Sierra

EPR is a ResMed term for Expiratory Pressure Relief. It is simply a reduction in the mask pressure when you exhale compared to when you inhale. In theory the setting refers to the number of cm of water pressure difference. To the CPAP user it usually feels subjectively good. The higher pressure on inhalation helps you get air in, while the lower pressure on exhalation makes it easier to get air out. It sounds like a good thing, so why wouldn't you always use it? This is where it starts to get complicated, but my resolution of it is that for most, but potentially not all people, obstructive apnea occurs on the exhale side of the cycle, not the inhale. So, if you have your machine set at 12 cm for example, and the EPR at 3 cm, you are only getting 9 cm pressure on the exhale cycle and that is your effective treatment pressure preventing obstructive apnea on exhale. And, at the same time your mask has to seal against the 12 cm pressure. Now if your machine is in APAP or AutoSet mode it will increase pressure to compensate for the EPR providing your maximum is high enough. If it is not, then treatment is going to be limited, and your AHI is likely to go up.

I use the AirSense 10 Autoset machine, and this is how I use EPR. I have found that I can run about 1.5 cm lower pressure and get the same effectiveness with the EPR off compared to having EPR set at 3. But, I still use EPR set at 3 during the Ramp cycle of use. I find the EPR of 3 makes the CPAP more comfortable when I am awake and trying to go to sleep. I set the Ramp start pressure fairly high (8.4 cm currently for myself), so it cycles between 8.4 cm on inhale to 5.4 cm on exhale during the ramp period. I use the A10 Auto Ramp feature, which holds the pressure at that level until it senses you are asleep, instead of the gradual ramp up for a set period of time. And, there is a setting to make EPR effective on Ramp Only in the Clinical Menu.

This said, is turning EPR off effective for everyone? Well for my wife not so much. She seems to get less benefit than I do from turning it off. Must have something to do with when/how she gets apnea. She seems to gain less than 1 cm by turning it off.

What about A-FLEX or C-Flex used by Dreamstation. Well, it seems they don't really reduce the pressure on expiry although they use the same 1, 2, 3 setting scheme. They just shape the pressure response a bit on expiry, but the average pressure is not really reduced any significant amount. So, while I have not used those machines, I kind of think the setting may be a bit of a comfort perception thing. If you try it and like it, then use it. But, it probably does not change the treatment effectiveness like it does on the ResMed machines. Those are just my conclusions. Here is a link to an article on the differences between the machines in this feature.

Comparing expiratory relief in different CPAP machines

I have the AirSense 10, live in Edmonton, and I don't think I have the issue. But then again, I have not registered for MyAir so have no idea what data is being sent. I do see the bars and lights flashing which is supposed to mean it works, but I have not bothered to check. I use SleepyHead to monitor my results and find that much more useful. I see the following info in the Clinician Manual

"The Wireless signal strength icon displayed at the top right of the screen indicates the signal strength. Advise the patient to check the signal strength on their device. Notes:  Therapy data might not be transmitted if used outside of the country or region of purchase.  Devices with cellular communication might not be available in all regions."

There is also a method to put the device in Airplane mode which shuts off the transmission, but you should get an airplane icon on the screen to indicate it is in that mode.

Sounds to me that it could be a wireless reception issue, or there is a problem with the machine. For what it is worth, there are people who believe this feature is an invasion of their privacy and go to great lengths to disable it. From what I understand it is very difficult and requires machine disassembly to accomplish. There is the airplane mode, but that is a temporary thing, and I think it keeps prompting you to shut it off.

Have you considered using SleepyHead to do your monitoring? I find it much more functional than that MyAir application.

Not sure, but here are a couple of possibilities to check:

1. Is there a SD card in both machines? I gather that some suppliers/providers are now removing the card before giving them to patients. This may disable the collection of detailed data in the machine, and force it to be sent via the cellular route to your provider. If so the solution may be just to put a 4 GB card in it.
2. There is one setting in the Clinical Menu in the Accessories category that is called Essentials. It can be set to On or Plus. Setting it to plus gives more control to the patient through the normal menu.

My machine has a card in it. I have not registered for MyAir. And I have the Essentials setting at Plus. When I go into the Sleep Report, below the MyAir line there is about 10 more lines with information on usage, pressures, AHI etc. Is that the detailed report you are referring to? I transfer my data to SleepyHead and can't say I look at the data on the machine much...

Hope that works,

Yes, getting used to a CPAP is not always easy. I also use the AirSense 10 AutoSet. My wife adapted quickly, and me, not so quickly. I think a lot of it depends on how well the mask is suited to your personal requirements. Everyone is not the same, so there seems to be no silver bullet for a mask.

