EPR/Bi-level generally bad?

[newuser1002]

This sleep tech says that EPR is almost always bad: https://myapnea.org/forum/not-understand...mment-5056, claiming that there's a reason why we breathe the amount that we breathe. 

"The second problem is that by raising and lowering the pressure as you breathe, EPR actually increases the amount of air that you are breathing. With standard CPAP the pressure is constant, and the movement of air in and out of you lungs is done purely by your own respiratory muscles, so the amount of air you breathe is the normal amount that you should be breathing. All CPAP does is hold your airway open so that you can breathe normally. EPR works like low level BiPAP. As you breathe in the pressure increases and as you breathe out it decreases, which means that more air is moving in and out of your lungs than normal - the EPR is slightly augmenting your respiratory effort. This may sound all well and good, but there is a reason that you breathe the amount you do. Too little is a problem, we all know that, but too much can be a problem too. The extra breathing work done by EPR can be enough to hyperventilate you, sending your CO2 level too low which, in turn, causes central events. Again, I have recorded evidence of this happening."


Thoughts on this? I've been at a bi-level difference of 4 (12 IPAP vs 8 EPAP) and haven't had any centrals. I've found that bi-level greatly reduces my flow limitation and makes me less tired. Should this be of any concern for me?

[pholynyk]

Yep, we have all seen too much EPR or Pressure Support cause an increase in central apneas. We tell those people to back off on the EPR or PS.

We have also seen where adding EPR can reduce hypopneas and provide more restful sleep. Bi-level machines were developed for those people who need the pressure assist on inhale without flipping them over into hyperventilation. It's a matter of degree.

Doctors and technicians who make flat statements do a dis-service to their patients.