Therapy Questions, EPR, CA, Low O2

[kingskid]

Your Autoset is only capable of 3-cm difference between inhale and exhale (IPAP/EPAP).  That is the EPR setting.  The IPAP (inhale) pressure range is 8 to 12, which results in pressures of 8/5 to 12/9.  So EPR reduces pressure.  I have never felt like bilevel pressure "pumps up my chest" however, it does part of the work of inspiration, and that is why it helps with flow limitation.

With an auto bilevel you could increase the pressure difference to 8/4 to 11/7 or something like that.  The pressures would actually be lower, but with more pressure support to make breathing easier.

Okay.  So with a BiLevel, there still is EPR, but may not be called that but is determined by the difference between the IPap and EPap settings?  Since I am sensitive to EPR, would a BiLevel be worse, or would it be something to just get accustomed to for the benefit provided?  (Sorry for all the questions!)

[kingskid]

Hi.  Finally got the results today from my new sleep test.  Recommendation was:  CPAP therapy with CFLEX at 6cm/H20 with 2Lpm O2.  Since I knew my prescription would be 6cm, I had already changed my setting from first sleep study setting of fixed 7cm to 6.2cm with no EPR.  I am going to lower the setting down to just 6cm but want to know since my AirSense for Her machine doesn’t have a Flex setting, if I should use EPR?  Maybe at 1??  BTW, the optimized setting the forum provided in June of 8 min/12 max, EPR of 3, I believe, just did not work for me.  I am one of those people who has a low AHI (it was 0.3 last night) who finds a low fixed pressure much more comfortable than higher BiLevel settings.  During the test, my O2 level was less than 85% for 12.6 minutes, hence new prescription for O2 therapy.  Anyway, should I use my EPR setting, and if so, at what level (1, 2, or 3).  Maybe I can tolerate EPR at the low 6cm setting.  Thanks much!

[Gideon]

Please post your Sleep Studies, both your diagnostic study and your titration study, the full copy with the charts and tables.  
I would suggest setting EPR = 2, Fulltime to best match with flex which is most typically about 2.  Then evaluate the results with OSCAR and adjust as appropriate.

[kingskid]

Please post your Sleep Studies, both your diagnostic study and your titration study, the full copy with the charts and tables.  
I would suggest setting EPR = 2, Fulltime to best match with flex which is most typically about 2.  Then evaluate the results with OSCAR and adjust as appropriate.

Thanks, bonjour, I plan on doing that, even though the test results came from a scanned copy and is not the best quality.  Will try EPR at 2 and will post 6cm charts both with and without the EPR so we can compare the difference. 

[Sleeprider]

Kingskid, CFLEX is a proprietary name for Philips Respiroics brand exhale pressure relief used with their fixed continuous CPAP. It works differently than EPR on a Resmed machine, however a CFLEX setting of 2 will provide up to 2-cm of flow dependent pressure relief, and is most closely equivalent to EPR at 2 using a Resmed machine.

Your doctor has prescribed fixed CPAP pressure, which can be met by using your machine in CPAP mode, or in any Autoset mode with the same minimum and maximum pressure.

[kingskid]

Kingskid, CFLEX is a proprietary name for Philips Respiroics brand exhale pressure relief used with their fixed continuous CPAP.  It works differently than EPR on a Resmed machine, however a CFLEX setting of 2 will provide up to 2-cm of flow dependent pressure relief, and is most closely equivalent to EPR at 2 using a Resmed machine.

Your doctor has prescribed fixed CPAP pressure, which can be met by using your machine in CPAP mode, or in any Autoset mode with the same minimum and maximum pressure.

Hi Sleeprider.  I have been in CPAP mode for some time now as that works best.  Changed from previous setting of 7 to 6cm and tonight will be my first night at 6 cm with EPR of 2.  Kind of excited about it....!

[kingskid]

Here are my sleep test results from Aug 14 2019.  There are 8 pages, so I may have to do this in two separate posts....we'll see.

[attachment=15180][attachment=15176][attachment=15177][attachment=15178][attachment=15179]

[kingskid]

Hopefully, pages 6, 7, and 8 of sleep test will post here...

[attachment=15181][attachment=15182][attachment=15183]

[kingskid]

P.S.  Any comments re my sleep test results are appreciated.  I will post my 6cm charts without EPR and with EPR of 2 after tonight.

[Sleeprider]

Well, without much doubt, you achieve efficacy from apnea, rera snore and other obstructive events at relatively low pressure of 5 or 6. This was an extremely limited CPAP titration test that did not attempt to resolve your oxygen or flow limitation issues, which would have required bilevel therapy. Your results posted here have never had high AHI, but you have a lot of flow limitations, which were not really considered in this titration. With 2-L/min of supplemental oxygen, your SpO2 stayed above 90%. I don't think that is anything to celebrate, but I suspect that either low pressure or flow limitation is what suppresses oxygen.

Basically, your titration did not evaluate flow limitation or the potential value of bilevel therapy, and instead is going to use supplemental oxygen to provide the therapy and maintain oxygen saturation. I would have far rather see a test that progressed to bilevel to see if flow limitation could be resolved and oxygen improved, but I'm just a forum moderator, not a test designer. I hope you have improved comfort, but it seems to come thanks to supplemental oxygen, rather than a positive pressure regimen that solves the root problem of UARS. What a waste of time! Welcome to the world of toting around an oxygen concentrator.