Adding EPR had unexpected effects

[TiredTom111]

Since getting my CPAP earlier this month I've had the EPR feature shut off.  I've been reading how it can help with flow limits, and I wanted to see if I could reduce mine, so I added 1cm of EPR last night.

On the plus side, this was my first night without a single central apnea event and with an AHI of 0.  However, my flow limit spikes actually increased, which also led to bigger pressure increases.  Also, it felt difficult trying to inhale through the nasal pillows.  Any ideas why my centrals and flow limits moved in the opposite direction of what one would expect?

   
   

[Sleeprider]

Let's take a closer zoomed view of that segment from 02:00 to 02:04.

[TiredTom111]

Here you go:

   

[Sleeprider]

Pretty much as expected, there is significant flow limitation and perhaps snoring associated with the pressure increases. I think you would get signficant relief from this by changing minimum pressure to 7.0, and increasing EPR to 3. I don't see a need to change maximum pressure at this time. Our wiki on flow limitation shows examples of how this works and has improved therapy with other member's therapy. https://www.apneaboard.com/wiki/index.ph...limitation

[TiredTom111]

I started the night with the settings you suggested, but I bumped up the minimum pressure to 8 because my mask wasn't fully inflating with an EPAP of 4, which made it feel like I was suffocating every time I started to inhale.  Even after bumping up the pressure, it felt like it took extra breathing effort at the beginning of each inhalation compared to having just a single pressure.  I'm a little confused about why that would be since my EPAP pressures were comparable to my single pressure levels from prior nights.

I've attached the data - most everything past 4am is me wearing the mask while awake.  Perhaps I'm just someone who doesn't tolerate bi-level pressure well?

   

[Sleeprider]

I do notice that the increased EPR allowed a few CA events in which is not uncommon. Most people adapt to it, some need to baock off on EPR. If you would prefer to step back to EPR 2, that is fine by me. You should still get the pressure support benefits, and it may feel more comfortable to you. If you want to continue with EPR 3, then a minimum pressure of 8 or 9 may be needed for comfort. There is no right or wrong about finding what works best.

[TiredTom111]

Sounds good, appreciate the input.

[Sleepy Quixote]

@TiredTom111

Hey TiredTom, you wont find any better than Sleepriders advice anywhere. His advice and others in these pages got me dialed in tight.

Here is a paper on flow limits that might help clear things up a bit -> https://www.apneaboard.com/wiki/index.ph...imitations

Good Luck! Keep at it, that's how we get good at it.

[TiredTom111]

I tried adding EPR on my own about a month ago, but the increased machine noise led me to turning it back off again.  I recently had a follow up with my sleep doc who added EPR and changed my pressure settings since I was having difficulty inhaling through the mask, which made it difficult to doze off again after waking up early.  I used the new machine settings last night with a good pair of earplugs to drown out the machine sounds.

I've attached screenshots of a typical 'before' night along with the new settings last night.  I know it's somewhat of an apples and oranges comparison, but do my results look any better with the new settings?  Are the increased central apneas any cause for concern?

   

   

[staceyburke]

The increase in central events WILL lessen as you get use to the EPR. take a look at the pressure graphs of both nights. Notice the spikes in pressure without EPR and notice the. Regular pattern with EPR.

The EPR should make your sleep better with deeper sleep and less waking during the night.