Been using AirSense 11 for about a month, need assistance with EPR

Hi!
I joined another CPAP forum but they are not as responsive as I would hope. Anyways, I started my machine almost exactly a month ago. It has been going pretty great so far but apparently I have a few events each night. Now my numbers are pretty constant under 5 AHI which I really like, but I have been reading about EPR recently and a lot of people had success with it off. I was suggested to turn my minimum pressure to 7.0 if I had my EPR at 3.0. Anyways, as you can see in the last chart posted that didn't work out too well, it was way too much pressure for me. I am going to try raising my minimum pressure to 5.0 tonight with an EPR of 2.0 just to use that for a while and see how that is tested. If all goes well, I will continue lowering the EPR until I'm comfortable. Does this sound like an OK plan? The charts are from my last 3 nights of sleep.

The last chart as you can see I tried raising the minimum pressure to 7.0 and EPR of 3.0. It was too much so I just reset to the min 4.0 / EPR 3.0 that I've been using. Thank you!
I use a Philips Nasal Piece that goes under my nose and a chin strap. I'm a mouth breather but I noticed switching to the nasal has really made me feel a lot better so I'm glad I at least found that!

Are you aware that you can set your EPR to be used in ramp only....and make use of your ramp feature so that you are more comfortable while awake? Just set ramp for a bit longer than it usually takes you to fall asleep.

Why are you dead set on eliminating EPR?

jlsmithseven wrote: ↑

Mon Dec 20, 2021 6:25 pm

but I have been reading about EPR recently and a lot of people had success with it off.

And just as many (arguably more) people have had success with it on.

EPR is a limited form of bilevel treatment, and many people (myself included) prefer the difference between the inhale and exhale pressure.

But in many cases, it's an individual preference, ie, whatever works for you.

At pressures as low as yours, (mine *start* at 11), it doesn't make much difference, especially since your machine can't go below 4, as indicated by the green line on the pressure traces.

I think I am dead set on eliminating it because I've read that it can actually add more pressure into your system than needed. When it is OFF, there is no added pressure, just what it says on the readout. So instead of the 6.0 pressure average I've been receiving it could actually be close to 8.0 or something? I didn't really like it at first as I felt rushed to breathe out, but I have gotten kind of used to it that I don't mind it. I tried a min. pressure of 5.0 with an EPR of 2.0 last night and it didn't do me any better. Should I test this setting a few more days to get an accurate reading on if it's helping or not or should I still stick with what I've been receiving because my AHI was under 2.0 both days. Someone told me to raise my min. pressure but I feel like it's just too much even at 5.0 sometimes. Should I try RAMP only for the pressure? I'm supposed to receive at least 6.0 I think to help clear my airway.

That's what she suggested...

The higher the EPR, the lower the min. pressure - you might be pushing yours lower if you set EPR higher - not the best idea.

jlsmithseven wrote: ↑

Tue Dec 21, 2021 4:12 am

I think I am dead set on eliminating it because I've read that it can actually add more pressure into your system than needed.

"More pressure than needed" is rarely an issue, though it can be for a small percentage of people.

If you want to turn EPR off, then just turn it off, it's only partially in play at this point anyway.

Thank you for the replies.
I think tonight I’m going to set everything back to default and raise the minimum pressure up to 5.0 with 3.0 EPR. It seems whenever I have an event, my pressure rises from the 4.0-9.0 and with the 3.0 EPR, it lowers back to 6.0. I think if I slowly rise my initial minimum pressure to one that will react quicker to the closed airways that it will be much better. I think my machjne does pretty well on automatic though. I might have a small ramp for the 4.0-5.0 pressure just to help because I am pretty strongly sensitive to pressures.

jlsmithseven wrote: ↑

Tue Dec 21, 2021 1:03 pm

I think if I slowly rise my initial minimum pressure to one that will react quicker to the closed airways that it will be much better.

Actually you might look at the higher minimum from a different viewpoint.
Try thinking of the higher minimum as actually holding the airway open better and more consistently and PREVENTING the collapse in the first place so there will be less need for the machine to react to the apnea event happening and increase the pressure.

In other words...a higher/better/more optimal minimum pressure can actually stabilize the pressures more and sometimes reduce the need for the higher pressures to even happen.

These machines work best by preventing the airway from collapsing in the first place.
They don't actually do anything during the apnea event anyway....they can't/won't increase the pressure DURING the apnea event. Instead they wait until the apnea event has ended and then they evaluate what just happened and what might still be going on in terms of snores and flow limitations and THEN they actually decide to increase the pressure somewhat so that it hopes to better hold the airway open and prevent the next apnea event from happening.
If you were thinking that the apnea event or collapse happens and the machine immediately increases the pressure in an effort to blow open the collapsed airway tissues....doesn't happen that way. The machine can't provide enough pressure that quickly for one thing and the other thing is that it simply can't move that much airway tissues that have collapsed in the airway. So it can't go high enough and fast enough to actually blow the airway open.

The whole idea is for the machine to hold the airway open in general and prevent the collapse from ever happening or if it does happen...it's infrequent and resolves quickly.

