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New to xPAP. Question about EPR and mask fit
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
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Sex: Female
Location: Missouri, USA

Post: #11
RE: New to xPAP. Question about EPR and mask fit
Hi itscaleb,
WELCOME! to the forum.!
Much success to you with your CPAP therapy.

trish6hundred
08-13-2015 09:48 PM
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PaytonA Online
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Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
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CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #12
RE: New to xPAP. Question about EPR and mask fit
(08-13-2015 01:42 PM)AshSF Wrote:  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!

It is not a rumor!!! Big Grin SHa_biggrin5 Sleep-well
08-13-2015 10:17 PM
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itscaleb Offline

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Posts: 5
Joined: Aug 2015

Machine: AirSense 10 AutoSet
Mask Type: Nasal pillows
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CPAP Pressure: 9-20 cm H2O
CPAP Software: SleepyHead Other Software

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Post: #13
RE: New to xPAP. Question about EPR and mask fit
So I tried some of the suggestions last night and it was a night and day difference.

I turned off my epr and it took me about 15 minutes to get used to it before I was fine. It actually feels better to me so far.

I turned off my ramp as I never liked it much anyways.

I switched from the medium to large pillows and this morning my nose didn't hurt at all, just felt a little tingling but no pain. It also fixed a problem I didn't realize I had. It took away a small whistling noise I didn't know I had till I switched.

I don't think I had any major leaks either. My front display listed my leak as 12L/min, but stated that the seal was good.

What does the 12L/min mean and what is an acceptable amount for that reading?
08-14-2015 07:36 AM
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
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CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #14
RE: New to xPAP. Question about EPR and mask fit
It's amazing what a few little tweaks can do! Smile
I went from a size extra small nasal pillow to a size small, and the seal was much better, plus I noticed that slight whistling sound was gone.
Good Luck itscaleb.

OpalRose
08-14-2015 08:21 AM
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becker44a Offline

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Machine: ResMed S9 Autoset
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Post: #15
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.

Hi itscaleb,
Welcome to the forum!!!

I use the predecessor model to your machine, and I use EPR set at 3. For me, the higher the pressure, the more trouble I have with aerophagia (air-swallowing). At this setting, the machine always lowers the exhale pressure 3 cm from whatever inhale pressure is called for. At startup, my Inhale/Exhale pressures are at 10/7. If I have a few events, and the inhale pressure is increased, say up to 14, the exhale will be at 11, a constant 3 less than inhale.

Since the EPR function reduces the average pressure, it helps with my aeropphagia - definitely a comfort improvement for me.

I have no information relating to your 2nd question, but you'll find plenty of P10 enthusiasts to help on that issue.

Good luck on your CPAP journey.

A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
08-14-2015 10:24 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Location: California, USA

Post: #16
RE: New to xPAP. Question about EPR and mask fit
(08-14-2015 07:36 AM)itscaleb Wrote:  What does the 12L/min mean and what is an acceptable amount for that reading?

ResMed machines report unintended leak. 12 Liter/minute was the reported rate of airflow (rate of airflow is volume per unit time) of unintended Leak.

In addition to unintended leak there is intended leak through the mask vent holes.

Unintended Leak under 24L/m is considered okay, unless it is quickly varying (jumping from high to low and back again a lot) which can sometimes fool the machine into falsely reporting clear airway apneas which are not really happening. (Looking at the Flow waveform during a reported apnea would tell us whether the reported apnea was real or not.)

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 08-15-2015 05:00 AM by vsheline.)
08-15-2015 03:23 AM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #17
RE: New to xPAP. Question about EPR and mask fit
(08-13-2015 01:42 PM)AshSF Wrote:  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.

For Philips Respironics System One machines, A-Flex and C-Flex Plus are a little different.

For PRS1 machines, an A-Flex setting of 2 will provide a basic 2 cmH20 of pressure relief during exhale, plus additional pressure variation based on the rate of our exhale and inhale, so that when exhaling strongly the pressure will drop even lower.

An A-Flex setting of 3 still provides the same basic 2 cmH2O exhalation pressure relief but in addition will provide the greatest amount of additional pressure drop based on the rate of our exhale and inhale. (By "rate" of our exhale I mean strength, how strongly we are exhaling, the rate of Flow into and out of our airway, not how many breaths we have been taking per minute.)

An A-Flex setting of 1 still provides the same basic 2 cmH2O exhalation pressure relief but will provide the least additional pressure drop based on the rate of our exhale and inhale.

The A-Flex setting also affects the shape of the pressure curve during inhalation. An A-Flex setting of 1 is the most abrupt, transitioning as we start inhaling or stop inhaling. An A-Flex setting of 3 slows down how quickly the pressure rises at the start of inhalation and also advances how early the pressure drops toward the end of inhalation while we are still trying to finish inhaling.


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 08-15-2015 11:50 AM by vsheline.)
08-15-2015 03:51 AM
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zonk Offline

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Machine: A10 AutoSet
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Other Comments: CPAP since Nov 2010

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Location: Australia

Post: #18
RE: New to xPAP. Question about EPR and mask fit
(08-14-2015 07:36 AM)itscaleb Wrote:  I don't think I had any major leaks either. My front display listed my leak as 12L/min, but stated that the seal was good.

What does the 12L/min mean and what is an acceptable amount for that reading?
You expect some leak but your leak was minimal. The machine display 95th percentile unintentional leak (mask leak + mouth leak) which means leak was at or below 12 L/m for 95% of the night
As vsheline pointed out, leak less than 24 L/m is acceptable, of course lower is better
08-15-2015 06:06 AM
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GeoffD Offline

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Machine: ResMed Airsense 10 AutoSet
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Location: New England

Post: #19
RE: New to xPAP. Question about EPR and mask fit
The only thing I have to add to what has already been said is that lanolin is used by women breast feeding. In the pharmacy, you'll find it next to breast pumps and other supplies for nursing mothers. I have a tube of it as a just-in-case that I have never needed to use.
08-15-2015 06:54 AM
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