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Can a higher pressure actually increase CAs?
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vsheline Online

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Post: #21
RE: Can a higher pressure actually increase CAs?
(11-21-2014 12:16 AM)Galactus Wrote:  EPR is just a comfort feature, raising it or lowering it is based on what you feel more comfy with.

Why are we talking EPR and Flex? I thought this was a resmed not a respironics?

It can't anticipate when you will exhale because your respiration rate is changing. It can know when you stop exhaling to raise pressure back up which is what it does. How it helps is to keep your airway open.

EPR is less "just a comfort feature" than 'Flex is just a comfort feature.

The end of EPR is synchronized to the change from exhalation to inhalation, meaning EPR is actually a limited form of bi-level because the exhalation pressure (EPAP) stays low for the entire time from the start of exhalation until the start of inhalation. Bi-level therapy is known to affect how many central apneas occur (for at least a few patients).

Also, if the therapy mode is fixed-pressure CPAP (instead of APAP), decreasing the amount of EPR used would be expected to slightly improve the AHI by increasing EPAP. In fixed-pressure therapy mode, when increasing the amount of EPR it is advisable to also increase the pressure setting an equal amount, so that EPAP is not lowered.

PRS1 'Flex, unlike EPR, is Flow based, meaning the 'Flex pressure reduction during exhalation goes away as the Flow goes away (as we stop actively exhaling), and 'Flex is less likely to worsen AHI, less likely to cause more obstructive apneas or more central apneas.

Reducing EPR may (for a minority of patients, like perhaps 10% or 20%, I think) reduce the AHI.

But, on the other hand, personally, I find EPR much more comfortable than 'Flex.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 11-21-2014 08:35 AM by vsheline.)
11-21-2014 07:53 AM
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Sleepster Offline
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Post: #22
RE: Can a higher pressure actually increase CAs?
(11-20-2014 01:24 AM)vsheline Wrote:  The pressure rises back to the inhalation pressure as we stop exhaling.

The pressure also decreases near the end of an inhale.

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11-21-2014 02:33 PM
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Sleepster Offline
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Post: #23
RE: Can a higher pressure actually increase CAs?
(11-21-2014 12:16 AM)Galactus Wrote:  EPR is just a comfort feature, raising it or lowering it is based on what you feel more comfy with.

Many people have reported that it has an effect on their AHI.

Quote:Why are we talking EPR and Flex? I thought this was a resmed not a respironics?

The OP uses a ResMed with EPR. I mentioned Respironics BiPAP with Bi-Flex because he expressed a desire for a feature present in the latter, but not in the former.

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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.
11-21-2014 02:37 PM
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Galactus Offline

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Post: #24
RE: Can a higher pressure actually increase CAs?
(11-21-2014 07:53 AM)vsheline Wrote:  
(11-21-2014 12:16 AM)Galactus Wrote:  EPR is just a comfort feature, raising it or lowering it is based on what you feel more comfy with.

Why are we talking EPR and Flex? I thought this was a resmed not a respironics?

It can't anticipate when you will exhale because your respiration rate is changing. It can know when you stop exhaling to raise pressure back up which is what it does. How it helps is to keep your airway open.

EPR is less "just a comfort feature" than 'Flex is just a comfort feature.

The end of EPR is synchronized to the change from exhalation to inhalation, meaning EPR is actually a limited form of bi-level because the exhalation pressure (EPAP) stays low for the entire time from the start of exhalation until the start of inhalation. Bi-level therapy is known to affect how many central apneas occur (for at least a few patients).

Also, if the therapy mode is fixed-pressure CPAP (instead of APAP), decreasing the amount of EPR used would be expected to slightly improve the AHI by increasing EPAP. In fixed-pressure therapy mode, when increasing the amount of EPR it is advisable to also increase the pressure setting an equal amount, so that EPAP is not lowered.

PRS1 'Flex, unlike EPR, is Flow based, meaning the 'Flex pressure reduction during exhalation goes away as the Flow goes away (as we stop actively exhaling), and 'Flex is less likely to worsen AHI, less likely to cause more obstructive apneas or more central apneas.

Reducing EPR may (for a minority of patients, like perhaps 10% or 20%, I think) reduce the AHI.

