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Anything I can modify to optimize?
RE: Anything I can modify to optimize?
(09-05-2022, 03:31 PM)KSMatthew Wrote: How can I reduce flow limitations?

By using EPR set at 3 (full time).
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RE: Anything I can modify to optimize?
(09-05-2022, 03:36 PM)OpalRose Wrote: By using EPR set at 3 (full time).

OK - that's what I did last night.  I'll give it a few days for me to settle into this and then post another screenshot for a before/after look.
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RE: Anything I can modify to optimize?
I set EPR = 3, full time.

I've noticed a few changes.

1) Because the pressure eases back after I inhale, the pressure inside the full face mask I used (F&P Evora) is low enough that I don't have the leak problem I used to have.  That's a really nice bonus.

2) My morning AHI numbers have increased from <1 average to about 2-3 average.

Attached is last night's numbers.  This seem to be about what I'm seeing on most nights.  Weather, pollen, dust, and a few other things have been interfering with my sleep recently but I think last night was pretty average.

Original "EPR = OFF"


Current "EPR = 3, full time"


Any thoughts on the new results and or anything else I can do to optimize?  I'll be seeing my doc in a couple weeks and can get him to modify my prescription, currently sitting at 7-10.  The rest I can change myself.  From the looks of the most recent graphs, I'm rarely hitting 10.
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RE: Anything I can modify to optimize?
Before EPR you had more flow limitations (see graph on left sidebar of your chart). ResMed machines increase pressure in response to flow limitations because they may grow into apneas. So if one can reduce flow limitations, pressure spikes should calm down. The one caveat (Gideon alluded to it earlier) is that for SOME (not all) people, a higher level of EPR can sometimes tend to increase Central Apneas. That is what happened here. Look at your central index before, and then after. EPR=3 has virtually eliminated flow limits (the 95% number is the one to watch) and pressure spikes are much less frequent.

It's a teeter-totter - centrals versus pressure spikes. Given that centrals (as I understand it) are less harmful to your body than hypopnea or obstructives, and given that your central index is not THAT high, then you have a decision to make. Extra bonus about the mask was not expected, a pleasant result.
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RE: Anything I can modify to optimize?
1. Your 95 FLs have come down nicely, good to see.  Notice how this has prevented your pressures reaching your set Maximum of 10. This would feel better.

2.Your increased AHI is from more #CAs, due to the increased EPR. This will settle down over time. Unless they are unduly long, don't worry about them.

3. Generally when you increase or add EPR this drops your expiratory pressure and may induce some more OA. The easy fix would be to increase Min Pressure by a similar or lesser amount. I would only do that if a) the number of OSA, just one component of your AHI, increases significantly, or b) the length of your OSA increase unduly. Just go the events tab and click on the Obstructive Events individually to see how long they last.

4. Thanks for sharing your leaks have come down with EPR, this will be useful info for others, myself included. Again, likely due to better control of FL and lower overall pressures during the night.

Best wishes.
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RE: Anything I can modify to optimize?
Thanks for the feedback. I’ll keep these settings for a while and monitor results.

EPR is now set to 3. Comments above indicate that might cause an increase in CA? Can someone explain how that works? Would changing to EPR 2 be a compromise?

Positive side effects:

I did mention fewer leaks. I switched to a FFM from nasal cushions when I started having more episodes of dry-mouth. The FFS solved that problem but introduced others. During the night skin oils and other moisture would build up and interfere with the skin to mask seal. Air would leak out the edges no matter how I adjusted the straps. The only fix was to get up, wash my face, wipe down the mask cushion, reseat everything, and go back to bed. With EPR 3, the pressure stays low enough that I can go all night with a good fit.

Also, with the lower pressure I haven’t been swallowing air during the night.

Even though my AHI numbers are a little higher, I’m getting better quality sleep.
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RE: Anything I can modify to optimize?
Question on EPR:

Attached is last night:


A couple posts above you can see the records of when I had EPR OFF.

Why would the pressures be so much higher overall with EPR off than with it on?  It looks like with EPR = 3, my pressures start lower, and then rise as needed.  But with EPR off, it looks like pressure starts at 7, then jumps immediately to 10?

I thought the EPR would just lower pressure during exhale, but it seems like the overall pressure pretty much stays low?  I'm thinking that I don't really know the algorithm for EPR after all.


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RE: Anything I can modify to optimize?
Scroll down and look at your flow limits graph. Your machine will increase pressure in response to flow limitation. EPR helps reduce flow limitations which keeps your machine from jacking up the pressure unless you have an event.
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RE: Anything I can modify to optimize?
EPR, in addition to the algorithms that ResMed uses will improve the therapeutic value of ResMed devices over much of the competition.
ResMed sees flow limitations as a precursor to full fledged hypopneas or obstructive apnea and are designed to agressively suppress future obstructive events by raising pressure In Response to flow limitations and he traditional hypopneas and obstructive apnea.
EPR is implemented as a difference in pressure of 1, 2, or 3 cmw. When adjusted for pressure to match that of a BiLevel with PS= EPR performs identically to that of a BiLevel (which is capable of fractional increments and much. Higher PS values). It is PS that is used to treat Hypopneas, Flow Limits, RERAS, and UARS. Within its limits of range EPR does the same.

Respironics uses vibratory snores to do what flow limitations does for ResMed. Phillips uses Flex as it pressure relief vs EPR on ResMed but the applied value of the flex is dependent on your breathing and much lower values of differential pressure are applied and thus are much less effective therapeutically.
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