New Apap user

[staceyburke]

Also I will have to work my way up to EPR 3 because I tried it earlier on and -hated- it.  It felt like my breathing rhythm was wrong and gave me a mild choking sensation. I will start tonight with EPR of 1 and lower limit of 5.8.  I'll work up from there.

I explained what EPR does - it has nothing to do with rhythm or when and how much you breath.  I don't know why you had a choking sensation but it would not have anything to do with EPR (exhale pressure relief).  All it does is reduce the amount of pressure on your exhale - it does it WHEN you exhale, it does not time it or start it, it senses when you start to exhale and lessens the pressure so you can have an easier exhale.  This also helps with flow limits, the only reason we wanted you to use it.

Flow limits are apnea that is what the cpap is treating (just as are all obstructive apnea).  Flow limits are just smaller apnea that are not timed.  The cause a person not to be able to get in deeper levels of sleep and sometime wake them up.  By using EPR we would lessen the amount and strength of the flow limits.

[Lovableluciferian]

I explained what EPR does - it has nothing to do with rhythm or when and how much you breath.  I don't know why you had a choking sensation but it would not have anything to do with EPR (exhale pressure relief).  All it does is reduce the amount of pressure on your exhale - it does it WHEN you exhale, it does not time it or start it, it senses when you start to exhale and lessens the pressure so you can have an easier exhale.  This also helps with flow limits, the only reason we wanted you to use it.

Flow limits are apnea that is what the cpap is treating (just as are all obstructive apnea).  Flow limits are just smaller apnea that are not timed.  The cause a person not to be able to get in deeper levels of sleep and sometime wake them up.  By using EPR we would lessen the amount and strength of the flow limits.

Yeah I'm not sure what to tell you.  I tried EPR for a week early on and it gave me a really uncomfortable sensation of breathing too fast and then stopping and choking.  I tried it again last night and it gave me the same sensation. I thought gradually working up to it might have been a way to make it work for me but it seems to have offended you somehow. 

I already consider myself a success story for the most part.  I think what you guys are doing for people struggling with their treatment is great and I hope you continue to do it.  As for me, arguing with a stranger on the internet over a sensation I get when I change a setting on my durable medication equipment doesn't seem like a good use of my time. I'll depart this forum.  

Thanks for your time, I appreciate it!  

[Gideon]

Post charts of that and let's see what is happening.

[Gideon]

A point.
EPR is essentially PS on a BiLevel. VAuto has the settings of Trigger and Sensitivity(?) to impact the initial breath start or the end of breath transition with defaults set to medium. I have to believe that in the CPAPs these are set, without the ability to change them, to Medium, the default setting.
so what you describe, as Stacey has said, has nothing (directly) to do with EPR itself. If I'm right a switch to a VAuto and an appropriate modification to those settings would fix the issue.

[OpalRose]

I already consider myself a success story for the most part.  I think what you guys are doing for people struggling with their treatment is great and I hope you continue to do it.  As for me, arguing with a stranger on the internet over a sensation I get when I change a setting on my durable medication equipment doesn't seem like a good use of my time. I'll depart this forum.  
Thanks for your time, I appreciate it!  

Hi Lovableluciferian,

Sorry that you're having so much trouble, but just know that the advice you have been given is sound.  These folk here have been advising for a long time, and their advice is based on experience.  

Sometimes we ask you to make a change in settings, in your case EPR, which you weren't comfortable with.  If you would post a chart showing the use of EPR, its very possible we can see why.  

Nothing is written in stone and can be changed/reversed.  

No one here is arguing with you...  the advice given is based on experience.
Of course that doesn't mean what works for someone else will work for you.
All we ask is you try.

Please use the links in my signature line to guide you in setting up your chart.
Use the F12 button to take a pic of the daily page.  This will give us what we need to see.  Use the attachment feature to post here.

If course, if you decide to leave, we won't stop you... that is your decision.
But if you want help, we're here...

[Lovableluciferian]

I feel a bit silly replying to this.  I should let sleeping dogs lie but I got notifications about the replies and I wanted to give my side of the story.  I'm sorry I've wasted all of your valuable time.  I truly do think you're doing a great thing for a lot of people and It's absolutely wonderful.

Hi Lovableluciferian,

Sorry that you're having so much trouble, but just know that the advice you have been given is sound.  These folk here have been advising for a long time, and their advice is based on experience.

