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Influence of EPR-Level on Central Apnea
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pizza41466 Offline

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Post: #1
Influence of EPR-Level on Central Apnea
This morning I noticed that my CAs were reduced considerably, after I have changed the EPR-level from 2 to1, before going to sleep. I had an average of more than 20 CAs per night. Today the the SleepyHead report showed only 6 CAs.
Has anybody made a similar experience?
Should EPR be avoided completely?
06-18-2015 03:40 AM
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zonk Offline

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Post: #2
RE: Influence of EPR-Level on Central Apnea
(06-18-2015 03:40 AM)pizza41466 Wrote:  Should EPR be avoided completely?
Hard to say, everyone is different
I don't use it but many folks like the idea of breathing out at lower pressure

For some people, EPR can increase AHI but like everything else, matter of trail and error

I don't think there is any benefit if starting at low pressure 4 or 5
Pressure does not drop below 4, regardless of EPR level settings
(This post was last modified: 06-18-2015 04:49 AM by zonk.)
06-18-2015 04:45 AM
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AshSF Online

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Post: #3
RE: Influence of EPR-Level on Central Apnea
EPR is the difference between IPAP and EPAP. Bi level machines call this pressure support. EPR provides PS of 1,2 or 3 cm H20.

In some people this PS can cause CAs due to excess CO2 washout.

For some people it may be a temporary thing that the body adjusts to within a few weeks at max.

So 2 things to try are:
reducing this PS by reducing EPR level
Or
Just wait it out a few weeks.

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
(This post was last modified: 06-18-2015 10:43 AM by AshSF.)
06-18-2015 10:42 AM
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richb Online

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Post: #4
RE: Influence of EPR-Level on Central Apnea
Has anybody made a similar experience?
Should EPR be avoided completely?

Started cpap 3 weeks ago. OA and HA combine for about 1.0. CA averaging around 30. No or minimal CA during sleep study and during titration. I started with bipap 9 - 13 getting severe episodes of CA. Saw Dr. and techs. They changed prescription to Auto with a low of about 8 and a high of around 12. Max set for 16. CAs increased to 36 still almost no OA or HA. Lower overall pressure as shown on the SH graph did not improve CAs. The only thing I can think of is that I am getting CO2 washout as a result of the EPR of 4. I am reluctant to change the settings myself because I am still being monitored by the Provider of the equipment and the techs.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-20-2015 03:04 PM
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pizza41466 Offline

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Post: #5
RE: Influence of EPR-Level on Central Apnea
The washout of CO2 is in my case obiviously the main reason for high numbers of CAs. I'm glad to have a simple explanation for my high CA index. In the meantime I had a night with only 3 CAs. Compared to my maximum of 23 CAs with EPR set to 2, this is pretty good. There is no guarantee that this will be the case in every night, because when you have a light sleep, or a disturbed sleep, where you often drift fom deep sleep to nearly wakefulness, you will probably have more CAs.
I wonder if my reaction to changes in the CO2-level is slightly different, because the sports I prefer include swimming, going fast on the bicycle and rowing.
06-21-2015 01:17 AM
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richb Online

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Post: #6
RE: Influence of EPR-Level on Central Apnea
(06-21-2015 01:17 AM)pizza41466 Wrote:  I wonder if my reaction to changes in the CO2-level is slightly different, because the sports I prefer include swimming, going fast on the bicycle and rowing.

You may be on to something. I too am an active person. In addition, I have a large lung capacity. I think the combination of lung capacity and epap functions like a large air leak on expiration. This in turn may be the explanation for the CO2 washout and the CAs.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-21-2015 06:58 AM
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pizza41466 Offline

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Post: #7
RE: Influence of EPR-Level on Central Apnea
I will now keep the setting of my machine for the next 2 weeks and hope that AshSF is right and that waiting it out might improve my CA index even further.

What is the main difference between the sleep study machine and the machine you are using now?
06-21-2015 08:54 AM
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richb Online

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Post: #8
RE: Influence of EPR-Level on Central Apnea
(06-21-2015 08:54 AM)pizza41466 Wrote:  What is the main difference between the sleep study machine and the machine you are using now?

I was titrated on a Respironics bipap machine. The tech started me on cpap with some kind of flex (EPR). I was then changed to bipap. My take home machine is a Resmed air sense 10 bipap with autosense. It was originally set with an IP of 13 and an EP of 9. 20 minute ramp up starting at 9 and 4. I was changed to autopap with a low of 8 and a high of 16. My pressure ranges between 9 and 12 on the SH graph. As far as I can see there is not much difference between the machines when set up the way ther were at the start. The auto feature may be OK but my OA and HA numbers are a tiny bit worse on Auto. I believe that my problem is with the EPR causing CAs. I have 1 to 1 1/2 hour periods with more than 1 CA per minute and over all AHI of around 30 with 29 being CA.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-21-2015 10:37 AM
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pizza41466 Offline

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Machine: S9 Auto Set
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CPAP Pressure: 8 -13; EPR 1
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Post: #9
RE: Influence of EPR-Level on Central Apnea
Have you ever tried to meditate? Sometimes we do it at the end of a yoga lesson. Even then I noticed that I have "forgotten" to breathe. The experts on the forum make it clear, that there are other rules of CO2 triggering during the time you are awake. When you sleep the trigger for inhale is a different one. During meditation you are between awake and asleep. It might be similar to the situation you have when you try to get used to all the CPAP rigging during the night.
I sometimes think with a bigger lung capacity than normal, it doesn't seem worth the effort to start an inhale for that little oxygen that we need while resting.
06-21-2015 11:45 AM
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tedburnsIII Offline

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Post: #10
RE: Influence of EPR-Level on Central Apnea
(06-20-2015 03:04 PM)richb Wrote:  Has anybody made a similar experience?
Should EPR be avoided completely?

Started cpap 3 weeks ago. OA and HA combine for about 1.0. CA averaging around 30. No or minimal CA during sleep study and during titration. I started with bipap 9 - 13 getting severe episodes of CA. Saw Dr. and techs. They changed prescription to Auto with a low of about 8 and a high of around 12. Max set for 16. CAs increased to 36 still almost no OA or HA. Lower overall pressure as shown on the SH graph did not improve CAs. The only thing I can think of is that I am getting CO2 washout as a result of the EPR of 4. I am reluctant to change the settings myself because I am still being monitored by the Provider of the equipment and the techs.

Wow! Might suggest speaking to another board-certified sleep doctor or pulmonologist. It sounds as if your case is not run- of- the mill.

My limited knowledge/understanding is that xPAP is not effective for complex apnea, if that is what you may suffer. I don't know much, though.

Dial-winging and fussing with the EPR just doesn't sound like it's the best solution. Seems as if it's a 'shot in the dark'. JMO.
(This post was last modified: 06-21-2015 12:15 PM by tedburnsIII.)
06-21-2015 12:11 PM
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