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Meaning of EPR and Essentials for Airsense 10
#11
RE: Meaning of EPR and Essentials for Airsense 10
(12-06-2015, 10:39 PM)rfin16 Wrote: Do you think it would be too much to set EPR to three? I am trying to train to breath through my nose with the pillows and its working except a feeling of difficulty breathing out at times. Would this undermine the therapeutic effects and make it difficult for the machine to reach optimal pressures? Thanks for your advice.


You can set EPR to 3, but with your pressure setting of 4-20, EPR won't kick in until the APAP reaches a pressure 7. Then you would get exhale relief of 3cm, and you would then be breathing against a pressure of 4. The APAP can't go lower than 4cm no matter what EPR setting you use.

EPR does not make it difficult to reach optimal pressure, has nothing to do with it, but with a starting pressure of 4, it could take the APAP longer to reach optimal pressure, and possibly miss some apneas.


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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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#12
RE: Meaning of EPR and Essentials for Airsense 10
(12-07-2015, 12:26 PM)OpalRose Wrote: ckingzzzs, there is no EPR setting of 4. There is only 1,2 or 3. If the EPR is set to off, then there is no pressure relief when exhaling. You will exhale at whatever pressure your APAP is at the time.

I think you are confusing EPR with the lowest pressure that the Cpap can be set at which is 4.
These are two different things.

Thanks opalrose. I know there is no EPR setting of 4. I meant that if the EPR is Off, then the machine will resort to the lowest possible pressure of 4.
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#13
RE: Meaning of EPR and Essentials for Airsense 10
(12-07-2015, 01:50 PM)ckingzzzs Wrote:
(12-07-2015, 12:26 PM)OpalRose Wrote: ckingzzzs, there is no EPR setting of 4. There is only 1,2 or 3. If the EPR is set to off, then there is no pressure relief when exhaling. You will exhale at whatever pressure your APAP is at the time.

I think you are confusing EPR with the lowest pressure that the Cpap can be set at which is 4.
These are two different things.

Thanks opalrose. I know there is no EPR setting of 4. I meant that if the EPR is Off, then the machine will resort to the lowest possible pressure of 4.

With EPR off, the pressure relief is zero. IPAP = EPAP
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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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#14
RE: Meaning of EPR and Essentials for Airsense 10
To clarify, with EPR off there is no pressure relief but the machine does not go to lowest possible pressure. It will be at the pressure it is currently blowing at.
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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. 
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#15
RE: Meaning of EPR and Essentials for Airsense 10
(12-07-2015, 01:50 PM)ckingzzzs Wrote:
(12-07-2015, 12:26 PM)OpalRose Wrote: ckingzzzs, there is no EPR setting of 4. There is only 1,2 or 3. If the EPR is set to off, then there is no pressure relief when exhaling. You will exhale at whatever pressure your APAP is at the time.

I think you are confusing EPR with the lowest pressure that the Cpap can be set at which is 4.
These are two different things.

Thanks opalrose. I know there is no EPR setting of 4. I meant that if the EPR is Off, then the machine will resort to the lowest possible pressure of 4.

No, only if the starting pressure is 4. The APAP can't go lower that the minimum start pressure.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#16
RE: Meaning of EPR and Essentials for Airsense 10
I was welcomed to the creepy high tech era of medicine - I wrote the provider about EPR and they changed it to 3 remotely via the cell connection. Will see how I do on that setting tonight.
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#17
RE: Meaning of EPR and Essentials for Airsense 10
My first day on APAP, first day here. My supplier had my AirSense 10 Autoset setup with the EPR on with a reading of 2. He told me EPR would make breathing easier and acclimate me faster to the pressure. I liked it ok when first trying out the mask but the minute I laid down, I didn't like it so much on warmup. But as the pressure ramped up, I found myself breathing deeper to the point of almost hyperventilating. As much as the supplier had hyped up EPR, I found it to be a relief when I got in there and turned it off. I instantly was able to breath normally . It's a useless feature for me, does more harm than good in my case.

Robin
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#18
RE: Meaning of EPR and Essentials for Airsense 10
I believe that the EPR setting can affect cpap therapy, at least indirectly. During my initial attempts at optimising my settings I turned off EPR as I thought it was simply for comfort while getting used to my machine. I settled on relatively low pressure that greatly reduced my apneas, both central and obstructive but left some hypopneas (that I'm pretty sure are also centrals). I recently turned on EPR due to a suggestion I had found on this forum. to my surprise my hypopnea immediately dropped and my flow limitation was lowered. With EPR on the machine appears to act as a poor-man's BiPAP.
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#19
RE: Meaning of EPR and Essentials for Airsense 10
From a Wiki article
http://www.apneaboard.com/wiki/index.php...herapy#EPR

EPR is exhale pressure relief. EPR acts a lot like bilevel (BiPAP/VPAP). To really understand its impact on therapy, you need to understand bilevel titration, where EPAP is used to resolve obstructive apnea, and pressure support (IPAP) can be used to manage flow limitation, hypopnea and RERA. A concern with EPR is that for patients with a CPAP titration based on fixed pressure, it actually can undermine the prescription, unless the CPAP pressure (IPAP) is increased.

For example, let's say you are titrated at 8 cm H2O pressure for CPAP. You get your new Resmed machine and dial in EPR at 3, and now instead of fixed pressure at 8.0, you now have bilevel pressure at 8/5. Well 5.0 cm EPAP pressure allows obstructive apnea to occur, so you find out you need a pressure of 11/8 and so you wonder why the clinic got it wrong. Happens all the time.


Compared to CFlex and AFlex used by Respironics, EPR is a true bilevel variable that is allowed as a "comfort feature". Flex is only a temporary pressure reduction at the beginning of exhale or inhale and is actually a comfort feature, and pressure returns to the CPAP level before exhale begins; but EPR is bilevel, and keep the pressure low until inhale begins, unless the airway collapses and then the pressure stays low until the apnea ends.


This is all more than you wanted to know, but the point is bilevel therapy is much more comfortable than CPAP, and if you use EPR, it helps to understand how it might affect therapy.

  • Start with a single CPAP pressure without EPR, for example 10 cmH2O

  • Set EPR to 1 cmH2O AND increase CPAP pressure by the same amount as the EPR to 11 cmH2O to continue the same support of Obstructive Apnea. This provides a range of 10-11 cmH2O on every single breath.

  • Make small changes and evaluate.

It's important to understand how EPR works on a Resmed Autoset, and the difference between an Autoset and a bilevel machine.

On a bilevel, EPAP (exhalation positive airway pressure) is the pressure the machine provides when you're exhaling. This is what splints your airway against collapse. As you breathe in, the machine adds additional pressure, called pressure support (PS) to achieve IPAP (inhalation PAP). Note that PS is added to EPAP to achieve IPAP.

These terms are not really applicable to CPAP or APAP. The machine provides a pressure, which is just called "pressure". If you have EPR set, when the machine detects that you're starting to exhale, it reduces pressure by the amount of EPR. It is actually the reverse of pressure support on a bilevel machine. As the name suggests - exhalation pressure relief - EPR lowers the pressure. This is equivalent to lowering your EPAP (exhalation positive airway pressure). So if you need a certain EPAP to overcome obstructive events, increasing EPR will actually lower the EPAP below the required level and your obstructives - and obstructive hypopneas - will go up. (EPR does not "fight" hypopneas).
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