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[Pressure] EPR/PS pros and cons
#1
Question 
What are the upsides and downsides to running with a drop in pressure on exhale. This is sometimes called EPR or PS.

What are the physiologic effects? How does it affect CA, tidal volume, et cetera.

Pros?

Cons?
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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#2
(04-19-2014, 02:40 PM)justMongo Wrote: What are the upsides and downsides to running with a drop in pressure on exhale. This is sometimes called EPR or PS.

Pros?

Cons?
The pros that I see right off hand are improved exhalation comfort, and reduced average pressure apparently yielding some relief from aerophagia.

The cons that I see are reduced average pressure allowing some relaxation of the airway and possibly some increased breathing disturbances, sensitivity to the pressure changes notably while trying to fall asleep, losing sync with the machine causing it to to feel like you are getting slapped with a wet noodle every time the machine thinks it is time to start an inhalation.

That is all that i can think of right now.

Best Regards,

PaytonA
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#3
From the beginning I have only run with EPR = Off. I really can't think of a good reason to turn it on. Physically, my challenge is emphysema, which is supposedly more characterized with an inability to exhale more than an ability to inhale. My working theory is that, in my case, it's good for me to work a little harder exhaling. So if I am, then for right or wrong, I'll go with that.
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#4
I've heard that about emphysema. I hypoventilate due to central obesity.
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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#5
(04-19-2014, 02:40 PM)justMongo Wrote: Pros?

Cons?

Pros
If you find it hard to exhale against pressure ... EPR is godsend, the best thing since sliced bread

Cons
I find it annoying and disturb my sleep, feel like the machine interfering with my breathing rhythm

Sum-up: some people swear by it while others swear at it Too-funny
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#6
The way my machine is setup i have EPR at 3, and with all the other settings it feels like natural breathing to me, with pressure support of course, i sleep great, have great numbers and no bloaty feeling where im not swallowing a bunch of air
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#7
I played around with it a while back. http://www.apneaboard.com/forums/Thread-EPR-good-or-bad

Also, keep in mind that ResMed and P-R do pressure relief differently.

One does it by sensing the end of the inhale and dropping the pressure for the exhale. I think this is what ResMed does.

The other does it by sensing the end of the exhale and raising the pressure for the inhale.

There is a difference.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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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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#8
Hi Mongo,

As far as I know, EPR is indeed the same as Pressure Support, except EPR is limited to 3 cm H2O, and except EPR is the amount that the EPAP pressure is lower than IPAP, whereas PS is the amount that the IPAP is higher than EPAP.

With EPR: EPAP = IPAP - EPR

With Pressure Support: IPAP = EPAP + PS

As far as what are the effects of having a difference between IPAP and EPAP, it varies from person to person.

A few people find that increasing Pressure Support lowers their Central Apnea Index (CAI), but I think this is rare.

A few people have reported that turning off EPR or PS dramatically reduces their CAI, but most people do not experience this.

When I was using an S9 VPAP Auto, I used PS of 1 or 2. I liked having at least some PS but the higher that PS was, the higher my CAI was, although a higher PS would also (slightly) tend to decrease my Obstructive Apnea Index (OAI). In retrospect, I was probably too concerned with avoiding central events, which I now think are no worse than obstructive events, so whatever PS would have minimized AHI would probably have been best for me, or whatever PS would best avoid apneas with long durations.

Now that I am using an ASV machine which automatically (and very quickly) increases PS to avoid (compensate for) both central events and obstructive events, I set my Minimum PS somewhere between 4 and 5 in order to best provide a stable SpO2 between 94 to 96 when I am asleep.

When my Min PS is 3 or less, my Tidal Volume (amount of air inhaled or exhaled per breath) and Respiration Rate can get too low and my SpO2 can dip below 90, which I've read is undesirable.

When my Min PS is 6, I tend to spend hours on end with an SpO2 of 98 or higher, which I have read is undesirable and can cause health issues like accelerating aging and interfering with prescription medications and can lead to serious problems.

I think a person with lung disease or impared lung function may need a minimum PS of 6 or higher to maintain good SpO2.

It is important to occasionally monitor SpO2 during sleep, using a recording oximeter. The kind which are worn like a watch and have a separate finger sensor are more comfortable for wearing an entire night or even multiple nights.

Take care,
--- Vaughn


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.
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