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EPR adjustment
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fullthrottle800 Offline

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Machine: ResMed S9 Autoset
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Post: #1
EPR adjustment
After going a week with AHI from 40-75 last night I lowered the EPR to 1 on the S9 and after having bit of a restless night I awoke to a AHI of 4.0 hopefully things are looking up.
08-08-2012 08:38 AM
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SuperSleeper Offline

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Machine: PR System One REMstar Auto (DS560)
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Post: #2
RE: EPR adjustment
(08-08-2012 08:38 AM)fullthrottle800 Wrote:  After going a week with AHI from 40-75 last night I lowered the EPR to 1 on the S9 and after having bit of a restless night I awoke to a AHI of 4.0 hopefully things are looking up.

Holy cow, is that the only change you made? And it resulted in a drop of your AHI from 40-75 range to 4.0 ??? Shock-2

I'd be interested in seeing your continuing results, not just one night's of data. That's an amazing drop in AHI for simply adjusting the EPR... doesn't make sense to me. Thinking-about

SuperSleeper
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www.ApneaBoard.com


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08-08-2012 09:48 AM
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zimlich Offline

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Machine: Respironics PR System One BiPap Auto SV Advanced
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Post: #3
RE: EPR adjustment
That is weird- it's a tremendous change in AHI for a drop in epr. mANY OF US FIND WE DO NOT NEED epr, OR FLEX. i HOPE YOUR GOOD NUMBERS CONTINUE- GOOD LUCK. Sorry- hit caps lock and am too lazy to retype.
08-08-2012 10:29 AM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Post: #4
RE: EPR adjustment
(08-08-2012 08:38 AM)fullthrottle800 Wrote:  After going a week with AHI from 40-75 last night I lowered the EPR to 1 on the S9 and after having bit of a restless night I awoke to a AHI of 4.0 hopefully things are looking up.

Welcome to Apnea Board, fullthrottle800!

Every person is different, of course, but I think some people who have Central Apnea events (like me, for example) may tend to exhibit Cheyne-Stokes Respiration when the EPR or Pressure Support is too high.

You might want to take a look at your apnea events and flow waveforms to see if your apneas were sometimes Central, and if your flow waveform tended to oscillate somewhat when you were using the higher EPR setting, with recurring peaks of strong but gradually reducing flow until a hypopnea or Central apnea occured, and then the flow increasing to a peak again, over the course of a minute or two. I think this could be called Periodic Breathing (if you do not reach Central apnea in the valleys) or Cheyne-Stokes Respiration (if you actually reach Central apnea in the valleys).

I recently started using a ResMed VPAP Auto machine, and think I may have discovered that when I use too much Pressure Support I tend to experience worse Cheyne-Stokes Respiration. So, lately, I've cut down from 4 or 5 cm H2O of Pressure Support (used last week) to just 1 cm H20 of Pressure Support (the past couple days), and my AHI has improved from worse than 10 (last week), to better than 5 (the past couple days). In a week or so I may lower the Pressure Support even further, to zero, to see if zero seems to be better for me than 1.

It has been just a few days since the change, so it is of course too early for me to form a definite conclusion yet, but so far it looks like the amount of Pressure Support I use has a significant influence on my AHI.

Pressure Support is similar to EPR except EPR on my old ResMed S8 APAP machine reduced the pressure during exhalation relative to the higher inhalation pressure, whereas on my new ResMed VPAP Auto machine Pressure Support boosts the pressure during inhalation relative to the lower exhalation pressure, but bottom line both EPR and Pressure Support act similarly, producing a pressure difference between inhalation versus exhalation. Also, compared to EPR, Pressure Support has aditional adjustment options; it can be set from zero to 10 cm H2O, and is adjustable on how quickly or slowly it triggers (turns on the boost) at the start of inhalation, and how quickly or slowly it cycles off at the end of inhalation.

