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Script needed for EPR?
03-01-2013, 08:39 AM
I have never used EPR or the ramp. CPAP machines are generally set up so the EPAP is high enough to inhibit apneas/hypopneas, and that would be your prescription pressure. EPR ignores this and as archangle said there are enough posts about the negative effect of EPR on AHI. Why would I want to decrease my pressure at the beginning of the night with a ramp feature? I want to get full theraputic pressure through out my treatment. Still, if your AHI is very low like some people I read about- way under five, I can't imagine it's use is dangerous- either EPR or Ramp.
03-01-2013, 11:19 AM
(02-28-2013, 03:46 PM)Dawei Wrote: In case you're not quite certain about this alphabet soup, EPR is ResMed's name for exhale pressure relief.
Respironics has multiple names for it: A-Flex, Bi-Flex, and C-Flex.
You do have to go into the clinician's set up manual to enable it if it has been disabled by the technician.
There is the prevalent view that it's a comfort feature and I believe the factory default setting is to have it enabled so the end user can adjust it from 1 to 3 or even turn it off altogether.
However, we've seen reports here that it seems to induce central apneas.
For many of us BiPAP's have been prescribed because they offer an even higher level of exhalation pressure relief and there is no doubt that they can induce central apneas.
My DME was totally unaware that my new BiPAP machine had the Bi-Flex feature. He came to my house with it and set it up. When I was trying it out I remarked that we could hear, and I could feel, three distinct levels of pressure. He said that there should only be two. The inhalation pressure (IPAP) and the exhalation pressure (EPAP). Those are the two levels of pressure you get from any bilevel (BiPAP or VPAP) machine.
After he left I looked into things more and discovered that the exhalation pressure relief known as Bi-Flex was responsible for that third (and lowest) level of pressure. If I recall correctly it was set at 2. Based on this evidence of the tech's ignorance I'm concluding that Respironics sets the Bi-Flex level at 2 at the factory.
So if your doctor were to prescribe no exhalation pressure relief a technician would have to go in there, set the Bi-Flex level to zero, and disable it so the patient couldn't even see the feature in the menu. But strangely enough Respironics advertises the feature to the patient by having a Bi-Flex demo feature prominent on the main menu. They do the same with the C-Flex feature and the A-Flex feature on their REMstar CPAP's and APAP's.
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