CPAP EPR, A-Flex, C-Flex Make Your Sleep Worse...probably! Explanation

[@Freecpapadvice]

Another long video, but it's needed for the nuance of EPR and Flex. Added some fun to this one, so watch until the end. Let me know what you think. Your respectful comments are always appreciated whether you agree or disagree. Thank you so much for spending a little time here. If you have a moment, please check out my links down below. Thank you! Links: 1. Have a PAP Analysis with me at: axgsleepdiagnostics.com 2. As an Amazon Associate, I earn on Qualified Purchases: amzn.to/3drPax1 3. Monthly basis: patreon.com/freecpapadvice

[@CPAPReviews]

That forum is toxic bro. Stay clear! This vid was kick ass. Very educational and yes you are much better looking than me

[@beseez]

PotAtoes are just as yummy as PotAHtoes, jussssst differently flavored. ;)

[@Alprazolam_25]

Didn't know y'all were buddies 😂. I love you channel as well!

[@scowell]

It's not as bad as Apnea Board and that SuperSleeper nazi.

[@scowell]

Not as bad as that other board with SuperSleeper... fash ist!

[@ViolaMelody03]

EPR is what keeps me compliant with my therapy. I did a good month+ without it and my sleep was terrible. Turned it on and things were much better. Should EPR be standard, no, but I am glad I had the option to individualize my therapy, and that is the important thing, we’re all different and we have different therapy needs.

[@preetimittal2123]

What is your update what is your Epr now?

[@davidhottenstine6497]

Whatever your opinions are, I take them as just that, opinions. I appreciate hearing the info you are putting out. I've been using a CPAP for about 10 years. Thank you

[@chrismrobison]

I've followed your channel for a while now. I'm going through trying to optimize my sleep. I think this its my 3rd time through this video and this time I took a bunch of notes. Thanks Jason!

[@clifft257]

I ran into the exact same situation with my sleep doctor and then my respiratory therapist. The optimal level for me was determined at 6cm in the lab, but then my therapist set the EPR to 2. My report said that my snoring was eliminated at that level. I downloaded oscar and noticed that I was still snoring, quite often...and my wife said it was true...not nearly as loud, but I was still snoring. I went to see my RT and she said she'd email my sleep dr and ask if she can raise the pressure. I'm still waiting for that confirmation. Since then I wondered if the EPR was causing my snoring...so I turned it off. The first night my snoring decreased by about 90%. I haven't turned that back on ever since. My AHI prior to making that change was about 1.5-2. Now it's settled to about .2-.5 per hour.

[@trento8397]

If you are using a resmed, the data the doctor's can actually access if very poor, only shows the average, if you using Oscar you can see breath by breath, you can look deeper and see when you had events,flow rate, mask leak ECT ECT. If you need to adjust pressure, hold the home button and the knob together

[@cebruthius]

6:00 The conclusion of that article is as trivial as "standing in the rain gets you wet." ResMed did us all a great disservice by making EPAP a *derived value* as the prescription pressure (PP) witih EPR subtracted from it. That means that once EPR is activated and increased, the EPAP drops which *will compromise* the airway stability since most PPs are determined as "the lowest pressure that controls apneas/hypopneas*. Besides this consideration, there is nothing wrong with Pressure Support in general that diminishes the effect of xPAP for airway stabilisation.

[@ToJoFickleFan]

Hey, LankyLefty. First time watcher, here. I love your humor. Oh, and I am an RT/pulmonary function technologist-still love the humor. You have partially answered my question already, but I’ll put some flesh on it. When performing PAP titration studies, I am a nasal-mask-first guy and will do anything possible to make that nasal mask successful for the first time user (and the user who has known only full face for years). I thoroughly document leaks and breath volumes (tidal volumes) as we proceed. At last resort, I will add EPR in an effort to reduce or resolve excessive mouth leaks. So, the estimated numbers look like this. I probably succeed in finding optimal pressures on patients via nasal interface about 70% of the time. Of those nasal interface users, I probably observe successful mouth leak control on 40% of those. If I cannot attain sufficient control of mouth leaks with maximal humidifier settings, chin strap (which fails about half the time due to non-compliance), AND/or with EPR, then I proceed to full face. Of course, since some studies have suggested that both full face masks and EPR might provoke the need for slightly more pressure, and since other studies (very old studies to boot) find that there are higher incidences of CPAP failure with full face masks, then the less-than-optimal placement of EPR during the sleep study seems to be efficacious for more reasons than pure pressure management can explain. So, I like EPR, as you mentioned, when used appropriately during the titration study. What do you think? (Whew!) Great channel. Thanks.

[@travv88]

I don't see how ramp is a comfort feature. You need a certain level of pressure to not have your airway collapse, and the pressure being lower than what is needed means you choke. That's not comfort, that's torture.

