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pressure vs EPR vs hypopnea vs humidity vs congestion

I've been on the cpap now for about three months. I figured out pretty quickly that it's in my best interest to make my own adjustments. So far I've gone from an AHI of 30 down to about 6. Still working on it and have some questions.

I noticed that when I turned down my EPR, my 90% pressure when up and as EPR went down, my humidity setting also needed to increase, but eventually it became ineffective. Now I wake up several times a night with total congestion. I've noticed that when I'm congested, hypopneas will increase.

So, is this trend common?

When my EPR is = 3 90% pressure is about 9-10, EPR=off 90% pressure = 14

Looking for advice on if limiting the max down to 12 or so with EPR off would be something to try or something to stay away from.

I'm also looking at getting an oximeter compatible with sleepyhead.

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EPR and humidity are not related. Sheer coincidence.

EPR is supposed to be just a comfort feature but for many people, it is more than that. EPR drops the pressure at exhale to make it easier to breathe out. If you do not have any problems doing that (some feel smothered without out it), then sure, turn it off. I once experimented with it and got used to the sensation of pushing against it on my own but wasn't happy with the slightly higher AHI. I also woke up a lot more.

You have to set it to where you are comfortable breathing at the exhale while still ensuring the AHI remains good. An increase in pressure is fine. Means the machine is working. An increase in OA events and AHI resulting in disrupted sleep, that's not fine.

Limiting the max pressure will not help with your AHI. If your 95% goes to 14, it is going there because it needs to.

Whatever changes you do, make them slowly. Even the EPR ones. Make a change and observe the data for at least ten days.

And I take back my thought in EPR and humidity not being connected. They may be in a way. If the EPR is set to 2 and your inhale is 10, then your exhale would be 8. The slight difference of ease on the breathing out may assist the lungs and the general atmosphere in helping to keep the nasal passages moist. But if you turn off the EPR, the pressure is a constant 10. There just may be an increased need for humidification for some people.
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As usual Paula covered your options very well. However, I would also consider dropping your humidity level. You do not say where you live, but unless you are located in a very dry part of the country, you may not need any additional humidity.

I do not use my humidifier at all during the long summer months here in Houston. Any additional humidity would plug me up in minutes. The same thing actually in the winter months if the incoming air temperature is too warm. (FYI - - I live in a high humidity area, but our A/C systems keeps our house between 45-50% humidity all summer so my bedroom conditions should be typical. In the winter months (days LOL) then the humidity in the house can drop into the 30-40% range.)

Check your bedroom's humidity with a hydrometer. If it is 50% or higher, you may not need a APAP humidifier. If it is above 60%, then you may want to consider either an A/C checkup, or adding a dehumidifier to your bedroom or home.
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Your profile does not say so but your discussion sounds like you have an auto machine operating in auto mode. It would help everyone when you have questions if your profile clarified this.

I thought that I had an answer to the change in 90% pressure but I thought about it some more and decided that it was not any kind of answer.

Can't really make any suggestions without seeing more of your data. Recommend posting some of your Sleepyhead charts.

Best Regards,

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I too use the A10. As others describe, EPR is a comfort setting for exhale pressure. EPR of 3 takes exhale pressure down 3 points and so on. I experimented with all EPR settings including OFF and eventually landed on an EPR of 1. Everyone is different but as Paula said make your adjustments gradually - 10 days is reasonable between adjustments unless you are really struggling. And.. agree with PaytonA, post some data and we can further help.
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In addition, the humidity level of the air you actually breath inside the mask can be affected by things other than the setting you choose on the blower unit. The incoming air humidity level and the sheer volume of air being delivered to the mask are among things to consider. If your 90% pressure level increases it could actually reduce the rh of the air you get from the mask since more air is being delivered while the same amount of moisture is being added.

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Thank you for your responses! Thanks

It seems everyone is different, which leaves me wondering why I keep getting, You've got a auto pap; we don't need to change anything; it knows what is best for you. lol, If the machine was a perfect fit for everyone, then why did Resmed make two APAP algorithms, one for men and one for women, and why did my tweeks make it better?

I'll keep experimenting. I've come a long way, from I hate this machine, to I feel good this morning. And I still have a ways to go yet.


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