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New to xPAP. Question about EPR and mask fit
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itscaleb Offline

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Post: #1
New to xPAP. Question about EPR and mask fit
First off, i would like to say hi as i am new to the board/xPAP community. I was wondering what the advantages to EPR were and if it helps improve your AHI having it on or off. I've tried searching the forum, but have only found stuff about turning ramp on and off.

My second question is about mask fit. I have noticed my nostrils hurt in the morning after waking up. Is this because my mask is too tight or is it just getting used to the pillows and will go away with time?

Thank you for any insight anyone can give.
08-13-2015 12:03 PM
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
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Post: #2
RE: New to xPAP. Question about EPR and mask fit
Welcome to the Forum!
The EPR is a comfort feature. It helps if you feel you have problems breathing out or when exhaling against the pressure. It will reduce your pressure upon exhaling depending on what setting you use, either 1,2 or 3, with 3 being the most relief. To see if it's something that you would like, try setting it at 2 and go from there. Some people don't use it. If you don't find it an issue when exhaling, then you probably don't need it.

Don't wait for your nostrils to get too sore. Try a lanolin cream or a nasal gel before putting on mask. Also, you can try a different size nasal pillow to see if it's more comfortable for you.

OpalRose
08-13-2015 12:22 PM
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itscaleb Offline

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Machine: AirSense 10 AutoSet
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Post: #3
RE: New to xPAP. Question about EPR and mask fit
(08-13-2015 12:22 PM)OpalRose Wrote:  Don't wait for your nostrils to get too sore. Try a lanolin cream or a nasal gel before putting on mask. Also, you can try a different size nasal pillow to see if it's more comfortable for you.

I'll try a nasal gel and see if that helps. Also, I'm currently using the medium size pillow with no leaks. I'll try the small and see if that helps and continues to have no leaks.
08-13-2015 12:41 PM
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DariaVader Offline
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Post: #4
RE: New to xPAP. Question about EPR and mask fit
EPR can help decrease water retention if that is an issue, in addition to making exhalation easier. On the other hand, it can also cause cpap induced CA events in those who are sensitive to pressure change. Whether or not EPR helps or hinders is individual.

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
08-13-2015 12:45 PM
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AshSF Online

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Post: #5
RE: New to xPAP. Question about EPR and mask fit
(08-13-2015 12:03 PM)itscaleb Wrote:  First off, i would like to say hi as i am new to the board/xPAP community. I was wondering what the advantages to EPR were and if it helps improve your AHI having it on or off. I've tried searching the forum, but have only found stuff about turning ramp on and off.

My second question is about mask fit. I have noticed my nostrils hurt in the morning after waking up. Is this because my mask is too tight or is it just getting used to the pillows and will go away with time?

Thank you for any insight anyone can give.

EPR is marketed as a 'comfort only' feature but it operates like a bilevel machine where the pressure support is limited to 3 cm (corresponding to setting of EPR =3).
EPR = IPAP - EPAP. Where IPAP is the pressure provided by the machine during inhalation. And EPAP is the pressure provided by the machine against exhalation.

In general, you need EPAP to eliminate obstructive events. IPAP is used to eliminate the Hypopnea events that are left over after the O events are eliminated. So you can use EPR this way.

In some people, EPR leads to high level of CO2 washout leading to central apnea events. But you need to evaluate an EPR level for at least 10 days because they may go away as your body adjusts.

For the mask fit, if your nostrils are hurting in the morning, you are wearing the mask too tight. We think that tightening a lot will reduce leaks but it's not true with most latest generation masks with double walls (like the Resmed P10). I wear mine loose in the nostrils before starting the machine. When the machine turns on, you can feel the nasal pillows inflate just a bit and they create a seal with the nostrils then. I never get a red nostril ever and my leak rates are 0.0 most nights. I have never had a large leak on the Resmed P10 ever.

That is why it's the best mask out there (there is a rumor that there is a P10 cult operating here on Apneaboard Smile )....Resistance is Futile!

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: 08-13-2015 01:48 PM by AshSF.)
08-13-2015 01:42 PM
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itscaleb Offline

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Post: #6
RE: New to xPAP. Question about EPR and mask fit
(08-13-2015 01:42 PM)AshSF Wrote:  For the mask fit, if your nostrils are hurting in the morning, you are wearing the mask too tight. We think that tightening a lot will reduce leaks but it's not true with most latest generation masks with double walls (like the Resmed P10). I wear mine loose in the nostrils before starting the machine. When the machine turns on, you can feel the nasal pillows inflate just a bit and they create a seal with the nostrils then. I never get a red nostril ever and my leak rates are 0.0 most nights. I have never had a large leak on the Resmed P10 ever.

