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On EPR, EPS, PS, they are identical, yes completely identical when you look at the flow rate and mask pressure. I actually view all devices based on the resulting pressures for inhale and exhale. Yes the calculations are different. Why? IMHO because a CPAP only have one pressure by definition. It doesn't have two pressures until EPR is implemented, then it behaves identical to a BiLevel of the same pressures (inhale and exhale).
Titration 101
It is exhale pressure, not inhale, that splints the airway. On a CPAP not using EPR, inhale=exhale= pressure.
Differential pressure between inhale and exhale, called Pressure support, EPR is what is used to treat hypopneas, Flow limitations, RERAS and UARS. It is the difference between in pressures that is important, not what it called or how it is calculated.
On a BiLevel PS is either added to exhale or it is simply the difference between inhale and exhale
On a CPAP it is sold as only a comfort feature with no therapeutic v from the only alue and (EPR) is subtracted from pressure which is then technically the inhale pressure
Surprise, ResMed chose to implement this pressure relief feature based on its BiLevel algorithm,but had to accommodate the fact the a CPAP had no exhale pressure to add to so the only option was to subtract EPR from pressure.
Then the question comes about increasing pressure to maintain the splint treatment for OA. Yes it is a consideration but in pure CPAP mode pressure is used to also treat hypopneas and all other obstructive events and thus usually no adjustments is needed but that always needs to be verified after implementation of EPR. You certainly can increase pressure by the amount of EPR and adjust after implementation.
Gideon - Project Manager Emeritus for OSCAR - Open Source CPAP Analysis Reporter
Your numbers, except for flow limits are excellent.
Your flow limits are clustered. Even with the lack of apnea and hypopneas events this still indicates positional apnea. Most likely
If you are using two pillows use one. Use a flatter less firm pillow. If that fails a soft cervical collar is likely to help. Read the articles on positional apnea and the collar in either case.
IMHO in the end you will use a much lower pressure and a lower pressure support. We can address that latter.
Gideon - Project Manager Emeritus for OSCAR - Open Source CPAP Analysis Reporter
Update. I've been trying to do 2 things at once: trial a bipap and change to an FFM. So, given the poor performance the last few days, I went back to my P10 and mouth tape for the 2nd half of last night, and the charts show the difference.
Specifically compare the 2nd half of the night to my Oct25 chart from earlier. It seems the bipap eliminates most of the FLs that I've been having, with only a few clusters which might be positional. I know I need some more time to validate the results (one night does not a trend make), but it seems as though there might be answer here to the sleep problems I've been having.
Sorry for the absence, but I was traveling most of last week, and when I travel, I use my AirMini, hence no data.
However, here are the charts from last night. Ignore the fact it says Airsense 11, it's still my AirCurve 10 vauto; the SD card got mixed up with my AS11 and so now everything gets written as that. Weird issue.
The pressure is set EPAP = 14, PS = 4; MAX = 24. I'm wearing a soft collar, chin strap, and mouth tape with a P10 mask. FLs look dramatically lower, and if it weren't for one CA, AHI would have been 0. I feel refreshed, however only had around 30 mins of deep sleep, so still sub-optimal.
Per your suggestion Gideon, I changed my pillow. I chose a tempurpedic that although is firmer, I find it keep my head much more stable than the poly-filled pillows I used before. That might explain some of the reductions of FL.
I put two graphs up; one for the whole night, the other zoomed in on where an FL occurs a few minutes prior to the CA.
I'm travelling again starting tonight, but I'm going to try setting my AirMini to 18 with EPR of 3 to approximate the AC10. I won't be able to record, but we'll see how I do. When I return, I'll try the same with my AS11 and record the data.
Any thoughts or inputs would be greatly appreciated. Thanks!!
