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IPAP, EPAP, and EPR on the S9 Autoset
#1
I have seen some confusion concerning the effects of max and min auto settings and EPR. It has gotten me confused too. Here is how I see it. Please correct me if I am wrong.

With an autoset, one sets the minimum EPAP and maximum IPAP and the EPR. Lets take settings of; min EPAP=8, max IPAP=15, EPR=3. This means that the EPAP will go no lower than 8 and when it is 8, the IPAP will be 11. At the other end of the scale, the IPAP can go no higher than 15 and when the IPAP is 15 the EPAP will be 12.

Best Regards,

PaytonA
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#2
(06-19-2014, 04:33 PM)PaytonA Wrote: I have seen some confusion concerning the effects of max and min auto settings and EPR. It has gotten me confused too. Here is how I see it. Please correct me if I am wrong.

With an autoset, one sets the minimum EPAP and maximum IPAP and the EPR. Lets take settings of; min EPAP=8, max IPAP=15, EPR=3. This means that the EPAP will go no lower than 8 and when it is 8, the IPAP will be 11. At the other end of the scale, the IPAP can go no higher than 15 and when the IPAP is 15 the EPAP will be 12.

Best Regards,

PaytonA


Hi PaytonA,
I don't believe that is correct. In my case, the prescription is 10 to 20 cm, and I am running EPR at 3 (and have for over a month now). When I look at the SleepyHead pressure graphs, it consistently shows the IPAP and EPAP lines are 3 cm different. When I start the machine, the starting IPAP pressure is 10, and the starting EPAP pressure is 7. That 3 cm difference is consistent all night long, as dictated by the EPR setting.

I believe another way to express this is:
The S9 Autoset pressure range controls the IPAP pressure.
If used, the EPR setting controls the EPAP pressure as follows:

EPAP = IPAP - EPR

If not used, then EPAP = IPAP.

Hope this helps.
A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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#3
Not exactly Payton. On the S9 you set a minimum and maximum pressure. For instance in your example 8 and 15. Not E or I, just pressure. Then, if you elect, as the OP wishes to do, you can set the EPR option on, and to 1, 2, or 3. The S9 will deliver whatever pressure it feels it should deliver between 8 and 15, and the EPR function will reduce that pressure by 1, 2, or 3 on exhale. So if the S9 thinks it would like to deliver a pressure of 8, an epr of 3 will result in an exhale pressure of 5. If it thinks 11 is the magic number, then 8 is the exhale pressure.

Also, the least pressure possible for the machine to deliver while on inhale or exhale is 4.

The op is requesting an epr of 3 from the doctor, which in my opinion should result in setting a minimum pressure of 8. 8 minus 3 equals 5.

That's ok, although my personal opinion is the range should be tighter than the 5 to 12 suggested, especially if epr is being used. 8 - 12 makes better sense, again ------ in my opinion. ....and as I suggested earlier, since the doc has admitted that he really doesn't know anything about these machines, then perhaps it would be incumbent on the DME to weigh in with his expertise, perhaps even calling the doctor.

But then again, what do I know?









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#4
I guess I was confused with how it works on the VPAP Auto.
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#5
Moderator Note: In the interest of helping the OP I have split this thread out of the original. In the interest of keeping the discussion civil I have deleted a couple of posts.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
(06-19-2014, 06:11 PM)becker44a Wrote: EPAP = IPAP - EPR

If not used, then EPAP = IPAP.

Is this still true if the IPAP - EPR is less than 4?

For example, if the IPAP is 5 and the EPR is 3, will the EPAP be 2? I would think that it would never be allowed to fall below 4 to keep the hose purged of exhaled CO2.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#7
There is no EPAP/IPAP on the auoset, autoset minimum and maximum pressure setting are nothing like bilevel EPAP/IPAP
Bilevel EPAP/IPAP are exhale/inhale pressure setting, on 8/12, you exhale at 8 and inhale at 12 all night long
Bilevel pressure support is the difference between EPAP/IPAP, EPR is nothing like that
The autoset deliver whatever appropriate pressure between setting range, if EPR enabled, pressure reduces at exhale and get suspended if apnea detected during exhale. For that reason imo EPR is more relevant in CPAP mode than autoset mode as set pressure is fixed all night
Some say if using EPR at 1, increase set pressure by 1 too and so on


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#8
I would have thought so, too, Zonk. But then I saw this:

(06-19-2014, 06:11 PM)becker44a Wrote: When I look at the SleepyHead pressure graphs, it consistently shows the IPAP and EPAP lines are 3 cm different. When I start the machine, the starting IPAP pressure is 10, and the starting EPAP pressure is 7. That 3 cm difference is consistent all night long, as dictated by the EPR setting.

Like you, I think calling these pressures IPAP and EPAP is misleading because those terms are more properly used when referring to bilevel machine pressures.

But evidently that is what this Autoset user is seeing on his SleepyHead graphs.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
(06-19-2014, 06:58 PM)PaytonA Wrote: I guess I was confused with how it works on the VPAP Auto.

the autoset is roughly like setting the vauto with a ps of zero, so ipap=epap, and then on exhale, you get a temporary 1-3cm epap drop.

vpap is like a boost on inhale, epr is a drop on exhale... the difference is where the pressure stays while you're not breathing. (to oversimplify things Wink)
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#10
(06-19-2014, 08:22 PM)Sleepster Wrote: Is this still true if the IPAP - EPR is less than 4?

For example, if the IPAP is 5 and the EPR is 3, will the EPAP be 2? I would think that it would never be allowed to fall below 4 to keep the hose purged of exhaled CO2.

you're right, epr to a minimum of 4.

setting epr with a pressure of 4 does nothing, just like setting ramp time Wink

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