[@layneh2817]

Thanks for all the helpful info, it has made things easier trying to sort out my settings . Been on APAP for 2 months including the trial and have turned ramp and EPR off because I was getting so many CA's, it seemed to help at first but they have returned recently, just not as many. I changed my pressures to 7.8 and 14.4 but think I need to adjust down somehow even though I'm reaching or almost reaching the max every night. but you and Nick have helped a lot in educating me on all things CPAP. cheers

[@preetimittal2123]

Now you are ok ??? Your central apnea are still high??

[@droptozro]

I have 4 nights of data and on airsense 11 auto with EPR I think it's causing my CAs.

[@droptozro]

I have 4 nights of data and on airsense 11 auto with EPR I think it's causing my CAs. I notice CA after pressure raises most times.

[@donrobbie5528]

I turned off ramp because I felt like I was smothering while I was waiting for the pressure to ramp up. Compared to a lot of people I had an easy transition starting CPAP compared to a lot of people but that was a deal breaker for me.

[@debramccawley1714]

Over a short period of time I noticed that my husbands Resmed 10 was showing his central apnea rising from 2.5 to 5.5 over time. He's been using cpap for two months now. After watching your video on the EPR setting I two stepped titrated him down. Since stopping it I've been watching his central apnea drop and is now 1.5. Thanks for all of the humorous and educational videos that have taught me so much. And yes, change those bloody defective sprayers, lol.

[@preetimittal2123]

Your husband has central apnea or obstructive apnea?

[@john99776]

Off topic, but thanks for the advice about mouth taping. Hint for those with facial hair..I use a length of self adhering elastic bandage over any type of tape, placed over the mouth tape and around and overlapped in back of the neck, like a gag would be placed. Still comfortable, and I don't need to worry about the mouth tape coming loose from my whiskers. Going to try a lightweight adjustable band (made for wig stabilization) next, as the elastic bandages have to be discarded after a few uses when they get crumpled and lose adhesion.

[@LarkinM]

I use epr of 2, without it I get severe stomach. My doctor did nothing to adjust my pressure range so I just increased min by 1 until I felt like I sleeping well. Wish it was more tuned though.

[@Freecpapadvice]

Aerophagia is a GREAT reason to use EPR.

[@LarkinM]

@@Freecpapadvice thanks for the reply! I tried several things before this to fix it. Different masks, pressure settings, epr levels, sleeping positions, diet. I was worried about the epr from watching your videos but I figured if I'm sleeping the whole night that's better than waking up with the aerophagia pain.

[@preetimittal2123]

​@@LarkinMnow at what level your epr be set?

[@preetimittal2123]

​@@LarkinMhi please reply

[@LarkinM]

@@preetimittal2123 2 but it's really up to the individual. I would suggest increasing your lowest limit on apap as you increase your epr. So if you're on 7 epr 2 and change to epr 3, you should move from 7-> 8.

[@edwardlove4300]

I've fiddled about with my Resmed air sense 10 and feel comfortable at 7cm and I'm using EPR. So if I turn off EPR should I raise my cm of water to 10? Thanks in advance. Edward from Osaka Japan

[@af1966]

Yes you are correct.

[@edwardlove4300]

Thanks for the answer I'll try it tonight and see how I feel in the morning.

[@beseez]

I think that's what I did, lowered EPR but didn't raise my standard value. Which is likely why I didn't always feel I had enough pressure, having arousal awakenings during the night.

[@kappa7]

Um, no. Look at the paper that was referenced. Figure 1 has measured pressure (Pm) graphs with EPR3. The grey line is the pressure without EPR and the black line is with EPR. If you switch off EPR and keep the pressure at 7cm then you will have a constant pressure of 7cm rather than (with EPR) a pressure at 4cm with spikes on inspiration up to 7cm. 10cm on exhalation will be rather uncomfortable if you're used to 4cm!

[@youngwang5546]

My baseline ahi is around 6 with very little central apneas. Just started my therapy this week. I was prescribed an apap even though previous experience proved that a bipap worked better for me. The results so far have been disastrous. The ahi is anywhere from 25-40 with 80% central apneas. I tried turning off the epr tonight and it made things feel a lot better. Previously, it felt like there was a lag before the pressure kicked in on my inspiration. My previous bipap was a dream station and didn’t have this issue. I believe the Philips pressure release system works better, but I quit using the machine due to the recalls.

[@andrewbarnes605]

Another fantastic video! Very educational and wrapped in some genuinely funny asides. Keep 'em coming Jason!

[@Freecpapadvice]

Thank you for watching!

[@A.Martin]

I made a mistake with the ramp setting, when I turned it on I set a ramp time, and I would fall asleep and end up with massive strings of apneas and wake up again. Then fixed it with the Auto Ramp after that.

[@cecyharders1512]

I was a tech and never used EPR. Bilevel was usually used for comfort and took care of arousals. We didn't measure CO2 levels.

