EPR at 3, very difficult to exhale

[Spinory]

Hi all-

I searched on the forums but didn't think I found exactly what I was looking for.

Last night was my first night on my S9 Autoset.

I have the pressure range from 9 to 13; sleep lab put me at an 11 and prescribed a straight up CPAP but I got an Auto so I changed it.

I used the ramp feature for 45 minutes, which was too long, but I did fall asleep without too much difficulty. (I'm decreasing the ramp time for tonight).

The problem I had was breathing on the exhale-I felt like I had to practically blow my nose to breathe. Is this normal? I purposely would open my mouth sometimes for relief; I'm pretty sure I am not a mouth breather though. I guess I could experiment and lower the EPR but that seems wrong...

I felt like I didn't sleep well at all and woke up with a wicked headache but my numbers were good; slept for 8.3 hours and AHI of 3.1. I didn't have an SD card but I bought one today so I can get more information i.e. leaks, etc.

Any suggestions? Thanks much!

Heather

[mindy]

Hi, I'm leaving my EPR turned off for the time being and set ramp to 10 minutes. Working very well so far ... No noise, no discomfort, low Ahi....

Mindy

[Pugsy]

EPR of 3 drops the pressure on exhale by 3 cm...so when you first start out you are using 9 cm on inhale and 6 cm on exhale. I think there is also a timing setting.. Medium or fast....it in the Clinical setup.
Look for it and play with it to see if the timing of the exhale change to inhale is better suited for you.

The machine can't go any lower than 4 cm... you could try 7 cm minimum and leave your maximum alone because it doesn't come into things until events drive the minimum up. The setting of 7 cm minimum might not be quite what is needed to deal with the events but it might buy you some time while you adjust to the pressure on exhale.

Or use a longer ramp with a lower pressure that is easier to exhale against.

In time, believe it or not but you will adjust to the pressure and what seems like gale force winds will be quite easy to breathe against later after you have some experience.

You can also try turning EPR off or down...the timing may be the problem and not the pressure itself.

First thing I would try though....see if I could find relief with the timing setting.

[Lizistired]

The fast, medium setting is only in cpap mode.
Have you looked at the machine when this happens to see what pressure it is?
If you press the knob the display should light up.

[teachcsg]

Hi Spinory,
I agree with Pugsy...what seems like a high pressure now will seem "normal" in the future. I am an RT and set up many patients on cpap, bipap etc..all day and what you are describing is a very common "complaint" and actually pretty normal the first few days. We advise pts to use the ramp feature, use EPR etc...We tell them that it usually takes about a month to start getting used to wearing a cpap. It may take longer or less for some people but it gives the pts a good starting point. All the suggestions you have received so far on this forum are correct. I would advise to continue to wear and eventually you will get used to the expiratory pressure

[Guest]

Well, last night was a little better so I will just keep at it...

thanks for the help!

[GumbyCT]

Well, last night was a little better so I will just keep at it...

thanks for the help!

That IS the secret to success. The first time you do anything is the hardest. Not being able to exhale is like not breathing at all. The body will adjust to it in time. As your muscles grow to deal with the increased force required to breath.

But first get ready for the sore chest muscles from breathing so deeply AND trying to exhale against an increased pressure from room air.

The problem I had was breathing on the exhale-I felt like I had to practically blow my nose to breathe. Is this normal?

Everyone is different physically and may have other medical problems that complicate adjusting to this form of therapy so hard to say what is 'normal'. For me I don't feel good unless my AHI is below 1 (incl. Flow Limitations which are not part of AHI). But it took me more than a year to get there. That doesn't mean you can't get there sooner, esp. today with SleepyHead and the many helpers here at this forum.

I started out with a machine w/o data then had a cpap at 18cm when I needed a bipap to get the exhale relief I needed. I had to figure all this out w/o the help of a sleep doc or RT. So stay with it.

NO one cares more about you than YOU!

Keeping an eye on your leaks is critical as you mentioned. IF you need a pressure of 11 but leaks or EPR (either one) bring that down to 8 on exhale and allow events to sneak in it may take you months to figure out what is happening. So daily monitoring can be very helpful. After you get dialed in you may be comfortable not checking data daily. I haven't checked mine in prob a year or more now but do understand just how critical it is in getting dialed in.

Keep a notebook for yourself. Beside your equip. make/model and settings make a note each day of how you felt and what change you think helped or didn't help. Keep notes of what went right, what needs to improve, and/or any changes you made that day or nite. I found going to bed about 30 min early helped me get settled in. When making changes be sure to record the old and new setting. AND to try it out BEFORE it is time for bed.

Good Luck

[chunkyfrog]

It gets easier--I promise.
Welcome.

[avi123]

If you don't use a chin strap and have some mouth leaks than the machine because of the leaks stays close to the max pressure in order to deal with obstructive apnea events. Since the machine is an APAP and not a BiPAP it would not reduce the pressure fast enough after those events before you exhale. Have you tried to use a chin strap to avoid mouth leaks?

If I am correct that in APAP mode you stay long time with pressures above 11 cm then you would be better off using CPAP mode at 11 cm, and EPR =3, full time, and then you'll be sure to exhale into 8 cm at all time. I myself set the Ramp to off.

[Kairosgrammy]

Off topic. You have the new kind of fx. Do you like it. Does it stay looped around your ears?

EPR of 3 drops the pressure on exhale by 3 cm...so when you first start out you are using 9 cm on inhale and 6 cm on exhale. I think there is also a timing setting.. Medium or fast....it in the Clinical setup.
Look for it and play with it to see if the timing of the exhale change to inhale is better suited for you.

The machine can't go any lower than 4 cm... you could try 7 cm minimum and leave your maximum alone because it doesn't come into things until events drive the minimum up. The setting of 7 cm minimum might not be quite what is needed to deal with the events but it might buy you some time while you adjust to the pressure on exhale.

Or use a longer ramp with a lower pressure that is easier to exhale against.

In time, believe it or not but you will adjust to the pressure and what seems like gale force winds will be quite easy to breathe against later after you have some experience.

You can also try turning EPR off or down...the timing may be the problem and not the pressure itself.

First thing I would try though....see if I could find relief with the timing setting.

[Pugsy]

Off topic. You have the new kind of fx. Do you like it. Does it stay looped around your ears?

Yep, sure do. Take a look at my recent comment (and a little brag) about the leak line.
viewtopic.php?f=1&t=75389&start=15

It does take some tweaking to get just the right tension on the loops. Too much and it hurts and they will slide off the ears and pinch .. Too loose and the pillows slide out of the nose.
When you get it just right. The loops don't move much and neither do the pillows.
I am still waiting for the Bella Loops SnuggleCovers. Nate and I both ordered some but they were back ordered and shipped yesterday. I don't really "need" any extra comfort...but I am always willing to see if I can make things work "better". I was totally happy with the original headgear but wanted to try the Loops just because I wanted to see if I would like them "better". Right now...either headgear choice has some pros and cons that sort of balance each other out.