Necessary to wean off of EPR?

chunkyfrog wrote: ↑

Wed Aug 15, 2018 11:12 pm

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

He also prefers a fixed pressure and not apap.

That doesn't make him a bad dude though. He has his own way of looking at some things and had developed his own thoughts....just like everyone else here. What he doesn't do is try to cram his beliefs down someone's throats and will at least offer other options and not tell the person that the other way will kill you or similar wording. He's more than willing to say "I prefer so and so but if so and so works best for you then I am all for it".

I have always felt like we can still be friends with people that have different opinions than ours.
A little something called respect....respect their right to hold a different belief. We don't have to agree with it but we should at least respect it.

Some people just don't like EPR for whatever reason....zonker is a recent example. He has tried it and just can't sleep well with it.
Maybe years of conditioning with the Respironics way of offering exhale relief is part of it....if he even used it at all.
Flex is different...it feels different...not bad different but just different and after years of using it or not using it then trying EPR and the ResMed way may just seem too foreign to get comfortable with. The brain and body likes predictability...they don't like for things to change and for some people it is simply too much of a change to deal with easily. The brain keeps saying "hey dude, something weird is happening and I am not comfortable with it so I won't let you go to sleep"

It is so nice to have options available though. Some people will think those options are the greatest thing since sliced bread and others will roll their eyes at the people using those options and some people even make fun of those people who elect to use those options (ramp, epr, humidity, etc). When they make fun of people using available comfort options...really irritates the hell out of me.

Every thing in life comes with baggage..everything...we just have to evaluate the baggage and decide if the baggage is worth it or not and maybe make some adjustments so the baggage doesn't weigh so much.
If using EPR drops the pressure down and allows the airway to close...easy fix if a person doesn't want to give up the comfort...just use a little more pressure to offset the drop.
If a person likes to ease into the pressures..use ramp and if using ramp maybe means falling asleep and having apneas go untreated before the ramp period is up...lots of ways to deal with that...from shortening the ramp period to even going with the new smart/auto ramp features on these new models that supposedly will end ramp if it thinks you are asleep.

There's always ways to lighten the baggage load...some might work for some people and not others but there are lots of things to try to make this therapy work better and more comfortably.

I turned off my EPR yesterday before bed just to see. I went up and down from 1 to 3, there is a big difference for me, turned it back on setting at 3 and slept like my puppy dog.

kteague wrote: ↑

Wed Aug 15, 2018 3:22 pm

Nice new avatar, Kathy. You are looking great!

Pugsy wrote: ↑

Thu Aug 16, 2018 6:30 am

. . .
He also prefers a fixed pressure and not apap.
. . .

Truth be told, my own range is rather tight--but it works for me.
I used a larger range in order to find it.
Everybody should be able to decide for themselves.
IMHO.

dang it! i responded to this yesterday but it didn't stick.

anywho, i seem to react to EPR in an opposite fashion. it's like it makes it harder for me to breathe. it's like it "shortens" my span of breath. like, as soon as i exhale, i MUST inhale immediately. and that's not how i normally breath at all.

so i've turned it off on my airsense and lowered pressure and slept MUCH better last night.

I was having bad problems with aerophagia, so Pugsy suggested an EPR of 3. That helped with the aerophagia, but a maximum pressure of 16 with EPR of 3 didn't seem to give me much different results aerophagia-wise than a straight max of 14 without EPR. I thought initially that it was the IPAP that was the prime factor in preventing obstructive apnea, but was told it EPAP was more important. Since the higher pressure causes more problems with mask leakage, I concluded that I'm better off without EPR and just using the lower pressure if my main concern was reducing my horribly high OAs. In reality, I need a max pressure of about 18, so I'm still looking for a mask that won't burp, fart and whistle at the higher pressures and won't give me the same level of aerophagia. (From my experience to date, some masks seem to be worse that way than others.)

Other than the effect of aerophagia, I didn't feel much different in comfort of breathing between EPR on or off.

