epr and cheynes stokes

[Gailofiowa]

I have been on apap since late 2021.  In general I have had good results with a pressure from 10.4 to 14.2 and an EPR of 3.  My average AhI is around 3 where about half of the apneas are central.  In mid-2022, I decided I wanted to try to get better results and I reduced the EPR to 2.  On days 7,8, and 12, around 5% of the night was flagged as Cheynes Stokes respiration.  On day 13, over 10% of the night was CS.  My AHI average was not improved over my 13 day trial and I went back to an EPR of 3.  

I do not have a heart condition and my sleep doctor was emphatic that I was not a candidate for bilevel.  

I have seen some recent youtube videos by Nicko where Dr. Noah is saying that EPR, while it can be good for comfort, it is bad for therapy and they no longer use it in their medical center.  A new Kcap is under development that gives more pressure at the end of exhalation and reduces inspiration pressure.  

I've been feeling more tired lately and I would like to improve my therapy if possible by reducing EPR.  However, I have heard that EPR is also a poor man's bilevel.  

Is the fact that I was getting CSR flags when reducing EPR significant?  With an EPR of 3 I very very rarely get a cs flag and if there is one, it is only for a short period of time. 

Thanks.

[Jay51]

If you don't have heart failure, then most likely when you decreased EPR, your machine falsely flagged Periodic breathing as CSR.  When a person decreases EPR who has been using it, more periodic breathing episodes can occur.  This would most likely be what is happening.  Long story short:  you seem to do better with EPR.  

There are a few other things that can cause CSR though.  Read this from our wiki to make sure none apply to you:   

• Cheyne-Stokes respiration
  

[Gailofiowa]

I agree that it is probably a false flag. Is it possible to wean myself off EPR?

[Jay51]

EPR helps to reduce flow limitations.  It is a definite balancing act for sure.  You could try therapy without an EPR, with EPR 1, 2, and 3, and see which OSCAR charts look the best, and most importantly, how you feel in the morning after sleep.