[@jonitalia6748]

Hi, thanks for the info! Is there any situation where EPR can be helpful for arousals? I don’t have the cash to buy a BiPAP right now. I have an APAP with EPR, and my pressure is 7

[@preetimittal2123]

Cpap brings my father's blood sugar high ...when he doesn't use cpap my father's sugar is normal and when he use ....his sugar level borderline high...please make video on this ...please throw some lights on this please i am very disturb...please throw some light on it

[@phin4life503]

I just gotta say thank you because I’ve been having trouble waking up. I feel like I’m suffocate I recently gain like 70 pounds. I don’t know if I changed the EPR cause I was having problems sleeping with the machine. I just cut it off. I haven’t been able to sleep for over an hour and a half For months. I just took it off and I slept two hours instantly because it felt like I was suffocating and I could instantly tell that when I released inhaled exhaled it was easier to push the air out and it was causing all kinds of problems for me like sleep, deprivation, fucking heart issues like I’m having. I can’t explain it, but this is what I needed to hear and I’m convinced that it was deep pure. I might’ve changed it. I don’t know a while back.

[@TheSteveLeo]

Great video / explanation. Will have to try turning EPR off. Also - does anyone think of Cocteau Twins when Jason says "waxing and waning"?

[@robertlarkham2428]

All of this is Greek to me. 😡 I’ve been on my cpap for five weeks. For the most part I’m sleeping great. My numbers are 8-15. I do not use ramp. At 30 days my therapist changed my machine to EPR 3. I don’t know why and can’t really tell if it’s better or worse. I do know before the change my mouth was always filling with air and puffing my cheeks out. Since changing to EPR that doesn’t happen. I’m sleeping 7+ hours a night and have been since starting the cpap. My 30 day AHI is 2.9. My daily AHI has gone up a bit since switching to EPR. It is now 4.5-5 daily.

[@beseez]

When I started CPAP I didn't know anything either. And this is one channel I watched to help learn about what I needed to help myself. I learned to change my own settings but I still don't exactly understand what I'm doing. Ultimately, I agree with you and that's what I'm fighting now. My poofing lips or my cheeks bubble out or I swallow so much air. In the beginning, Fighting mask fit, being such a very light sleeper, any tiny whoosh sounding from air leaks, etc. But, all my numbers were phenomenal. The sleep doctors could not believe how well my numbers were just from using it. I still never felt good and I was still sleepy and I wasn't sleeping through the night and I was tossing and turning and throwing the mask off my face blah blah blah so I feel for you I get it. If you feel good that's what counts. If you're healing and getting healthier that's what counts.

[@michaelholland709]

So I watched this video a few times in my first few months of self managed titration. I turned EPR on/off and couldnt notice much difference but reasoned to keep it off. But after a spell with covid and bad fever I had upped my pressure to 11.6 (airsense 10) and turned on EPR (2/3). Then about a month later I noticed these low level all day headaches creeping in without much change in core stats in Oscar. Thought it might be over tight mask or poor headgear and was about to pull trigger on new gear but then remembered this video and watched it again (and again). Interesting facts....a) I understood so much more after 6 months than I thought I had at 2 months. b) Turned off EPR and headaches immediately gone, I could see in Oscar exactly what was described had crept into my airflow reading i.e. arousels not preceeded by airflow obscruction but followed by wave pattern of mini hypopneas/reras continuing for 5 to 10 minutes. Not that many but just enouhh I reason to hurt. c) I am a 10/11 kind of guy which in the video puts me into the 'might benefit from EPR' category. thank you Stewie & LL.

[@memrec1]

I understand EPR is less ideal, is it still that bad if your AHI is 2.0 or less? I am very new to this (cpap) and as a recent user, the pressure to exhale is the main issue so I'd favor using the machine with EPR than no machine but I guess ultimately you get use to the pressure? Then perhaps EPR is good IF you eventually transition without it?

[@preetimittal2123]

Cpap brings my father's blood sugar high ...when he doesn't use cpap my father's sugar is normal and when he use ....his sugar level borderline high...please make video on this ...please throw some lights on this please i am very disturb...please throw some light on it

[@KPHVAC]

I like EPR set at 2, it's more comfortable for me. It took me months to dial in the right pressure. Now I start at 10 with a max of 12. I'm going to try out fixed pressure at 11 or 12 to see if that's even better. My doctor started me at 5 to 16 and that was horrible! Way to big of a range.

[@preetimittal2123]

Still your epr level is 2??? After 10 months

[@KPHVAC]

@@preetimittal2123 I still have EPR set to 2. Is it not good to have EPR on?

[@preetimittal2123]

@@KPHVAC you check your oscar report regular???

