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Time for Adjustment, drop EPR or raise pressure?
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Rcgop Offline

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Posts: 210
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Machine: Resmed AirSense 10 autoset
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: installed
CPAP Pressure: 6.0 - 10.0 / EPR 2
CPAP Software: SleepyHead

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Sex: Male
Location: Orlando Fl

Post: #1
Time for Adjustment, drop EPR or raise pressure?
My numbers are good. Last week AHI was all less than one with 2 days being at zero. But I am still not sleeping like I think I should. I believe I am sensitive to pressure changes. I have changed my pressure from 4 to 5 and again from 5 to 6. All had a positive affect on my sleeping and numbers. I have also changed my EPR from 2 (most comfortable) to 1 (still comfortable) again with positive results.

I do not use the ramp feature as I get used to the machines pressure within the first few minutes of use. I have awakened with the pressure at 9 and 6, at all times my breathing was comfortable. I feel my nest step is to increase my pressure, be it by directly increasing the pressure or reducing the EPR. The say EPR is a comfort setting but I feel ( at least in my case) it can affect my numbers and sleep.

The other change I made was to try a "Large" pillow instead of my "medium" pillow. The air flow is more comfortable not to say the "medium" is uncomfortable. I do not see where this should affect my numbers but I feel I did sleep better with the large.

Back to the question, do I increase the pressure, or turn the EPR off? I feel either will not change my comfort position but I need to eliminate some of the sleep/wake junk and the big swings in pressure.

HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
07-09-2016 04:55 PM
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Crimson Nape Offline

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Machine: ResMed S9 Autoset
Mask Type: Other
Mask Make & Model: P-10 / F&P Simplus / DreamWear
Humidifier: H5i w/Climateline
CPAP Pressure: 8 - EPR 3
CPAP Software: SleepyHead

Other Comments: CMS-50F & 50IW

Sex: Male
Location: Georgia

Post: #2
RE: Time for Adjustment, drop EPR or raise pressure?
Seeing your CA's, I'd turn off the EPR first and see how they respond.

Statistics prove that people who have more birthdays live longer.
07-09-2016 05:08 PM
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Rcgop Offline

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Posts: 210
Joined: May 2016

Machine: Resmed AirSense 10 autoset
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: installed
CPAP Pressure: 6.0 - 10.0 / EPR 2
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Orlando Fl

Post: #3
RE: Time for Adjustment, drop EPR or raise pressure?
That was my first thought too.

HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
07-09-2016 05:20 PM
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PoolQ Offline

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Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #4
RE: Time for Adjustment, drop EPR or raise pressure?
strange as it sounds I would not worry at all about your apneas or numbers anymore, IMHO they are fine. Personally I kept bringing up my numbers to my Doctor and I was very frustrated when he kept saying to ignore them. I was not sleeping well and I was trying to find a solution.

Turns out the Doctor was right, you don't need zero events, you need to get quality sleep WHILE you are keeping your numbers under control.

I dont' think your lower pressure is high enough, you are getting a lot of flow limits and they can be disruptive, I would not worry about EPR and set it to give you the best comfort while you increase your lower pressure.
07-09-2016 06:20 PM
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Rcgop Offline

Advisory Members

Posts: 210
Joined: May 2016

Machine: Resmed AirSense 10 autoset
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: installed
CPAP Pressure: 6.0 - 10.0 / EPR 2
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Orlando Fl

Post: #5
RE: Time for Adjustment, drop EPR or raise pressure?
I agree, not to chase numbers. Something is disturbing my sleep however. I know I have slept through many if not most of the OAs and HAs but something else is disturbing my sleep. I figure the rapid change in pressure, caused by flow limits, causing over breathing, causing CAs and whatever.

I don't want change EPR and min pressure at the same time even though I will probably have to change both eventually. Just trying to get my priorities straight.

Thanks for the advice. Thanks

HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
07-09-2016 06:39 PM
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Sn00zeAlarm Offline

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Machine: Resmed A10 autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Builtin
CPAP Pressure: 5-7
CPAP Software: SleepyHead

Other Comments: Heated hose

Sex: Male
Location: Florida US

Post: #6
RE: Time for Adjustment, drop EPR or raise pressure?
my graph looks a lot like this some nights. What exactly is "flow limit"?
I have turned off EPR myself and so far so good.
07-09-2016 06:56 PM
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DeepBreathing Offline
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Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Perth, Western Australia

Post: #7
RE: Time for Adjustment, drop EPR or raise pressure?
I wonder if you're not hyperventilating at times? Your respiration rate is a little bit high and tidal volume is a little bit shallow. It might help (no guarantees) to train yourself to breathe a little bit slower and deeper as you go to sleep. A nice slow steady rhythm might be more conducive to restful sleep. My RR is always around 10 and Vt is 500 - I find that gets me to sleep quickly and I am always refreshed.

