Leak rate super low, Low AHI ..waking up with brain fog?

[tierdal]

Your min can not be set lower than 4. Your EPR can be set at 0, 1, 2 or 3.

Remember your min is the inhale pressure. If it were 0 you would not be able to breath through the mask.

min is inhale? i thoughjt max was in hale cause it push ur airways open ? i thought EPR was for exhaling?!?

[sheepless]

with apap, min and max set the range of inhale pressures. epr reduces whatever the inhale pressure is by the epr setting during exhale. if set at fixed 10 and epr 3, for example, you inhale at 10, exhale against 7. with min at 8 and max at 20, the machine is free to adjust inspiratory pressure according to it's algorithms between those values and epr reduces whatever the pressure is when exhale begins.

without epr, inhale pressure = exhale pressure. epap (exhale) is what keeps the airway open against obstruction. with epr, epap is inhale pressure - epr. if you need a min of 8 to treat obstructives, you only get 5 at epr 3, which is easier to exhale against but isn't sufficient to do the job of keeping your airway open.

[SarcasticDave94]

With this machine, the AutoSet, the pressure is inhale pressure.

EPR is exhale pressure relief. So correct, EPR is exhale pressure.

If you were on the VAuto a BPAP, EPAP would be your Min, taking place of your pressure now. PS would be like EPR but it adds to exhale pressure to get IPAP the inhale pressure.

On your AutoSet, EPR reduces inhale pressure to get you an EPR, the exhale relief of 1, 2, or 3.

[tierdal]

With this machine, the AutoSet, the pressure is inhale pressure.

EPR is exhale pressure relief. So correct, EPR is exhale pressure.

If you were on the VAuto a BPAP, EPAP would be your Min, taking place of your pressure now. PS would be like EPR but it adds to exhale pressure to get IPAP the inhale pressure.

On your AutoSet, EPR reduces inhale pressure to get you an EPR, the exhale relief of 1, 2, or 3.

i thought EPR reduced EXHALE preasure making it easier to breathe OUT? Why would it lower the preasure breathing in?

The inhale preasure it was opens ur airways...ur airways dont close when u breathe out?

is EPR bad? should i turn it off ? why do i stil have brain fog in morning if my charts so good?

[staceyburke]

The min is your beginning inhale pressure and IF you have an obstruction it will quickly rise up to your max pressure. If no obstruction the machine will continue at the min pressure. That is what it means by autoset. You have a range of pressures, anywhere between the min and max pressure. 

Many people leave the max on 20 but they never need that much pressure to stop the obstruction you have. So if you only need 10 (for example) the autoset will not go higher than 10.

[SarcasticDave94]

In order:

EPR does reduce exhale pressure. It's called Exhale Pressure Relief because that's what it does.

The base pressure is your setting of somewhere between 4 and 20. Forget EPR just a second. The pressure you set without EPR is inhale and exhale pressure, it works to keep your throat open. So yes it does it's job at whatever setting you need and have set. Now when EPR is introduced, your pressure is still there but on exhale it drops the amount of EPR setting 1, 2 , or 3 cmH2O.

Unless you have Central Apnea that reacts to the effects of EPR, it's not bad.

Why the brain fog? One, we just got you to work on large leaks that hindered good accurate therapy. Now it's OK. If after a reasonable time it didn't clear up but PAP therapy is still good, then it could be some other medical cause. Or it may be that therapy needs more time to make things feel better.

[cathyf]

Brain fog only makes this harder, especially when we start throwing around the jargon   

The problem is that EPR is kind of an afterthought. The morons of sleep medicine think it's some "comfort feature" that they throw at us whiny idiot patients, when it is a vital component of therapy if you have a particular form of sleep-disordered breathing.

CPAP is something that has evolved over decades, and the language gets set in stone and then we learn more stuff and the language we started with doesn't make sense anymore.

-- So we started with straight CPAP, with a constant pressure. There is this whole rigamarole of "titration" where you are in a lab and the tech is controlling the pressure up and down and zeroes in on THE perfect pressure for you, and that's your prescription. Except that in real sleep apnea, that's like trying to nail jello to the wall -- the "right" pressure is moving around all night and is different on different nights.

-- So now we come to the APAP, where these astonishingly clever engineers came up with sensors where the machine follows what you are doing continuously and raises and lowers the pressure so you get the right pressure for right now.

-- Well except that pressure getting really high can get to be uncomfortable, so let's add on a feature on these high-pressure machines (a bipap goes to 25 while an APAP goes to 20) which give the patient a lower pressure on the exhale side.

-- The clever engineers then added some limited pressure support thingy to the APAPs and they called it EPR because they thought that the "regular" cpap users could do with some extra comfort, too. Because it's all about high pressures, they didn't even think about what happens when the gap between inhale and exhale pressures that you ask for is larger than the gap between the minimum pressure that you asked for and the minimum pressure that the machine can do.

-- Well except that it turns out that lowering the pressure on the exhale side isn't just a comfort feature for high pressures, it can actually cure UARS (like with me!) at really minimal pressures.

So now we have this machine that cures UARS when used in a mode that the engineers weren't even thinking about when they engineered the user interface, and confusing language because they didn't invent language to talk about things that they weren't thinking about!

There is one user interface tweak that they could do that would sure make things clearer...

Have the user dial in the EPR first, and then when it comes to dialing in the minimum pressure or the ramp pressure, you don't allow the dial to roll down below 4+EPR. So if you set your EPR to 3, you wouldn't be able to set your minimum to below 7. EPR of 2, minimum can't go below 6, etc.

Part of the problem as well is that the sleep medicine idiots are fixated on the patients' stupidity as being the only problem with sleep therapy. If they could only bully or trick us self-destructive dumbbells into "compliance" then the machine itself is magic. Dialing in proper therapy for real patients with complex problems takes skill, intelligence, experience, intuition -- you know, practicing medicine. Being an effective bully, salesman, and/or con-man is a completely different skill set. So they get derailed when something gets invented as a "comfort feature" because they think this is about convincing us. With EPR (which I actually find mildly annoying and less comfortable than no pressure support) they are just completely off the rails. Since they think EPR is snake oil, they want to be as confusing as possible when it comes to selling it to you!

[Sleepster]

how is it these leaks are disturbing my sleep so badly?!

Maybe they aren't. But if they are they do so by waking you up.