EPR

I'm using a ResMed S8 VPAP ST. This is my back up machine as after 6 months I couldn't tolerate my S9 AutoSet, which was basically a CPAP machine. I don't see an EPR setting when I get into the clinical menu. I had that setting when if I change it from VAUTO to CPAP mode though. Is it there? I'm starting to not get a restful night's sleep, and becoming sleepy during the day. I'm also told that I would have to get another sleep study. As I'm Medicare eligible derailing with them is like talking to the wall. I can talk to 10 different people asking the same question and get 10 different answers.

My data card is different than an S9 card also, and I don't have a card reader to see my data in SleepHead My former DME was LINCARE whom I no longer deal with. They were the only one in Colorado Springs at the moment.

Pat

from my crude understanding
I think a VPAP machine already compensates for exhaling

I am sure someone with more knowledge will correct me if I am wrong

apw5746 wrote:I'm using a ResMed S8 VPAP ST. This is my back up machine as after 6 months I couldn't tolerate my S9 AutoSet, which was basically a CPAP machine. I don't see an EPR setting when I get into the clinical menu. I had that setting when if I change it from VAUTO to CPAP mode though. Is it there?

EPR is only available in cpap or apap modes...not available in any bilevel modes. It's ResMed's form of exhale relief and functions very much like bilevel pressures with change in exhale and inhale and since that's what bilevel does...ResMed didn't see the need to add EPR to the bilevel modes. They are already reducing the pressure when using a different EPAP and IPAP setting.
Using EPR in cpap or apap mode makes the machine function sort of like a bilevel pressure machine would function. The timing is a bit different but overall it feels about the same. I tried cpap mode with EPR of 3 and fixed bilevel mode with PS of 3 and it felt pretty much the same. Maybe tiny bit of difference if I really strained to perceive a difference.

Some doctors around town have been requesting or even ordering that we do not use EPR or CFlex because they state it increases AHI on their patients. We have also had some patients (not many but some) come back and have some general complains regarding air flow etc.. and when we turn off the EPR or CFlex they do better. As the other post said...helpful when first starting off on cpap but then it wears of as you get used to cpap in general.

That would be a great topic for a formal study. I don't think this has been explored previously... has it?

With EPR, you're spending part of your sleep cycle at a lower pressure. It would make sense that for some people, this might increase AHI. Perhaps, rather than eliminating EPR, it might be useful to slightly raise the base pressure. There might still be some value in EPR doing it this way.

As for centrals, the results reported here seem to be conflicting. Some see an improvement, some get worse.

I think EPR is something that should be tried, and then evaluated for each patient, especially in terms of CA. Patient comfort with EPR also seems to be a trial and error thing.

Hosecrusher, there have been several studies (but most have been funded by Repironics and focus on C-Flex). The studies seem to show no effect of exhalation relief on the efficacy of therapy (which is what the manufacturers would want the findings to be) with a short term effect of exhalation relief on compliance.

It has worked for me and since my numbers are good, I haven't bothered turning it off (even though I think I would be fine with it off).

archangle wrote:With EPR, you're spending part of your sleep cycle at a lower pressure. It would make sense that for some people, this might increase AHI. Perhaps, rather than eliminating EPR, it might be useful to slightly raise the base pressure. There might still be some value in EPR doing it this way.
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Or set it up only in ramp mode

I believe in "creature comforts" and want to be as comfortable as possible while I sleep, so I use EPR.

I started off with it set to 3, but my pressure was so low (around 9 or 10 if I recall correctly) that it caused some problems. I then dropped it to 2. About this time a discussion came up about EPR reducing therapy below what is needed and a suggestion was made that it may be worth thinking about increasing the pressure on fixed CPAP to compensate for the pressure drop. I moved from a CPAP to an APAP and found the range of pressure that seems to work best for me.

A few months of reviewing data helped me dial things in, so now I have EPR set to 1 and spend 95% of the time at or below 11.

I believe the propaganda that ERP and Ramp offer additional comfort. I think it helps. Placebo or real, I really don't care. I wake up refreshed after a comfortable nights sleep and over the past year have seen my AHI hoover around 3.6 with an Apnea Index average of 0.7. My particular machine (S8) is very aggressive at scoring Hi's so the AHI is inflated.