EPR

I've used C-Flex and EPR (C-Flex on a Respironics Auto & I use EPR on my Resmed S8 Vantage).

C-Flex was a great aid to help me get started on therapy & I recommend it to anyone wanting exhale relief. For me as a GERD sufferer I tend to steer away from C-Flex = 3 as that tended to exacerbate aerophagia.

I like the EPR on my travelling S8 (just used it the past 2 nights while away) - it is the 2nd best thing to having a bilevel to travel with. Works very well for me but originally took me a few days to adjust to after using my PB330 Bilevel (that I had as my main machine back when I started with the S8 & EPR).

Sadly this issue of exhalation relief brings the emotional worst out in some of us memebers here

Fact it both types of exhale relief are very effective for a lot of people. It is meaningless to emotionalize it.

DSM

rested gal wrote:

Paul56 wrote:I did a search on the forum yesterday and found an old posting by "Rested Gal" that when using EPR she increased her pressures according to the EPR level selected. Sorry, no link to the post... but it is out there.

Perhaps it was this one:
viewtopic.php?p=289264#p289264

Where I wrote:
Personally, if I were going to use a cpap machine that has EPR, and I were going to use EPR, I'd set the cpap's regular pressure one or two cms higher than I'd been prescribed. So that the drop I received during exhaling with EPR would not be as likely to allow my throat to close off with an apnea at the end of the exhalation and prevent getting another breathe (sp. "breath") STARTED in a timely fashion...a scenario which could happen over and over again if my prescribed pressure was right on the cusp, so to speak, of keeping my throat at least partially open (so that inhaling could be STARTED) during the pause before starting to breathe in again.

Using the example of the fellow who needs 10 to prevent full apneas at the end of exhaling, if I were him and were going to use a cpap machine with EPR, I'd set my pressure at 12 if I were going to use EPR 2 or 3. I'd set the pressure at 11 if I were going to use EPR 1.

But that's just me, and I'm not a doctor or anything in the health care field.

What I'd do "if it were me", and what works best for me, might not for another person. The fact that I get better treatment if I adjust the pressure up to account for EPR's drop doesn't mean other people using EPR need to do that to get good treatment. I'm just "someone" who does need to do that if I use an S8 Elite with EPR turned on.

As Bill correctly pointed out:

billbolton wrote:There's quite a difference between some and many!

Okay, just so there is no confusion here...

My comment "EPR really means "Extra Pressure Required"." really was meant as a joke and not a sweeping guideline regarding EPR... so don't anyone go taking that comment seriously in terms of your therapy.

I am certainly in no position to be offering sweeping guidelines regarding sleep apnea and machine settings... I can only offer up my own unique experiences which may or may not work for others.

Yes rested_gal, that was the post I was referring to... and for me it made sense considering how my own numbers rose when using EPR. But, I have NOT tried EPR with my pressure numbers increased. I only tried EPR ONE night with my pressure range of 10-15 (that range seems to be working... so far).

The one night I tried EPR I did not like it and my AI was elevated. Last night I turned EPR off and I'm back to AI = zero while HI = 5. My intention at this point is to leave EPR off as for me it does not make any difference in terms of comfort... actually in terms of comfort I find it less comfortable and think I will be feeling better today once I get going... still dawdling over breakfast here.

Paul56 wrote:
The one night I tried EPR I did not like it and my AI was elevated. Last night I turned EPR off and I'm back to AI = zero while HI = 5. My intention at this point is to leave EPR off as for me it does not make any difference in terms of comfort... actually in terms of comfort I find it less comfortable and think I will be feeling better today once I get going... still dawdling over breakfast here.

