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[Treatment] Relationship between EPR and Flow Limitations
#1
Relationship between EPR and Flow Limitations
Hi all,

I've plotted my flow limitations as a function of EPR. What is a significant 95% flow limitation? Are these worth chasing? 

Note: there is a general trend for lower flow limits with > exhale pressure relief, which I am sure has been described here before, but what I am less familiar with is if, even for no EPR, these limitations are notable. 

Thanks for any comments and suggestions. Learning so much here! Smile

   
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#2
RE: Relationship between EPR and Flow Limitations
The use of EPR with a Resmed device is the same as using bilevel limited to a pressure support of 3.0 cm. EPR provides a separate IPAP and EPAP pressure channel and this has very clear benefits in reducing flow limitation, which is a flow restriction that can lead to respiratory effort related arousal (RERA) and hypopnea. The rising pressure during inspiraiton actually supports inspiration, offsetting airway restrictions and keeping the airway patent at a time when the negative pressure from inspiratory effort might collapse the airway and result in arousal or worse. In my opinion, it is a basic principle of making therapy more comfortable and effective. Other YouTube stars may disagree, but we have see quantifiable benefits from the use of EPR. It is normally my objective to see the 95% flow limit below 0.5, and preferably closer to zero. In cases with very stubborn flow limits with the user expressing continued discomfort or fatigue, I frequently suggest a move to bilevel therapy with higher pressure support. Here are a couple Apnea Board Wiki articles for your consideration:
Flow Limitation: https://www.apneaboard.com/wiki/index.ph...limitation
Flow Limitation UARS and BiPAP https://www.apneaboard.com/wiki/index.ph..._and_BiPAP

I like your graphs showing the relationship of using EPR with your results for flow limitation. That seems consistent with what we've been saying for a long time. The flow limitation wiki shows examples of the flow charts with and without EPR or pressure support that are also in -line with your results. I think you are among those I consider a candidate for more pressure support and the use of PS at 4.0 or more.
Sleeprider
Apnea Board Moderator
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#3
RE: Relationship between EPR and Flow Limitations
Thanks for the great information, Sleeprider! I have a follow-up question for you. It makes sense to increase my minimum pressure by the same value as EPR. For example, if my minimum pressure is 5.6 cm with EPR = 0, if I increase the EPR to 3 cm, I'd want to increase the minimum pressure to 8.6 cm. However, this change of minimum pressure is greater than where I have my maximum currently set.

Should I consider fixing the pressure to about 8.x cm? Or increase the maximum pressure as well?
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#4
RE: Relationship between EPR and Flow Limitations
We always want to see minimum pressure plus EPR setting as the minimum pressure. So EPR 1 is 4+1=5, EPR 3 is 4+3 or minimum pressure 7. Beyond that, we tend to watch the results to make sure EPAP min is adequate to prevent obstructive events. Without seeing a chart, I can't say, but we can get you dialed in pretty quickly.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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.
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#5
RE: Relationship between EPR and Flow Limitations
Hey @Sleeprider,

Here are some data from last night. I started with min pressure of 4 + EPR level (4+3 = 7 cm), but felt a little starved for air so I increased the minimum a bit. Looks like some centrals there, but that's not new for me; however, usually they are later in the night. 

I also hope I've addressed the leaks by putting on a new cushion. Any suggestions?


Attached Files Thumbnail(s)
   
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#6
RE: Relationship between EPR and Flow Limitations
It looks like pressure was near 7/4 (inhale/exhale) most of the night. I might change pressure range to 7.6 to 9.0 and see what happens. Not too worried about CA events at this stage.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Organize your OSCAR Charts
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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.
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#7
RE: Relationship between EPR and Flow Limitations
Thanks for the suggestions @Sleeprider! The attached screenshot is from last night. 

Any suggestions to improve from here?

   
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#8
RE: Relationship between EPR and Flow Limitations
If you can get the leaks under control, it would clean things up a lot. If you are losing the seal at your nose, try the P30i cushion which fits your mask frame. If it is opening your mouth and escaping we can talk about controlling the air. Your results looks pretty good, and as I said, the CA at this stage are often changes in sleep stage or movement, and generally resolve on their own as you adapt.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#9
RE: Relationship between EPR and Flow Limitations
I've noticed that my CA tend to be during the second half of the night, likely during REM sleep stage.

I'll sort out these leaks and report back. Thanks for your help!
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#10
RE: Relationship between EPR and Flow Limitations
I used some mouth tape last night and I'm seeing an improvement in the large leak percentage, but there still seems to be a lot of leaks. I do not feel air leaking around the nasal mask that I am using (F&P Brevita w/ Nasal pillows).

Could there be a leak somewhere else? Does this figure control for the natural venting of the mask?

Thanks again.

   
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