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Does the EPR have to be increased or decreased to treat hypopnea and RERA? - Printable Version

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Does the EPR have to be increased or decreased to treat hypopnea and RERA? - jerry1967 - 10-05-2019

people with mainly hypopnea and RERA nearly always display considerable flow limitation, which is treated better with the exhale pressure relief (EPR) feature on your Resmed.

Does the EPR have to be increased or decreased to treat hypopnea and RERA




RE: Sleep study mostly Hypopneas? - Sleeprider - 10-05-2019

A higher EPR seting (3) provides more pressure relief than a low setting (1). Since you are using a pressure of 11-15, you can try EPR 3 and your inhale/exhale pressure range will be 11/8 to 15/12. As you can see, these are bilevel pressure notations, and that is exactly what your Autoset is in fact, a bilevel with pressure support limited to 3-cm. Pressure support helps to boost inspiration and make expiration easier which improves ventilation volume. This in turn is a solution for flow limitation, RERA and hypopnea.


RE: Sleep study mostly Hypopneas? - jerry1967 - 10-06-2019

(10-05-2019, 10:49 AM)Sleeprider Wrote: A higher EPR seting (3) provides more pressure relief than a low setting (1).  Since you are using a pressure of 11-15, you can try EPR 3 and your inhale/exhale pressure range will be 11/8 to 15/12.  As you can see, these are bilevel pressure notations, and that is exactly what your Autoset is in fact, a bilevel with pressure support limited to 3-cm.  Pressure support helps to boost inspiration and make expiration easier which improves ventilation volume. This in turn is a solution for flow limitation, RERA and hypopnea.

How would this affect the Centrals that I get if I put my pressure support at 3?


RE: Sleep study mostly Hypopneas? - jaswilliams - 10-06-2019

(10-06-2019, 09:50 AM)jerry1967 Wrote:
(10-05-2019, 10:49 AM)Sleeprider Wrote: A higher EPR seting (3) provides more pressure relief than a low setting (1).  Since you are using a pressure of 11-15, you can try EPR 3 and your inhale/exhale pressure range will be 11/8 to 15/12.  As you can see, these are bilevel pressure notations, and that is exactly what your Autoset is in fact, a bilevel with pressure support limited to 3-cm.  Pressure support helps to boost inspiration and make expiration easier which improves ventilation volume. This in turn is a solution for flow limitation, RERA and hypopnea.

How would this affect the Centrals that I get if I put my pressure support at 3?

For some people a higher EPR or Pressure Support can raise the level of Centrals. But you won't know until you try


RE: Sleep study mostly Hypopneas? - Sleeprider - 10-06-2019

(10-06-2019, 09:50 AM)jerry1967 Wrote:
(10-05-2019, 10:49 AM)Sleeprider Wrote: A higher EPR seting (3) provides more pressure relief than a low setting (1).  Since you are using a pressure of 11-15, you can try EPR 3 and your inhale/exhale pressure range will be 11/8 to 15/12.  As you can see, these are bilevel pressure notations, and that is exactly what your Autoset is in fact, a bilevel with pressure support limited to 3-cm.  Pressure support helps to boost inspiration and make expiration easier which improves ventilation volume. This in turn is a solution for flow limitation, RERA and hypopnea.

How would this affect the Centrals that I get if I put my pressure support at 3?

I'm not aware of any chart ever being posted by you.  How are we supposed to know if CA events are a significant issue if you don't give us a little help? We know that your sleep test had no centrals, and this is the first mention of CA you have ever made.


RE: [split] Does the EPR have to be increased or decreased to treat hypopnea and RERA? - mesenteria - 10-06-2019

SR, I believe his question to be generic/rhetorical.  That is, he isn't saying he HAS centrals, or suspects that he might, just wants to know the reasoning behind dropping pressure support in order to control CAs.  I could be wrong...


RE: Sleep study mostly Hypopneas? - jerry1967 - 10-06-2019

(10-06-2019, 01:51 PM)Sleeprider Wrote:
(10-06-2019, 09:50 AM)jerry1967 Wrote:
(10-05-2019, 10:49 AM)Sleeprider Wrote: A higher EPR seting (3) provides more pressure relief than a low setting (1).  Since you are using a pressure of 11-15, you can try EPR 3 and your inhale/exhale pressure range will be 11/8 to 15/12.  As you can see, these are bilevel pressure notations, and that is exactly what your Autoset is in fact, a bilevel with pressure support limited to 3-cm.  Pressure support helps to boost inspiration and make expiration easier which improves ventilation volume. This in turn is a solution for flow limitation, RERA and hypopnea.

How would this affect the Centrals that I get if I put my pressure support at 3?

I'm not aware of any chart ever being posted by you.  How are we supposed to know if CA events are a significant issue if you don't give us a little help?  We know that your sleep test had no centrals, and this is the first mention of CA you have ever made.

I did have centrals in my sleep test and I still get them with Oscar. I have posted many graphs on here and was told to lower my EPR to 0 or 1 which I have and it did not make any difference. I was told I need a special machine. ASV I guess it is called. Until I get this machine should I use 1 or 3 as my EPR?


RE: [split] Does the EPR have to be increased or decreased to treat hypopnea and RERA? - Gideon - 10-06-2019

Jerry 
which gives you the lowest overall AHI?
then which manages the centrals better?

The general rule if you had no initial centrals that they are treatment-emergent centrals.  These are usually caused by the better breathing that you are getting from your CPAP.  Higher EPR or Higher PS provides a higher degree os washing the CO2 out of your system.  It is the higher concentration of CO2 at your chemoreceptors that provides the primary drive to breathe.  In some individuals, this increased washing out of the CO2 decreases the drive to breathe causing central apneas.  One "fix" to this is to decrease the washing effect by decreasing the PS or EPR, often to zero.  That lacking you decrease the washing effect by decreasing pressure.

Do note that decreasing PS or EPR and/or decreasing pressure may increase obstructive events.


RE: [split] Does the EPR have to be increased or decreased to treat hypopnea and RERA? - jerry1967 - 10-07-2019

My first two sleep tests didn't show and central but when I had to have a new test because of switching insurance centrals showed up. Being older and on new medicine, I think affect my breathing and causes the central. 

Nothing I can do about the medicine for right now so I am trying to get the best sleep I can..


RE: [split] Does the EPR have to be increased or decreased to treat hypopnea and RERA? - jerry1967 - 10-08-2019

My AHI keeps getting worst, I am up to 30 now with 8 of them central, with no Opstuctions.