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[CPAP] Clarification on EPR
#1
Clarification on EPR
There have been a number of threads on EPR, but information I found on a [Supplier #26] link (apparently from Resmed), raises a question; specifically "EPR and event detection" at the bottom of this link: [commercial URL removed]

I just replaced an old Resmed S9 with a new Resmed AirSense 10.  I've used a succession of Resmed autopaps since starting CPAP treatment based on advice that Resmed autopaps are better able to handle shallow breathing that is characteristic of allergy sufferers.  After decades of CPAP use with Resmed machines, the AirSense 10 seems to behave differently regarding EPR.

EPR has been a feature since the S8.  The AirSense 10 came preset to an EPR level of 2 and always active, which I believe is consistent with the previous machines.  I've been using it for several weeks, and experiencing a problem I did not have with the previous machines. 

At low pressures, like while falling asleep or waking at the end of a sleep cycle, I can breathe normally.  However, I find myself awakening during periods when the pressure is at the "treatment" level.  I notice that breathing is very shallow, ranging between my lungs being fully inflated and almost fully inflated.  I have the urge to yawn, but can't because my lungs are already full.  My chest feels like it's had a workout.  I open my mouth to relieve the air pressure and can breathe normally through my mouth until I fall asleep again.  I'm sleeping several hours longer than I did with the previous machines (10 hours), but waking up feeling like I still need more sleep.  The symptoms are consistent with poor oxygen exchange due to lungs staying full of stale air.

I suppose it's possible that the machine is defective, or there has been some design change in this model making it less responsive to my breathing patterns than the previous models.  I was just going to try bumping the EPR level to 3, but the page linked to at the beginning seems to indicate that the EPR behavior may be working "as designed", in which case it isn't clear what the solution might be.

That link and others describe EPR as being more of a "psychological" help than simulating the behavior of a bipap.  EPR can be set to operate only while the machine is ramping up, so that breathing feels more normal while you're still awake.  However, even if it's set to be on all the time, the linked article indicates that the machine temporarily stops EPR if it detects shallow breathing.  The article refers to the S8, which would indicate that the behavior isn't new with the AirSense 10.  The shallow breathing that triggers suspension of EPR appears to be exactly the problem with the new machine, and what I was looking to EPR to solve.

My apnea is during inhalation rather than exhalation, so I would not expect EPR to make it worse on that basis.  I'm a shallow breather, which caused a problem with my very first cpap, and led me to Resmed machines.  I've done well with prior Resmed machines; this is the first one with this problem.

Can anyone shed any light on the situation?  Has there been a design change in the 10 which might make it no longer suitable for me?  I don't want to just exchange it for another machine of the same model if that would be expected to behave the same.


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#2
RE: Clarification on EPR
EPR should work the same on this machine as your S9. If you download the free SleepyHead software, we can see exactly what is going on. EPR does work as a limited bilevel, and it can have therapeutic applications. It can also cause central events in sensitive individuals. EPR can be set toff, ramp only , or full time, and setting are 1-3. Your pressure is set at 7-15 with EPR 3. I thinl using Sleepyhead to see the pressure and events at the times of your arousals could be very helpful.
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#3
RE: Clarification on EPR
Sleeprider, thanks for the reply.  I was aware of the settings, variability in patient response, and potential for central events. 

I downloaded ResScan and looked at the data.  Its output doesn't distinguish between inhalation and exhalation. 

I downloaded SleepyHead (thanks for the link),and that was very useful. According to that output, EPR is working.  There also doesn't seem to be a direct correlation between high pressure and other factors that are indicative of exhalation problems (respiration rate, expiration time, tidal volume, or flow rate).  Problem indicators on those readings were often associated with very modest pressure, and were generally good around the upper limit. 

So now I'm stumped.  Something about the new machine performs differently from previous machines and causes periodic exhalation problems.  But the reports indicate that the machine is working as it should.

I'm going to try bumping EPR to 3 just to see if that makes a difference.  If it doesn't, maybe Resmed can shed some light on what might be different in the new machine.
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#4
RE: Clarification on EPR
Good luck. Let us know how that works out.
Sleeprider
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www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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