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[Pressure] How to set EPR Levels
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yogigupta Offline

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Posts: 5
Joined: May 2013

Machine: Res Med S9 Autoset
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air
Humidifier: Res Med
CPAP Pressure: 13
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Ohio, USA

Post: #11
RE: How to set EPR Levels
(03-24-2014 08:51 AM)robysue Wrote:  My best guess is that in your case the variability is being caused by the fact that you have both your min and max pressures set below 13, which if I recall correctly is your titrated pressure. When EPR = 1, the pressure drop is still leaving you with enough exhalation pressure to prevent most of the events; but when EPR = 3 the exhalation pressure is now low enough to allow more events to sneak by.

Out of curiosity: What are your median and 95% pressure levels? If you're getting AHI < 1 with EPR = 1 at these settings, then it's possible that you were a bit over titrated in the lab.
From Sleepyhead
AHI = 0.47 (Hyp=0.16, O = 0.31)
95% Levels
- Pressure = 9.8
- EPAP = 8.8
- Leaks = 19.2

CPAP set at 13 was very un-comfortable, back pressure on Ears almost deaf, Headache, even dizziness. Thats when I decided to convert from CPAP to APAP on my own in hopes of making it more bearable. First I reduced the pressure from 13 to 9 than increased to 9.8. I can handle this pressure. Now, working on minimum pressure and EPR levels.

EPR = 3 is comfortable but high, AHI. EPR =1 is uncomfortable but acceptable AHI.
Next, I plan to increase minimum pressure to about 7 and set EPR =2. I hope that will give me the right answer.


03-24-2014 10:28 AM
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robysue Online
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Posts: 1,238
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #12
RE: How to set EPR Levels
(03-24-2014 10:28 AM)yogigupta Wrote:  From Sleepyhead
AHI = 0.47 (Hyp=0.16, O = 0.31)
95% Levels
- Pressure = 9.8
- EPAP = 8.8
- Leaks = 19.2

CPAP set at 13 was very un-comfortable, back pressure on Ears almost deaf, Headache, even dizziness. Thats when I decided to convert from CPAP to APAP on my own in hopes of making it more bearable. First I reduced the pressure from 13 to 9 than increased to 9.8. I can handle this pressure. Now, working on minimum pressure and EPR levels.

EPR = 3 is comfortable but high, AHI. EPR =1 is uncomfortable but acceptable AHI.
Next, I plan to increase minimum pressure to about 7 and set EPR =2. I hope that will give me the right answer.
I'd recommend making only ONE change at a time and leaving

Since EPR = 3 is more comfortable to sleep with, I'd suggest keeping EPR = 3 and start working on slowly increasing the pressure up to where the AHI is under control.

Week 1: See if you can tolerate min pressure = 5.5 and max pressure = 10.1 if EPR = 3.

If the AHI is still too high, but you are comfortably able to tolerate these settings, then during week 2 use min pressure = 6 and max pressure = 10.5. And leave it there for a week or so

Keep repeating the process of increasing the min and max pressure by 0.5 cm once a week as long as (1) the AHI remains too high and (2) you can tolerate the current setting.

Once the AHI is below 5, you can leave the settings alone.

If you find that you can't tolerate the pressure at some point, then try reducing the pressure settings by 0.5 cm and reducing EPR to 2.
03-24-2014 10:37 AM
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PaulaO2 Offline
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Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

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Location: western NC, USA

Post: #13
RE: How to set EPR Levels
Yes, any changes you make, make one at a time and wait AT LEAST a week or two in between. Make a written/typed note of what change was made when and the result.

You cannot make changes based on a single night's data. It doesn't work that way.

PaulaO2
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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.
03-24-2014 11:03 AM
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yogigupta Offline

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Posts: 5
Joined: May 2013

Machine: Res Med S9 Autoset
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air
Humidifier: Res Med
CPAP Pressure: 13
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Ohio, USA

Post: #14
RE: How to set EPR Levels
Thanks everyone. I learned a lot. I will make future changes with the knowledge gained from your postings. Thanks again. I will probably post an update during April sometime.

03-25-2014 08:30 AM
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brianwood619 Offline

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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 16-22cm/h2o
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Peaceful Acres

Post: #15
RE: How to set EPR Levels
My elite is set for the following
Pressure: 12 (found in clinical settings)
EPR: full-time (found in clinical settings)
EPR level: patient (found in clinical settings)
Ramp time: 15 minutes (patient settings)
EPR Inhale: Med (clinical settings)
EPR level: 3 (patient settings)
Tube heat: 80
Humidity: Auto

With my machine set this way it feels like natural breathing to me using a simplus oral nasal mask. With the inhale set at medium I don't get aerophagia like I used to because I think set on fast was forcing air a little too quickly. My AHI has consistently been less than 1.0 and most nights 0.0. Resmed makes a good machine, once you get all the settings in harmony it's even better.

