HYPOPNEA [and EPR]

[jerry1967]

If someone has many HYPOPNEA wouldn't it be better to set the EPR to 3?

[TASmart]

IF you are referring to EPR, my experience is that any EPR at all leads to more hypopneas, I believe that I am quite sensitive to the pressure changes, and more disturbed sleep and lots of arousals the machine sees as hypopneas.

[Sleeprider]

In bilevel titration, the minimum EPAP is increased to remove OA, then pressure support is increased to treat hypopnea. We are assuming obstructive hypopnea. The corollary in CPAP with the Resmed units is to use minimum pressure to treat OA and then add BOTH pressure and EPR to see if it helps hypopnea. The reason is that EPR actually lowers EPAP, and you could end up with more OA if you don't compensate. As you add 1 cm of EPR you need to add one cm of minimum pressure, and so forth. This will act like pressure support when used that way, however it is limited to 3 cm with the Autoset and other Resmed machines.

[jerry1967]

In bilevel titration, the minimum EPAP is increased to remove OA, then pressure support is increased to treat hypopnea.  We are assuming obstructive hypopnea.  The corollary in CPAP with the Resmed units is to use minimum pressure to treat OA and then add BOTH pressure and EPR to see if it helps hypopnea.  The reason is that EPR actually lowers EPAP, and you could end up with more OA if you don't compensate.  As you add 1 cm of EPR you need to add one cm of minimum pressure, and so forth.  This will act like pressure support when used that way, however it is limited to 3 cm with the Autoset and other Resmed machines.

Sorry  but I guess this is over my head. My OA is down to 0 with  EPR at one. If I increase my EPR by 1 would I have to increase the min level by 1 also.?
(The reason is that EPR actually lowers EPAP,) This is what I don't understand. Isn't EPR just a pressure relief for exhaling?

[Walla Walla]

Yes that's right

[Gideon]

To maintain the same effective support for OA, Yes.

[jerry1967]

To maintain the same effective support for OA, Yes.

Would this increase my support to cut  the  Hypopneas ?

[Sleeprider]

In bilevel titration, the minimum EPAP is increased to remove OA, then pressure support is increased to treat hypopnea.  We are assuming obstructive hypopnea.  The corollary in CPAP with the Resmed units is to use minimum pressure to treat OA and then add BOTH pressure and EPR to see if it helps hypopnea.  The reason is that EPR actually lowers EPAP, and you could end up with more OA if you don't compensate.  As you add 1 cm of EPR you need to add one cm of minimum pressure, and so forth.  This will act like pressure support when used that way, however it is limited to 3 cm with the Autoset and other Resmed machines.

Sorry  but I guess this is over my head. My OA is down to 0 with  EPR at one. If I increase my EPR by 1 would I have to increase the min level by 1 also.?
(The reason is that EPR actually lowers EPAP,) This is what I don't understand. Isn't EPR just a pressure  relief for exhaling?

Hi Jerry.  Your pressure is set wide open with the minimum pressure at 5.0.  We don't know anything else in terms of what your median and 90% pressure is.  With a minimum pressure of 5.0, adding 1, 2 or 3 cm of EPR makes your minimum pressure 4.0.  If you add EPR of 3, your exhale (EPAP) pressure won't start to increase until your pressure rises to more than 7.0 cm.  Your AHI is zero with a minimum pressure of 5 and EPR at 1 and if that's working, that's great and your starting pressure is actually 5/4 (IPAP/EPAP).  The need for EPR as a comfort feature is usually tied to higher pressure.  Since your pressure is this low, I would not add additional EPR unless you also raised minimum pressure for each cm of EPR you add. 

You are currently at 5/4 with EPR at 1.  To change to EPR at 2, change minimum pressure to 6/4, and for 3 change to 7/4. That way, there is no lag in EPAP when your machine detects a need to increase pressure to prevent an obstructive event.

[jerry1967]

In bilevel titration, the minimum EPAP is increased to remove OA, then pressure support is increased to treat hypopnea.  We are assuming obstructive hypopnea.  The corollary in CPAP with the Resmed units is to use minimum pressure to treat OA and then add BOTH pressure and EPR to see if it helps hypopnea.  The reason is that EPR actually lowers EPAP, and you could end up with more OA if you don't compensate.  As you add 1 cm of EPR you need to add one cm of minimum pressure, and so forth.  This will act like pressure support when used that way, however it is limited to 3 cm with the Autoset and other Resmed machines.

Sorry  but I guess this is over my head. My OA is down to 0 with  EPR at one. If I increase my EPR by 1 would I have to increase the min level by 1 also.?
(The reason is that EPR actually lowers EPAP,) This is what I don't understand. Isn't EPR just a pressure  relief for exhaling?

Hi Jerry.  Your pressure is set wide open with the minimum pressure at 5.0.  We don't know anything else in terms of what your median and 90% pressure is.  With a minimum pressure of 5.0, adding 1, 2 or 3 cm of EPR makes your minimum pressure 4.0.  If you add EPR of 3, your exhale (EPAP) pressure won't start to increase until your pressure rises to more than 7.0 cm.  Your AHI is zero with a minimum pressure of 5 and EPR at 1 and if that's working, that's great and your starting pressure is actually 5/4 (IPAP/EPAP).  The need for EPR as a comfort feature is usually tied to higher pressure.  Since your pressure is this low, I would not add additional EPR unless you also raised minimum pressure for each cm of EPR you add. 

You are currently at 5/4 with EPR at 1.  To change to EPR at 2, change minimum pressure to 6/4, and for 3 change to 7/4.  That way, there is no lag in EPAP when your machine detects a need to increase pressure to prevent an obstructive event.

 Sleeprider those numbers are not right. Now I am at 10-15
.so if I increased the EPR by one I also have to increase the minimum by one so I would be at 11-15 right?

[Sleeprider]

Jerry, you can experiment with EPR at those pressures. Just remember that OA is controlled by EPAP pressure, and when you add EPR you reduce that. I would not hesitate to try a higher EPR, but if your OA rate increases, you know the reason why and how to solve that. You may have increased pressure due to flow limits or hypopnea...I don't know. There are definitely comfort and some potential therapy benefits to EPR/Pressure support.

If you were on bilevel with pressure of 10 to 15, pressure support could be added to increase IPAP. With EPR, it works in reverse, and lowers EPAP. So if we go with EPR at 2, your effective pressure range is 10/8 to 15/13. Nothing wrong with that, but be prepared to increase the minimum if necessary.