 
I'm not having trouble, my life has improved dramatically thanks to CPAP therapy.  I don't deny that these people are very experienced and that their advice is good.  I have no reason to dispute that, nor have I.

Sometimes we ask you to make a change in settings, in your case EPR, which you weren't comfortable with.  If you would post a chart showing the use of EPR, its very possible we can see why.

I don't mind changing the settings, and I haven't said I minded.  I'll change it to anything.  What I do mind is feeling like I'm hyperventilating and choking all night.  If I change a setting and it causes me to feel that way then I know better than to just do it.  I thought about moving to the setting incrementally but that was somehow not a good idea...?

No one here is arguing with you...  the advice given is based on experience.

I told someone I experienced choking when I turned on EPR and they said:

I explained what EPR does - it has nothing to do with rhythm or when and how much you breath.  I don't know why you had a choking sensation but it would not have anything to do with EPR (exhale pressure relief).

To me that's arguing or at the very least condescendingly telling me what I described was impossible. 

Like I said before what you guys are doing is great, I highly encourage you to continue to you do it and I apologize for being ungrateful.  I have no doubt that you guys have literally saved lives here and you all should be proud of yourselves.

[Gideon]

You show improvement over your 17 Oct. chart.  EPR=1 has lessened considerably your flow limits.
Your charts show a significant correlation between the flow limit chart and pressure increases.  Please set the y-axis to +/-50 to display more detail of the Flow Rate when looking on zoomed images.
The CA event in the image is IMHO not a true CA as you had arousal immediately preceding it which means that you were likely holding your breath. The RE (RERA) is a period of reduced volume (shallow) breathing. Many of the breaths show clipped indicating Flow Limits.  This chart IMHO is more indicative of UARS than OSA.  The treatment is mostly to increase PS/EPR (PS=Pressure Support) and as such manage your flow limitation.

What I proposed, Min Pressure =7, EPR=3 Fulltime should reduce your flow limits to the point where pressure is not significantly increased.  I'll add to set your Max Pressure=9.  
Trying to only partially fix this has confirmed my beliefs but you need to be bold and bury the flow limits as much as possible with the higher EPR.


Try this, If you fail by choking take a 5 minu break and reset your settings.  That from an experimental point of view will be a success as you should ve captured what the problem is. 
FYI If I am right is is likely that you will need a BiLevel such as ResMed's VAuto with its capability of higher PS.

[DaveL]

Welcome to the forum!

I got a brand new apap about 15 months ago after following advice here.
I had to learn to be patient as I set it up following the recommendations I received.

I'm very happy with the results. I feel so much better now.

Just telling you my experience....I was diagnosed almost 35 years ago. My treatment was terrible for more than 30 years. The wonderful people here helped me so much.

I was reluctant to useEPR too...but it made all the difference.

DaveL

[Lovableluciferian]

You show improvement over your 17 Oct. chart.  EPR=1 has lessened considerably your flow limits.
Your charts show a significant correlation between the flow limit chart and pressure increases.  Please set the y-axis to +/-50 to display more detail of the Flow Rate when looking on zoomed images.
The CA event in the image is IMHO not a true CA as you had arousal immediately preceding it which means that you were likely holding your breath. The RE (RERA) is a period of reduced volume (shallow) breathing. Many of the breaths show clipped indicating Flow Limits.  This chart IMHO is more indicative of UARS than OSA.  The treatment is mostly to increase PS/EPR (PS=Pressure Support) and as such manage your flow limitation.

What I proposed, Min Pressure =7, EPR=3 Fulltime should reduce your flow limits to the point where pressure is not significantly increased.  I'll add to set your Max Pressure=9.  
Trying to only partially fix this has confirmed my beliefs but you need to be bold and bury the flow limits as much as possible with the higher EPR.


Try this, If you fail by choking take a 5 minu break and reset your settings.  That from an experimental point of view will be a success as you should ve captured what the problem is. 
FYI If I am right is is likely that you will need a BiLevel such as ResMed's VAuto with its capability of higher PS.

I really hope I won't need a bipap.  I had to pay out of pocket for my apap and it will take a looooong time before i can afford a bipap

[Lovableluciferian]

I used the 7/9 EPR 3 settings you suggested and... Hoiy hell that was miserable. This was by far the worst attempt at cpap therapy I've had, ever.  I'm going back to my old settings. 

Please set the y-axis to +/-50 to display more detail of the Flow Rate when looking on zoomed images.

I'm not 100% sure what that means but I'll post what I think it means.