Post Reply 
Script needed for EPR?
Author Message
Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #1
Script needed for EPR?
That's what I heard today from the RT I've been seeing at my DME! In case you're not quite certain about this alphabet soup, EPR is ResMed's name for exhale pressure relief. I believe Respironics calls it Auto-Flex. Besides off, there are three settings offering 1-3 cm pressure relief on exhale only.
We know that EPR is strictly a comfort feature that the manufacturers have built into their machines' software, and the RT at my DME absolutely agrees with this view.
At the same time, he told me that docs in my area have begun telling his company's therapists to no longer turn patients' EPR machine functions on unless it is specifically ordered in the Rx they write! The only EPR now allowed without a script is EPR during Ramp!
I should note that this also makes no sense to the RT who was telling me about it. When pressed for a reason, he could only say that docs have indicated that (somehow) they feel EPR affects the therapy provided by the machine. He was unaware of anything beyond that general idea.
02-28-2013 03:46 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #2
RE: Script needed for EPR?
Oops, that got posted before I had quite finished typing. I was going to add that the question this brings to mind is whether there is something about EPR that we don't know--some medical reason docs would try to put the brakes on EPR use, or is it simply docs displaying their ignorance about current machine technology?
02-28-2013 03:50 PM
Find all posts by this user Post Reply Quote this message in a reply
DocWils Offline

Members-b

Posts: 1,271
Joined: Jul 2012

Machine: Philips Remstar series 60
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10
Humidifier: same as machine
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Switzerland

Post: #3
RE: Script needed for EPR?
No, not ignorance, just a trend developing that shows that EPR (or A-Flex) really doesn't work all that well and can raise AHI numbers - the exhalation pressure being reduced, in some patients it is enough for the throat to begin to collapse. It probably is best to leave it off and is really sort of a gimmick. Some people report that it helps with relieving the bloating they get in the morning because of back swallowing air, but it is anecdotal, while the print outs of the compliance numbers aren't. One time when it might be useful is during a cold, because the relief or pressure is enough to keep the phlegm from being forced down the back of the throat and blocking the trachea. But even there your mileage may vary. The other exception is when the doc deems it useful for the comfort of the patient and only if it doesn't up the AHI in the process, and that of course will depend on the cause of the apnoea in the first place..
(This post was last modified: 02-28-2013 08:40 PM by DocWils.)
02-28-2013 04:23 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #4
RE: Script needed for EPR?
yes poor doctors and DME have to eat just everyone else
if EPR have any effect ... it would not be called comfort feature

some newbies reported EPR have an effect on AHI numbers but maybe co-incidental as it get better as their sleep quality improve

for folk who find hard to exhale against pressure or have problems with swallowing air (aerophagia) ... EPR can be useful

PRS1 machines have a Flex demo, you can test each setting and see which one you like best or none
02-28-2013 05:05 PM
Find all posts by this user Post Reply Quote this message in a reply
Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #5
RE: Script needed for EPR?
I started out with the RemStar Plus (brick blower) , and ended up around 16-17cm.
Constant blower speed means pressure soars +2-3cm with each exhalation then drops another 2-3cm on inhale. I saw this happening with a manometer inline.
It took a while each night to aclimate to breathing against that back pressure. The harder you try to exhale the higher the pressure you have to exhale against.
!!!
Since I switched to the S9 Autoset, it applies *regulated* pressure so it's a lot easier to work with. The S9 also runs at a lower average pressure so I have almost no aerophagia issues now.

Cheers!

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
02-28-2013 05:17 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,067
Joined: Feb 2012

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

Sex: Undisclosed
Location: western NC, USA

Post: #6
RE: Script needed for EPR?
I was going to do a test with EPR off but am experiencing some wonkiness lately. As soon as it is over, I'll give it a try.

EPR promotes compliance. Since they are all about that term, I'm surprised they care. And since they keep okaying bricks, how the hell do they even know if it helps or hurts?!?!

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
02-28-2013 07:00 PM
Find all posts by this user Post Reply Quote this message in a reply
Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #7
RE: Script needed for EPR?
A very good point, Paula. In light of what Dr. Wilorg wrote in response, I am planning to turn mine off and see if anything else changes as a result.
Since this script-for-EPR thing is new (at least in my area), it makes me think that the docs recently concluded that EPR negatively affects AHI readings. Otherwise, they would have nixed it from the get-go. Up until and including my most recent doctor visit not too many months ago, EPR was just a personal, comfort decision, which as Paula pointed out, has compliance implications.
02-28-2013 08:55 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
archangle Offline
Wiki Editor
Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #8
RE: Script needed for EPR?
Enough people on the boards have reported EPR affects their AHI numbers that you can't dismiss it as purely a comfort feature. This includes people who have got enough posting history that you can tell they have an idea what they're talking about.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
02-28-2013 09:18 PM
Find all posts by this user Post Reply Quote this message in a reply
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #9
RE: Script needed for EPR?
Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep
http://journal.publications.chestnet.org...id=1083869
(This post was last modified: 02-28-2013 09:59 PM by zonk.)
02-28-2013 09:58 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Ugly Offline

Preferred Members

Posts: 568
Joined: Oct 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Micro
Humidifier: ResMed H5i
CPAP Pressure: 7-14
CPAP Software: ResScan SleepyHead

Other Comments: Hydrocephalus, myopia, depression, chronic ugliness, stupidity, tinnitus, mixed sleep apnea.

Sex: Male
Location: Barrie Ontario Canada

Post: #10
RE: Script needed for EPR?
(02-28-2013 05:05 PM)zonk Wrote:  yes poor doctors and DME have to eat just everyone else
if EPR have any effect ... it would not be called comfort feature

some newbies reported EPR have an effect on AHI numbers but maybe co-incidental as it get better as their sleep quality improve

for folk who find hard to exhale against pressure or have problems with swallowing air (aerophagia) ... EPR can be useful

Thanks for the insight. Actually I have my EPR set to 1 currently but if it can contribute to inaccurate readings then I'd best not activate it if I succeed with acquiring a sparkly new AutoSet tomorrow afternoon.
02-28-2013 11:26 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Advice needed for struggling CPAP user Fubblin 35 1,986 11-18-2016 07:18 PM
Last Post: Sleeprider
  Help Needed [am I doomed?] jennie54 3 312 10-13-2016 04:04 PM
Last Post: PaytonA
Question AHI still 6~10 after 2 wks. Advice needed jm54 14 877 09-15-2016 08:42 AM
Last Post: richb
  Severe Apnea - Advice Needed Dreams of Green 25 1,548 08-31-2016 03:25 PM
Last Post: martinsr00
  Help needed explaining what is happening during this OA episode toinewi 1 228 08-10-2016 08:03 PM
Last Post: green wings
  SleepyHead download help needed FrustratedWife 7 524 05-12-2016 07:10 AM
Last Post: Mich
  Help Needed Please RapmasterUK 11 682 05-10-2016 11:11 AM
Last Post: RapmasterUK

Forum Jump:

Who's Online (Complete List)