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Dugy40 [Doug's Therapy Thread]
RE: Dugy40 [Doug's Therapy Thread]
If you're tuning up the new to you machine, you post when you feel like it. It's not required daily if you don't want to. It's if you want progress checked out or some question about the data answered. Start with a standard look unless asked for some variation, then go from that view. If you have a specific area that you want details, focus on that via a zoom and mention symptoms/complaints/issues along with the screenshot.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Dugy40 [Doug's Therapy Thread]
(07-14-2020, 04:11 PM)Dugy40 Wrote: I'm glad you asked. This is one of my favourite topics to bend people's ears about. EPR stands for Expiratory Pressure Relief. It is a function that ResMed introduced in their S8 and later models and it is the the same as C-Flex on Respironics machines, which they have had since the M series (although I'm sure both companies would swear blind they're totally different).
They are considerably different. EPR is a fixed pressure offset, Flex is variable and depends on how 'hard' you are breathing.
The idea is to drop the pressure slightly on expiration in order to make the pressure more tolerable. Sounds reasonable but it is, in fact, a huge problem and should be avoided in almost every instance. "Why?", I hear you ask. I'll try not to get into too much detail explaining this.

The first problem is that EPR (and C-FLEX) lower your effective CPAP pressure.
True they both do this.  Most users do not require compensation, but if it is needed you would increase the ResMed pressure by the amount of EPR and the PR machine by the amount of "relief" that is applied which is typically 2.  This drop in EPAP is more critical on a PR machine because it is slower to respond and pressure needs to be higher than that on a ResMed machine.
For example, if you need a CPAP 12 to breathe properly, but have EPR set on 3, you will only be getting an effective CPAP pressure of somewhere between 9 and 10, and because this is lower than is required you will obstruct. What will often happen next is that the patient will complain of persistent symptoms (because their OSA is not being adequately treated) and their download will show a higher than desirable AHI, so the pressure will be turned up making it less tolerable, increasing leak problems and leading to overall lower compliance with therapy.
Of course it will if you don't understand all that is happening in the therapy and are not following the therapy close enough to make quick corrections. Especially so if you are not alloowed to change the doctors prescribed settings (pressure).
I have had to deal with this on more than one occasion.
Not stated below is the fact that CPAP on fixed pressure and without EPR or Flex can, and does, do the same thing that EPR/Flex does, though to a lessor level.
The second problem is that by raising and lowering the pressure as you breathe, EPR actually increases the amount of air that you are breathing. With standard CPAP the pressure is constant, and the movement of air in and out of you lungs is done purely by your own respiratory muscles, so the amount of air you breathe is the normal amount that you should be breathing. All CPAP does is hold your airway open so that you can breathe normally. EPR works like low level BiPAP. As you breathe in the pressure increases and as you breathe out it decreases, which means that more air is moving in and out of your lungs than normal - the EPR is slightly augmenting your respiratory effort. This may sound all well and good, but there is a reason that you breathe the amount you do. Too little is a problem, we all know that, but too much can be a problem too. The extra breathing work done by EPR can be enough to hyperventilate you, sending your CO2 level too low which, in turn, causes central events. Again, I have recorded evidence of this happening.
We see this all the time, usually before we make any changes.  and yes, in sensitive individuals increasing EPR may increase the incidence of Central Apnea.  The solution is simple. be aware of this and when it happens respond, usually with a reduction of EPR/Flex and at times reduction in pressure and pressure variations, possibly going into effectivly CPAP mode.  Also realize the EPR/PS (pressure support) is very effective in treating Flow Limits, RERAs, Hypopneas, UARS, and Snores.  It allows a lower average pressure which can reduce Aerophagia/air in the stomach. 
Where I work, we only ever allow our patients to use EPR or C-Flex if they have had a sleep study with it and we can verify that it is not causing any harm. Otherwise we do not use it at all. I can think of fewer than 5 people who have actually had some benefit from using EPR/C-Flex in all my years of being a sleep tech.
That is because doctor and his team do not have a rapid follow up on settings that you have by utilizing OSCAR on a daily basis.  I have seen thousands that have benefited from EPR.  These users have taken advantage of their ability to readily alter their settings to optimize their therapy.  Note that medical staff is limited to settings prescribed by the doctor and cannot make changes unles the doctor changes the prescription.  
The people who sell the machines and the reps for the companies who make them will extol the virtues of EPR/C-Flex and tell you that it is perfectly safe. IT IS NOT. One of the engineers who designed the system admitted as much to another tech I work with.

