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EPR and Sleep Quality
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me50 Offline

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Post: #1
Question EPR and Sleep Quality
I changed my EPR to 3 to see if it helped me or not.

I have not had a good night sleep since I changed it. I was waking up all the time. So, last night, after waking up twice in less than 4 hours, I turned the EPR back to off and I slept for another 3 plus hours without the fitful sleeping.

I cannot see what the EPR would have to do with this but I am wondering if anyone else has experienced this or something similar.

Thanks and have a great day.

Help
10-03-2013 07:53 AM
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luckydog Offline

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Post: #2
RE: EPR and Sleep Quality
I have my EPR set at 2 I find it is a more relaxed breathing - I believe the exhale is 2 less than the setting in pressure - sorry for terminology - When I am in a deep sleep I breath shallower and at setting one the air flow was difficult to was more labored - I have gone from 3-4 ahi to .6-1 by going from epr 1 to epr 2
(This post was last modified: 10-03-2013 08:36 AM by luckydog.)
10-03-2013 08:35 AM
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PsychoMike Offline

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Post: #3
RE: EPR and Sleep Quality
(10-03-2013 07:53 AM)me50 Wrote:  I changed my EPR to 3 to see if it helped me or not.

I have not had a good night sleep since I changed it. I was waking up all the time. So, last night, after waking up twice in less than 4 hours, I turned the EPR back to off and I slept for another 3 plus hours without the fitful sleeping.

I cannot see what the EPR would have to do with this but I am wondering if anyone else has experienced this or something similar.

Thanks and have a great day.

Help

Depends on what you are used to, me50.

If you've grown accustomed to the full pressure in and out, then suddenly having the machine drop the exhalation pressure would be "different" enough to play games with your mind (i.e. - what's wrong with my dream machine?)

If you're comfortable with the machine set EPR=0, then that's what works for you. I personally like the EPR=3 setting with my nasal mask, but I am noticing the "pulse" of the change when using a ffm...I may be experimenting in the not too distant future.
10-03-2013 11:21 AM
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PaulaO2 Offline
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Post: #4
RE: EPR and Sleep Quality
There's been a lot of discussion here and elsewhere about whether EPR is helpful or not. We've heard reports that some sleep docs are having it turned off as the default as they think it attributes to more events.

It is touted as a comfort feature and for the most part, it is. All it does is raise the pressure on inhale or drop the pressure on exhale (different manufacturers use different methods). With Resmed, the number of the setting corresponds to the pressure change. So a setting of 2 means the exhale is dropped 2 points.

Aha! I found it. I did an "experiment" a while back to see if EPR makes any difference.
http://www.apneaboard.com/forums/Thread-EPR-good-or-bad

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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.
10-03-2013 11:45 AM
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alby_c Offline

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Post: #5
RE: EPR and Sleep Quality
I like the epr.
I find I use different settings with different masks
Nasal pillows I like 3.
Nasal mask 2 and full face mask I like it at 1 or off
I am now consistently getting an AHI at about 0.5 +/- 0.3 so am pretty happy with it and use the pillows unless I have a cold. Then as the nose get sore I switch to the nasal or full face depending on the severity.

i do not think it really matters what it is set to for treeatment - just find the setting that works for you with the mask you are using.
10-04-2013 06:23 AM
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archangle Offline
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Post: #6
EPR and Sleep Quality
I think for most people, it's a comfort thing and has little effect on AHI.

However, it affects the results of some people. Since you spend half the time at a lower pressure, you might need to up your pressure a little.

A small number of people find their AHI is better or worse with EPR. The difference is especially notable in terms of central apnea.