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: 08-09-2012 04:54 AM by vsheline.)
08-09-2012 04:24 AM
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fullthrottle800 Offline

Members

Posts: 13
Joined: Aug 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model:
Humidifier: H5i
CPAP Pressure: 6-10 auto
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #5
RE: EPR adjustment
[attachment=243]My apnea when starting machine has been almost entirely showing up as CA even though It was OA that I was having trouble with. These are my settings and results on AHI I find it a bit interesting since setting changes havnt been that much except now for EPR.
(This post was last modified: 08-09-2012 10:06 AM by fullthrottle800.)
08-09-2012 10:00 AM
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vsheline Offline

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Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #6
RE: EPR adjustment
(08-09-2012 10:00 AM)fullthrottle800 Wrote:  My apnea when starting machine has been almost entirely showing up as CA even though It was OA that I was having trouble with. These are my settings and results on AHI I find it a bit interesting since setting changes havnt been that much except now for EPR.

Hi fullthrottle800,

I see you're using SleepyHead. I've been using only ResScan, but I just installed SH and like it, too.

To see whether you were having Cheyne-Stokes Respiration (CSR), try looking at SleepyHead's Daily tab to see your waveforms, and move the cursor/pointer to the Flow Rate waveform, and zoom in around some of your apnea events (you can hold and drag the cursor over a portion of a waveform to select the time period for viewing, and you can use the cursor to "left click" on a waveform to zoom in, or right click to zoom out) until about ten minutes is shown across the screen, near the time of some of your apnea events. Ten minutes is a fairly good time scale to see CSR, if it is happening.

I've attached a screen shot of my Flow Rate waveform which I think shows CSR. My machine was in Auto mode, with 7 for minimum inhale, 11 for maximum exhale and 1 for EPR (actually called Pressure Support on my machine). In my screen shot, the minimum pressure shows around 9 instead of 7, because the machine had previously automatically increased the pressure to prevent flow limitations and obtructive apneas.

If I did not have a machine which is fully data capable, I would not have realized that I experience Central apneas and CSR, and I may need to be cautious of EPR and high pressures.

Every night and every hour my waveforms show either more CSR or less CSR, so I need to observe for about a week between making adjustments. Soon I'll try turning off EPR completely to see if this is better for me.

To treat the Centrals and CSR I may need a different type of machine, such as an Adaptive Servo Ventilator (ASV) machine. I'll be seeing my doctor next week and will discuss this with him.

Take care, all.


Attached File(s) Thumbnail(s)
   

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: 08-10-2012 11:26 AM by vsheline.)
08-10-2012 11:03 AM
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fullthrottle800 Offline

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Posts: 13
Joined: Aug 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model:
Humidifier: H5i
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Post: #7
RE: EPR adjustment
After I posted how well AHI was working out havnt had a good night since. Last nights AHI was 47 mostly all CA.
08-12-2012 10:14 AM
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fullthrottle800 Offline

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Posts: 13
Joined: Aug 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model:
Humidifier: H5i
CPAP Pressure: 6-10 auto
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Post: #8
RE: EPR adjustment
[attachment=245]Anybody make anything out of this mess?
08-13-2012 08:51 PM
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Podd Offline

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Post: #9
RE: EPR adjustment
Mmmm, interesting, I have been using EPR on my S9 machine after reading posts on this site. I only get a report of sleep times so I have to assess 'How I feel'.
Initially my EPR was turned off, so I tried it on 3 and EPR reaction time set to fast, my sleep 'Quality' improved drastically.
I was going to try this for a month and then switch it off again and see if it had any 'Noticable' effect.
Well, the 'Tinkerer' inside me decided that the EPR reaction time was a bit fast as I was started to hold my breath every now and again just to see if the pressure increase kicked in (Don't ask, I the guy who touches painted surfaces, ignoring the 'WET PAINT' sign.)
I altered the EPR reaction time to MED(ium?) and just had an awful night's sleep, waking a little after 04:00hrs.
I will change it back to (FAST)for tonight, hopfully I will 'Reap' the benefits and 'Try' not to tinker again (For a while anyway?)
Thinking about it, I found the EPR 'Kicking in' quite relaxing, I guess it was 'Comforting', possibly like 'Counting Sheep'???
08-13-2012 11:03 PM
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fullthrottle800 Offline

Members

Posts: 13
Joined: Aug 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model:
Humidifier: H5i
CPAP Pressure: 6-10 auto
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #10
RE: EPR adjustment
AHI was 75 this morning so either the machine register something wrong or settings are way wrong or this is the wrong machine for me.
08-14-2012 08:29 AM
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