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Expiratory Relief and Preliminary Report Analysis
#1
Question 
Expiratory Relief and Preliminary Report Analysis
Hello everybody,

I have been recently diagnosed with sleep apnea and I am waiting for the CPAP device to be delivered.

In the meantime, I would like to pick up your brains on the Clinician Menu Settings for the ResMed AirSense 10 Autoset, in particular how to set the EPR (1, 2, 3), considering that my AHI from the sleep test is >50 and the initial pressure is going to be set at the maximum allowed range (4-20).

Thank you in advance for sharing your experience.

Sleep-well
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#2
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
Hello, good evening, and welcome.

A10 quick instructions: https://www.apneaboard.com/resmed-airsen...setup-info

How to get the clinician's manual: https://www.apneaboard.com/adjust-cpap-p...tup-manual

Follow the directions on that second page, especially the section "How to ask for a Clinician Manual via email".

Here's a tip: Disable the mickey-mouse "ramp" feature (not to be confused with EPR) to let the machine's APAP algorithm get to a useful therapeutic pressure more quickly. 4 to 20 is too wide a range and your doctor really should have specified a narrower one. Does your prescription actually say 4 to 20?

P.S.: A10 user's guide in case you don't have a paper copy: https://www.resmed.com/us/dam/documents/...er_eng.pdf
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#3
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
A double-take about the 4-20 pressure range: Did you not go through the titration phase of the sleep study, so that you're going to do that part at home and the doc is going to give you a narrower pressure range after looking at the data ... or what? Just curious.
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#4
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
Thank you for the reply, FD.

Because the sleep study did not include some parameters that the doctor could have found useful, the suggestion was to start with the full pressure range and then narrow it down progressively and slowly in a matter of weeks.

The sleep tech's educated guess, based on the mask-fitting and "nap" trial, was to keep the pressure between 6 and 12, but I can't verify this until I get the machine, which is going to be soon, I hope.

So, you are suggesting to turn the AutoRamp off, which I will surely do.

What about the EPR setting? In my understanding, 1, 2, 3 refer to by how much the pressure should decay on exhaling, to make breathing against pressure easier. What did you use at first? Do you still use it?

Best
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#5
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
Welcome to the forum.  We can and will help you with all things apnea.  To best do that we like to use data.  The best data comes from a free program called SleepyHead.  It lets us look at your night on a breath by breath basis if necessary.  See my signature for link.

Now read the Mask Primer.  It contains a lot of info about masks fitting and leaks. Each of us are unique thus Masks are individual what works for me may or may not work for you.  Use the visit to the DME to try several different masks. Insist on it. Try Nasal Pillows, the P10 by ResMed is a good one, nasal masks and finally full face masks. You will likely have one of these attached to your face while sleeping for the rest of your life. Try. The asks under .Pressure and lying down as close to sleeping position as you can get. It is important.

Finally post a full copy of your sleep studies.  Your initial diagnostic study and your titration study.  The full study not just the summary.  There are usually gems of info available in the details that are not mentioned in the summaries.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#6
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
EPR is possibly somewhat tricky if your apnea includes CA, central [nervous system] apnea, in addition to OSA, obstructive sleep apnea. I'm not an expert and will defer to the pressures-and-charts experts on this (so someone correct me if I'm wrong), but my understanding is that EPR, which is usually advertised by the manufacturer as a comfort feature, is also a therapeutic setting when CA is involved.

Case type 1, CA involved: The EPR setting is the inverse of PS, pressure support, the difference between IPAP (inhalation/inspiratory) and EPAP (exhalation/expiratory), and should not be messed with for comfort but should be considered a component of the set of titrated pressure settings: EPAP, PS, et cetera (with IPAP=EPAP+PS). Beyond that, I'll leave it to the experts.

Case type 2, strictly OSA (including mine): EPR is very useful as a comfort feature, but because the therapeutic pressure is EPAP rather than IPAP, the determined (titrated) pressure in the Rx should be increased by the EPR amount to get the machine setting. So my Rx is straight 15 cmw, but I want an EPR of 2; therefore I set the machine to 17 and EPR=2 so I'm getting 15 on exhalation. With EPR=0, I would set it to 15, but I find that uncomfortable. I've also used EPR=3 (pressure=18).
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#7
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
I'll add the standard p.s. about Fred's request for the sleep study (same goes for prescription): All personal or identifying information should generally be blacked out or excised on a photocopy of each page before scanning & posting. Or you could do that digitally to a PDF or image file if you're a digital-document wiz.
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#8
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
Sorry I forgot EPR
Some of us here like to use EPR on the autosert as a therapeutic setting to minimize flow limitation as on a Bilevel machine. ResMed describes it as a comfort setting. While I'm sure that EPR is likely in your future I'd like to see your graphs from sleepyhead first without and see what kinds of events you are having.

Thus the need to see sleep studies in detail. I have seen summaies that aid OSA when all events were central.

To comment on settings, any settings without data.without seeing how you react is not a good practice.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#9
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
Thank you for the guidelines, Fred, will do.

One more question: How long after starting the therapy can I post the SleepyHead results, to receive meaningful feedback?

Best

(01-01-2019, 07:58 AM)Fats Drywaller Wrote: I'll add the standard p.s. about Fred's request for the sleep study (same goes for prescription): All personal or identifying information should generally be blacked out or excised on a photocopy of each page before scanning & posting. Or you could do that digitally to a PDF or image file if you're a digital-document wiz.

Will do, thank you again for your replies.
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#10
RE: [Newbie] Expiratory Relief Settings on AS10 Autoset
Post after the first night. And please keep all you posts in the same thread. That provides an easily accessible history.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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