Necessary to wean off of EPR?

So I was watching some YouTube vids from the LankyLefty and in one of his many vids he makes mention of EPR settings on CPAP machines and I swore I heard him say to wean off of EPR as one gets accustomed to using CPAP. Is that actually true? I did try shutting off EPR on my unit and I found it to be quite weird to breathe against my CPAP starting pressure around 11 cwt. I can’t imagine trying to exhale at 15+ CWT.

If it is TRUE that one should wean themselves off of EPR is it just time and a gradual reduction in EPR that ultimately leads to being EPR free?

I find with EPR enabled at 3 (as how I was given the machine) that breathing feels very natural and I have no complaints otherwise.

Thanks,

EPR is strictly a comfort thing for some people, and others have a hard time sleeping with out it. I use a bilevel machine with fairly high pressure (17 - 20) and find the pressure support makes it much easier to sleep at night. I can exhale against that much pressure, but it feels almost like it does when I have an asthma attack. We all do what ever makes it easier for us to sleep well, not just sleep.

Nope.

Just 'cause someone posts something on a public forum doesn't mean it's true, or they know what they're posting about.

The obstruction part of OSA takes place during inspiration (breathing in). That's the stage of breathing that it's most important to support by means of increased pressure. Once the lungs are full and the diaphragm muscles relax, tension in the rib cage provides plenty of pressure to force the air back out. Reducing the back pressure during expiration aids in the flow of air, but isn't necessary. It's a comfort issue, not a functional one.

Do what gives you an effective and comfortable therapy.

I dislike EPR, but it's OK for you to like it.

I like EPR/exhale relief...been using it for all the years (9+) I have been using cpap and I don't plan on stopping it...nor do I want to.

This is one area that I disagree with Jason (LankyLefty) on though I do understand where he is coming from and why with his thoughts about it. Just like in everything else about cpap there are some pros and cons. As long as person understands them and accepts them..nothing wrong with using or not using it.
You get to decide what feels best for you .......
Some people can take it or leave it....some people having that available exhale relief is a critical difference between tolerating the machine and not.
I can take it or leave it ...but I prefer to take it.
And since it is my body I get to do with it whatever I want.

Thanks for the quick responses. Okay so I didn’t hear him (Jason) wrong. Yeah I tried just one night with no EPR and although AHIs were down slightly (not statistically signicant) that I’d hate to try another night with EPR off.

Some people who are having trouble adjusting to treatment or having side effects like air in the belly end up needing to either lower their pressure or fully utilize their pressure relief on exhale to get them over the hump and persevere with treatment. When these types of changes cause a compromise in effectiveness of treatment that is not acceptable over the long haul, one might be best served to gradually go back to more effective settings if they find they have adjusted and no longer need them. If the settings do not overly compromise the effectiveness of treatment, there is probably no need to give them up. I do suggest any efforts to make changes be done incrementally. Why turn EPR off if turning it from 3 to 2 is an option? If turning it off proved problematic, moderation may be key.

I started out with EPR, and had not considered turning it off
until it was advised to help a cloth mask fit better.
After that, I got used to not having it; and I never needed to use it again.

CPAPSteve wrote: ↑

Wed Aug 15, 2018 1:55 pm

If it is TRUE that one should wean themselves off of EPR is it just time and a gradual reduction in EPR that ultimately leads to being EPR free?

No, it's not true. I'm quite happy with the equivalent of a 6 epr ('course, that means bilevel)

Think he might have mentioned eliminating RAMP not EPR. Most don't use ramp after adjusting to being a hosehead.

Muse-Inc wrote: ↑

Wed Aug 15, 2018 8:53 pm

Think he might have mentioned eliminating RAMP not EPR.

I haven't watched all his videos but just the other day he was telling someone to reduce or turn off EPR because it lowered the pressure on exhale and sometimes this creates a problem. A lot of sleep techs have their own way of doing things or looking at things...you should see them argue over on the sleep tech forum....I used to go read there just to watch the fights. Makes some of our fights here look lame by comparison.
So sleep techs also come with that big old YMMV sticker.

Pugsy wrote: ↑

Wed Aug 15, 2018 9:05 pm

...he was telling someone to reduce or turn off EPR because it lowered the pressure on exhale and sometimes this creates a problem. A lot of sleep techs have their own way of doing things or looking at things...you should see them argue over on the sleep tech forum....I used to go read there just to watch the fights. Makes some of our fights here look lame by comparison.
So sleep techs also come with that big old YMMV sticker.

Wow, just wow! Thanks Pugsy.

Other than that little thing, I like Jason.
Nobody's perfect, but he's a decent dude.

Moderation is probably best but I got wondering and thought in shutting EPR (level 3) off to see if I could tell the difference. Suffice to say that it felt like it was a lot harder to exhale. My AHI improved slightly with EPR turn off but my AHIs were low to begin with. Needless to say I feel much more comfortable with EPR on. Interesting that such subtle differences in pressures can have such a profound impact on comfort and AHI numbers!

I think I saw the same video and, presuming my newbie, non-confident understanding is semi-close, he was talking about how CO2 impacts your body's "drive" to breathe and he saw EPR as a contributor to (for some folks) leading them to over-oxygenate and/or lower their CO2 levels. So presumably, hyperventilation is "easier" for some folks with EPR on?

It sounds plausible, but what the heck do I know? I once thought nothing was as easy as breathing. Then my Doc referred me for a sleep study and *BAM*, a whole new education began and it's not always intuitively clear. So my understanding of things is not yet accompanied by any decent level of confidence...

Personally, I have EPR turned off because I tried it and my breathing felt (purely subjectively) more "satisfying", for lack of a better word. I believe I could tolerate it either on or off.

-JD