Epr making me feel worse?

[ttrani01]

So I originally started on a pressure of 9 and only used epr on ramp which I would use for 10 or 5 minutes. Well my doctor upped my pressure to 11 then turned epr to 3 full time and I feel horrible I haven't been sleeping great. I wasn't sure If it just took awhile to get used to the change of pressure or if it's epr making me feel horrible. Thanks for your advice!

[Crimson Nape]

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[ttrani01]

So heres my most recent i have been using the new setting for 3 or 4 nights. It so far hasnt really seemed to change my AHI my ahi before the pressure and epr change was always between 5 and 6 anyways

[OpalRose]

What I see is Positional Apnea (chin tucking).  See the Apneas that are clumped together.

Think about how you are sleeping.  Do you find yourself on your back?  This is usually the worse position for positional apnea.  What type pillow do you use?  Do you use one vs. two?  More than one bed pillow or a real tall pillow will likely cause your head to tilt forward, thus cutting off your air supply... sort of like a kink in a hose.
 
Using one thinner but supportive pillow is much better and will help keep your head and neck aligned.

There are some here that use a soft cervical collar to help keep them from "chin tucking", but look at your sleep position and pillow first.  

Raising the pressure as your doctor did is unlikely to help with this.  And most doctors don't recognize positional apnea.  All they are looking at is your AHI number.

The addition of EPR should help with the Flow Limitation once you get your positional apnea under control.

[ttrani01]

I have been using two relatively flat pillows but come to think of it that's probably not great for it. That makes sense though I'll try that. It's really strange though I didn't feel great before but 3 days in the pressure changes and I feel worse than I have in a long while

[ttrani01]

What kind of a pillow would you reccomend 2 pillows was probably too much as you said but my pillows are old and pretty flat what would be supportive?

[Apnea23]

What a strange change to your settings he has provided.

EPR can really mess therapy up for some - encouraging waxing/waning/periodic breathing that can cascade in to apneas, and he's reduced your exhale pressure by 1cm with EPR 3 despite your inhale rising to 11cm.

You're receiving less pressure exhaling, putting your airways at more risk of collapse, and your body has to try and manage the dance of o2 with a 3cm pressure difference with far more instability on exhale than inhale. How can your systems achieve that if the airway resistance isn't consistent?

That's a lot to ask.

Why don't you try 10cm or 11cm fixed instead for a few nights with no EPR, and go from there.

At the very least, you could keep the 11cm with EPR 1 or EPR 2 instead, so that your exhale is 10cm or 9cm as your original fixed pressure was.

You will just have to experiment, but after having suffered with EPR myself I'm a big fan of fixed with no EPR and allowing your brain to better manage its respiration.

Even APAP 9cm - 12cm with no EPR could give you some good data.

[ttrani01]

Yeah that's what I thought too I have no idea why she decided to put it up to 3. I asked her and she told me it was a comfort feature that didn't affect therapy at all... I'm probably going to try and turn it off for a night a since I usually use 2 pillows just use one to maybe prevent positional apnea and see how that goes