[Pressure] How to set EPR Levels

[yogigupta]

I use ResMed S9 Autoset with Humidifier, Quattro Air Full Face Mask, Slimline hose, Sleepyhead software. I have set the following pressures:
1. Start: 4
2. Minimum: 5.2
3. Maximum 9.8
4. Ramp 5 minutes
5. EPR: Full Time
6. EPR level: 1 or 3 ???
I have found that AHI levels change dramatically, as I change the EPR level. When I set EPR=3, AHI level is near 6, the Face Mask Leak is under 10. If I set EPR =1, AHI is less than 1 (Between 0.4 to 0.8), Face Mask leaks go upto 17 which is still acceptable.
Has anyone done any experimentation in this area of EPR?

[zonk]

Has anyone done any experimentation in this area of EPR?

Mine turned off, annoying feature, yet lifesaver for some people
Everyone is different, no doc or anyone can tells whats the best for you, figure it out for yourself

[trish6hundred]

Hi yogigupta,
WELCOME! to the forum.!
Hang in there for more answers to your questions and best of luck to you.

[yogigupta]

Has anyone done any experimentation in this area of EPR?

Mine turned off, annoying feature, yet lifesaver for some people
Everyone is different, no doc or anyone can tells whats the best for you, figure it out for yourself :coffee:

You are absolutely right. Normally, the physician prescribes a CPAP machine at a given pressure. You can set the min Pressure = Max Pressure, and EPR Off, and use it as a basic CPAP machine.
Reason to use an Autoset machine is to use it as APAP for comfort, where you set the min and max pressures. For further comfort, the machine also provides for EPR feature, also called 'Breathe Easy' by some.
I like to use mine as APAP machine, just learning how to take advantage of EPR feature as well.

[herbm]

There is evidence that EPR can increase AHI, especially CAs.

I turned mine off and never noticed the difference (pressures in the 10-14 range).

You can turn it off in the User settings menu IF the clinical menu is set to allow that.

You can always turn it off in the clinical menu.

Ramp is another thing that many (most?) experience users will dispense with.

If you really need it, use it, but anyone who hasn't tried might consider just turning the ramp off and starting at the therapy pressure(s).

[zonk]

You can select EPR in CPAP mode or AutoSet mode
In CPAP mode you can set EPR Inhale to Med or Fast

[PaulaO2]

I did an experiment with EPR a while back. Let me see if I can find it.

Yep! Here it is.

http://www.apneaboard.com/forums/Thread-EPR-good-or-bad

I have also found that the mask makes a huge difference in the EPR comfort. With the Breeze, I was comfortable with it off. But with the Swift LT, I was struggling to breathe out. I had to raise the EPR to 3 for several weeks just to get used to it then was able to go to 2. I tried it at 1 but couldn't do it. I have the Nuance now but I've left the EPR at 2.

[me50]

I use ResMed S9 Autoset with Humidifier, Quattro Air Full Face Mask, Slimline hose, Sleepyhead software. I have set the following pressures:
1. Start: 4
2. Minimum: 5.2
3. Maximum 9.8
4. Ramp 5 minutes
5. EPR: Full Time
6. EPR level: 1 or 3 ???
I have found that AHI levels change dramatically, as I change the EPR level. When I set EPR=3, AHI level is near 6, the Face Mask Leak is under 10. If I set EPR =1, AHI is less than 1 (Between 0.4 to 0.8), Face Mask leaks go upto 17 which is still acceptable.
Has anyone done any experimentation in this area of EPR?

I am curious. Your profile says your pressure is 13 (and you say this in another post) so why do you have your settings as you mention above?

Since EPR is only for exhale, I have a few thoughts but I cannot say positively why AHI is higher with EPR set at 3 as opposed to EPR set at 1.

Others will be able to help you more.

[c0reDump]

My prescription actually says "maximum EPR", it is either that or moving up to a VPAB / BiPAP to deal with the Central Apnoeas. I love the EPR=3 setting, someone here called it " Easy Breathe": that is a perfect description.

Of course, other people hate it and turn it off.

[robysue]

I use ResMed S9 Autoset with Humidifier, Quattro Air Full Face Mask, Slimline hose, Sleepyhead software. I have set the following pressures:
1. Start: 4
2. Minimum: 5.2
3. Maximum 9.8
4. Ramp 5 minutes
5. EPR: Full Time
6. EPR level: 1 or 3 ???
I have found that AHI levels change dramatically, as I change the EPR level. When I set EPR=3, AHI level is near 6, the Face Mask Leak is under 10. If I set EPR =1, AHI is less than 1 (Between 0.4 to 0.8), Face Mask leaks go upto 17 which is still acceptable.
Has anyone done any experimentation in this area of EPR?

Yes, a lot of people have experimented with EPR through the years.

For most people, there's no real change in overall AHI (as measured over the course of weeks of data, not indivdual nights) regardless of the EPR setting---providing that the minimum pressure setting is sufficiently close to their titrated pressure needs. For others, there is some variability in AHI as the EPR is changed.

There are two potential causes for an increase in AHI when EPR is increased from 1 to 2 to 3.

First: Some people simply sleep more soundly with EPR = 3, and when you are sleeping soundly, there's more REM sleep and (potentially) more supine sleep that you are unaware of. And both REM sleep and supine sleep can be associated with a worsening of the OSA, which in turn increases the AHI.

Second: For many people even a small change in the exhalation pressure can change the AHI: The pressure on exhalation needs to be sufficiently high to prevent the OAs from happening. If the EPR setting allows the exhalation pressure to fall below the person's real pressure requirement, then that can allow more events to get through the CPAP/APAP's defenses. For some people this can lead to a rather dramatic increase in AHI as they go from EPR = Off (no drop in pressure on exhalation) to EPR = 3 (a drop of 3cm in pressure on every single exhalation)

In general, the farther below your min setting is from your titrated pressure and the higher the EPR setting, the more likely you are to run into problems with EPR causing an unacceptable increase in AHI. In this case the fix is usually a choice: Either increase the min pressure up to something very close to your titrated pressure needs OR decrease the EPR OR both.

My best guess is that in your case the variability is being caused by the fact that you have both your min and max pressures set below 13, which if I recall correctly is your titrated pressure. When EPR = 1, the pressure drop is still leaving you with enough exhalation pressure to prevent most of the events; but when EPR = 3 the exhalation pressure is now low enough to allow more events to sneak by.

Out of curiosity: What are your median and 95% pressure levels? If you're getting AHI < 1 with EPR = 1 at these settings, then it's possible that you were a bit over titrated in the lab.