EPR OR FLEX OR NONE

epr or flex , do you guys use these comfort features or do you choose not to have them on i have been told it is better for youre therapy if you have them off, what do you guys think?, i would value your opinion thanking you in advance.

First, if you already have not, you should read through the posts in this fairly recent thread.

https://myapnea.org/forum/not-understand-epr-setting

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 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?

Joe,

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.