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EPR - Why would you not use it if available?
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ginzo Offline

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Post: #11
RE: EPR - Why would you not use it if available?
Rcgop, No info just my opinion. I use it because I am a lazy breather. The release of pressure on the exhale has made a ton of difference. My biggest issue was large leaks so I'm lucky I don't fight other issues.

Since I started here, I have taken control of my therapy, (Dr. will find out next month). I plan on bringing my Sleepy head overview data for the last year to show my changes and progression.

The Dr. had me set on CPAP as I was since 2007. Since I upgraded from a S-8, basically no usable data for the end user, and his comment about LL's last visit, to a S-10, my therapy has improved 100% when I went to APAP. He had me at a steady 14 cmH2O and the mask was leaving my face.

Slowly, I adjusted pressures until I have almost no issues. The resources here are endless as far as info goes. SO, the bottom line is, I LOVE EPR, set at 3, and a 5 minute ramp starting at 5. the rest you can see in my bio.

Good luck and don't be afraid of EPR. Small baby steps and keeping records of different adjustments to track your progress will have you up and running smooth as silk!!! This process takes time, be patient.Sleep-well
(This post was last modified: 05-11-2016 07:10 PM by ginzo.)
05-11-2016 07:09 PM
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Sleepster Offline
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Post: #12
RE: EPR - Why would you not use it if available?
(05-11-2016 08:18 AM)Rcgop Wrote:  My prescription did not call for any EPR setting. Why??

Because, like ramp, it's considered by the industry to be a comfort feature, not a therapy feature. And like ramp, you use it if you want to, and not if you don't.

Some people do find that EPR adversely affects their therapy, others just don't like how it feels. Personally, if I have it I'm going to use it.

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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.
05-11-2016 07:17 PM
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green wings Offline

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Post: #13
RE: EPR - Why would you not use it if available?
Just want to confirm I understand what you mean, Alan. Are you saying that when you use EPR, you end up with different behavior from the machine's pressure response algorithm than when EPR is turned off?

(05-11-2016 07:07 PM)AlanE Wrote:  I have had bad results with EPR on. no matter what settings I try. With it off I get a constant cm unless stuff happens.
05-11-2016 08:40 PM
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archangle Offline
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Post: #14
RE: EPR - Why would you not use it if available?
People don't understand EPR. This also includes doctors, respiratory therapists, and DME's.

It's not always more comfortable for everyone.

It can make your numbers better or worse, especially central apnea.

It's one of the things that should be worked out on a trial by error basis.

I suspect most people would do better with than without, but it's not a 100% clear thing. This is yet another case of the medical mafia not doing their job by proper followup using a good, data capable CPAP machine and the remote monitoring tools.

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05-11-2016 10:54 PM
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holden4th Offline

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Post: #15
RE: EPR - Why would you not use it if available?
My EPR is set at two. I have used it since I switched to a Resmed S9 and the switch has made a huge difference in my therapy. Most of my events are CAs confused with sleep wake junk but there are some definite CAs in there.

I'm wondering if dropping the EPR to 1 will make a difference.

I don't use the ramp feature

How does this look

http://i.imgur.com/5KXia0X.png
05-12-2016 03:37 AM
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0rangebear Offline

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Post: #16
RE: EPR - Why would you not use it if available?
(05-11-2016 08:18 AM)Rcgop Wrote:  My prescription did not call for any EPR setting. Why??

EPR was not on my original script, nor was it explained to me by the DME, respiratory therapist, or physician. They even seemed surprised when I told them I turned it on. I chalk this one up to them; not doing their homework.

I first learned of it though this forum. I was waking up feeling like I could not exhale during my first month. Forum members recommended ERP so I turned it on and set it on 3. It eliminated the exhale problem.

2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
05-12-2016 07:39 AM
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Sleeprider Online
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Post: #17
RE: EPR - Why would you not use it if available?
(05-12-2016 03:37 AM)holden4th Wrote:  My EPR is set at two. I have used it since I switched to a Resmed S9 and the switch has made a huge difference in my therapy. Most of my events are CAs confused with sleep wake junk but there are some definite CAs in there.

I'm wondering if dropping the EPR to 1 will make a difference.

I don't use the ramp feature

How does this look

http://i.imgur.com/5KXia0X.png

As suggested above, EPR is one of those things you decide by trial and error. Try a setting of 1 for a while and decide if you're more or less comfortable with it. As far as your data, you have very good results with a smattering of centrals that probably are not too important to be concerned with.

