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Script needed for EPR? - Dawei - 02-28-2013
That's what I heard today from the RT I've been seeing at my DME! In case you're not quite certain about this alphabet soup, EPR is ResMed's name for exhale pressure relief. I believe Respironics calls it Auto-Flex. Besides off, there are three settings offering 1-3 cm pressure relief on exhale only.
We know that EPR is strictly a comfort feature that the manufacturers have built into their machines' software, and the RT at my DME absolutely agrees with this view.
At the same time, he told me that docs in my area have begun telling his company's therapists to no longer turn patients' EPR machine functions on unless it is specifically ordered in the Rx they write! The only EPR now allowed without a script is EPR during Ramp!
I should note that this also makes no sense to the RT who was telling me about it. When pressed for a reason, he could only say that docs have indicated that (somehow) they feel EPR affects the therapy provided by the machine. He was unaware of anything beyond that general idea.
RE: Script needed for EPR? - Dawei - 02-28-2013
Oops, that got posted before I had quite finished typing. I was going to add that the question this brings to mind is whether there is something about EPR that we don't know--some medical reason docs would try to put the brakes on EPR use, or is it simply docs displaying their ignorance about current machine technology?
RE: Script needed for EPR? - DocWils - 02-28-2013
No, not ignorance, just a trend developing that shows that EPR (or A-Flex) really doesn't work all that well and can raise AHI numbers - the exhalation pressure being reduced, in some patients it is enough for the throat to begin to collapse. It probably is best to leave it off and is really sort of a gimmick. Some people report that it helps with relieving the bloating they get in the morning because of back swallowing air, but it is anecdotal, while the print outs of the compliance numbers aren't. One time when it might be useful is during a cold, because the relief or pressure is enough to keep the phlegm from being forced down the back of the throat and blocking the trachea. But even there your mileage may vary. The other exception is when the doc deems it useful for the comfort of the patient and only if it doesn't up the AHI in the process, and that of course will depend on the cause of the apnoea in the first place..
RE: Script needed for EPR? - zonk - 02-28-2013
yes poor doctors and DME have to eat just everyone else
if EPR have any effect ... it would not be called comfort feature
some newbies reported EPR have an effect on AHI numbers but maybe co-incidental as it get better as their sleep quality improve
for folk who find hard to exhale against pressure or have problems with swallowing air (aerophagia) ... EPR can be useful
PRS1 machines have a Flex demo, you can test each setting and see which one you like best or none
RE: Script needed for EPR? - Shastzi - 02-28-2013
I started out with the RemStar Plus (brick blower) , and ended up around 16-17cm.
Constant blower speed means pressure soars +2-3cm with each exhalation then drops another 2-3cm on inhale. I saw this happening with a manometer inline.
It took a while each night to aclimate to breathing against that back pressure. The harder you try to exhale the higher the pressure you have to exhale against.
!!!
Since I switched to the S9 Autoset, it applies *regulated* pressure so it's a lot easier to work with. The S9 also runs at a lower average pressure so I have almost no aerophagia issues now.
Cheers!
RE: Script needed for EPR? - PaulaO2 - 02-28-2013
I was going to do a test with EPR off but am experiencing some wonkiness lately. As soon as it is over, I'll give it a try.
EPR promotes compliance. Since they are all about that term, I'm surprised they care. And since they keep okaying bricks, how the hell do they even know if it helps or hurts?!?!
RE: Script needed for EPR? - Dawei - 02-28-2013
A very good point, Paula. In light of what Dr. Wilorg wrote in response, I am planning to turn mine off and see if anything else changes as a result.
Since this script-for-EPR thing is new (at least in my area), it makes me think that the docs recently concluded that EPR negatively affects AHI readings. Otherwise, they would have nixed it from the get-go. Up until and including my most recent doctor visit not too many months ago, EPR was just a personal, comfort decision, which as Paula pointed out, has compliance implications.
RE: Script needed for EPR? - archangle - 02-28-2013
Enough people on the boards have reported EPR affects their AHI numbers that you can't dismiss it as purely a comfort feature. This includes people who have got enough posting history that you can tell they have an idea what they're talking about.
RE: Script needed for EPR? - zonk - 02-28-2013
Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep
http://journal.publications.chestnet.org/article.aspx?articleid=1083869
RE: Script needed for EPR? - Ugly - 02-28-2013
(02-28-2013, 05:05 PM)zonk Wrote: yes poor doctors and DME have to eat just everyone else
if EPR have any effect ... it would not be called comfort feature
some newbies reported EPR have an effect on AHI numbers but maybe co-incidental as it get better as their sleep quality improve
for folk who find hard to exhale against pressure or have problems with swallowing air (aerophagia) ... EPR can be useful
Thanks for the insight. Actually I have my EPR set to 1 currently but if it can contribute to inaccurate readings then I'd best not activate it if I succeed with acquiring a sparkly new AutoSet tomorrow afternoon.