All we can do is explain how it works and why it doesn't. Proof is in the pudding, you'll notice the only ones defending EPR is those from down under in Aussieland, home of Resmed hey no biased opinions there

Snoredog wrote:

Paul56 wrote:
The one night I tried EPR I did not like it and my AI was elevated. Last night I turned EPR off and I'm back to AI = zero while HI = 5. My intention at this point is to leave EPR off as for me it does not make any difference in terms of comfort... actually in terms of comfort I find it less comfortable and think I will be feeling better today once I get going... still dawdling over breakfast here.

All we can do is explain how it works and why it doesn't. Proof is in the pudding, you'll notice the only ones defending EPR is those from down under in Aussieland, home of Resmed hey no biased opinions there

Cmon snoredog, there is defence & there is practical use. Intro emotion & the practical discussion gets scuppered

DSM

Paul56 wrote:I tried EPR on my machine last night with a setting of 3.

-In terms of breathing I found it a little difficult to get used to and did not find it more comfortable.

-Also the results this morning in ResScan show 6 apneas... where I have been scooting along all week with zero or one apnea.

I know this is only one evening; however, the results and my experience with it are not encouraging at this point. I don't think EPR... certainly not set to 3 is for me as I seem to do better with no EPR.

Now, is my understanding here correct... "Easy Breathe Technology" and EPR... is "Easy Breathe Technology" a constant while the EPR is user selectable? In other words... is "Easy Breathe Technology" being used even when EPR is turned off?

I also have an S8 Elite II - I set my EPR to "full-time" the level to 2 and inhale to fast. I have terrible AHI numbers and would love to get them below 5. My pressure is at 9 cm H2O increased from 7 cm witt EPR to "off." However, my numbers jump all over the place and did before and after turning on EPR. With EPR off I had some AHI readings of 14.8, 21.2, 25.8, 14.8, 22.5, 17.2, and 15.6. With EPR on and increasing my pressure from 7 to 9 my highest AHI was 13.9 but I have also had readings of 7.9, 8.4, 6.0, 12.8, 6.4, 6.5, 8.2, 7.6, 5.3 and 10.8. I find with my EPR set as above, it was easy to get used to and was more comfortable.

Ken, if your AHI numbers are made up mostly of hypopneas (the HI -- hypopnea index) rather than apneas (AI -- the apnea index) I wouldn't worry about trying to get an even lower AHI than the numbers you mentioned you get with pressure set at 9 and EPR "on."

ResMed machines seem to score some changes in airflow as "hypopneas" that other brands score as "flow limitations." That doesn't mean that one brand is spotting hypopneas better than other brands. Nor does it mean one brand is letting more hypopneas through than other brands. It's purely a matter of the differing definitions each manufacturer designs into their own machines -- as to when a flow limitation is bad enough to be called an "hypopnea."

So...if it's mostly hypopneas and very few apneas that comprise your AHI, I'd just mentally cut the ResMed's AHI in half and expect that would be about what I'd see as an AHI with other brands. A ResMed AHI of 6 could very likely have been reported as an AHI of 3 or less had you been using another brand under the exact same circumstances.

That difference in what it takes to rate as an hypopnea is neither bad nor good... it's just... a "difference" in what each manufacturer decides to designate as "hypopnea." None of the manufacturers use the kind of definition sleep labs use during a PSG. In a PSG sleep study, there has to be a certain amount of reduction and duration not only in the airflow, but also a certain percentage of drop in SpO2 (oxygen) level for an event to be scored as an hypopnea. Our treatment machines are not using oxygen drops in their varying definitions of hypopnea.

In my case, C-Flex proved wrong for me because the pressure relief doesn't last through exhalation. I felt as if the machine was prompting me to inhale before I was ready and was far more comfortable on EPR. Still, I got better numbers by turning off EPR on my Elite S8. Now, with my S8II, I find that setting pressure a bit higher than originally titrated and using EPR on 2 (plus the undocumented fast-response option in the clinician's menu), I can use the pressure changes of EPR to help even out my breathing and reduce my AHI to reasonable levels. And I'm not even from Australia.

rested gal wrote:Ken, if your AHI numbers are made up mostly of hypopneas (the HI -- hypopnea index) rather than apneas (AI -- the apnea index) I wouldn't worry about trying to get an even lower AHI than the numbers you mentioned you get with pressure set at 9 and EPR "on."

