CPAPtalk.com

Today the AHI is 2.2 with the EPR turned off so I am pretty happy with that. F20 mask. 1/2 central, 1/2 OAs. Will keep it this way and see how it goes.

Down anyone know why turning the EPR completely off has helped? I'm just wondering how it works.

EPR is exhale pressure. EPR 1 drops the pressure by 1 cmH2O, EPR 2 drops pressure by 2 cmH2O, and EPR 3 drops pressure by 3 cmH2O when you exhale.
If your setting is 10 cm, EPR 1 = 9 cmH2O, EPR 2 = 8 cmH2O, EPR 3 = 7 cmH2O when you exhale.
In my (not so educated) opinion, maybe this drop in pressure is the reason for your high AHI's

Iamstumped wrote: ↑

Tue Jun 28, 2022 1:04 pm

EPR is exhale pressure. EPR 1 drops the pressure by 1 cmH2O, EPR 2 drops pressure by 2 cmH2O, and EPR 3 drops pressure by 3 cmH2O when you exhale.
If your setting is 10 cm, EPR 1 = 9 cmH2O, EPR 2 = 8 cmH2O, EPR 3 = 7 cmH2O when you exhale.
In my (not so educated) opinion, maybe this drop in pressure is the reason for your high AHI's

In general when using EPR and the associated drop in pressure causes a higher AHI is is when that drop takes the pressure down to below the level of pressure that is needed to stent the airway open. When this happens we usually see an increase in OAs/hyponeas because the pressure down below the needed level just allows the airway to collapse.
The OP in this thread hasn't seen that increase though. She has mostly central apneas that she is concerned with.

Now sometimes people who whose bilevel pressures can see an increase in real asleep centrals just from the bilevel pressures causing too much carbon dioxide wash out and the brain doesn't see the need for centrals. Unsure why this happens to a few people and not the majority of people who use bilevel pressures or some form of exhale relief but it can happen to a very small minority of people.

The OP in this thread is VERY new to cpap therapy and also having great difficulty sleeping soundly (not a new problem either) so we don't know at this point just how many of the centrals are maybe real asleep centrals or not.
What we haven't seen is an increase in the OAs or hyponeas with the use of EPR though.
So using EPR isn't causing OAs or hyponeas.....but it may be causing some centrals. Too soon to know for sure
She needs more nights with EPR reduce or even turned off to get an idea if her centrals are related to using EPR.

Pugsy wrote: ↑

Tue Jun 28, 2022 1:24 pm

Now sometimes people who whose bilevel pressures can see an increase in real asleep centrals just from the bilevel pressures causing too much carbon dioxide wash out and the brain doesn't see the need for centrals. Unsure why this happens to a few people and not the majority of people who use bilevel pressures or some form of exhale relief but it can happen to a very small minority of people.

I believe Pugsy meant to write "and the brain doesn't see the need for breathing" not what she actually wrote... Inhalation is triggered by the amount of CO2, (carbon dioxide) in your breath. Lower exhale pressure makes clearing CO2 easier, and may thus cause the person to stop inhaling for a period long enough to be identified as a central apnea i.e. a brain induced, central nervous system induced episode of non-breathing.

ozij wrote: ↑

Tue Jun 28, 2022 7:39 pm

I believe Pugsy meant to write "and the brain doesn't see the need for breathing" not what she actually wrote... I

Correct. Brain and fingers not in sync. Short night last night.
Eyeballs "saw" breathing but I don't know why fingers went wild.
Maybe I am getting old....oh wait...I am old.

Thanks everyone. Makes sense. I have the EPR still turned off and AHI today is 1.86 with 9 CAs (1) and 6 OAs (.6) but a lot of leaks because I used mouth tape and kept lifting the mask to mess with it. But still a good AHI - how do the leaks affect overall effects of therapy?

jumblegirl wrote: ↑

Wed Jun 29, 2022 9:23 am

how do the leaks affect overall effects of therapy

It depends on just how big the leaks are and the duration....besides the obvious effect on sleep itself.
With the ResMed machine...when you start seeing leaks above 30 to 35 L/min then the machine could potentially have a problem sensing and recording events...meaning a nice low AHI might not really be all that low.
Is it low because the machine missed something or because nothing happened...that kind of thing.

Could a leak also make it think that an event happened that didn’t, or cause one? I did have 40 but that was at 99% level st 95 it was 7.

A leak can cause an arousal/awakening and the irregular breathing associated with the arousal could get flagged as some sort of apnea event but if you weren't asleep then it isn't a real "event".
So the awakening can cause false positive flagging.

Now if the leak is really large....yes it could allow the airway to collapse and that can of course lead to a flagged event.