Whether or not to use EPR and, if used, how to set

[Nicholas]

What are the pros and cons of using EPR?

Do *you* use it? Why or why not?

If used, how does one you determine the setting - is it just trial and error based on what feels comfortable?

[Gideon]

Typically EPR is a comfort setting, your choice.  Comfort is almost always trial and error.

Note your CA score before and after setting it.  We will ask for EPR to be reduced or turned off if we see signs of complex apnea in your data.

If you haven't it never hurts to post your Sleepyhead charts and ask.  Please keep all in a single thread and see my sig for how to.

[Crimson Nape]

The EPR is listed as comfort feature however I found that using it has reduced the frequency and magnitude of my Flow Limit.  Using EPR has the possibility of increasing your CA's due to CO₂ washout.  Another potential problem is the EPR will lower your back pressure on exhale to the extent that your airway closes.  Again, this doesn't affect everyone. The Resmed can not go below 4cm,  Setting the EPR to 3 will only come into full reduction when your pressure reaches 7cm.  Using the EPR 3 setting at 7cm and below will only allow your exhale pressure to be 4cm.

I'm unaware of any guideline as to the initial setting.  Basically, try a setting number and if you have problems, reduce the value.

I hope this may help.

[srlevine1]

I have significantly less events (mostly hypopneas) using EPR = 3. This appears to give me the best results for my case. It appears to have reduced my leak rate ... and I found sleeping on my side produced a lower score than sleeping on my back.

With EPR off, I see my AHI average around 4.2
With EPR at 3, I see my AHI range from 0.3 to 1.2 and average 0.8.
For me it was trial and error to check the results using 2-week periods. Then I went backwards from 3 to off to confirm the results.

[cands]

I stuck with EPR of 1 for many weeks when I started therapy. My AHI averaged out at .48

I then tried EPR of 2. The difference was incredible. I was a lot more comfortable, my central component of the AHI didn't increase and my average AHI went down to .32 over the next 140 day.

Then I thought: 'why not try EPR of 3?' Although it seemed breathing was easier, my sleep was not as restful and I gave it up and went back to 2 after three nights.

Trial and error, find your 'sweet spot'. Worked for me!

[Timur]

The EPR is listed as comfort feature however I found that using it has reduced the frequency and magnitude of my Flow Limit.  

Same here, my flow limitations are significantly reduced when I use a higher EPR setting, and this makes breathing much easier for me. Does anyone know why using higher EPR reduces flow limitations for some of us?

[Sleeprider]

Nicholas, it seems different people react differently to EPR. Some find it comfortable and that it helps hypopnea, others may find it causes CA events. What is important to realize, is that it reduces EPAP pressure by 1-3 cm. You previously used CPAP pressure at 9.0 with no EPR. It is possible that with EPR at 3, resulting in a pressure of 9/6 (IPAP/EPAP), you may have more obstructive event. The solution to obstructive event increases is to increase minimum pressure. If you find EPR gives you clear airway events, you may need to back off on EPR to a lower setting until you can adapt to the pressure changes.

The best way to approach it is to just try it, and see what works for you. It may not have an effect on your results, or it may have significant effect.

[Nicholas]

So, from what I gather from the responses so far, it seems EPR not only affects comfort but can also potentially affect results for some users. So, it seems one should try out it for both reasons.

[Crimson Nape]

Nicholas,
You are correct, Sir. It can't hurt and can provide additional insight to your therapy.

[Gideon]

and post your Sleepyhead charts.  Based on your profile of 4-20 it is likely we would recommend raising your min to ???? (that's what the charts are for)