ResMed S8 elite EPR Question(s)

Based on some good info I got from members yesterday, I did some poking around on my machine and discovered that the EPR setting on my machine was set to 3. My machine was set up for a flow of 9, but the LED readout each morning was consistently around 7.6 (I think EPR on explains that anomaly).

I changed the EPR setting from 3 to 2 - and I actually had a better night's sleep and - interstingly enough - was much more comfortable at a setting of 2 rather than 3. With a setting of 3, I felt like I wasn't getting enough air through the mask.

The machine seemed a bit louder - and my mask leaked like a sieve off and on (leakage rate of 1.5 as opposed to the .28 I had been averaging). I know the mask leaking contributed quite a bit to the extra sound.

From what I've read, EPR is a patient comfort feature moreso than anything else. Is this a correct perception? When I took the nightly LED readings from my machine this morning, they indicated that my flow was 8.5 - very close to the 9 I was prescribed. Probably more interesting, my AHI's - which were averaging 12.4 dropped to 8 last night (when I changed the EPR setting from 3 to 2).

Bottom line is that i was more comfortable, perceived that I was breathing better, and slept better with an EPR setting of 2.

Anyone have any insights or experiences they'd care to share?

As an aside, I'd like to say thank you so far to everyone who has read through the verbose postings of a new and uninformed member. Answers to my posts and simply reading through history on on this forum has been a tremendous help and comfort.

Resmed's EPR setting of 3 was providing 3 cms of pressure relief on exhalation (9 cms inhalation, 6 cms exhalation). The EPR setting of 2 is giving you 2 cms pressure relief (9 cms inhalation, 7 cms exhalation).

Respironics' C-Flex and A-Flex work somewhat differently and the settings are not at set cms of pressure relief as Resmed's EPR settings are.

Well, yes, EPR is a comfort feature, but, while some of us eventually as we adjust to breathing air being blown into our face, no longer need that comfort feature, many will always NEED that feature in order to maintain good sleep all night long. The comfort and need vary w/the individual.

And there are times that we need to adjust, turn on or turn off EPR due to that night's circumstances: i.e. a bit of a cold and some congestion or some sinus irritation or stuffiness, etc.

Keep in mind that we don't sleep exactly the same every night. It is best to make just ONE adjustment at a time whether it is a different mask, an EPR setting or what, and to stay with that adjustment one full week before making ONE other adjustment. A week's data will give you a more accurate picture of what is and isn't working best for you. Make two adjustments the same day or w/in just one/two days of each other and you won't know for sure which is responsible for the improvment or setback.

Are we having fun yet???

the machine pressure setting is based upon the IPAP (inhale) setting. If you were set to 9.0 cm pressure and using a EPR=3 setting, then EPAP (exhale) was dropping to 6 cm on exhale (which is the pressure that actually maintains the splint pressure or pressure that holds your airway open/patent).

Dropping to a EPR=2 means that on exhale it would now only drop to 7 cm (instead of prior 6 cm). This extra 1 cm splint pressure can be enough to lower/reduce any apnea that was borderline with use of old settings, could be why you feel better. Every increase seen to EPAP would also lower your threshold for FL or Hypopnea.

If you felt better going from 3 to 2, many try 1 and feel even better which is why most don't use that feature.

Just be careful changing those settings cuz the next house you blow up may be your own

Giggle. Choke. Its a good thing that Robbie has some kind of idea of what he is getting into or you'd scare him to death w/that comment, DreamStalker!!

For quite some time I've thought:

1. If a person were titrated to a single pressure on cpap in a sleep lab
and
2. If that person was using a resmed machine at home with EPR turned on "Fulltime" and set at EPR 2 or EPR 3...

It might be a good idea to discuss with their doctor raising the fixed cpap pressure to compensate for the lower than prescribed pressure (considerably lower...3 whole cm's lower with EPR at 3) they'll now be getting throughout the entire exhalation.

Perhaps adjust the cpap pressure like this:

If using "1" for the EPR setting (which gives 1 cm pressure drop during exhalation) - leave the cpap prescribed pressure as is.