[@KPHVAC]

@@preetimittal2123 I've never checked the Oscar report or done any of that yet. I sleep great with a small range of 12 to 13cm. I probably should buy a data card and figure out how to look at the Oscar info.

[@NigelM18]

I find epr is nice while I'm sick. I had to turn it on for it cause I couldn't breathe out very comfortably being exhausted.

[@danieljrgensen133]

Thanks for that explanation Jason. I actually(undtill now), just saw EPR as a "comfort feature" meaning = why not just use it?! So thanks for that little clarification on possible sides, if one is on low cpap/apap pressure(something like between 4-8cmh2)! 🙂 Wish you a merry Xmas, when the Hollidays arrives! 😉

[@scowell]

One thing I've found is that EPR makes my palate prolapse hard! When I turn it to 1 or off I don't get the 'face slaps' that I get at 3... it's like your face is being slapped, from the inside... a curious thing. It's also positional, in that I get it on my left side or supine, but not on my right... and it seems to be worse after a full night of sleep, so maybe it's shrinking my palate? Don't know, saw an ENT, he said 'tongue' and recommended another sleep study... which I failed (original AHI >100, why did I think I could pass one after 14 years on the hose?). So I'm going in for a titration in a month for both CPAP and bi-level... my current pressure is 16cm with EPR 1, APAP hanging out between 16 and 17cm with AHI of 0 or 0.2. Not sure if bi-level will do the same thing to my palate, but I'll let a pro titrate me and we'll see.

[@pbrian9527]

Now I have to get a copy of my titration study to see if they used EPR

[@HappyCupsInc]

I have troubles with sleep/insomnia so I try to do some breathing exercises I learned from Patrick Mceowan of Oxygen Advantage, where you breathe very low and slow. It works surprisingly well, but I found that even with the lowest EPR setting I’ll hit kind of a dead spot of air for a second or two when I’m inhaling, where it feels like I can’t pull in air. I guess the machine’s EPR algorithm just doesn’t work well with how slow I breathe. Anyway, I switched to straight cpap with initial ramp and that weird issue is gone. Still getting used to cpap and have had issues with aerophagea, not fun but I’m taking it slow and hoping I can creep the pressure up over time to get to essentially 0 AHI and minimal arousals.

[@HappyCupsInc]

Also part of what I’m learning is that the faster you breathe and thus the faster the air going through your airway, the more likely it is to collapse in. I worry that the EPR algorithm will encourage faster breathing patterns rather than allow for slower ones like a fixed pressure might. I know that with cpap the negative pressure on the airway created from breathing is probably a non-issue, but as I intend to eventually cure my apnea I don’t want to have to re-learn a faster sleep breathing pattern caused by EPR.

[@trento8397]

Things that help me fall asleep fast is using acupressure on certain pressure points on my hands head and feet

[@trento8397]

And the meditation pose, where you cross your legs while lying on your back, this causes your legs to get very tired

[@bwo8641]

Thanks for the good info on here. Hey, the Mask Bright black sprayer that you include with the pack of three is great. I’m still using the same black sprayer and on bottle #3 with no issues.

[@Freecpapadvice]

Well thank God one of them works!!!!! 😄

[@user-uc1ps9nw8n]

I thought I read somewhere in a resmed manual that the ramp feature will turn off if it senses a major event? Also for me EPR was a great help to get use to cpap. Without it I would have tossed it out the window. So for me EPR was a good choice at first.

[@BLenz-114]

I have a RedMed 11, and I've played around with the ramp settings, and looked at how they're supposed to work, etc. I think what you mention is maybe the "autoramp" feature, which supposedly detects when you fall asleep and then ramps up the pressure. I just now went looking at the manual again, and I can't see that it mentions that it will jump to full pressure during ramp if it detects an event, but theoretically, you wouldn't have an event until you're asleep anyway, so it probably works out the same. If you can find somewhere in the literature where it does do as you say, please let me know, I'm curious.

[@-zach-crook-]

Why don’t you fake an event to try and trigger the ramp feature to shut itself off. Lay there with the ramp feature on and just stop breathing for about 15 seconds and see what it does. Try this on both auto ramp and specifically timed ramp…Just a thought.

[@cypiongm8698]

hi, i use a ressmed airsense 10 autoset since 3 monthes. when i wake up, it tells me that i 0.5/h. but i am tired.why?ty

[@screamtoasigh9984]

Wear a pulse oximeter (to check spo2).

[@cypiongm8698]

@@screamtoasigh9984 ok. With the CPAP I could have less oxygen? Heart or pulmons?

[@preetimittal2123]

​@@cypiongm8698whats the update now?

[@preetimittal2123]

@Freecpapadvice when i turn down the Epr of my father from 3 to 2 ....he start getting Ahi down to 1...but yesterday last night when i turn lower the Epr from 2 to 1 my father get starts chock so much and mask is leaking pressure he is so confirtable and I check his Ahi increase in 1 hour ( 3.7 events in 1 hour and 20 minutes) I scared and immidiately i turn increase the Epr from 1 to 2 again and then he sleep well and in morning i check the Ahi that is (2.2 ) I wondered why he is suffering so much when I turn down the Epr from 2 to 1.

