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EPR, Not a comfort setting?
I have heard it is best if you can do without EPR and it is there for comfort until you get used to the machine.

I cannot tell the difference between
EPR=1 and ramp off and
EPR off and ramp at 5 minutes.
BUT, my body does.

Last month I went the whole month AHI less than 3 and relatively good sleep quality. Most importantly, my 90% pressure AND my AHI were trending down.

Last night I turned off EPR and all hell broke loose. The first 4 hours were great (AHI .83). The last 4 hours, the pressure shot up, leaks were a problem, periodic breathing kicked up, sleep was very poor, and AHI was 5.7 for the full 8 hours. Resmed's MyAir report gave me a 100 for the night. What a joke!

Any thoughts, advice, comments, or did I just have a bad night?
HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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I would not judge any change in settings based on a single night. There is not general rule of thumb for EPR, but it is considerably different from the Respironics Flex pressure relief. EPR is very close to a bilevel, limited to 3 cm of pressure support. The problem with EPR is mainly when the settings include low CPAP pressures, as it will make the EPAP very low and may allow OA For example, any pressure under 7.0 cm with EPR at 3, results in an EPAP of 4.0. That EPAP pressure does not turn to IPAP until you initiate an inhale. If the airway closes at that low pressure, the machine never senses the inhale and stays low until the apnea passes. Some people respond to EPR with central apneas. So it is not for everyone, but for the majority, it is comfortable and promotes improved tidal volume.

Learning about bilevel titration can help you understand the importance of a minimum EPAP pressure. This is where EPR fails some patients. I think the bottom line is, the response to EPR can vary a lot between individuals, but at low pressures, it probably should not be used as it can allow pressure to fall way under prescription to prevent OA.
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I experimented some with EPR and discovered that for me, I need it. My AHI increased with it off. This was done with a week one each setting (off, 1, 2, and 3). I do better with it at 2 but, depending on mask. I need it higher with my pillows mask (2 or 3) than with my FFM. I could not tolerate it off and prefer to not do 1 but could survive.

Others do not need it at all.

I think it is a comfort feature but our level of comfort can effect the amount of air we are breathing in and out. I feel like I am smothering without the EPR on my nasal pillows. At one, I can barely tolerate it. At 2, it is better. At 3 it is better. Another pillows mask, 3 made me feel smothered because I could not handle the sudden jump in pressure. I had to use that one at 1 for a week until I got used to it then switched it to 2 where I was more comfortable.
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IMO EPR is not just a comfort setting, but can have a lot of effect on therapy either for the better or the worse depending on the specifics of your apnea. EPR is a "mini-bilevel" and the reason that genre of machines exist is because the effects can be profound. I keep my EPR at the max of 3, because it is better therapy for me in terms of water retention (expiratory pressure is linked with an increase in intrathoracic pressure which in turn affects kidney function) I have an appointment to be titrated for bilevel in December if my Ins co doesn't nix it due to my very good compliance on APAP. Conversely, in a patient who has complex or central apnea EPR or BiLevel treatment can have a negative impact. It's all about looking at the data and finding what works for you.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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Thanks Sleeprider, Paula02:
That's what I think is so strange about my case. I do not believe I need a bilevel PAP.
My 90% pressure is <9 and rarely have obstructive events. One per week on average. The remaining events happen during half awake, half asleep periodic breathing. Awake/sleep junk?

It seems that an EPR of 1 softens these series of events.
HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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