setting (1).....not only was it the most comfortable setting for me but also over the long run has yielded my best ahi numbers, although it would be difficult to prove that the EPR setting had any real contribution to the lower numbers. Like they have said above just go ahead an play with it to see what works best for you, everyone is different, I am just one that doesn't get along well with EPR on a higher level. After you make a change give it a few nights to see how it works....need to give your changes some time to really get an accurate read.

[Jay Aitchsee]

Celeb, in my opinion many people do better without epr while some do better with it.
Why not post a screenshot or two of your sleep charts - events, flow, pressure, etc. so someone might be able to give you a little advice on what they see?
Good luck on a new doctor, good ones are hard to find. Again, my opinion is that most successful people learn how to manage their thereapy themselves, including setting the pressure(s) if need be.