[@yanzhang6938]

I'm using cpap for 1.5 months and I could never sleep well. My sleep doc did nothing. So I had to try myself. Now I found EPR is helping. I still wake up 2-3 times at night, but at least my mouth is no longer dry and I don't feel too hard to go back to sleep. But I still don't get the resting sleep I am looking for. Should I try shorter ramp time or higher pressure?

[@cebruthius]

10:05 When they turn off EPR, the EPAP is increased. How do you know that this undulation pattern that you describe isn't caused by insufficient airway stenting?

[@Freecpapadvice]

The undulation pattern is when EPR is on. I know it's not insufficient stenting because it's a central hypopnea pattern.

[@cebruthius]

@@Freecpapadvice How do you know for sure it has central origin?

[@Freecpapadvice]

Convex vs. Concave pattern. Central is convex in way series of respirations show.

[@kentheaps2115]

Jason, my bi-pap Airsense 10 came prescribed by the doctor with 6-15 air pressure, and with EPR tuned on. I have since increased my bottom pressure to 9 'cause I felt I needed more pressure. Would you suggest I leave the EPR turned on?

[@cebruthius]

9:30 Except EPR doesn't do that. It provides a fixed amount of ventilatory support and/or augmentation at all time.

[@Freecpapadvice]

Right...remember at the beginning of this I say what sets this cycle off is a large arousal which includes a 2-3 breath hyperventilation period. The EPR causes the post arousal central hypopnea or apnea (which is normal) to persist for much longer than 1-2 cycles. It definitely does it, just not for everyone. Just one of the reasons I'm against the blanket use of EPR.

[@cebruthius]

@@Freecpapadvice And this large arousal isn't caused by an obstructive condition? One would abolish those if EPAP is increased as EPR is disabled. Just an alternative theory.

[@Freecpapadvice]

I may have to do a video on this (grab a screenshot) of this so that you can see the specific pattern I'm talking about and how it starts. Definitely not obstructive apneas prior. Not even hypopneas. Usually the airway is fairly well controlled up until the arousal. Sometimes spontaneous, sometimes subtle RERAs or flow limitations just prior.

[@youngwang5546]

⁠@@FreecpapadviceI think I’m having this exact issue. Using an apap with epr set at 3 is causing me to have a lot of large arousals and recording central apneas of 20+. I feel myself drifting in and out of sleep and breathing very rapidly and shallow. Epr seems to restrict air flow by causing a lag between the expiration and inspiration , for a split second I feel like I can’t get any air to come in and that wakes me up.

[@cebruthius]

4:30 You conflate EPR with the EasyBreathe sharkfin. On older S9 machines you could use EPR *with or without* EasyBreathe. On Air10 and onwards EPR comes with mandatory EasyBreath sharkfin. You should know that VPAP/VAuto PS = 3 with EB on is exactly the same as EPR 3 on an Airsense10.

[@Freecpapadvice]

Completely disagree. You can feel the difference between the two. EPR is extremely smooth as if the Rise Time is set to 900ms. Transition is much faster VPAP PS.

[@cebruthius]

@@Freecpapadvice Have you tried turning EasyBreathe on with a VPAP or VAuto machine?

[@Freecpapadvice]

Yes. EasyBreathe for me feels much different than EPR. (that's what the rise time comparison was above)

[@GuyScharf]

Are you saying the shape of the curve and response is different between EPR and a VAuto with default settings? I didn't notice a real difference with VAuto default settings. I increased Trigger setting to greatly improve breathing. I also tried turning EasyBreathe OFF with VAuto-S and and found that to be hideously uncomfortable.

[@icarrera6969]

I take it you are talking about ramp up..mind was set at Auto ,I changed to 45 minutes (5 start works up to 6)an changed to nasal with heating tube ...just one month user . Is it normal to fine tune like I am ?

[@TabithaRJohnson]

I feel like I breathe deep when I first go to sleep then it slows down closer to going to sleep. What settings should I set to help? I had to turn Ramp off as I was gasping. What other settings should I set?

[@NickNackpaddywhack]

I found if I increase epr my apnea gets worse, I also reduced ramp time to 15 minutes which is more than enough to get comfortable.

[@rainavanhorn549]

Thanks for all your recommendations. I've used them and gotten rid of all but CAs - my doctor won't prescribe a bipap because my numbers are below 5.0 AHI - so I'll just continue to use the resmed 11. Thanks again.