Good luck
03-26-2014 07:17 AM
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nativedancer Offline

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Machine: Resmed S9 Vpap ST
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CPAP Software: Not using software

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Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #16
RE: How to set EPR Levels
I don't find the EPR setting on my S9 -- is that a later development?
06-27-2015 01:41 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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Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
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CPAP Pressure: 15 EPAP, PS 5-10
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Post: #17
RE: How to set EPR Levels
(06-27-2015 01:41 PM)nativedancer Wrote:  I don't find the EPR setting on my S9

Hi nativedancer,

In ResMed machines with EPR, the pressure during exhalation ("EPAP") is equal to the pressure during inhalation ("Pressure" or "IPAP") minus EPR. EPAP = IPAP - EPR.

ResMed neglected to add the EPR feature to your machine when operating in "CPAP" therapy mode, but when operating in "S" therapy mode the machine can use Pressure Support to do everything EPR allows, plus more.

Your bi-level S9 VPAP ST machine has four therapy modes:

1. "CPAP" fixed pressure mode, without EPR. I think this is the only therapy mode in which the S9 VPAP ST performs Central Sleep Apnea Detection. In all other modes, all apneas will be of type Unknown even when the unintentional Leak is not high.

2. "S" mode has separately adjustable EPAP and Pressure Support. The pressure during exhalation (EPAP) plus the Pressure Support (PS) equals the pressure during inhalation (IPAP). EPAP + PS = IPAP.

ResMed EPR can only be adjusted up to 3 cmH2O, but in S mode on your machine PS can be adjusted up to 10 cmH2O.
Also, the rise time (how quickly in milliseconds the pressure rises when transitioning from EPAP to IPAP) is adjustable.
Also, the Trigger sensitivity is adjustable, between Very High (IPAP triggers early, as soon as inhalation barely begins) and Very Low (IPAP triggers late, well after inhalation has begun).
Also, the Cycling sensitivity is adjustable, between Very High (cycling back to EPAP early, as soon as inhalation even slows down) and Very Low (cycling back to EPAP late, giving more time for inhalation to finish).

In S therapy mode the machine synchronizes changes between EPAP and IPAP to mach your natural "Spontaneous" breathing rate. If you stop breathing, the machine stops and stays at the EPAP pressure.

3. "ST" mode is like S mode except if you were to stop breathing for any reason the machine will automatically trigger into IPAP and will automatically cycle back to EPAP, at a fixed "backup" respiration rate. If PS is around 8 or 10 cmH2O or higher, the machine may be able to provide enough ventilation to treat/prevent central apneas.

4. "T" mode, in which the machine cycles back and forth between EPAP and IPAP at a set respiration rate, period.

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: 06-27-2015 08:03 PM by vsheline.)
06-27-2015 06:54 PM
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FrankNichols Offline

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Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

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Post: #18
RE: How to set EPR Levels
In My Not So Humble Opinion - I think the best setting for EPR is OFF. However, a lot of people use it and like it.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
11-13-2016 12:24 PM
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PaulaO2 Offline
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Machine: S9 Autoset
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CPAP Software: SleepyHead

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Location: western NC, USA

Post: #19
RE: How to set EPR Levels
Ladytimes, I split your posts and the response to its own thread. You can find it here:

http://www.apneaboard.com/forums/Thread-Sleep-Apnea-Alphabet-Soup
11-13-2016 03:54 PM
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robysue Online
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Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
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CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

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Location: Buffalo, NY

Post: #20
RE: How to set EPR Levels
(11-13-2016 12:24 PM)FrankNichols Wrote:  In My Not So Humble Opinion - I think the best setting for EPR is OFF. However, a lot of people use it and like it.
I'll respectively disagree. I don't think there is a "best" EPR setting---as in one that is most appropriate of most people most of the time.

If a person is just as comfortable or more comfortable with EPR = OFF as with EPR = 1, 2, or 3, then great, turn EPR OFF and leave it off.

But if a person is MORE comfortable with EPR turned ON, then it can be a big mistake to turn it off in an effort to tweak things. The first and foremost thing that has to happen for someone to become a fully compliant, successful PAPer, is that s/he has to be able to get to sleep with the machine. And if you are uncomfortable because you just cannot exhale against the pressure, then you are not going to be able to get to sleep. This is probably the most important reason to choose to use EPR: If using EPR makes you more comfortable and more likely to stick with xPAP therapy in the long run, you are much better off using EPR.

Likewise, if you are dealing with a lot of aerophagia, EPR can make a huge difference in managing the aerophagia. (But oddly enough turning EPR off will help a minority of people with aerophagia problems.)

All that said: Since EPR is indeed a poor man's version of bi-level, it is possible that the pressure settings for a Resmed CPAP/APAP may need to be increased slightly if the AHI goes up when the EPR is increased.

Questions about SleepyHead?
See my Guide to SleepyHead
11-13-2016 06:12 PM
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