Is EPR a form of BiPAP?

With the ResMed S9 models that are equipped with Exhalation Pressure Relief (EPR), there is a lower pressure when you exhale then when you inhale. What's the difference between that an BiPAP?

Well, for one thing, EPR on cpap/apap machines only drops the pressure 1-3 cm h20. Bipap machines can handle a much larger difference in pressures.

I suppose that in an over simplistic view EPR could be considered as a form of bipap. Obviously bipaps have other some other functions that a machine with only EPR will not have and of course wider ranges in exhale relief than the 3 cm that EPR offers. So while not a "real" bipap it does offer a mini version of one feature that bipaps have.

I'm not an expert on this stuff (at all) but I think the two are probably similar in appearance (both allow for variation in pressure between inhalation and exhalation) but from a medical/engineering/software perspective, I suspect they are two totally different beasts. EPR and C-Flex/A-Flex are designed as comfort features to allow for easier exhalation by slightly reducing pressure on each breath. As I understand it, there is no medical need for this, simply patient comfort, which, in turn, helps with compliance. A BiPAP has separate set pressures for inhalation and exhalation, and, as noted, those differences in pressure can be extreme. A BiPAP can also be programmed to cycle at a set number of breaths per minute, helping to encourage the patient to continue to breathe along with the machine, whereas the EPR simply responds to the patient's own breathing. A BiPAP unit is obviously a more highly engineered machine as reflected in the huge price difference between CPAP/APAP machines and BiPAP models.

There's long, thoughtful and informative discussion about the differences between BiPAP, EPR, and the various Flexes on the PR machines in this thread starting on page 2 if I recall correctly. Lots of good graphs by -SWS illustrating when and how the various algorithms increase the pressure and comments from me about how the three algorithms actually felt/feel for me.

EPR is essentially mini-BIPAP with no bells and whistles.

Hmm, I like bells. I am not a fan of whistles.

PtownKev wrote:EPR and C-Flex/A-Flex are designed as comfort features to allow for easier exhalation by slightly reducing pressure on each breath. As I understand it, there is no medical need for this, simply patient comfort, which, in turn, helps with compliance.

I know what you're saying, but if one of the medical purposes of the the therapy is to improve the quality of your sleep, and you find CPAP so annoying without exhalation relief that you can't get to sleep or you wake up, then even if you have an iron will and wear the mask anyway, there is a medical need for something like EPR or one of the Flexes. Dismissing this as an unimportant comfort feature, as many do, just shows how unclear some of the pros are on what this therapy really is. No sleep therapy is going to work while you're awake.

TalonNYC wrote:Hmm, I like bells. I am not a fan of whistles.

Another useful term: "ramp." Like EPR and Flex/Flex+ ramp is a "comfort measure" enabled on some machines. Ramp allows you to start your treatment at bedtime at a lower pressure and have it increase gradually as you are falling asleep (or even after you are asleep). Useful when you are getting used to the machine, or a new level of pressure on the machine. Some people hate it and never use it. You can vary the length of the ramp and where the ramp starts.

As time goes on (I started CPAP 2/17/2011) I have been shortening the length of my ramp and starting it higher. My pressure is @ 9.5 and I think I start my ramp at 6.0 now with a 15 minute build.

Edited to add: I agree that comfort measures should be accorded respect.

DD

I do use Ramp, as I like to listen to audiobooks for a bit while in bed as a mental trigger to start going to sleep. The Ramp allows the pressure to "sneak up on me" while I listen =)

TalonNYC wrote:I do use Ramp, as I like to listen to audiobooks for a bit while in bed as a mental trigger to start going to sleep. The Ramp allows the pressure to "sneak up on me" while I listen =)

Is ramp a bell or a whistle?

DD

Drowsy Dancer wrote: Is ramp a bell or a whistle?

DD

Bell, definitely a bell.

I have a theory the newer ones are pretty much the same machine with one having more internal software wise (maybe with a faster cpu).

Somebody please prove me wrong.