Some questions:

What make and model of a mask are you using? My experience has been that a nasal pillow type mask like the ResMed P10 can actually help keep the nasal passages clear. With it, if I go to bed clear, they usually stay clear all night.

Being short of air while going to sleep or during the night can be a CPAP setup issue of there not being enough pressure. Are you using the Ramp feature? What start pressure? What are your minimum and maximum pressures set at? Are you using EPR?

As for the humidifier I use the heated climate hose, and just set the Climate Control on Auto. Temperature is set at 27 C (80-81 F). If I sleep for 10 hours I pretty much use all the water. Using it all in 6 hours seems high, unless you are in a really dry climate. I would try using the auto setting to see how that goes.

Hope that helps some,

Could you clarify exactly what make and model machine you have? I'm wondering if you have an APAP machine with two set pressures (minimum and maximum) rather than a true BiPAP? Either one should work for you, but it would be helpful to know exactly what machine you have and what it is set at.

What make and model of a machine do you have? Have you considered downloading SleepyHead to view your data in detail? That is about the only way of making some sense of AHI numbers that go up and down drastically.

I have the AirSense 10 and the standard power supply is suitable for 100-240 volts, and 50-60 Hz. It will work fine in the UK. You just need the adapter to make the connection to their UK sockets.

Just joined today. I have been involved in the CPAP stuff for about 3 years now, when my wife got diagnosed with OSA at an AHI of about 75. Had no insurance so we bought a ResMed S9 online to reduce the cost, and I became the setup and tech support guy. Now I have been also blessed with OSA too and have a AirSense 10 AutoSet. I like to use SleepyHead to track the treatment of both of us as we have no sleep doctor or sleep tech support. Short story - self taught, and I am slowly learning that there is nothing simple and obvious about apnea treatment. It is complex, and not an exact science. I think the secret is to keep an open mind, and remember that we are always learning.

I had a similar issue with the P10. I had a fit pack with the three different sizes of inserts. For me the medium size caused more of a problem than the large size which I settled on. For you it sounds like the reverse might be true. My sore spots were just inside my nose.

I used a 1% hydrocortisone cream on the tender spots. I did not put it on in the evening with the mask, but in the morning after I took it off. I switched to a Brevida mask a few days ago and the issue has reemerged. I assume the contact points have changed. So I am back to using the hydrocortisone again. Note that I am not a doctor or a pharmacist so I can't comment on the safety of the product. It says it for external use only, and the edge of the nose is close enough to that for me...

I am currently having the same problem so I hope you get some suggestions that are the silver bullet!

I have tried 4 different types of chin straps and while they help, none seem to solve the problem completely. The best one so far was the cheapest. You can find them on ebay for as little as $2 each. They are just an elastic strap with two holes for your ears, and a Velco fastener at the top.

I have tried the paper medical tape over the mouth, and it does work too if you can keep the tape on. I was a bit reluctant about taping my mouth shut, and you will read warnings about how it could be dangerous if you throw up during the night. But how often does that happen, and is tape any worse than having a full face mask if that occurs.

This is an ongoing project for me, and my attempt tonight is to combine a chin strap and the tape to see if that works.

As for the full face mask solution, I tried the Mirage Quattro and couldn't tolerate it for more than a few hours. It seems to leak and make rude noises that wake me up, and I just couldn't get any sleep. I've also tried the AirFit F20. It was better and I lasted 4 nights with it before I gave up on it. I wouldn't rule out a full face mask solution as many tolerate them. If you are paying for them, try to get one that is returnable if it doesn't work for you.

One minor change that you could try that may help a little is setting your EPR to Ramp Only. That way you get the benefit of the exhale pressure reduction when you are going to sleep, and then it discontinues when you are asleep. With no EPR your treatment pressure may reduce a little - perhaps by 1-2 cm. That could delay the onset of when you start to have a mouth leak, but probably will not eliminate it. To do this you need to set the Ramp Time to Auto. I would set the start pressure higher than where you are now (4 cm), and increase it to 7 or 8 cm. This can be more comfortable when you are trying to go to sleep. Then finally set the EPR to ramp only. This will require access to the Clinical Menu. It is easy to get into. Just hold the bottom Home button down and the round button down at the same time for 3-4 seconds, and you will be into the Clinical Menu. But, like I say, it probably will not be the silver bullet.

Edit: One more trick I intended to mention. Some find it possible to hold their tongue at the top of their mouth, and pushed up against the back of the top teeth. I find it does stop the blow by effect, and you can do it when you are awake. The trick seems to be doing it when you are sleeping, and I can't claim to have that part figured out...