First, if you already have not, you should read through the posts in this fairly recent thread.
My thoughts on EPR are that it does provide some comfort benefits by reducing the pressure on the exhale. The disadvantage is it also reduces your treatment pressure on exhale and if you are susceptible to apnea during exhale (and many are), then turning it on when it was off, can reduce your treatment effectiveness. If you have an auto CPAP and the maximum pressure allows it, your machine will probably compensate for it by increasing your inhale pressure. When it increases, so does exhale pressure, so you kind of come full circle, and have not really accomplished anything. And with an increased inhale pressure you are likely to have more issues with mask leaks.
For these reasons, my preference is to use EPR but only during the Auto Ramp portion of the nightly cycle. With EPR set at 3 and the start pressure set at 7-8 cm, the pressure will cycle on inhale and exhale to provide maximum comfort while you are going to sleep. Then when you are asleep the EPR goes off and inhale/exhale pressure become the same. This maximizes treatment effectiveness, and results in a lower maximum pressure during treatment.
Flex is much the same as EPR but the pressure reduction is less than the nominal setting. It modifies the reduction based on flow and pressure, and the impact on treatment effectiveness probably is less. Not sure if you can set Flex to be used only during the ramp on a Dreamstation, but if you can, that is how I would use it.
Hope that helps some,
my epr was on it was me who switched it off, as with it on i felt i was not getting enough air now i seem to be getting more air, but i am waking up more since i turned it off. i was told with it on it reduces your pressure, thank you for your prompt reply.
If you are using low pressure settings, less than 7 cm, then the EPR is going to be limited in what it can do. The machine will not allow the pressure to go below 4 cm. Say for example your minimum pressure is set for 5 cm, even if you set EPR at 3, all it will do is give you 5 cm on inhale and 4 cm on exhale. If your minimum is 7 cm then an EPR of 3 will give you 7 cm on inhale and 4 cm on exhale. Many find that comfortable. Over time I have adjusted my Ramp Start pressure up from 7 cm to currently about 8.6 cm. My test to determine whether or not it is set right is to breathe normally when I first go to bed, and see if I can feel any restriction on inhale or exhale. It should almost feel as if there is no mask on your face at all. i.e. no restriction in air flow.
Unfortunately many machines are delivered to the user with the minimum at 4 cm, and the Ramp Start at 4 cm. That can easily result in a feeling of not enough air. EPR on or off when the minimum is set at 4 cm will make no difference, because it cannot do anything.
My PR system one was originally set on Flex - 2, which means my machine provides 2 cm less pressure on exhale - all night long including my 5 minute ramp period. I love the comfort of my therapy and my nightly AHI is usually in the 0.56 to 0.89 range, which sleepyhead states is "pretty darn good". I've been using the Flex - 2 setting from the get-go and now it's 6 years later. There doesn't appear to be any harm done by my machine having been set up this way.
There's a confidence that comes in allowing the clinicians to set and adjust the treatment pressures. They understand the particular apnea that I have and assume full responsibility for its' treatment. They know the ins and outs of sleep studies and pressure settings and which patients could benefit from what. After all, they went to school for a long time to do what they do, plus many of them have lots of experience at the treatment "helm" of patient care.
If I doubted that I was getting the most advantageous treatment, I would call on my clinicians and ask them what they thought of thus and so and would it be ok, since I have access, to make the following changes to my therapy. And then I would listen to what they had to say. Isn't this one of the benefits of a good clinician/patient relationship? I should think that professional advice would be preferred. Don't you?
I noticed from your bio that you are from Canada. Are you in a situation where you have bought your own machine and do not have a care provider to monitor/adjust your machine? I am in that situation and essentially look after myself when it comes to CPAP. I noticed from one of your earlier posts that you use SleepyHead. With that software it is not all that hard to see how well your machine is set up and is performing for you. If you need any help just ask. For what it is worth, I believe that taking control on one's own machine and monitoring your own results is far superior to blindly waiting and following advice from the "health care system" which does not have nearly as much interest in my health as I do.
thank you for your reply , yes basically on my own have been to see my sleep doctor asked him if i need to come back for checkups, no just keep using the machine everything i have learned about cpap has been self taught, thank you for your kind offer of help , if i need it i will be in touch on here ok once again thank you for caring, i just feel so alone on this whole process.
I believe you have the AirSense 10 machine. If so here is a link to a pdf of the Clinical Guide for this machine. It is much more comprehensive than the user guide they give you with the machine. I would suggest downloading it and saving it as a pdf as these documents come and go on the internet. Pages 4-11 alone are a worthwhile read to just understand how the machine works. Best to grab it while you can. If you have the Dreamstation I can give you a link to the detailed manual to it as well. Just ask.