EPR 2 (2 cm pressure drop for exhale) - raise the prescribed cpap pressure 1 cm.

EPR 3 (3 cm pressure drop for exhale) - raise the prescribed pressure 2 cm's.

That's what I'd do, anyway. But I'm no doctor.

Of course, it would be a little ridiculous to have to keep toting the machine back and forth to have a DME punch a button or two to change the prescribed pressure every time the user wanted to try different levels of EPR.

Most people could probably get their doctors' blessing to let them make a couple of cm's change in pressure themselves.

Inveterate tweakers are gonna do what they want to do, regardless.

Robbie wrote:From what I've read, EPR is a patient comfort feature moreso than anything else. Is this a correct perception?

A great deal of what is in comtemporary flow generators is a comfort feature for some class or user or other.

Robbie wrote:Anyone have any insights or experiences they'd care to share?

As understanding of the range of Sleep Disordred Breathing presentations involving OSA increases, the suppliers add facilities (aka features) to their range of flow generators which address the specific points for particular classes of users who share common responses to specific aspects of CPAP treatment.

The name of the game in medical terms is "compliance"... that is, how do you get people who start using CPAP to persevere with the treament and achieve positive medical outcomes. So, if any particular new approach can be identified that is likely to make "compliance" easier for an identifiable class of patients, the suppliers usually will work at providing that a facility to support that approach in their flow generator range.

Trying to tell for sure in advance whether any particular user will benefit from any particular facility of a flow genearor is still somewhat of a turkey shoot until they actually start to use CPAP treatment. In some cases there are clear indicators from the sleep study, but in many cases its just not that clear, which is why you often see people here recommending getting a high end machine that has a lot of facilities to chose from.

Over time you can find out what really works most effectively for you.... that could be just very basic CPAP, or it could be some particular flow generator facility that makes treatment sustainable for you. Keep in mind that CPAP treatment started out with just one facility that worked effectively enough to produce worthwhile compliance outcomes for definitely non-trivial numbers of indiviudals (that is, a significant class), and that very basic approach still works today for that class.

Anyway, whether the EPR facility make any difference for you is something you need to figure out for yourself. You may find that you fall into a class of users who are better off without using any EPR.

Cheers,

Bill

RG - Point(s) taken and both implied points made were understood very clearly - thanks .

Billbolton - i really appreciate what you had to say. I was slowly coming to a few of those conclusions, but couldn't quite "connect the dots" so to speak. In my line of work, the answer is frequently (and genuinely) "It depends .." Seems like that's the answer for a lot of thngs.

Thank you for taking the time to share some background and information on this. I look forward to being an active participant in making CPAP therapy work well for me. I like to make informed choices - kind of of a tough thing to do without good information.

Thanks again!

[quote="Robbie"]Based on some good info I got from members yesterday, I did some poking around on my machine and discovered that the EPR setting on my machine was set to 3. My machine was set up for a flow of 9, but the LED readout each morning was consistently around 7.6 (I think EPR on explains that anomaly).

I changed the EPR setting from 3 to 2 - and I actually had a better night's sleep and - interstingly enough - was much more comfortable at a setting of 2 rather than 3. With a setting of 3, I felt like I wasn't getting enough air through the mask.

The machine seemed a bit louder - and my mask leaked like a sieve off and on (leakage rate of 1.5 as opposed to the .28 I had been averaging). I know the mask leaking contributed quite a bit to the extra sound.

From what I've read, EPR is a patient comfort feature moreso than anything else. Is this a correct perception? When I took the nightly LED readings from my machine this morning, they indicated that my flow was 8.5 - very close to the 9 I was prescribed. Probably more interesting, my AHI's - which were averaging 12.4 dropped to 8 last night (when I changed the EPR setting from 3 to 2).

Bottom line is that i was more comfortable, perceived that I was breathing better, and slept better with an EPR setting of 2.

Anyone have any insights or experiences they'd care to share?

As an aside, I'd like to say thank you so far to everyone who has read through the verbose postings of a new and uninformed member. Answers to my posts and simply reading through history on on this forum has been a tremendous help and comfort.