Sierra

I don't think much of this LankyLefty guy and his youtube videos. He makes me wonder if he even uses a CPAP machine.

Using the EPR is certainly not dangerous, but it may not give you the optimum results. About all you can do is monitor your results with OSCAR with it (for a week or more) and without it. For me using EPR at 2 cm made a very significant reduction in my hypopnea events. However, if you are not having hypopnea events, then it may be worth while to set the machine up to use EPR on ramp only, and then it is off after your go to sleep. In some this allows the maximum pressure to be lower.

Depending on what you are getting for results I think a max of 20 may not be ideal. I find it best to limit maximum pressure to what is really needed to limit the occurrence of OA (obstructive) events. What is your breakdown of typical OA, CA, and H events, and your total AHI?

The display of the 8.9 must be a rounding issue. You can only set the A10 in increments of 0.2 cm.

I would set your machine to AutoRamp as I find it works quite well. However, a start pressure of 5 may still be a little low. But it is what you find comfortable.

Hi Rob,

If you read the posts in this thread you will see there is no uniform opinion on the use of EPR. Over time I have changed my opinion on it too. While I initially thought there was some benefit in just turning it off, I now think that at least in some cases (like mine) it does have value.

First, what machine do you have? Since you use the term EPR and have an auto ramp setting, I assume it is an AirSense 10 AutoSet? If so I like to use the AutoRamp feature. It is not really a ramp, but is an initial pressure HOLD mode that keeps the pressure constant until you fall asleep. It has a Ramp Start Pressure that you can set to determine what the hold pressure is. I find that if you experiment with different settings you will find a hold pressure that is comfortable to go to sleep with. It needs to be high enough that it is comfortable to take deep breaths without it feeling like the machine is restricting the flow of air. I think 4 cm is way too low, and 7 cm is more reasonable. I have my machine set now at 9 cm for ramp start. It is a personal preference for comfort.

On EPR I used to use it set at 3 cm and Ramp Only. Then I would get the pressure relief for comfort, and when I go to sleep the EPR would shut off. In some there is an advantage to doing that. In others it may not. About the only way you can find out is to try it both ways to find out what works for you. What I found is that some EPR set at 2 cm makes a significant reduction in my hypopnea events. I also find that the OSCAR program which is free to download is very helpful in determining how the machine is working for me.

If you have any questions just ask,

If you breath more and more shallow until breathing stops, that is typical for central apnea. This is an example of what it looks like on a SleepyHead or OSCAR graph.

This pattern of breathing can sometimes be caused by a CPAP using more pressure than it needs to use. One possible method of reducing the occurrence of central apnea is to minimize the IPAP pressure used, to the extent that it does not cause obstructive apnea. Another method that can help is to use the fixed pressure CPAP mode instead of the automatic mode. But, again the IPAP pressure has to be kept as low as possible.

There are universal inline bacteria filters which go between the CPAP hose and mask hose. I wonder if you could tap in a connection for the O2 to this filter housing. You could remove the filter media so it is really just a connector piece. See this link:

Generic Outlet Bacteria Filter

I believe all CPAP, APAP, and BiPAP machines have a minimum pressure (EPAP or IPAP) of 4 cm.

I use a nasal pillow mask and find it keeps my nose clear.

Using water with minerals in it is not going to be harmful to you as the water essentially gets distilled by the humidifier. Only pure water vapour goes with the air to your lungs. However, it is not good for your humidifier in the CPAP. Minerals will build up and will have to be removed using vinegar. You should be using distilled water, demineralized water, or reverse osmosis purified water.

This said when we travel and have no access to distilled, demineralized, or RO water, we just use tap water. Up to a couple of weeks does not result in too much mineral build up in the humidifier. When you do this, you should throw the remaining water in the humidifier each morning. That will get rid of most of the minerals.

I have not done much research on the stages of sleep. But, perhaps a stimulant suppresses the REM stage of sleep, so it may not be counter intuitive.

@RayRBD has posted a link to what looks like a very useful resources site for RBD. They are looking for volunteers for a study, but seem only to be located in the US, and Montreal in Canada.

Yes, I am surprised that regulators allow the use of ozone cleaners for CPAP use. Without a doubt it is an effective way to sterilize the CPAP, hoses, and mask. However, it is a significant risk to the longevity of the materials. Ozone is a naturally occurring form of oxygen. Before during or after a thunderstorm it can be smelled in the air. Lightning can cause it to form and linger at levels high enough to be detected by the nose. But, on the more positive side, ozone is very reactive and does not last long. It is commonly used in bottled water to kill any bacteria which may form. Unlike tap water which will have a residual chlorine or chloramine to kill bacteria, distilled water or bottled water will not have anything in it, unless ozone is added. That is my pet peave with bottled water. The plastic containers are another contributor to our plastic pollution problem. And, bottled water is almost always activated carbon filtered to take out the chlorine and chloramine which leaves it vulnerable to bacteria contamination and growth. Some, but not all bottled water is treated with ozone to overcome this problem.

I am not so convinced that these ozone cleaners like SoClean are a health hazard to people, but they certainly can be to your CPAP equipment.