As you makes changes, compare the average tidal volume and see if you notice any increases or decreases with EPR. Most people see an increase with increased EPR. Again not important, but an interesting observation if it applies to you.

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05-12-2016 07:40 AM
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Sleepster Offline
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Post: #18
RE: EPR - Why would you not use it if available?
EPR (Exhalation Pressure Relief) is a brand name, specific to ResMed AFAIK.

Respironic's version is called Flex, but officially it's C-Flex, C-Flex+, Bi-Flex, and A-Flex.

When they delivered my Respironics BiPAP the DME watched me use it. I mentioned that I could feel three pressures during each breath cycle. He shrugged. Later I figured out that those are IPAP, EPAP, and Bi-Flex. I believe the factory default Bi-Flex setting is 2. It can then be changed manually to 3, 1, or 0 (off). In addition to lowering the pressure on exhale, Bi-Flex also changes the shape of EPAP portion (negative portion) of the pressure graph. When you inhale you the highest pressure (IPAP), when you stop inhaling you get the intermediate pressure (EPAP), when you exhale you get the lowest pressure (something less than EPAP that depends on the speed and probably the acceleration -- how fast the speed changes --of the exhalation).

It's hard to tell how much of this really makes a difference and how much of it is marketing hype. The strategy, both with this issue and in general, is to offer a dizzying array of options. It appears to be an attempt to overwhelm the buyer. Automobile manufacturers employ the same strategy. The buyer ends up confused and goes for whatever the salesman is offering. It's a way, I guess, for the seller to clear out excess inventory of models on which they're overstocked.

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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.
05-12-2016 10:05 AM
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robertbuckley Offline

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Post: #19
RE: EPR - Why would you not use it if available?
There is science involved with C/A/Bi-Pap and there is also art. And, repeat after me Ladies and Gentlemen, Boys and Girls, and children of all ages - We are all different, though with close similarities.
I will just chime in here with my personal experience (which may or may not be yours). I started 13 years ago with a C-Pap (auto) with C-flex. First experience with Pap and had the Flex set at 3 because I couldn't stand the exhale back pressure at first and needed that much relief. (90% at a pressure of 9.4). In '08 upgraded machine which had A-flex. My pressure at 90% was around 9.8. I was OK with a 2 on the flex. In '10 was having problems, and we (the Dr. & I) played with pressures and ended up with upping the floor of the auto range to 13.5 and a top of 16 - needed to go back to a Flex of 3. (Footnote- My Dr. was involved and we emailed back and forth trying different settings and sending her reports - no DME involvement - in fact Dr. "ordered" the clinician's manual to be left with me so I could change settings). 3 years ago it was determined that I needed to go to an higher pressures and an ASV. I am now at a floor of 15; minimum support of 4, top end +10. With the switch to the Bi-pap and ASV (breath rate set at auto) there was a period of adjustment to the machine. In getting used to it, I had a strange sensation on the exhale, that was disturbing, like not enough air. Mentioned to the Dr. - she said, "What do you have the Flex set at? " I said "3, like we used to". She said, "Crank it back to 1, see what happens, or even 0, I have patients that prefer it to be lower because the Bi-Pap is doing most of it already".
The point of this lengthy scree is that we are not dealing with a one-size fits all, and there is some art in response to the clinical "feel" as well as just the data. I am fortunate to have a Dr. that knows this, as well as her science, and stays involved. I had the Flex set at 3 for most of my Pap "career". I now have it set at 1, and some of it is just trial and error.
(The scene in my office when they delivered the ASV, and it was a new DME, and I asked for the clinician's manual is another story. Told them to take the machine back if they weren't going to leave it, while I tried to get the Dr. on the phone to tell them that it was OK, and yes she had written that in the order.)
Hose on my friends...
05-12-2016 01:15 PM
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DariaVader Offline
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Post: #20
to epr, or not to epr - that is the question...
Everybody is different. Some reasons you might want EPR
  • Feels hard to exhale against pressure
  • Decrease cpap induced water retention (yes, really)
  • UARS requires a higher IPAP than EPAP to treat. EPR is better than straight pressure for treating UARS

Some reasons you might not
  • CA can be caused by varying pressures
  • Varying pressures may cause you to sleep less deeply or even to wake

Not exhaustive by any means, but it really does depend on the therapy you need individually

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
05-12-2016 04:07 PM
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