ResMed machines seem to score some changes in airflow as "hypopneas" that other brands score as "flow limitations." That doesn't mean that one brand is spotting hypopneas better than other brands. Nor does it mean one brand is letting more hypopneas through than other brands. It's purely a matter of the differing definitions each manufacturer designs into their own machines -- as to when a flow limitation is bad enough to be called an "hypopnea."

So...if it's mostly hypopneas and very few apneas that comprise your AHI, I'd just mentally cut the ResMed's AHI in half and expect that would be about what I'd see as an AHI with other brands. A ResMed AHI of 6 could very likely have been reported as an AHI of 3 or less had you been using another brand under the exact same circumstances.

That difference in what it takes to rate as an hypopnea is neither bad nor good... it's just... a "difference" in what each manufacturer decides to designate as "hypopnea." None of the manufacturers use the kind of definition sleep labs use during a PSG. In a PSG sleep study, there has to be a certain amount of reduction and duration not only in the airflow, but also a certain percentage of drop in SpO2 (oxygen) level for an event to be scored as an hypopnea. Our treatment machines are not using oxygen drops in their varying definitions of hypopnea.

All I have to go one is what is reported daily on the results display of mt S8 Elite II. My AI numbers have been 1.7, 2.6, 0.3, 1.4, 0.4, 3.3, 1.4, 1.0, 0.8, 0.7, 0.4, 3.3, 0.7, 4.9, 2.7, 4.3, 1.9, 1.7, 1.8, 0.2, 2.0, 4.6, 4.3, 3.9, 2.0, 1.5, 0.5, 2.6, 0.7, 1.0, 1.7, 0.6, 0.4, 1.3 and 3.0. Since I am using my equipment for 8 hours on the average each night, I assume those AI numbers are apnea events per hour on the average. I certainly feel better since therapy started but if I can improve my numbers I expect I will feel even better. I also have never seen my sleep study report (repeated requests for a copy have not resulted in receiving a copy) so I have no idea what my numbers were before treatment. All I know is what my primary care physician wrote to me which was "you do have a fairly severe case of sleep apnea with an average 47 episodes per hour where you stop breathing or breathe more shallowly than you should for periods, on average, of 18 seconds at a time." That is not a lot of information to compare my reading to.

Generally (not "always"), to get the AI (apnea index) down, this usually works:

If using a CPAP -- Raise the single pressure.

If using a bilevel (bipap) -- Raise the EPAP (the exhale pressure.)

If using an autopap -- Raise the minimum pressure.

Of course, before making decisions about pressure setting, it's important to have leaks well under control. Excessive leaks (from mask, or from mouth if not wearing a FF mask) can skew the events data. Best to have a nice low leak rate before raising a pressure setting.

Thanks again. I watch my results and record them daily so I will keep my eye on leaks and AI readings. One thing I was told by the sleep tech at my sleep study after my test was that in spite of my events my oxygen levels were not affected by my events. I intend to inquire of my sleep doctor what that really means when I see him. I also will ask for a copy of my sleep study and for him to explain the findings to me. I also want a copy of my prescription and I will discuss with him any changes he recommends. Certainly, because I am told by my equipment provider that I need a "prescription" for any mask they do not usually stock, if I decide upon any particilar mask by then and if my provider can not provide that mask to me without a prescription for it, I will ask my sleep doctor for that mask prescription. Right now I have tried everything my provider thought might work for me so I am buying the masks I am using directly. Lastly, right now I see no downside to changing from CPAP to an APAP so I am going to ask for a prescrition change to a ResMed AutoSet II. If my numbers do not improve by the time I see my sleep doctor and if he refuses to prescribe an APAP then I will probably buy one directly.