But, on the other hand, personally, I find EPR much more comfortable than 'Flex.

Take care,
--- Vaughn

Good to know I shall remember that for the future.

(11-21-2014 02:37 PM)Sleepster Wrote:  
(11-21-2014 12:16 AM)Galactus Wrote:  EPR is just a comfort feature, raising it or lowering it is based on what you feel more comfy with.

Many people have reported that it has an effect on their AHI.

Quote:Why are we talking EPR and Flex? I thought this was a resmed not a respironics?

The OP uses a ResMed with EPR. I mentioned Respironics BiPAP with Bi-Flex because he expressed a desire for a feature present in the latter, but not in the former.

Ahhh ok, was wondering where we went there and what I missed. Thanks!

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11-21-2014 02:55 PM
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rjberube Offline

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Post: #25
RE: Can a higher pressure actually increase CAs?
I'm unsure about an increase in pressure causing MORE centrals...

I can report that in my case, lowering the minimum pressure on my ResMed S9 Autoset actually DROPPED the reported centrals and therefore improved my AHI. [actually, I shifted the whole range (min/max) down by 2]

Transitioned to an AirSense 10, and tried tried dropping the range yet again, down to 4-12... law of diminishing returns kicked in, and I found raising the minimum up to around 5 got better results...

Current settings (with note that I mostly sleep on my side) include EPR set to 3, manual temp (83) and humidity (4) settings, ramp starts at 4, range currently set to 4.5-12

Assuming something at work isn't on my mind (and affecting my sleep), long term trending currently has AHI at under 2, and on a really good night I'll get AHI < 1.

Bottom line: careful, SLOW changes in your settings will help you find YOUR best machine setup... Sleep-well
11-25-2014 12:28 AM
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TyroneShoes Offline

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Post: #26
RE: Can a higher pressure actually increase CAs?
(11-21-2014 12:16 AM)Galactus Wrote:  ...It can't anticipate when you will exhale because your respiration rate is changing. It can know when you stop exhaling to raise pressure back up which is what it does...

I understand that. But it needs to be smarter than that. My ex rate is not going to change that drastically from breath to breath, so it should look at the last 20 breaths and try to make an educated guess in order to anticipate when it should kick into the EPR mode, hopefully just before I exhale again.

It doesn't have to be that accurate; anything close or even different would be better than it being wrong every single time, which is what happens when it waits to detect me exhaling.

If it's early by half a second, no blood, no foul. If it's late, it's just like it works now. If I get the "tic" in one out of 5 breaths that way, so be it; that's still a step in the right direction.
11-25-2014 03:47 PM
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PaytonA Offline
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Post: #27
RE: Can a higher pressure actually increase CAs?
Maybe you might want to consider getting a VPAP where there adjustments affecting the transitions from IPAP to EPAP and vice versa.
11-25-2014 04:43 PM
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TyroneShoes Offline

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Post: #28
RE: Can a higher pressure actually increase CAs?
I think insurance is reluctant to go there due to the cost; I think you have to have a high centrals to obstructives ratio before they will allow it. Mine is about 2:1, which might be the right ratio, but I am also under a 3 for AHI, so they may not think it is all that important.

I would like the most technically-advanced machine, sure, but I would also like a BMW i8 or a Tesla. Practicality is the driving factor. For the ability to drop my centrals to 2 per night rather than 2 per hour, it would be a pretty steep cost, and probably not worth it from the standpoint of the pencil-pushers who determine what is allowed and what isn't. And of course my comfort level doesn't even enter into the equation.
11-25-2014 08:36 PM
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Galactus Offline

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Post: #29
RE: Can a higher pressure actually increase CAs?
VPAP/BIPAP is also an issue for compliance based on pressure settings as well.

Keep in mind you list in your profile 5-20 pressure and that will have a lot to do with the changing pressures and what you are describing. Narrowing the pressures might help you.

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11-25-2014 08:50 PM
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PaytonA Offline
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Post: #30
RE: Can a higher pressure actually increase CAs?
My understanding is that CAIs play no part in selection of a BiPAP machine. CAIs are important to the justification for an ASV machine. Apparently high therapeutic pressure is a factor in BiPAP justification.
11-26-2014 12:03 PM
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