So, to sum up, do not use EPR/C-Flex unless you have had a sleep study with it to make sure it's OK. It's not worth the risk. On ResMed machines EPR can be set to ramp only which is much less risky. Otherwise, if you think you really need it, get a study done while using it. As always, consult with your doctor, but you will probably find that they know nothing about this, as most of them don't in my experience
Since EPR is so dangerous, what makes it safe during the Ramp?  Nothing.  Events are not reported (at all) during the ramp period, therefore they couldn't have occured right?  You are having absolutly NO Obstructive Apneas, NO Flow Limits, NO Hypopneas during the ramp right?  If you say yes that's correct I'm throwing the BS flag.

In summary your therapy needs to be reviewed any time you are making a change, to make sure that the result is what was intended.  You can't wait 30 days, or more likely 3+ months for a followup.  EPR is extremely useful.  By the above reasoning any change that might cause an increase in central apneas is bad and should not be done. In addition to EPR/Flex, this also includes increasing the pressure, and on an APAP increasing the difference between min and max pressure settings.  By extrapolation, why use CPAP at all since anything we do with it MIGHT, just might, cause an increase in teh incidence of central apneas. In fact, the vast majority of users do not see any negative impact from CPAP use.
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RE: Dugy40 [Doug's Therapy Thread]
Thanks to bonjour for the more detailed response than my own, however I'll still stand by the author is clueless. One addition is that in auto CPAP mode, any machine should be able to compensate for the lower EPAP pressure, but in real-life, only the Resmed accomplishes that. Comparing Flex with EPR is ridiculous. They are both patented approaches to expiration pressure relief, but only Resmed offers the same approach as what is used in their bilevel (Aircurve) machines. Philips Respironics frequently fails to sync with patient needs and those of us that have used both machines can describe the difference, and you have to dig deep into the patents to learn what it really is. There is a reasI on many of the veteran members of the forum advocate that new users get a Resmed machine, and it is not because they are the same or that we have any kind of interest in finding any manufacturer better than another. I live in the town where Philips Respironics is designed and manufactured, and nothing would make me happier than to say this is the machine you should get. As you know, that's not the case.
Sleeprider
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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.
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RE: Dugy40 [Doug's Therapy Thread]
I was not as concise as you were in saying the Sleep Tech was clueless. I'll back you up on it though.
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RE: Dugy40 [Doug's Therapy Thread]
I think the sleep tech drivel warrants a second opinion. I was wrong, he's not Timmy. He's Stu Pid. And yes he's clueless too.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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A lot of reras
good morning. i feel pretty good but prob not as restful as usual. i faintly remember waking and feeling like my heart was acting up. didnt feel good. almost got up. it was bout the time of these cluster of reras. i know the definition. but can you explain whats going on and if my resmed will help these? my nose feels sorta clogged today. my nose was burning last night so i  turned the humidifier up one. think its on 4. two screenshots. fullscreen and zoomed on cluster of reras. ty Doug

       
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RE: Dugy40 [Doug's Therapy Thread]
That's a lot of flow limits. The only thing you can do with your machine is to increase pressure. Best would be a switch to ResMed.
On the humidifier, Try turning the humidifier up, if that doesn't work, turn it down. This is a personal preference more than a therapeutic choice.
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RE: Dugy40 [Doug's Therapy Thread]
Is this a true hypopnea? all four look like this. if it is. why? what characteristic makes it a hypopnea? ty Doug.
ps tracking says my resmed comes today. excited.
       
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RE: Dugy40 [Doug's Therapy Thread]
Your image of the hypopnea shows considerable flow limitation (flattening of the inspiratory wave) with interspersed recovery breaths due to the lower amount of air you are taking in due to flow limitation. That reduction in respiratory flow rate is essentially the definition of hypopnea as determined by a CPAP machine. BTW your closeup captures a RERA that is not flagged at 02:38:20.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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Got Resmed Airsense 10 autoset. setttings help
none of the boxes were checked, hard any data on the side showing, using the previous persons data to see how its set. setting in prefereces not to import data after yesterday. so all the old data will disappear. need help with these check marks. thanks Doug
i checked alot of what was checked on my other profile but need to know if i am doing this right
i set auto to 8-12 recomended epr 3 changed y axis on flow to 80             
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