[@discontinuity7526]

I've been having really bad aerophagia, I've decided to use constant pressure at 13 instead of auto 12-13, and use EPR 1, I'm hoping that will solve everything for me. I think I'm building up CO2 because it is hard to exhale then I try gasping and using my mouth to breath, which inflates my cheeks and causes tape leaks, then I swallow the air lol. I'll collect data for a while then get a pap analysis, thanks Jason

[@rjcarmineglorso7323]

How are your pillows and head support? I use pillows to position myself on my side - two pillows for my head, and a long body pillow to keep me on my side. If I turn on my back and my head flops back while I sleep, the CPAP shoots air straight down my gullet and it's horrible.

[@johnwayne397]

I've noticed no matter what pressure my cpap pulsates when I'm breathing very calm or hold my breathe why...resmed air sense 10

[@pamelaruigh8185]

Hi Jason, 81 yo papper here. Still battling leaks on full face that don't show on sleep report. I have an occasional wake up with spiked blood pressure and HR but nothing showed up on the sleep report. 4 eye infections this year from leaks around eyes. Pressure 9-12 ResMed 10 +F 20. Taping not good because punky airway and narrow nostrils that block in the night. Tried it for a long time. I'd love to support you but I'm in a heat or eat battle up here in the NE. Sleep lab and sleep doc ain't worth sh@t. Average pressure is 12, ramp off. I think EPR helps me breathe better. Mild apnea with severe drops in O2. When pressure is 12 I cannot contain leaks. I wake up with mask farts galore but nothing on sleep report. My solution might be is to have a fixed pressure because my cpap is ramping up from leaks and 12 is too high for me. I have tried most FF masks and jaw drop is horrible. Ordered a new chin strap and N 20 to try a nasal mask again. Also at 81 your face caves in and the mask that might have fit once no longer fits when your teet fall out and your face looks like a Shar Pei dog.

[@screamtoasigh9984]

I have narrow nostrils and have had nasal surgery, xhance nasal spray has been amazing. Maybe you can switch to a mask with the hybrid? Nasal pillows plus mouth mask?

[@coreycantwell5990]

So I use an old s7 resmed. I have bought 3. I also have a dream one but the epr releases pressure when I breath out. When I turn the epr off it still does the same thing. Is there any way around this so it keeps a constant pressure?

[@sopheana9425]

I do not get it , I m no expert no doubt but have been digging into some CPAP basics recently , should not c flex and EPR makes exhaling easier so you wo not feel like struggling to breathe ?how come that turning it off will decrease CO2 level !!

[@AlwaysAudacity]

Serious Lanky is my spirit animal.

[@screamtoasigh9984]

Do you explain soft setting in any video? (Also can you explain why, well, DME mailed me a new mask to try today and i tested it out during the day to see if it would work ( I have the chick version of your nose 🤣, it is the n20 for her memory foam in small after I tried the n20 reg in medium /silicone, and it leaked like sieve and got into my eyes... And the headgear hit the middle of my neck... Too big, so for her ) so I wore it for an hour,, and it SAID I HAD 6 AHI an hour 😒 , I was awake... Sitting up and awake (during the night I am usually at 0.8-2 when the mask says on, p10 xs for her). What does this mean?!

[@managingmarlys]

So is the lower the Epr the more pressure or less pressures,on exhalation

[@DoubtingThomas333]

Less pressure, but EPR can be helpful for breathing support...especially if your flow rate with your breathing seems to look a little flat... though you should always fix that with more pressure, first.

[@standupandscream211]

Any thoughts on using a short ramp for about 5 minutes just so you can get comfortable and don't instantly blast your airways with the max pressure?

[@markstevenson3880]

Try a VCOM

[@patrickradcliffe3837]

15:48 don't horrify me like that again Jason! I don't need a vision of you in froggy boxers! How soon before FreeCPAPadvice is back up?

[@af1966]

I turned off epr and I couldn't sleep because it was blowing air so strong I wasn't able to sleep so I turned it back on and I'm able to sleep well.

[@beseez]

My big issue is that it slows my breathing. Watching this video I wondered if I was feeling that it was helping keep my breath and Rhythm that would help my body heal. Because in any meditation or mindful moment or health moment they're saying you need to breathe and go slow and deep repetitively. But Lefty made a valid point, in the area of irregular breathing after an arousal.... taking 5 minutes or so to even out. I believed or felt that my breathing would resynchronize with the epr and I would go back to feeling better sleeping. And now I'm not sure. This video makes me rethink. I enjoy learning. Edited to add, are truly meaning EPR that you turned off, or another setting? Happy New year

[@preetimittal2123]

Same with my father...now how are you ....

[@preetimittal2123]

How are you now...did you turn off the epr or not?

