New to xPAP. Question about EPR and mask fit

[trish6hundred]

Hi itscaleb,
WELCOME! to the forum.!
Much success to you with your CPAP therapy.

[PaytonA]

That is why it's the best mask out there (there is a rumor that there is a P10 cult operating here on Apneaboard )....Resistance is Futile!

It is not a rumor!!!

[itscaleb]

So I tried some of the suggestions last night and it was a night and day difference.

I turned off my epr and it took me about 15 minutes to get used to it before I was fine. It actually feels better to me so far.

I turned off my ramp as I never liked it much anyways.

I switched from the medium to large pillows and this morning my nose didn't hurt at all, just felt a little tingling but no pain. It also fixed a problem I didn't realize I had. It took away a small whistling noise I didn't know I had till I switched.

I don't think I had any major leaks either. My front display listed my leak as 12L/min, but stated that the seal was good.

What does the 12L/min mean and what is an acceptable amount for that reading?

[OpalRose]

It's amazing what a few little tweaks can do!
I went from a size extra small nasal pillow to a size small, and the seal was much better, plus I noticed that slight whistling sound was gone.
Good Luck itscaleb.

[becker44a]

First off, i would like to say hi as i am new to the board/xPAP community. I was wondering what the advantages to EPR were and if it helps improve your AHI having it on or off. I've tried searching the forum, but have only found stuff about turning ramp on and off.

My second question is about mask fit. I have noticed my nostrils hurt in the morning after waking up. Is this because my mask is too tight or is it just getting used to the pillows and will go away with time?

Thank you for any insight anyone can give.

Hi itscaleb,
Welcome to the forum!!!

I use the predecessor model to your machine, and I use EPR set at 3. For me, the higher the pressure, the more trouble I have with aerophagia (air-swallowing). At this setting, the machine always lowers the exhale pressure 3 cm from whatever inhale pressure is called for. At startup, my Inhale/Exhale pressures are at 10/7. If I have a few events, and the inhale pressure is increased, say up to 14, the exhale will be at 11, a constant 3 less than inhale.

Since the EPR function reduces the average pressure, it helps with my aeropphagia - definitely a comfort improvement for me.

I have no information relating to your 2nd question, but you'll find plenty of P10 enthusiasts to help on that issue.

Good luck on your CPAP journey.

[vsheline]

What does the 12L/min mean and what is an acceptable amount for that reading?

ResMed machines report unintended leak. 12 Liter/minute was the reported rate of airflow (rate of airflow is volume per unit time) of unintended Leak.

In addition to unintended leak there is intended leak through the mask vent holes.

Unintended Leak under 24L/m is considered okay, unless it is quickly varying (jumping from high to low and back again a lot) which can sometimes fool the machine into falsely reporting clear airway apneas which are not really happening. (Looking at the Flow waveform during a reported apnea would tell us whether the reported apnea was real or not.)

[vsheline]

EPR is marketed as a 'comfort only' feature but it operates like a bilevel machine where the pressure support is limited to 3 cm (corresponding to setting of EPR =3).
EPR = IPAP - EPAP. Where IPAP is the pressure provided by the machine during inhalation. And EPAP is the pressure provided by the machine against exhalation.

For Philips Respironics System One machines, A-Flex and C-Flex Plus are a little different.

For PRS1 machines, an A-Flex setting of 2 will provide a basic 2 cmH20 of pressure relief during exhale, plus additional pressure variation based on the rate of our exhale and inhale, so that when exhaling strongly the pressure will drop even lower.

An A-Flex setting of 3 still provides the same basic 2 cmH2O exhalation pressure relief but in addition will provide the greatest amount of additional pressure drop based on the rate of our exhale and inhale. (By "rate" of our exhale I mean strength, how strongly we are exhaling, the rate of Flow into and out of our airway, not how many breaths we have been taking per minute.)

An A-Flex setting of 1 still provides the same basic 2 cmH2O exhalation pressure relief but will provide the least additional pressure drop based on the rate of our exhale and inhale.

The A-Flex setting also affects the shape of the pressure curve during inhalation. An A-Flex setting of 1 is the most abrupt, transitioning as we start inhaling or stop inhaling. An A-Flex setting of 3 slows down how quickly the pressure rises at the start of inhalation and also advances how early the pressure drops toward the end of inhalation while we are still trying to finish inhaling.

[zonk]

I don't think I had any major leaks either. My front display listed my leak as 12L/min, but stated that the seal was good.

What does the 12L/min mean and what is an acceptable amount for that reading?

You expect some leak but your leak was minimal. The machine display 95th percentile unintentional leak (mask leak + mouth leak) which means leak was at or below 12 L/m for 95% of the night
As vsheline pointed out, leak less than 24 L/m is acceptable, of course lower is better

[GeoffD]

The only thing I have to add to what has already been said is that lanolin is used by women breast feeding. In the pharmacy, you'll find it next to breast pumps and other supplies for nursing mothers. I have a tube of it as a just-in-case that I have never needed to use.