EPR is mainly for comfort exhaling against the pressure. It also can be useful to help reduce flow limitations in some people but your flow limitations aren't really all that bad.
Comfort...ease in breathing against the pressure so that you can fall asleep easily. Without sleep none of this stuff matters. Comfort can be pretty important.

You need to understand that the machine can't ever go below 4 cm...no matter what the EPR setting is and when you start out the night at 4 cm....EPR won't/can't do anything at all. EPR only kicks in once you are asleep and if/when the pressure starts to need to increase. If you use a setting of 3 for EPR...you can't ever get a full 3 cm drop during exhale until your pressure has reached 7 cm.
If the pressure goes to 5 cm...the most you can't get is a 1 cm drop no matter if the EPR setting is 2 or 3...the machine can't ever drop below 4 cm.

I don't know where you got the idea that EPR was bad or using it made you experience higher pressures than you need.
It's simply not the case.

Now you may or may not need or even like EPR if your machine doesn't go very high but with the minimum at 4 cm...you really can't evaluate EPR one way or the other.

You are new to this therapy and I understand that 4 cm seems like a lot right now but with time it won't be so "big feeling" .
We do get used to it.

I do think that once you get more comfortable with the pressure and can use the 6 cm minimum that you will find the pressures won't be so widely varying and may not even go as high as they are now...or if they do with less frequency because the higher minimum will actually prevent the airway from collapsing so there simply will be less need for the higher pressures.
Whether you use EPR or not is a personal choice thing but using it doesn't make the machine go higher than it needs to go.
The machine only goes to where it needs to go to hold the airway open...doesn't matter if EPR is involved or not.

Thank you for your reply. So would a good plan of action be raise the min. pressure from 4 to 5 then to 6 over time? I usually fall asleep within the first 30 mins, but sometimes it can take an hour. Should I set RAMP time to Auto? If I set the ramp to AUTO and wake up to go to the bathroom at night, will it reset the auto again or will it still hold the same pressure?

On the second posted picture in my first post, I actually got one of the best night's of sleep I've ever had, and I saw my AHI as being 2.0 or so. I realize now that this is normal and I'm the kind of person who shoots for perfection, but I should have just let enough be because it was perfect almost I just thought I could get it even better. Maybe I can just leave the min pressure at 4.0? A lot of people have suggested raising the min. pressure though but I don't do well with it. I will try min. to 5 tonight with a long ramp time and see what happens.

Auto ramp will only last for 30 minutes at the maximum or it can end if it thinks you have gone to sleep prior to that 30 minute time limit.
If you normally take longer than 30 minutes to fall asleep it's not going to work well for you.

Anytime you get up in the middle of the night and turn the machine off and then back on again...your settings whatever they might be for ramp or minimum will reset themselves and start new.

Don't go trying for that elusive AHI of 0.0 thinking that means "perfect"....it doesn't....and it's an unrealistic goal anyway.
It will drive you bonkers trying to achieve it for a bunch of reasons. One being we don't sleep the same each night anyway and another being that it's common to have false positive flagging occur while awake just from normal irregular breathing while awake.

Listen to what your body is telling you about your sleep and don't target AHI numbers alone.
The numbers are just part of a big picture.

I do think it is worth eventually trying the minimum of 6 once you are comfortable with it...with or without EPR.
I think that your overall pressure graph lines will stabilize a bit and promote maybe a little better quality sleep.
Less chance for false positive flagging as well.

Any change you make...try to stick with it for several nights because you want to see if any trends are developing.
Don't go changing things every night unless the results are horrible and you don't want to risk repeating them.
Remember....we don't sleep the same each night so some variations will happen. We move around in bed...we have REM stage sleep where we often need more pressure and sleeping on our backs can also cause a need for more pressure.

Use the machine during the day when not trying to go to sleep to get yourself comfortable with any changes you make...like with the minimum or even EPR.

Thank you! I think I am going to leave EPR at 3.0 and try to move the minimum up to 6.0 without the RAMP on. I will test it before I go to sleep to see if it will work. It's not a ton of pressure I think I could handle it fine, it's just more than I'd like to. I think I could easily get used to it though. I will test it for a while and see how it goes. I read your sticky thread earlier today and a lot of the stuff you explained very well I really appreciate it!

So I tried the 6.0 pressure last night 3.0 EPR, I read for about an hour with the pressure and it all went pretty well I didn't even notice it after the hour was up. Went to sleep for maybe 4 hours, then woke up with a huge headache and dry mouth. I think everything was way too tight on my face because it was hard to get the seal correct with the pressure so I had to clamp down a little. Needless to say, I threw off the mask. 10 minutes later I decided to change everything back to default with 4.0 min. pressure and I slept like a baby throughout the rest of the night. I think I'm just going to leave it be for the moment because I do feel I get great sleep with how the default settings were. My biggest hurdle was finding the correct mask setup and I think I found it. Here's my screenshot if you want to check it out. Thanks for the help.

2nd screenshot I zoomed in on the event process leading up to me taking off the mask. Do you see anything really out of line here? Any clue to what happened because it looked like the pressure and everything was well stabilized until this.