EPR

Tried searching the forum, but maybe the EPR search was a little short to find anything.

Saw a post about aerophagia and EPR. Can someone explain EPR? How does it help OSA and CPAP/APAP therapy? I realize it reduces exhalation pressure and is more for comfort, but will it help or hurt OSA treatment?

The forum search feature won't do 3 characters or less...which is why you didn't get much from a search for EPR...3 characters.
Try exhaled pressure relief or do a site specific google search for cpaptalk.
In the google box type this
Site: cpaptalk.com EPR
https://www.google.com/search?client=fi ... lk.com+EPR

Usually considered a comfort thing because it drops the pressure upon exhale making it easier to breathe out against the pressure but for some people it actually can help flow limitations.

EPR...essentially pressure support....creates a bilevel pressure situation.

In addition, the term EPR is registered exclusively to Resmed,
though other companies may use a somewhat similar function-
-but must call it by a different name, and achieve their reduction differently.

I've read that you shouldn't use it unless you've had a sleep study to titrate things.

I'm assuming you could tinker with it and look at your data with Oscar. Question is if it's worth it.

In addition to improving comfort by decreasing exhalation pressure, increasing EPR may reduce flow limits and that may reduce apneas but may increase CAs. Decreasing EPR may decrease CAs. Increased number of CAs is a common side-effect of increasing EPR (which may be set to 0, 1, 2, or 3 cmH2O). Notice lots of use of the word "may"! You can't really tell what's happening without using OSCAR (or ResScan).

southerndoc wrote: ↑

Sun Jun 20, 2021 11:37 pm

I've read that you shouldn't use it unless you've had a sleep study to titrate things.

I'm assuming you could tinker with it and look at your data with Oscar. Question is if it's worth it.

First I have heard of that.
I am using the equivalent of 4 EPR (if EPR could go to 4) without a problem and I sleep better and feel better with it.
It's always been considered a comfort feature and something that patients could adjust on their own based on comfort.

chunkyfrog wrote: ↑

Sun Jun 20, 2021 11:25 pm

In addition, the term EPR is registered exclusively to Resmed,
though other companies may use a somewhat similar function-
-but must call it by a different name, and achieve their reduction differently.

for example, devilbiss calls it smartflex.

southerndoc wrote: ↑

Sun Jun 20, 2021 11:37 pm

I've read that you shouldn't use it unless you've had a sleep study to titrate things.

Well, whoever said that was talking out the wrong end.

southerndoc wrote: ↑

Sun Jun 20, 2021 11:10 pm

Tried searching the forum, but maybe the EPR search was a little short to find anything.

Saw a post about aerophagia and EPR. Can someone explain EPR? How does it help OSA and CPAP/APAP therapy? I realize it reduces exhalation pressure and is more for comfort, but will it help or hurt OSA treatment?

EPR is a limited bilevel, a limited amount of pressure support, however where PS adds to EPAP, EPR drops EPAP, leaving IPAP at the set level.

So instead of saying "I need 9 EPAP to hold my airway open, but I'd like a little PS to make breathing easier, I'll dial in 3 PS" you have to say "I need 9 EPAP to hold my airway open, I'd like 3 PS, so I'll set my pressure to 12, EPR 3"... same end result. You can't even tell a difference in the pressure waveform.

BlueDragon wrote: ↑

Sun Jun 20, 2021 11:50 pm

In addition to improving comfort by decreasing exhalation pressure, increasing EPR may reduce flow limits and that may reduce apneas but may increase CAs. Decreasing EPR may decrease CAs. Increased number of CAs is a common side-effect of increasing EPR (which may be set to 0, 1, 2, or 3 cmH2O). Notice lots of use of the word "may"! You can't really tell what's happening without using OSCAR (or ResScan).

Please bear with me so I can bring this down to my "for dummies" level:

The higher the number I set the EPR to, the more it reduces the pressure during exhalation?
If I reduce the pressure during exhalation more, it might increase central apneas?
If I download my data to Oscar, I should be able to see if it is increasing central apneas?

I'm one of the people who is bloating up with air from my new Airsense 10 For Her machine. It was so bad last night, I switched back to my Philips machine in the middle of the night. I had set my max pressure down a notch and set the EPR to 1 but it still blew me up like a balloon. Unfortunately, it seems like the air would rather go down my esophagus than my trachea. I'm on the "for her" algorithm.

I went to check the data with Oscar today only to find out there's no SD card, so I picked one up at Walmart today. Hope it works!

ILoveFlowers wrote: ↑

Mon Jun 21, 2021 11:09 pm

If I reduce the pressure during exhalation more, it might increase central apneas?

Sometimes in a very small percentage of people bilevel pressures can trigger centrals. This is actually a very small number of people.
Bilevel is when we have 2 distinct pressures...one for inhale and one for exhale....using EPR creates this bilevel situation with the drop during exhale.
Even when it does trigger centrals it's doesn't always mean you can't use it though.
Sometimes there's a line where a little more difference causes centrals but below it doesn't.
I have a friend who gets about 15 centrals per hour with a 4 cm difference between inhale and exhale and with a 3 cm difference she doesn't have a problem at all.

If you are having aerophagia problems...set EPR to 3 and see if that helps or not.
The odds are it won't increase the centrals but if it does then we deal with it.
Your machine will flag the centrals if they happen and will show up both on the LCD screen and/or the OSCAR software.

You do need the SD card to be in the machine during the night to get all the details though.

Thanks, Pugsy, I'll give it a try tonight!