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Hannibal 2 wrote:try and adjust

Did you use that colloquially? Or, did you really mean to express it that way?

Not criticizing, just curious.

Oh, I don't like EPR. But, try it both ways and do what works for you.

Hannibal 2 wrote:I don't have doubts, I know it's good for some people, just wondering if it's better to try and adjust to not using it.

Here's my opinion on any form of exhale relief....do whatever it takes to make you feel comfortable breathing so that you have the best chance of getting good sleep. We have to be comfortable number one to have the best chance of falling asleep and staying asleep and we gotta get the sleep first...then worry about optimizing therapy.
Best numbers in the world are totally worthless if your sleep is like crap.

I actually prefer 4 cm difference between inhale and exhale...it just feels more "perfect" to me in terms of matching my own respiration. I can do without 4 cm difference but I don't sleep as good or as long and my sleep is already fragile enough from stuff unrelated to sleep apnea so I take every advantage I can to ensure the best sleep possible.
That's why I use a bilevel machine...I found I slept almost an hour longer on average with 4 cm difference...and that extra hour translates into feeling hugely better during the day.
EPR or Flex or Pressure Support (bilevel)....are not crutches or training wheels just because they are considered "comfort" settings. I think that "comfort" is a huge factor in sleep quality and everything is fair game in the sleep quality improvement category.

What are your goals? Is it good math scores or good quality sleep?

Try the various EPR settings including off...use the one that feels more comfortable to you regardless of the setting.

Pugsy wrote:

Hannibal 2 wrote:I don't have doubts, I know it's good for some people, just wondering if it's better to try and adjust to not using it.

Here's my opinion on any form of exhale relief....do whatever it takes to make you feel comfortable breathing so that you have the best chance of getting good sleep. We have to be comfortable number one to have the best chance of falling asleep and staying asleep and we gotta get the sleep first...then worry about optimizing therapy.
Best numbers in the world are totally worthless if your sleep is like crap.

I actually prefer 4 cm difference between inhale and exhale...it just feels more "perfect" to me in terms of matching my own respiration. I can do without 4 cm difference but I don't sleep as good or as long and my sleep is already fragile enough from stuff unrelated to sleep apnea so I take every advantage I can to ensure the best sleep possible.
That's why I use a bilevel machine...I found I slept almost an hour longer on average with 4 cm difference...and that extra hour translates into feeling hugely better during the day.
EPR or Flex or Pressure Support (bilevel)....are not crutches or training wheels just because they are considered "comfort" settings. I think that "comfort" is a huge factor in sleep quality and everything is fair game in the sleep quality improvement category.

What are your goals? Is it good math scores or good quality sleep?

Try the various EPR settings including off...use the one that feels more comfortable to you regardless of the setting.

That there is excellent advice from Pugsy...

Attila wrote:
That there is excellent advice from Pugsy...

As always

Pugsy wrote:
What are your goals? Is it good math scores or good quality sleep?

I've always been far better at sleep than maths!
It's a no-brainer really!

I used EPR on max until I was trialing the Sleepweaver Elan.
Since varying pressure negatively affects the fit of a fabric mask, I turned it down.
I got used to little or no exhale relief, and stopped using it altogether.
Comfort is integral to CPAP therapy; so the question is moot.
If you need it, use it. If not, please try not to think less of those who do.

Hannibal 2 wrote:I've always been far better at sleep than maths!
It's a no-brainer really!

And I am better at math than sleep but my sleep issues are unrelated to sleep apnea. Getting good numbers is the easy part...feeling them is a whole other thing.

A nice low AHI and/or leak rate doesn't guarantee that we will feel as good as those numbers say we should feel.
There's just so much more to good restorative sleep than getting a nice low AHI and perfect leak line.
But it seems that we are a "numbers" society and need "numbers" to judge how well things are going. It's human nature I suppose but I always say that the only thing a good "number" guarantees is a nice math score.

