Can anyone explain EPR to me?

My DME placed me with a CPAP machine that did not have anything, not even a card so my doctor ordered one with a card. The DME grudgingly gave me an Escape II which has the card as well as EPR. However he turned off the EPR. I know how to access, but do not know where to set it. I am in FL for 3 months and brought the wrong book with me and can not find the info on line for this unit. Before I got it, I felt like it was rushing me to breathe out so I set it on medium at level 2. Am wondering if this is reasonable. I feel much better while it is on, however during the day, I feel as though I don't have as strong a breathe when I exhale as I did before using CPAP. Thanks for any help anyone can give me. This site is a great help to me as I was new in October. I use a Fisher & Paykel #407 nasal mask. My CPAP is set at 9.2

its respiratory relief. it drops the pressure momentarily to make exhaling feel more natural. It shouldn't hurt to mess around with it and find a setting you like.

Pressure relief for exhale can sometimes cause an increase in apneas, so watch your numbers. You may need to raise your regular pressure when you begin using EPR.

On December 21, 2008, rested gal wrote:

When using a ResMed machine with EPR turned on, I also like to raise my regular pressure setting a cm or two. I'm not a doctor or anything in the health care field. All that is just my opinion, and "what I do."

viewtopic/t38162/viewtopic.php?f=1&t=37 ... 83#p323683

jnk wrote:Pressure relief for exhale can sometimes cause an increase in apneas, so watch your numbers. You may need to raise your regular pressure when you begin using EPR.

Does the Resmed Escape give track the kind of numbers that give the necessary info?

O.

ozij wrote:

jnk wrote:Pressure relief for exhale can sometimes cause an increase in apneas, so watch your numbers. You may need to raise your regular pressure when you begin using EPR.

Does the Resmed Escape give track the kind of numbers that give the necessary info?

O.

Oops. Thanks, ozij. No it does not.

That would require an Elite or Elite II:

viewtopic.php?p=307168#p307168

That being the case, if I were flying blind with an Escape, I would probably choose to raise my pressure by the amount of EPR I used. If I used EPR set on 1, I would raise my pressure by 1. If I used EPR set on 3, I would raise my pressure by 3.

But more important, I would be doing everything I could to get a data-capable machine so that I was not flying blind.

I'll try to cover EPR in as simple manner as I can


EPR is quite different from CFlex. Technically both are referred to as exhale relief but in reality EPR sets up a bilevel operation as it delivers a settable epap pressure and a settable ipap pressure. Unlike most bilevels though, it has few adjustments to things like the speed of change from exhale to inhale (risetime) & the sensitivity of cycle changing (exactly when to change), but, in general it does it quite well.

Also one needs to understand that EPR whilst it can be set for an ipap/epap gap of 1, 2 or 3 CMs, the machine applies EPR by dropping from the set pressure (IPAP) to an exhale pressure (Epap) by the chosen pressure gap value (1, 2 or 3 CMs). What this means is that EPR starts with the normal ipap pressure as its baseline & drops to the exhale pressure. Bilevel machines use epap (exhale) as the baseline & rise up in pressure to the inhale (ipap) setting. When a bilevel has any problems it will revert to epap pressure whereas an EPR machine uses inhale (ipap) as the baseline & if it senses problems it reverts to inhale pressure (ipap).

The best way I can explain is how I use my EPR machine. I was titrated at 13 CMs, when I use EPR I set my machine for 13 CMs and EPR= 3. This means that as I breathe out, the machine detects my change of breathing direction & drops pressure to 10 CMs then as I revert to inhaling it rises back up to 13 CMs. This works pretty well for me. But remember, my titration was for CPAP 13 CMs. My EPR epap is 10 CMs & 10 seems to be the magic number for eliminating obstructions so my set up is a workable one. If you were titrated at 11 CMs and had EPR=3 then unless up choose a higher ipap, it will be 11 Cms & with EPR=3 the epap will be 8 CMs and at 8 it has dropped below the magic 10 CMs & thus may be more likely to allow obstructions. This issue of 10 CMs as a magic number is that many researchers believe 10 CMs is adequate to hold the airway open for the majority of OSA sufferers. As a rule that seems to work for me.

Whilst EPR doesn't have the tunability of a bilevel, it does have some 'smarts' they they usually don't. If the machines starts to detect significant HIs or AIs, it reduces the EPR gap & will eventually suspend EPR altogether & rely on plain CPAP operation until the events pass. This is a very useful plus. What it means is the machine will deliver the bilevel operation until that is not adequate then it will suspend it until the sleeper comes good.

My advice to anyone wanting to use EPR is to consider setting it to EPR=2 & see how that goes. After time try EPR=3. If that feels good & AHI scores don't increase then stay with that. If setting EPR=3 causes AHI to rise over a few nights, then raise your base pressure setting by 0.4 CMs per night (leaving EPR set as is) & see if that drops AHI score.

If yes then it indicates that the epap pressure (exhaling with EPR on) is dropping your pressure a little too low & the fix is either reduce the EPR gap or raise your pressure setting. Raising the pressure setting can be done in 0.2 CMs increments so is an esier fine tuning tool that adjusting EPR which is done in 1 CMs steps.

In balance, I regard EPR as the most sophisticated exhalation relief ever put forward by any vendor short of a bilevel machine or an SV machine (Bipap AutoSV & Vpap Adapt SV).

DSM

#2 added further comments

Thank you so much to all of you and especially DSM for your detailed explanation. I am sure it helped someone else too. I will try your suggestions. I don't have a way to check my results until I return home in April and see the lung specialist who is the sleep doctor for our area and doesn't seem very interested in checking after prescribing a CpAP. My machine doesn't have any capability for checking and my DME provider seemed to think I should not even be asking for a CPAP with a card. Maybe I can find a sleep doctor in the FL area where I am living who is more involved with sleep disorders. In my home area, you must see the doctor that I saw in order to be studied but he seems very uninterested in results. Thanks again.