[@fracman55]

I started with auto ramp and epr at the beginning of my cpap on my autoset 10 1 year ago , slowing ramping but now I just go too my max pressure on start up no auto ramp and sleep like a baby is that ok .for me it works much better ,it took a year too get too this point

[@semiephemeral9]

How did people get the idea that EPR "treats" flow limitations? The seems to be super prevalent in the community. The way I've seen it presented is: EPAP splints open the airway, preventing obstructives but... IPAP prevents hyponea's/RERA/UARS? I'm....puzzled how hypopneas/RERA's can sneak by a fully patent airway.

[@DoubtingThomas333]

Pressure support is like... spooling up for inhalation...like a turbo... it helps the inspiration side of breathing. Believe me, I have UARS, and I can tell that not only do I need a higher pressure, but a bit of a kick from pressure support helps deal with preventing awakenings. EPR/bilevel also reduces overall average pressure... so if I was fine on a static 8, but had epr set to 1, it would give an average of 7.5. Obviously, you need to up the total pressure if it's not doing its job. I look for flattened peaks in my flow rate. You dial up your pressure without allowing your AHI to get out of control...I'd say trying to keep it below 2.0 as a rule of thumb

[@youngwang5546]

@@DoubtingThomas333I tend to be an irregular breather, with many short shallow breaths followed by one long and deep breath. I just started treatment this week with an apap and it’s causing me to have 20+ central apneas per hour, when my baseline was like 5 obstructive with 0-1 central. For some reason the cpap is making me breathe much slower, or hold my breath and not not breathe at all.

[@jskim2510]

So what if Epr is already accounted for by sleep technician??? You blocked it with advertisement

[@semiephemeral9]

Jason does anyone in the lab ever actually use FLEX or EPR while doing in lab titrations?

[@canuckchris5733]

I think this episode was frickin hilarious 😎 PS chunky frog has a fans only page 👀

[@gregcarson3444]

OK I think we need to dump the cat channel, and become a Lanky Lego channel, man that little dude cracks me up every time. But seriously when I got my resmed auto set 10, five years ago, the DME had set the EPR to 3, because, “it is more comfortable “, the problem was the noise drove me nuts, loud and quiet loud and quiet. At that time my pressure was only 8, so for sure did not need the EPR, I turned it down to 2 as soon as I figured out what was making that noise. After years of watching your video’s you have convinced me that EPR is poo poo. So I turned it off a couple of years ago, and I believe I am better for it. Oh yeah pressure at 10 now.

[@MrMIDWEST323213]

Can sleep apnea go away if loosing weight

[@NigelM18]

Dumb question, what's the difference between EPR and autoset? My 11 has both? I thought it was the same thing?

[@screamtoasigh9984]

Nigel, don't quote me on this but autoset is apap (automatic setting of your "cpap" levels aka automatic cpap) EPR is setting your exhales to be lower than the (automatic in autoset) pressure setting on your inhales. When you inhale the air pressure is "natural" just extra, when you exhale on cpap you are "blowing out" against the air (basically not natural as far as how humans breathe), so the epr will lower the pressure solely while you exhale so you aren't "battling against" the forced air. The pressure setting in autoset will adjust to you, epr adjusts it (lower) further but only on exhales.

[@MC-yx9oe]

Theres no link for why you hate apap 😭

[@john99776]

Thanks, Jason. I've had the flex on 1, just because it's there. I'll turn it off.

[@Freecpapadvice]

No need to if it's working for you! If you're dialed in, steady as she goes.

[@preetimittal2123]

​@@Freecpapadvicesir please reply when i turn Epr offf my father gets so much aerophagia and bloating stomach pain so much...then I turn Epr at level 2 then my father is doing well ...no aeriphagia nothing...so can i use epr or not

[@Freecpapadvice]

@@preetimittal2123 If your father is benefiting from EPR, then he should use it. There is no right answer for everyone. The things to look at are: 1. Is his leaks steady throughout the night? 2. Is the pressure correct. 3. Is the mode of therapy correct?

[@preetimittal2123]

@@Freecpapadvice leak rate 11liter/ minute

[@preetimittal2123]

​@@Freecpapadvicemy father auto cpap pressure is ...8.8 to 10.00 with epr 2...i dont have oscar support because my father use cpap machine from 2 months...nd with lack of knowledge and mistakenly we bought resmed airstart 10 instead of *airsense 10* now we realize airsense 10 is best ...but we are middle class family cant affort expensive airsense 10 machine...that's why we bought this machine...now my father is doing well with Epr - 2....please help us what should we do...

[@SilentServiceCode]

Can't understand how you say turn EPR off yet pimp bilevel at the same time

[@Freecpapadvice]

It's 3:40 into the video. Did you cut out before that?

[@SilentServiceCode]

​@@Freecpapadvice I generally don't watch anything ever

[@katialamanna173]

Great information... thank you! Is it bad that I watch these videos in hopes of getting a glimpse of Stewie?! :)

[@Freecpapadvice]

Not at all! 😂

[@Freecpapadvice]

For You. 😄 kzbin.infoDvG3El-eDPE

[@bmills9821]

Just received my first order of mask bright works great nice scent.