In defense of Jason, he did say essentially that it was a minority of people that had problems with the EPR, but that he was concerned about that minority.

CPAPSteve wrote: ↑

Thu Aug 16, 2018 4:10 am

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!

EPR *lowers* your effective pressure. If your AHI improved with EPR off, then try raising your set (or min) pressure by the amount you have EPR set to.

ie, your pressure is 10, turn on EPR 3, that makes your pressure 7, so, raise your set pressure to 13, which brings the effective pressure back to 10.

JayDee wrote: ↑

Thu Aug 16, 2018 5:07 am

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?

Yes, absolutely, a small subset of people get pushed over a line, and their body says "oh, I'm good, I don't need to take a breath for a little longer than usual" and the machine records a central. But, saying "OH, GET OFF EPR JUST IN CASE" is short sighted.

JayDee wrote: ↑

Thu Aug 16, 2018 5:07 am

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.

If you don't find an advantage having it, then don't use it, easy peasy.

zonker wrote: ↑

Thu Aug 16, 2018 11:22 am

dang it! i responded to this yesterday but it didn't stick.

anywho, i seem to react to EPR in an opposite fashion. it's like it makes it harder for me to breathe. it's like it "shortens" my span of breath. like, as soon as i exhale, i MUST inhale immediately. and that's not how i normally breath at all.

You're a weird one, Zonker.

Uff Da wrote: ↑

Thu Aug 16, 2018 1:32 pm

I was having bad problems with aerophagia, so Pugsy suggested an EPR of 3. That helped with the aerophagia, but a maximum pressure of 16 with EPR of 3 didn't seem to give me much different results aerophagia-wise than a straight max of 14 without EPR. I thought initially that it was the IPAP that was the prime factor in preventing obstructive apnea, but was told it EPAP was more important.

Yes, IPAP is *totally irrelevant* with OA... it's the lower pressure that holds your airway open, if your airway closes, you won't be able to take the breath that causes the pressure to switch to IPAP.

palerider wrote: ↑

Thu Aug 16, 2018 2:14 pm

zonker wrote: ↑

Thu Aug 16, 2018 11:22 am

dang it! i responded to this yesterday but it didn't stick.

anywho, i seem to react to EPR in an opposite fashion. it's like it makes it harder for me to breathe. it's like it "shortens" my span of breath. like, as soon as i exhale, i MUST inhale immediately. and that's not how i normally breath at all.

You're a weird one, Zonker.

<tips hat>

Hey zonker....when you were using the Respironics machine did you use Flex exhale relief at all?

Pugsy wrote: ↑

Thu Aug 16, 2018 6:55 pm

Hey zonker....when you were using the Respironics machine did you use Flex exhale relief at all?

i DID try it on the respironics. and with pretty much the same results. in one post, way back when, you even suggested i turn it off.

i only tried it on this machine on the off-chance it would work "more better". ( i don't know why i thought that!) but, alas and alack, it doesn't

not that i'm worried. as i said, last night was great and we'll see how tonight goes.

zonker wrote: ↑

Thu Aug 16, 2018 7:41 pm

not that i'm worried. as i said, last night was great and we'll see how tonight goes.

There must be something in the timing of the change from inhale to exhale and back to inhale that your body just doesn't like.
It's not worth worrying about though. We will just put you in the weirdo category...you aren't alone.
Just joking....it's okay for you to be different...it's just proof for why we say YMMV.

Pugsy wrote: ↑

Thu Aug 16, 2018 7:45 pm

zonker wrote: ↑

Thu Aug 16, 2018 7:41 pm

not that i'm worried. as i said, last night was great and we'll see how tonight goes.

There must be something in the timing of the change from inhale to exhale and back to inhale that your body just doesn't like.
It's not worth worrying about though. We will just put you in the weirdo category...you aren't alone.
Just joking....it's okay for you to be different...it's just proof for why we say YMMV.

hmmmm....great! i get to be the exception that enforces the rule!

no problem at all. maybe i can be an example to others to realize THEY can be different too!