I used to chase numbers thinking that if I could just better the numbers that I would feel like a whole new woman. It doesn't work that way...the good numbers help but there is so much more to getting good quality restorative sleep than an AHI number or a perfectly flat leak line.
I could get a perfect 0.0 AHI fairly easily enough if I wanted to use a higher pressure all night...and I could get a nice perfect leak line if I wanted to tape my mouth shut but I learned a long time ago that while taping wasn't horrible...it did disturb my sleep and for sure I don't want to use 18 cm pressure all night just to get a perfect 0.0 AHI. It simply wouldn't be all that comfortable for me and anytime anything isn't comfortable....I don't sleep the best.
If I don't sleep decently...nothing else matters. If chasing numbers means I have to do something that messes with my sleep quality then I am just shooting myself in the foot. Sometimes the cure is worse than the disease.

Pugsy wrote: I used to chase numbers thinking that if I could just better the numbers that I would feel like a whole new woman. It doesn't work that way...the good numbers help but there is so much more to getting good quality restorative sleep than an AHI number or a perfectly flat leak line.

That's pretty much what I'm doing right now, even though you've advised so many times not to. It's become a little tongue in cheek now, I know that there are so many variables that can effect how well we sleep. Yesterday my partner and I both felt tired all day for reasons we couldn't really explain. I just blame it all on my machine jokingly now, but of course I'm still learning about all of this stuff and want to optimize my therapy to the point where I KNOW that the machine cannot be blamed

In addition to what has been said I think much depends on your pressure and the mask style. At low pressures EPR may not work or may cause more problems by dropping below your effective pressure. Or can cause mask movement (and irritation) as indicated.

I think it is high pressures where it is more useful and effective. If one cannot exhale at the high pressure it is the same as not breathing and you may not be blowing of the CO. A drop in pressure can be just what is needed to blow off the CO and allow one to exhale. IMO that is where it is really important.

Hannibal 2 wrote:

Pugsy wrote:
If you want to set a target for the minimum...look at the median average..it's a better target for a minimum.

Thanks for clarifying, and apologies to Rick for misquoting him - he said average pressure, not average 95 per cent pressure.

So I'll look at my median over the past week and take the average of that.

you'd do better by looking at the time at pressure graph.

trying to do anything by min/max/median/average/95% is ... shortsighted.

palerider wrote:

Hannibal 2 wrote:

Pugsy wrote:
If you want to set a target for the minimum...look at the median average..it's a better target for a minimum.

Thanks for clarifying, and apologies to Rick for misquoting him - he said average pressure, not average 95 per cent pressure.

So I'll look at my median over the past week and take the average of that.

you'd do better by looking at the time at pressure graph.

trying to do anything by min/max/median/average/95% is ... shortsighted.

Makes sense I guess, thank you

The target of our treatment is to reduce the number of events and increase the quality of sleep (more hours of sleep)

EPR is generally considered to be a comfort setting. Use it as such to achieve that quality of sleep.

BUT
Many do not get the more advanced BiPAP needed to best handle their Central or Complex Apnea. For those individuals I suggest using therE to treat, not for comfort, their apnea. Obviously limited e pressure support but better than not having any,until a better machine can be acquired.

Last time I saw the doc, he said I could try changing the EPR to see if I got improved results. He sets his own to off and says that helps prevent his airway from collapsing during exhales. Aside from comfort issues are you saying there could be a downside to no or reduced EPR in the form of increased Central or Complex Apneas?

LoBattery wrote:Last time I saw the doc, he said I could try changing the EPR to see if I got improved results. He sets his own to off and says that helps prevent his airway from collapsing during exhales. Aside from comfort issues are you saying there could be a downside to no or reduced EPR in the form of increased Central or Complex Apneas?

Just saying/thinking that if EPR is lowering pressure, the machine may be slightly less effective in hitting the required pressure in time to deal with events, but clearly if EPR helps someone to sleep better, then even with a slightly raised but 'treated' AHI you're going to feel better. As Pugsy says, sleep quality is far more important than the Math, it's just getting the balance right.