[@Freecpapadvice]

Yeah...you're not wrong.

[@cebruthius]

1:00 Why you dump on my beloved DSX900 my man 😢

[@Freecpapadvice]

Collateral damage....🤣

[@brittanylevinson741]

Still love your videos and especially the comedy. I went from resmed to Philips but their algorithm just works better for my weird ass breathing. Maybe you’re just normal? Who knew LOL

[@peterlawrence738]

Why didn’t you tell us how to turn it off…

[@lolw7837]

What cpap device do you have?

[@jimramsey3279]

Sometimes the humor throws me off track. Call me stupid but my pea brain can't handle the variations.

[@-zach-crook-]

I appreciate the info and the humor. I am cursed with a 4th grade sense of humor so I find ALL of your shenanigans hilarious. Please don’t quit, I love it. Also, I’ve been on cpap for almost three years now and my machine reports an AHI 365 day average of 1.25 & last 90 days as 1.0. Do you think this is good enough or should I be shooting for zero?

[@trento8397]

The machine report is very very limited only shows average, best to use Oscar and see exactly what time you have ahi, and you can see any abnormalities in other graphs such as pressure, leaks ect..

[@drtbke]

You’re comedy alone is worth well over 100k subscribers in my opinion, the information is better but I’m here for both 😁

[@ederdmann7347]

I want to know if Stewie agrees with you and what’s his take on EPR. These are things we need to know. 😂

[@Freecpapadvice]

I said, "EPR". Stewie bit me. Draw your own conclusion.

[@karenzimmer7607]

Why do you keep saying water pressure? Aren't we getting air pressure.. 😅

[@markstevenson3880]

You stole that tie from Trump, right? That my comedy input. Many of the below comments refer to high air input flows/ ramping, may I suggest that they look at a VCOM device for moderating sudden air flows.

[@whynotbekind1957]

People should take the advice of their physician who treats them for their sleep apnea…because they know first hand what the patient needs…. sleep tech are not doctors. they may have some helpful tips, but i would be cautious changing your settings on the advice of a you tuber…I am a retired surgical nurse, and know many things…but i would not give advice like i, myself am a surgeon….so take the helpful hints about cpap that is appropriate …but leave the rest to your doctor

[@michaelholland709]

very 20th century thinking. What about people who struggle to access good physician, facing a bombed out service or just came out their annual check up confused about facts and choices. My Dr has only basic knowledge of this topic and can barely get her on the phone. Getting a specialist referral would take over 6 months meanwhile I was literally dying on 60 events an hour. £1k and 50 hours on youtube and I am dialed in on my therapy and feeling great thanks to people like this guy. All you are saying really is be cautious of what you reply on from the internet but you could say that about anything in life. Relying on a doctors has risks too. If your a digital native you understand this, if the majority of your life to date has been spent in 20th Century you are going to struggle. I had double cataract surgey, sure I woudnt try that in my kitchen following a YT video but titrate my own CPAP pressue I can do that.

[@luisxavier8124]

Very well said 👍

[@karenzimmer7607]

Exactly...I got no explanation about my report. She just said your doing good..I don't even think she knows how to read the stats that well. It's scary when this is so important to your health yet you get no guidance or time of day from your pulmonary Dr

[@markstevenson3880]

Oh sh*t, I hate it when you make sense. Definitely not about the calendar

[@bestimmaa]

Just raw dog constant pressure, all these features are distracting.

[@2sweetmebrah]

hahah the toxic cpap community

[@jyotipethe]

First

[@Freecpapadvice]

My videos aren't "first" worthy. 😂 Never have been....never will be.

[@candacenagle505]

I would love for you to deliver the important information without the comics

[@Freecpapadvice]

We're not taking requests today. There are plenty of other uptight CPAP channels out there. You may find one of them better suited for your tastes.

[@johncollins2955]

@@Freecpapadvice Don't EVER stop the comics! :) Your level of technical information is nicely balanced by the fun factor. Perfect.

[@af1966]

Since you hate APAP machines do you like bipaps, do you think they're better?

[@Freecpapadvice]

Don't hate APAP machines. Hate APAP mode for long term use. Bilevel is fine when it's not used in VAuto mode and is the appropriate mode of therapy for the person.

[@preetimittal2123]

Cpap brings my father's blood sugar high ...when he doesn't use cpap my father's sugar is normal and when he use ....his sugar level borderline high...please make video on this ...please throw some lights on this please i am very disturb...please throw some light on it...this is really a big concern ....have you any reply on that???

[@af1966]

We get advertisements from KZbin before we can watch a video and we get your advertisement in the middle of this video, oy vey.

[@Freecpapadvice]

They should be showing more than that. Thanks for letting me know! 😉