do use EPR and why?

I have to rename the title as am not after the explanation of EPR but rather your preference to a particular setting and how do you know it does what it suppose to do,I have tried all setting from off, 1,2,3,really can not tell the difference and stats shows max pressure rise up to 15/17.5 .Thanks.

When EPR is enabled, the machine detects when you start exhaling and drops the pressure down by 1, 2 or 3 cm depending on the setting (1, 2, or 3).

Obviously this is more effective when your pressure is 6 cm and it drops to, say, 5 than when it is 15 cm and it drop to 14.

As I understand it, your S9 AutoSet can operate as a standard CPAP mode or an APAP mode. If it's in the CPAP mode then you could set only one pressure for both inspiration and expiration. But you could lower the expiration pressure by using the EPR. You could set the EPR to: 0, 1, 2, 3. Each level is in cmH2O. So if you set the CPAP pressure to 10 cmH2O and the EPR to to 2 (cmH2O) then the expiration pressure will be at 8 cmH2O. Lower Exp pressure feels better.

On the other hand, if you set your S9 AutoSet on automatic then the machine decides the inspiration and expiration pressures (within the set range) automatically.

I assume that I am correct.

How do you set the expiration pressure in the S9 Elite? Probably you can't seperate the inspiration pressure from the expiration on the Elite. Only by using the EPR you can lower the exp pressure.

The following applies to both S9 Autoset and S9 Elite:

Expiratory Pressure Relief (EPR)

EPR decreases the pressure at the beginning of each breath and keeps the pressure low throughout the exhalation. The pressure is reduced by an exact pressure drop of one, two or three centimeters of water pressure. EPR gradually changes therapy pressures so there is little ventilatory effect. EPR also has an Event Detection Circuit. When a sleep disordered breathing event lasts longer than 10 seconds, EPR stops until the event concludes and normal breathing with EPR resumes.

EPR with Easy-Breathe technology also allows users to customize the RAMP feature. Set the S9 Elite to EPR RAMP ONLY mode to enhance comfort and help improve compliance. Users are more aware of pressure changes as they fall asleep, using pressure relief during the ramp period naturalizes this process.

Obviously this is more effective when your pressure is 6 cm and it drops to, say, 5 than when it is 15 cm and it drop to 14.

I have to respectfully disagree with the above statement............EPR is no less effective when you have higher pressures and drop 1, 2, or 3........

I think Scrapper is right.

In fact, I'd think that the "comfort" aspect of EPR dropping pressure for exhaling would be even more important for people who have to use high pressures.

I stand corrected. I guess I was speaking mathematically rather than physiologically or psychologically.

I have nothing useful to add other than the fact that my S9 Autoset is set to titrate between 9-16 with a starting pressure of 7 and a newly turned on (three days ago) EPR set at 3 and that I'm finding breathing on my machine to be easier now that the EPR is on.

I did an OP about it here.

My pressure is set at 17 and I am on my 5th machine. Many years ago the EPR was not an option and there were many times where the high pressure was uncomfortable. Last year I picked up an S8 Elite and set my EPR to 3 and felt immediate relief. With the EPR I can use nasal pillows without them blowing out of my nares. I know it is because of the EPR because I did experiment and shut it off which caused my pillows to leak profusely. With the EPR I sometimes have to check that the machine is turned on.

After trying all the various combination's, I have ended up with my EPR at 3 and inhale EPR at medium.

When I wake up in the morning, this combination is the least intrusive of all the settings. I can almost breathe "normally" without being "prompted" by the machine.

I have mine set to EPR-1 and inhale to medium.

I find without the EPR on just a little bit, I tend to mouth breath more. I think it's because my body has been so used to not being able to breath through my nose for so long (chronic sinusitis most of my life) that if it detects that extra pressure it feels like my nose is blocked and reverts to mouth breathing.

Personally, I just use my EPR (or flex, in my case) at what my DME set it at. I have no problems with it, so I figured why bother. It is ONLY a comfort measure, so if you are comfortable with it, and your AHI is not effected, then it doesn't really matter.

I do not use EPR... I found that my AHI went up significantly when I enabled it, even when I increased my minimum pressure by the same (increased to 10-13 with 1 EPR to correspond to my usual 9 - 13). I think some of us are more prone to apneas on expiration than others, and therefore respond to the drop in pressure by the throat closing up. I am very comfortable without EPR, so figured there is no reason at all to use it since it is just a comfort feature.

[quote="jmelby"]I do not use EPR... I found that my AHI went up significantly when I enabled it, even when I increased my minimum pressure by the same (increased to 10-13 with 1 EPR to correspond to my usual 9 - 13). I think some of us are more prone to apneas on expiration than others, and therefore respond to the drop in pressure by the throat closing up. I am very comfortable without EPR, so figured there is no reason at all to use it since it is just a comfort feature.[/quote]


My thoughts:

Depending on your lungs condition, for example if you have been a smoker (like I was) and have developed some COPD then you may want a bit higher expiration pressure, and you'll get it with low or no EPR. The higher expiration pressure acts like a PEEP* to keep those collapsed alveoli a bit opened and allow more air to enter the alveoli during inspiration. Accordingly, it also allows a reduction of the inspiration air pressure. This is like blowing a baloon where it's easier to blow if the baloon is already expanded a bit.


PEEP*: Abbreviation for positive end-expiratory pressure. A method of ventilation in which airway pressure is maintained above atmospheric pressure at the end of exhalation by means of a mechanical impedance, usually a valve, within the circuit. The purpose of PEEP is to increase the volume of gas remaining in the lungs at the end of expiration in order to decrease the shunting of blood through the lungs and improve gas exchange. PEEP is done in ARDS (acute respiratory failure syndrome) to allow reduction in the level of oxygen being given.

In my case I have had to increase my pressure to get things under control and did find that as I got higher in pressure the EPR made it more natural to breath but also did impact the numbers as well. I found that at higher pressures and not using EPR I was seeing higher numbers of centrals and did not feel as rested in the mornings. WIth the same settings and using EPR the number of obstructive apneas increased but I felt more rested. I'm currently running auto at 15-18 with EPR set to 2 and fast, this is keeping both obstructive and centrals well under control and so far seem to the be the best for me but I need to take more data to be sure.

In doing my research and paying close attention to much of what others have posted or told me it does seem that, at least for some people, the EPR may contribute to obstructive apneas and actually require a higher operating pressure to then overcome this. This may be one of the major reasons that many people at higher pressures fail CPAP and are moved to BiPAP as there is more latitude for the pressures for both inhale and exhale, as well as allowing higher pressures to be set as well.