Removing EPR setting.

[RoseWeissman]

Hi , my second question today is in relation to EPR. I bought my machine last week to end my rental contract and knew how to go in to clinical settings and copy in the same settings from my rental to my own machine. Noticed EPR and that mine was set at 3. Googled what this meant and I do remember when I started on my CPAP February 2019 that I was really struggling with therapy. I wanted to be compliant but with claustrophobia and feeling like I couldn't breathe, I think the company put the EPR to 3.

From what I'm reading today on this forum and in other discussions it seems it would be better not to have this at 3, so I reduced it to 2 to see how I go overnight and then after a few nights go to setting 1. Or to try the ramp feature for this. I had no idea that with a setting of 3 it actually meant my pressure of 14 wasn't always at a pressure of 14.

My question is, is there any chance that by eliminating the EPR setting that I could feel just a little bit more refreshed the next day? I know CPAP takes times and I reckon I had untreated OSA for at least 20 years if not longer so there is a lot of deprivation to get rid off. I do well unbelievably better since starting CPAP and everyone who knows me can't believe that I'm a completely different person now. But I would just love to feel a bit more refreshed and if eliminating EPR does it then great.

Would welcome any feedback on this

[upsman]

As far as I understand EPR, the setting only comes into play when you exhale. You should always be getting your prescribed pressure to keep your airway open. 

If your minimum pressure is 14 cmH2O, then it will drop to 11 when you exhale if your EPR is set to 3. It's strictly a comfort setting but could have some effect on your therapy if you're experiencing a lot of central apneas.

The ramp feature is also a comfort setting that would start your pressure off very low and gradually build up to your prescribed pressure. Some people feel starved for air with this enabled, but personally I don't use it and just enjoy the immediate blast when I put my mask on. With a starting pressure of 14, you might find it more comfortable to enable the ramp.

[OpalRose]

Just looking at your chart from a previous thread, your results are excellent.  In your case, EPR should be used for comfort, so using EPR at a setting of 3 is fine for you.  At a fixed pressure of 14, EPR (exhale relief pressure) drops the pressure by
3cm upon exhalation.  If you don't feel refreshed (as you stated), try EPR of 2, but I don't see any correlation on how we feel and use of EPR in your graph.

There may be other reasons for not feeling refreshed.  Do you feel you sleep well or wake up frequently?  In this previous thread, you said you have a lot of trouble with your mask.  Maybe the fit needs adjusted or even trying different masks.
This seems to be the hardest part for many members... finding the right mask.  

http://www.apneaboard.com/forums/attachm...?aid=24233

[RoseWeissman]

As far as I understand EPR, the setting only comes into play when you exhale. You should always be getting your prescribed pressure to keep your airway open. 

If your minimum pressure is 14 cmH2O, then it will drop to 11 when you exhale if your EPR is set to 3. It's strictly a comfort setting but could have some effect on your therapy if you're experiencing a lot of central apneas.

The ramp feature is also a comfort setting that would start your pressure off very low and gradually build up to your prescribed pressure. Some people feel starved for air with this enabled, but personally I don't use it and just enjoy the immediate blast when I put my mask on. With a starting pressure of 14, you might find it more comfortable to enable the ramp.

Thanks upsman for the reply. Sorry I forgot there are 2 ramp settings (I think)- the one to let you get asleep, which I think is set at 10 minutes for me. But when looking at the EPR settings there seems to be a second ramp setting for EPR and that when the machine detects you have fallen asleep then the EPR setting is switched off. But I could be wrong about that.

With the regular ramp setting I do need that unfortunately to fall asleep. Funny think is when I wake up in the morning I have to check that the machine is on as not aware of the pressure and can fall asleep again with it at full pressure. I'm too big a chicken for the full blast at the start!

[RoseWeissman]

Just looking at your chart from a previous thread, your results are excellent.  In your case, EPR should be used for comfort, so using EPR at a setting of 3 is fine for you.  At a fixed pressure of 14, EPR (exhale relief pressure) drops the pressure by
3cm upon exhalation.  If you don't feel refreshed (as you stated), try EPR of 2, but I don't see any correlation on how we feel and use of EPR in your graph.

There may be other reasons for not feeling refreshed.  Do you feel you sleep well or wake up frequently?  In this previous thread, you said you have a lot of trouble with your mask.  Maybe the fit needs adjusted or even trying different masks.
This seems to be the hardest part for many members... finding the right mask.  

http://www.apneaboard.com/forums/attachm...?aid=24233

Thanks OpalRose. To be honest I knew I was clutching at straws to hope it might make me feel more refreshed.

I can go for weeks with sleeping the whole night through and feel a bit refreshed. Compared to pre CPAP there is a massive difference but still just don't feel fully refreshed- but on the other hand not falling asleep at work, driving is safe for me now, and not falling sleep or wanting to nap during the day. But just still not what I would have hoped to be. Lately with the pollen and humidity here I was waking frequently, but I also noticed looking back at OSCAR that leaks weren't under control so that could have been waking me up. Since starting CPAP my AHI has never gone above 2.5. Unfortunately at my last sleep study last October I had the worst night sleep ever so it was hard for them to figure out how things were going.  

I have had so many masks in just over a year. Some were very comfortable but I might as well have been wearing a sieve on my face with the leaks I was having. Some I can't even get to sleep with his the hissing and very obvious leaking. A lot of trial and error and money spent but the F20 seems to be best. I have seen mention of the F10 FFM mask so might have a wee look at that and see.

[Crimson Nape]

The ramp feature may be set to, off, ramp only, or full time. If it is set to ramp, that means that it will only be active during your ramp time period. After that it will be off. Normally if you are going to use this option, you will set it to "Full time".

[Gideon]

EPR, though not medically documented, is as important as PS is on a BiLevel up to its limit of 3cmw.  it TREATS Flow Limits, Hypopneas, RERAs, and UARS within its limits.

Without question, it is listed as only a "Comfort" setting.  It does far more than just lowering Centrals when decreased, I would expect to see some obstructive events increased when lowered and reduced when raised.

[Gideon]

EPAP_, Exhale pressure is what treats Obstructive Apnea, that is what splints the airway open. You need to be aware of this.
Post OSCAR daily charts for a proper evaluation.

[RoseWeissman]

EPR, though not medically documented, is as important as PS is on a BiLevel up to its limit of 3cmw.  it TREATS Flow Limits, Hypopneas, RERAs, and UARS within its limits.

Without question, it is listed as only a "Comfort" setting.  It does far more than just lowering Centrals when decreased, I would expect to see some obstructive events increased when lowered and reduced when raised.

EPAP_, Exhale pressure is what treats Obstructive Apnea, that is what splints the airway open.  You need to be aware of this.
Post OSCAR daily charts for a proper evaluation.

Hi bonjour. Do you think it is better that I don't decrease/ remove the EPR setting? This is still all very new to me so was going on what I was reading. So my assumption was better to have 14cm H2o at all times rather than only on inspiration, because I don't know any better. I don't think my sleep dr has any idea what if any EPR setting I have on the machine.

[OpalRose]

According to your chart from your other thread..  
http://www.apneaboard.com/forums/Thread-...te-numbers

EPR would not a problem for you.  If you experienced Clear Airway events, then you may see advice to turn EPR down or off.    

If what we see on this graph is pretty much the norm for you, then there is no reason to not use EPR if you are comfortable with it.
EPR is there to aid you in breathing against pressure.