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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Here are a couple of real life examples of using EPR compared to not using it.

On my AirSense 10 AutoSet I adjusted pressure over time to do the best I could with an EPR of 3. To get a technically acceptable but poor AHI of about 4 I needed a maximum pressure setting of 15 cm. Now over time with EPR set at 3, but acting only during the ramp (set on auto) period of time, I have managed to get my maximum pressure setting down to 12 cm. While my AHI is still not super great because I have central apnea issue, I still have gotten it down to the 2.4 range, with the lower pressure of 12 cm. If you look at obstructive apnea events only, I do much better, with my last night actual scoring at zero for OAs! After I go to sleep I don't find it hard to exhale against 12 cm of pressure.

My wife uses a ResMed S9, and has been using it over 3 years now. I tried some time ago to convince her to stop the EPR, but she said she did not like it. So up until a couple of weeks ago she was using a maximum pressure setting of 15 cm and an EPR of 2 (that was our compromise a while ago), and getting an AHI of 1.6. While she started with a diagnosed AHI in the 70's and more than double my diagnosis, she gets much better AHI's as she has almost no centrals. Two weeks ago I convinced her to try the no EPR route again. I set her machine at EPR 3 but ramp only, with a maximum pressure of 14. Her average AHI to date with this setting is 1.1, and she even got a zero AHI in the past week. So far, my wife has not complained this time about exhaling against 14 cm of pressure. Now if she stops getting nights with zero AHI the discussion may be back on again!!

So, I gained the full 3 cm of pressure reduction with the elimination of EPR during the sleep period. My wife gained 1 cm reduction with a 2 cm change in EPR. So, it seems the hit from EPR can be a bit of an individual thing.

On the issue of getting more oxygen due to the high pressure during inhale compared to exhale, I am not so convinced. For sure it is real, but I have to question the magnitude of it. Why? The amount of oxygen in air is determined by the absolute pressure of the air, not the relative or gauge pressure that we use in CPAP. At sea level using CPAP units of pressure the absolute pressure is 1033 cm of water. So if we make an EPR 3 cm change in pressure that changes the oxygen content in the same volume of air by 3/1033 or 0.3%. Not a big number. And to put it in context our weather is changing our actual atmospheric pressure in the order of 35 cm of water from a high pressure event to a low pressure event. That means oxygen content is changing just due to weather as much as 35/1033 or 3.3%. That is a much higher impact than using EPR.

That said, I encourage using EPR, but only during the ramp period where it does not compromise the treatment of apena when you are sleeping.

I have attempted to fix my wife's Mirage FX mask which broke at the strap attachment clip. I first tried silicone as I thought that would be flexible and not break. However, it was not strong enough, and did break almost immediately. Also it takes a long time to set up. Then I tried Gorilla crazy glue, and it was relatively successful. She wore it for a while, and now keeps it as a spare.

You might want to consider buying some F20 parts yourself to keep as emergency spares and not tell them about it. While it seems in the US you need a prescription to get a full mask, you are able to buy parts without one. Some apparently just buy all the parts and put them together themselves to get a complete mask. There are many places to go, but here is a link to CPAP.com. The silicone mask cushion is $54, while the complete mask assembly without headgear, is $118. If you added the headgear it would be another $31, and you would have a complete mask. However it sounds like all you really need is the cushion...

AirFit F20 Assembly Kit

One more thought. The F20 comes in two versions. The AirFit version uses a silicone cushion. The same mask frame can be used with the memory foam cushion, and then I believe it is called the AirTouch. Some like the memory foam, and some do not. Many report it is not durable and easily tears. If you have the memory foam type, you may want to go with the silicone cushion for better durability.

The manufacturer recommends against using stuff like Vaseline on the mask, and claim it causes the cushion to deteriorate. I just keep mine clean. I have the F20 with silicone, but was not able to get it to stop leaking, so I am afraid I am not a good one to give advice on that aspect...