DeepBreathing
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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.
07-09-2016 06:56 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #8
RE: Time for Adjustment, drop EPR or raise pressure?
(07-09-2016 04:55 PM)Rcgop Wrote:  I have changed my pressure from 4 to 5 and again from 5 to 6. All had a positive affect on my sleeping and numbers. I have also changed my EPR from 2 (most comfortable) to 1 (still comfortable) again with positive results.

Can you tell us what happened that has led you to conclude that you've gotten "positive results"?

Quote:I feel my nest step is to increase my pressure, be it by directly increasing the pressure or reducing the EPR.

Pressure changes based on feelings are not recommended.

AHI changes from night to night even if you don't make any changes to your pressure settings. When you make a change in pressure, and see a change in AHI, it's a fallacy to conclude that the pressure change caused the change in AHI. You could have just as easily gotten the same change in AHI by not changing the pressure or by changing it in the other direction.

What you need to do instead is look at trends. Keep the settings unchanged for a week or two, or even more, before you ponder making changes.

Sleepster
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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.
07-09-2016 07:13 PM
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green wings Online

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Posts: 544
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Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
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CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #9
RE: Time for Adjustment, drop EPR or raise pressure?
(07-09-2016 06:56 PM)Sn00zeAlarm Wrote:  my graph looks a lot like this some nights. What exactly is "flow limit"?
I have turned off EPR myself and so far so good.

If you look in the Beginner's Guide to SleepyHead and search for "APAPs also respond to snoring and flow limitations by increasing the pressure", you'll be at the beginning of the section that defines flow limitations. If you see them show up on your graphs, if you zoom in on the flow rate graph for the corresponding time, you should see non-uniform breathing waveforms. "Pre-apneas" is a good description of flow limitations.
07-09-2016 11:26 PM
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Rcgop Offline

Advisory Members

Posts: 210
Joined: May 2016

Machine: Resmed AirSense 10 autoset
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: installed
CPAP Pressure: 6.0 - 10.0 / EPR 2
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Orlando Fl

Post: #10
RE: Time for Adjustment, drop EPR or raise pressure?
(07-09-2016 07:13 PM)Sleepster Wrote:  
(07-09-2016 04:55 PM)Rcgop Wrote:  I have changed my pressure from 4 to 5 and again from 5 to 6. All had a positive affect on my sleeping and numbers. I have also changed my EPR from 2 (most comfortable) to 1 (still comfortable) again with positive results.

Can you tell us what happened that has led you to conclude that you've gotten "positive results"?

Quote:I feel my nest step is to increase my pressure, be it by directly increasing the pressure or reducing the EPR.

Pressure changes based on feelings are not recommended.

AHI changes from night to night even if you don't make any changes to your pressure settings. When you make a change in pressure, and see a change in AHI, it's a fallacy to conclude that the pressure change caused the change in AHI. You could have just as easily gotten the same change in AHI by not changing the pressure or by changing it in the other direction.

What you need to do instead is look at trends. Keep the settings unchanged for a week or two, or even more, before you ponder making changes.

Positive results include both better sleep and better numbers. The reason was because I felt starved for air at 4 and 5, and I felt I was in a constant battle with the machine. Searching to maximize comfort, I set the EPR to 2. This introduced more CAs and an over breathing when I was half asleep which seemed to compound the problem. Backing it down to 1 seemed to help without compromising my comfort level. I have been at this setting for the past several weeks and my numbers (with a few exceptions) have been around 1 or less. While my sleep has been OK, I feel it should be better.

My flow limits seem to be a bit to many and since things improved (both numbers and sleep quality) last time I made changes, I am contemplating another change. EPR to off, or a pressure hike from 6 to 6.5.

I have graphed my AHI by month and run a least squares line for the last four months. Each month the line is downward sloping and below the previous month so I know things are improving. I think I am going about this correctly but I want to be sure and get as much advice as possible.

HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
07-10-2016 10:10 AM
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