EPR settings

So I'm given the choice of off, 1, 2, and 3. My doctor has set mine to 2. What differences will I feel as I lower the number setting? Increase? Off? The clinician's manual mentions the settings, but doesn't define what the numbers mean? (unless my apnea induced confusion has made me miss this entry!)

Mark.. the EPR is a comfort setting, to assist you with your exhaling. That, of course, is why it available to you as a user. The Doc/DME or whoever set up your equipment, set it on (2) because thats a middle of the range to help you get started. They have no other means to know what your "comfort" range may be. You may not even care to use the EPR, once you get accostomed to CPAP use.
The setting of (1) gives a small amount of exhale relief, maybe (depending on your equip) drops the constant pressure down about 1 -2cm
(2) middle of the road, drops the pressure down 2-3
and (3) the most EPR relief, drops the pressure down maybe 3-4cm during your exhalation.
Some people don;t even use the EPR.
Strictly comfort!! Play with the settings.. I suggest changing it to another setting, if uncomfortable, after 3 or 4 days of trial. You must at least stay with one setting for several nights, just to get used to the EPR. Trial and error, that all.

I have an Intellipap, and I can change that setting with the machine on. So I put my mask on and sat there and figured out which one felt the best to me. 3 seemed to blow back into my face too much when it came back up to pressure. 1 didn't seem to let me relax enough - I felt the effort to exhale. So, 2 it is!

Also if you are in CPAP mode, there is an additional setting to adjust how fast the pressure comes back. This is not availablein AUTO.

EPR made me feel like I had to breathe at the machine's pace, so I turned it off and had much better results. It's an individual thing.

Lizistired wrote:Also if you are in CPAP mode, there is an additional setting to adjust how fast the pressure comes back. This is not availablein AUTO.

EPR made me feel like I had to breathe at the machine's pace, so I turned it off and had much better results. It's an individual thing.

I had the same experience as Lizistired. I tried EPR in all different settings and couldn't get used it. I turned it off and don't have any difficulty breathing out against 14 cm and higher.

In my titration study, I had a very hard time exhaling against. At home, I initially had EPS set to 3 with "medium" breaths (only medium and short I think were the choices). As Anon already mentioned, the "blowback" was uncomfortable for me. I've been at 1 the past three nights. Works for me. I'd suggest using the mask fit mode to test or if you have a straight CPAP set on your Autoset, turn it on for a few minutes (lying down) and see which feels more comfortable. Nice thing is you can easily change it as well. As Pap4Life already mentioned, I'd give it at least 3 days though when trying a new setting to make a permanent decision.

Thanks for all of these helpful replies. My S9 is set to auto, and my average pressure seems to be about 6.5 to 7.5 most nights. The doc has the auto pressure settings between 5 and 20. So if I understand what I've read from your answers, the S9 is dropping my pressure to between 4.5 and 5.5 on exhale. I'll give a try lowering the EPR setting to 1, since sometimes it barely feels like the cpap is doing anything while I'm using it.

cpapman1 wrote:Hope this helps a little:

EPR is a reduction in pressure on the exhale. 3 is equal to a drop in pressure of 3 cm H2O. 0 is no reduction in pressure. It means that the pressure will drop up to the numbers of cm H2O you have selected. I always suggest a setting of 3 unless the set pressure is 7 cm H2O or less. At a pressure setting of 7 cm H2O and an EPR setting of 3, the CPAP machine would drop to a pressure of 4 cm H2O on the exhale. That is as low as the machine will go.

I'm curious about this... my S9 (Elite, not autoset) is set at 7cm per my titration... I feel pretty good, but not great. I also have EPR on 3.

Will changing/taking it off help more? I'm using a FFM if that helps...

Let me know... kinda wondering now..

Keep in mind when EPR is used, it effectively reduces cpap pressure during exhalation....therefore in theory one needs to increase the cpap pressure by the same EPR number. For instance, if your cpap setting is at 9 and you decide to go with EPR of 2, you should increase cpap from 9 to 11. If you're on apap, as long as the range is broad enough, no need to adjust.

scottjf8 wrote:'m curious about this... my S9 (Elite, not autoset) is set at 7cm per my titration... I feel pretty good, but not great. I also have EPR on 3.

Will changing/taking it off help more?

Give it a try. Some people it helps, some it doesn't. Reducing it a little will effectively raise the overall average a wee bit and it may feel better, work better or do nothing. I have seen reducing EPR or turning it off make huge changes in a person's data and I have also seen where it makes no change at all. There is no hard fast rule on what to expect but it hurts nothing to try. It is a comfort feature. It is there to make exhale easier and more comfortable. Might be greatly appreciated at 14 cm of pressure but at 7 cm not needed nearly so much. It is only important to how YOU perceive it.
Impact, if any, will vary from person to person.

dtsm wrote:Keep in mind when EPR is used, it effectively reduces cpap pressure during exhalation....therefore in theory one needs to increase the cpap pressure by the same EPR number. For instance, if your cpap setting is at 9 and you decide to go with EPR of 2, you should increase cpap from 9 to 11. If you're on apap, as long as the range is broad enough, no need to adjust.

I don't agree with this. If you increase your pressure by your epr, say to 11, you are exhaling against 9 again. There's no point in that and now your inhale pressure is higher than needed. I can see the comfort feature to get used to the machine but I don't see the sense in raising your inhale pressure to exhale against the same pressure.

Well said, Liz.

The intent of EPR is for ""comfort"" relief. It makes no sense whatever (theory???) to increase your inhale (IPR) because of a intended drop of a couple of cm/H2O in the EPR for comfort. Where is the comfort going to come from in that manuevour? If that were the case, then why did the manufacturers put the EPR settings on the machines?. Hit "0" and turn the EPR off, would serve the same results, (no comfort).

Mark184 wrote:I'll give a try lowering the EPR setting to 1, since sometimes it barely feels like the cpap is doing anything while I'm using it.

You tend to notice the pressure less and less as you get used to it. If I put mine on, I sometimes can't feel the pressure at all and sometimes I have to lift up the edge of the mask to convince myself the machine is on.

Once you get used to it, you might want to turn EPR off and see if it feels comfortable.

In humans, exhalation is the result of muscular relaxation, and not of muscular effort. Therefore, it's the difference between inhale pressure and exhale pressure that makes exhalation easier. And that's why as far as exhale relief is concerned, it does make sense to increase your pressure by your EPR. There may be other reasons not to increase Inhale pressure - but if you can set your exhale pressure to something lower, exhalation relief is not one of them.

Encyclopaedia Brittanica: The mechanics of breathing

I moved my EPR from 3 to 1 last night. Slept pretty good overall.