Yet another reason to have the software and check your own results, and to tinker with things like EPR or pressure.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
10-04-2013 07:05 AM
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Peter_C Offline

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Post: #7
RE: EPR and Sleep Quality
This is why I changed to a BI-PAP back in the day, as my pressure was so high that I couldn't exhale easily. I do think that change takes a while to get used to (like a week or three). In my thinking I can't stress enough the need to make changes slowly, and one at a time, otherwise it's like a sleep study - was it just a good night or a bad night?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-04-2013 12:02 PM
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Sleepster Offline
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Post: #8
RE: EPR and Sleep Quality
When I first went on a BiPAP my CA index shot way up (around 17 or so). So I can understand that a drop in the exhalation pressure, even though it's a much smaller drop with EPR than with a BiPAP, could cause problems for some people.

Right now I have the BiPAP set at 12 over 11, with Bi-Flex set at 3. (Bi-Flex is EPR). If I raise the EPAP higher than 11 I start swallowing air.

Keep in mind that all of these effects are transient. Once I get used to a setting I can change it infrequently by small amounts. That's the way I get the benefits and minimize the side effects.

What I mean is that originally I went from CPAP at 13 to BiPAP at 13 over 8 (because I was swallowing air big time). The doctor and the DME were totally unaware that the BiPAP had EPR and didn't seem interested in learning about it. Then they changed it to 11 over 8, then 10 over 7 (because my CA index was so high it was putting my AHI over 5).

Once my AHI was staying below 5 every night, I started making my own changes. My goal is to get back to a CPAP pressure of 13. The side effects are air-swallowing and elevated CA index. Although my AHI stays below 5, I find that as I raise the pressure back up (by 0.5 per month) I can lower the CA index and thus lower my AHI. But when I got above a CPAP pressure of 11 I started swallowing air again, so I went back to BiPAP mode at 11.5 over 11. Then the next month I went to 12 over 11. Next month it'll be 12.5 over 11, unless I notice an increase in my CA index.

Sleepster
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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.
10-05-2013 11:07 AM
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RonWessels Offline

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Post: #9
RE: EPR and Sleep Quality
I'm a little confused about Bi-Flex. Let's start with something simple: what is the difference between a CPAP set at 12 with a C-Flex setting of 1 (ie. 12 on inhale and 11 on exhale) and a BiPAP with IPAP 12 and EPAP 11? My understanding is that they are essentially identical.

Now, this leads to Bi-Flex. With a separate EPAP and IPAP, Bi-Flex cannot be a pressure reduction on exhale like C-Flex (or EPR) is, since that is controlled by the EPAP setting. I had thought that Bi-Flex was simply a smoothing of the transition between the IPAP and EPAP pressures, with the higher Bi-Flex settings meaning that the transitions were smoother (and taking a longer time). Is this correct, or am I missing something?
10-07-2013 05:19 PM
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Sleepster Offline
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Post: #10
RE: EPR and Sleep Quality
(10-07-2013 05:19 PM)RonWessels Wrote:  I'm a little confused about Bi-Flex. Let's start with something simple: what is the difference between a CPAP set at 12 with a C-Flex setting of 1 (ie. 12 on inhale and 11 on exhale) and a BiPAP with IPAP 12 and EPAP 11? My understanding is that they are essentially identical.

I have noticed that the pressure doesn't jump from EPAP to IPAP until I start to inhale. With C-Flex, on the other hand, the pressure jump occurs at the end of the exhale. Not much of a difference, but it is a difference nevertheless.

Quote:Now, this leads to Bi-Flex. With a separate EPAP and IPAP, Bi-Flex cannot be a pressure reduction on exhale like C-Flex (or EPR) is, since that is controlled by the EPAP setting. I had thought that Bi-Flex was simply a smoothing of the transition between the IPAP and EPAP pressures, with the higher Bi-Flex settings meaning that the transitions were smoother (and taking a longer time). Is this correct, or am I missing something?

You are correct in that there is a smoothing of the transitions (a change in the shape of the pressure graph) but there is also a reduction in pressure over and above the reduction between IPAP and EPAP.

Bi-Flex can be set to 1, 2, or 3, in the same way as C-Flex or A-Flex. All three are essentially the same except for the way the pressure transitions, or to put it another way, the shape of the pressure graph.

Sleepster
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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.
10-07-2013 06:17 PM
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