EPR/flex make me feel really crappy.. why?

Hello all

UARSer here trying to figure out cpap.

I've tried my prescribed pressure without success. I was titrated for snoring, not FL or arousals.

Trying to increase pressures gradually but have had a harder time at anything above 9 due to difficulty exhaling. I will actually wake up because of it. Note I use straight pap.

In the past Whenever I use flex or EPR (I have two machines, have tried both), I wake up feeling extremely shitty/headache/ tired .. moreso than usual. Very foggy too. There are no centrals in the sleepyhead report.


I'm wondering as I have the opportunity to buy a bilevel but not sure if I should waste the money, if I've had a poor experience on EPR and FLEX.

I've tried this numerous times. Feel shitty on any relief setting, but fine/baseline at straight pap.

Why??

Don't know why you have problems with EPR/Flex unless the drop in pressure with the use of exhale relief is allowing more flow limitations to happen when end up meaning poor quality sleep.
Sometimes when people use EPR/Flex they have to use a little bit more pressure to offset what might happen during the time at lower pressure during exhale when exhale relief is used.

But that then creates another problem ...higher pressure which caused the need to use exhale relief in the first place.

With EPR at 3...that's like using a bilevel machine set to 3 Pressure support. Feels the same and pretty much works the same except with a bilevel machine you can have greater than 3 difference between inhale and exhale. Might allow you to use higher pressures with more comfort. It's the difference between inhale and exhale that makes it easier to breathe.
Example...10 cm pressure...not all that high but a bit uncomfortable for some people.
Using 12 inhale and 9 exhale is actually more comfortable than using 10 without any relief despite the 12 inhale.
Using bilevel you can stretch it out a bit and maybe use 12 inhale and 8 exhale and get the same results and be more comfortable. The higher IPAP helps offset what might happen during the drop on exhale.

Flex...the most you can get is a 2 cm reduction because Respironics bases their flow reduction on how forcefully you breathe.
It's not a linear reduction like ResMed EPR. With Flex relief the most anyone can get is a 2 cm reduction even at a setting of 3.

Would switching to a bilevel help....you have UARS which makes it hard to evaluate. I honestly don't know if it would enable you to use higher pressures or not comfortably enough and do the job because with UARS we don't always know what the pressures are. Tough call.
But using PS Pressure Support which is just the difference between inhale and exhale...of 4 is much easier to breathe with than 3... PS of 5 is easier than 4...I don't suggest going higher than 5 in PS unless under a doctors care. Too much PS can create breathing instability issues and centrals. Now sometimes people need higher PS because of lung issues...and those people need to be under a doctors care anyway.

Okay thanks.

Does it get easier to breathe against higher pressures after a few nights?

I'm so sad. I feel so crappy and am missing out on life. I don't know where to go to find help for a proper titration. Aside from maybe Krakow.

Yes, I think that it gets easier to exhale against higher pressures as one goes along.
Plus...you don't have to do a big jump. There's nothing wrong with taking the slow road upwards.
ResMed machines allow 0.2 cm increments...Respironics 0.5 cm increments.
Use a setting for a week or 2 and then make another small adjustment.
I did that back when I was first starting therapy and I was using a 10 cm minimum and 20 cm max in apap mode.
It was a Respironics machine so 0.5 cm increments. Going from 10 to 13 wasn't real pleasant.
The purpose of the experiment was to see if I saw any difference in AHI numbers or how I slept or felt.
So I did 0.5 cm each week until I hit 13 for a week. Was much easier for me.

Come to find out no difference at all between 13 and 10 minimum so I aborted the experiment and saw no need to go further.
Now something interested did happen when I went immediately down to 10 starting instead of the 13...I felt a bit air starved...like I was suffocating. I knew what it was though so I just bulled through it and in a couple of days it wasn't an issue.

mangos21 wrote:Okay thanks.

Does it get easier to breathe against higher pressures after a few nights?

I'm so sad. I feel so crappy and am missing out on life. I don't know where to go to find help for a proper titration. Aside from maybe Krakow.

Yes - time will help. I found that it takes a few days to get used to every 1 cm change. I now exhale into 15cm and it feels effortless.

xxyzx wrote:

mangos21 wrote:Okay thanks.

Does it get easier to breathe against higher pressures after a few nights?

I'm so sad. I feel so crappy and am missing out on life. I don't know where to go to find help for a proper titration. Aside from maybe Krakow.

==

the higher the pressure the easier it is to breathe
it is the exhale that can be harder

i had trouble at 10 cpap
they gave me 11/14 bipap and no problem breathing per se (other problems due to sleep lab effupp)
then i got an ASV
i have had no problem with breathing either inhale or exhale at even higher pressures
it was set for exhale min/max 10/10 and inhale min/max 10/25
basically straight cpap at 10 unless the machine decided to fix some other problem
i just noticed today that somehow that exhale got changed to 10/15 and i need to call the DME to see if they did that

i would bet a bipap could help but rent it first to see how it works
i would bet more an asv would help but that is way too expensive unless you cant get a bipap to work at all

Your post does not appear to have anything to do with the posters question. Perhaps you could respond to the question or delete your response.

xxyzx wrote:

TedVPAP wrote:

xxyzx wrote:

mangos21 wrote:Okay thanks.

Does it get easier to breathe against higher pressures after a few nights?

I'm so sad. I feel so crappy and am missing out on life. I don't know where to go to find help for a proper titration. Aside from maybe Krakow.

==

the higher the pressure the easier it is to breathe
it is the exhale that can be harder

i had trouble at 10 cpap
they gave me 11/14 bipap and no problem breathing per se (other problems due to sleep lab effupp)
then i got an ASV
i have had no problem with breathing either inhale or exhale at even higher pressures
it was set for exhale min/max 10/10 and inhale min/max 10/25
basically straight cpap at 10 unless the machine decided to fix some other problem
i just noticed today that somehow that exhale got changed to 10/15 and i need to call the DME to see if they did that

i would bet a bipap could help but rent it first to see how it works
i would bet more an asv would help but that is way too expensive unless you cant get a bipap to work at all

Your post does not appear to have anything to do with the posters question. Perhaps you could respond to the question or delete your response.

go bleep yourself

it absolutely has meaning in context of the question

As MANY HAVE SAID: IGNORE XXYZX. HIS ADVICE IS USUALLY WRONG AND CAN BE DANGEROUS!