I will also try making it not so tight. From what I've read, making the two straps in the back further apart should make it looser correct?

(08-13-2015 01:42 PM)AshSF Wrote:  there is a rumor that there is a P10 cult operating here on Apneaboard Smile )....Resistance is Futile!

If this mask works well after trying what you all suggest, I might have to try and join the P10 cult. :grin:
08-13-2015 02:34 PM
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surferdude2 Online

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Post: #7
RE: New to xPAP. Question about EPR and mask fit
Worth mentioning is that having read many past posts on the P10, the consensus has been that if you are having problems with the medium size, go to the large. I have never read where the small were recommended as a trial option.
08-13-2015 03:01 PM
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zonk Offline

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Post: #8
RE: New to xPAP. Question about EPR and mask fit
(08-13-2015 12:03 PM)itscaleb Wrote:  First off, i would like to say hi as i am new to the board/xPAP community. I was wondering what the advantages to EPR were and if it helps improve your AHI having it on or off.
Hi itscaleb
For some, EPR can cause rise in AHI, others find no such effects
Impossible to predict the outcome without seeing for yourself, whether you're better off with it or without

It can be of some benefit for people having problem breathing out against the pressure
I don't like it, interfere with my breathing pattern, for some its a blessing ... everyone is different

As for "nostrils hurt", try a nasal mask and give your nose some rest from nasal pillows
(This post was last modified: 08-13-2015 06:10 PM by zonk.)
08-13-2015 06:08 PM
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parkerdt Offline

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Post: #9
RE: New to xPAP. Question about EPR and mask fit
EPR of 2 makes it way more comfy for me to sleep at night. Now, mind you, my AHI is a little better with EPR off, but I am averaging 2.2 over the last 30 days with it on. And I sleep SO much more comfortably.

I used a P10 mask with no humidity and no EPR during my sleep study, and it hurt like heck. That experience alone has soured me on the P10. Now I mainly use a Respironics WISP. But there are many masks out there; find the one that is comfy for you. At that point, you can play with EPR, etc. and fine tune.
08-13-2015 07:40 PM
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ginzo Offline

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Post: #10
RE: New to xPAP. Question about EPR and mask fit
Welcome from another forum newb!

FWIW.Thinking-about

I'm transitioning from a FX (med pillow) to a P-10 (med pillow). Now that I may have my LL under control, I think it is doable.

EPR @ 3 and all humidity/ramp/heat settings on auto. I also have the heated tubing, which I hated the 1st night, but now its perfect.

(08-13-2015 02:34 PM)itscaleb Wrote:  
(08-13-2015 01:42 PM)AshSF Wrote:  For the mask fit, if your nostrils are hurting in the morning, you are wearing the mask too tight. We think that tightening a lot will reduce leaks but it's not true with most latest generation masks with double walls (like the Resmed P10). I wear mine loose in the nostrils before starting the machine. When the machine turns on, you can feel the nasal pillows inflate just a bit and they create a seal with the nostrils then. I never get a red nostril ever and my leak rates are 0.0 most nights. I have never had a large leak on the Resmed P10 ever.

I will also try making it not so tight. From what I've read, making the two straps in the back further apart should make it looser correct?

(08-13-2015 01:42 PM)AshSF Wrote:  there is a rumor that there is a P10 cult operating here on Apneaboard Smile )....Resistance is Futile!

If this mask works well after trying what you all suggest, I might have to try and join the P10 cult. :grin:

(08-13-2015 07:40 PM)parkerdt Wrote:  EPR of 2 makes it way more comfy for me to sleep at night. Now, mind you, my AHI is a little better with EPR off, but I am averaging 2.2 over the last 30 days with it on. And I sleep SO much more comfortably.

I used a P10 mask with no humidity and no EPR during my sleep study, and it hurt like heck. That experience alone has soured me on the P10. Now I mainly use a Respironics WISP. But there are many masks out there; find the one that is comfy for you. At that point, you can play with EPR, etc. and fine tune.
08-13-2015 08:15 PM
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