ResMed AirSense 10 EPR: Should It Be Onor Off?

A Complete Settings Guide for AirSense 10 and AirSense 11 Users

If you have a ResMed AirSense 10 or AirSense 11 CPAP machine and you are wondering whether to turn EPR on, what level to use, and how it affects your therapy — this guide answers all of it in plain language The Short Answer

For most new CPAP users: turn EPR ON, set it to EPR 2, Full Time. This makes exhalation feel natural and significantly improves early compliance. Leave EPR OFF only if: your doctor has specifically asked you to keep it off, or your data shows your AHI increases when EPR is on. Keep reading for the full explanation, settings guide, and how to change it on both AirSense 10 and AirSense 11.

What Is EPR on a ResMed CPAP Machine?

EPR stands for Expiratory Pressure Relief. It is a comfort feature built into ResMed AirSense 10 and AirSense 11 CPAP machines that temporarily lowers the air pressure as you breathe out — then brings it back up to your prescribed level as you breathe in.

Without EPR, a CPAP machine delivers the same constant pressure throughout the entire breathing cycle — both in and out. This means you are always exhaling against that pressure, which many patients describe as 'breathing through a straw' or 'fighting the machine.' EPR eliminates this sensation. Think of it this way: imagine trying to exhale into a balloon that is already inflated. That is what CPAP feels like without pressure relief. EPR slightly deflates the resistance on exhale so breathing out feels effortless — while the inhalation pressure still does the job of keeping your airway open EPR vs Standard CPAP — What Changes

	Standard CPAP (EPR Off)	CPAP with EPR On
Inhale pressure	Full prescribed pressure (e.g., 10 cmH O)	Full prescribed pressure (e.g., 10 cmH O
Exhale pressure	Same as inhale (e.g., 10 cmH O)	Reduced by 1–3 cmH O (e.g., 7–9 cmH O)
What it feels like	Constant resistance — can feel forced	Natural rise and fall — closer to normal breathing
Therapy effectiveness	Full pressure maintained	Maintained — pressure returns fully on each inhale
Who it suits	Patients comfortable with constant pressure	Most patients — especially new users

EPR Levels Explained: 0, 1, 2 and 3

The AirSense 10 and AirSense 11 both offer four EPR settings. The number represents how many cmH O the pressure drops on exhale:

EPR Setting	Pressure Drop on Exhale	What It Feels Like	Best For
EPR Off (0)	No reduction — pressure constant	Firm resistance on exhale throughout	Patients who are already comfortable on therapy; doctor-instructed
EPR 1	1 cmH₂O lower on exhale (e.g., 10 → 9 cmH₂O)	Slight softening — barely noticeable for some	Patients who want minimal change; trying EPR for the first time
EPR 2	2 cmH₂O lower on exhale (e.g., 10 → 8 cmH₂O)	Noticeably more natural — most patients' sweet spot	Most new CPAP users — recommended starting point
EPR 3	3 cmH₂O lower on exhale (e.g., 10 → 7 cmH₂O)	Maximum relief — very natural, close to unassisted breathing	Patients who strongly feel they are “fighting the machine” on lower settings

EPR Type: Full Time vs Ramp Only

Beyond the level (1, 2, or 3), you also choose when EPR is active. There are two options

EPR Type	When EPR Is Active	Use This If...
Full Time	Active throughout the entire night — every breath in and out	You want consistent comfort all night (recommended for most patients)
Ramp Only	Active only during the ramp-up period at the start of therapy; switches off once full pressure is reached	Your doctor wants full pressure maintained during sleep, but you need help falling asleep at the start; less common

Recommendation for most patients: EPR Full Time. Unless your doctor has specifically requested Ramp Only, Full Time gives you the best comfort benefit throughout sleep — not just during the initial few minutes.

How to Change EPR Settings on ResMed AirSense 10

EPR settings on the AirSense 10 are in the Clinical Menu — a settings area that requires a few extra steps to access. This is intentional: it prevents accidental changes to therapy settings.

Method 1: Accessing the Clinical Menu (Standard) Step 1: Make sure the machine is ON and at the home/start screen. Step 2: Press and hold the Home button (the house icon, bottom left of the display) for approximately 3 seconds until the Clinical Menu appears. Step 3: Use the dial to scroll to Therapy and press to select. Step 4: Scroll to EPR and press to select. Step 5: Set EPR Type: choose Full Time or Ramp Only. Step 6: Set EPR Level: choose 1, 2, or 3 using the dial. Step 7: Press the Home button to exit and save

If Step 2 doesn't work — try this alternative Some AirSense 10 units have a clinician lock. To access: with the machine OFF, press and hold the dial (the large circular button on the right) AND the Home button at the same time for 3 seconds. This enters the Setup Menu. If a passcode is requested, your supplier or prescribing doctor can provide it. Healthy Jeena Sikho can assist customers in adjusting comfort settings on their rented or purchased devices. Method 2: Via myAir (AirSense 10 with Wireless)

If your AirSense 10 is equipped with wireless connectivity (some units), comfort settings including EPR may be accessible through your ResMed myAir account under Device Settings. This depends on whether your prescriber has enabled patient-adjustable comfort settings remotely How to Change EPR Settings on ResMed AirSense 11 The AirSense 11 has a touchscreen interface, making EPR settings significantly more accessible — no Clinical Menu passcode is needed for comfort settings. Method 1: Via the Touchscreen

Step 1: Turn on the device using the button on top of the machine.

Step 2: On the touchscreen home screen, tap the three-line menu icon (top left corner).

Step 3: Tap My Options.

Step 4: Tap Pressure Relief.

Step 5: Toggle EPR On or Off, then select the level (1, 2, or 3).

Step 6: Select Full Time or Ramp Only for EPR Type.

Step 7: Tap the back arrow or Home to save and exit

Method 2: Via the MyAir App (AirSense 11)

Step 1: Open the MyAir app on your phone (iOS or Android).

Step 2: Tap Menu → My Device → Device Settings.

Step 3: Tap Comfort Settings.

Step 4: Adjust EPR Level and Type, then tap Save.

Step 5: Changes sync to the device automatically.

AirSense 11 — Note on Clinician Locks

If your prescriber has locked therapy settings on your AirSense 11, the Pressure Relief option may appear greyed out. This means your doctor or supplier has restricted patient access to therapy changes. Contact your prescribing sleep clinic or your supplier (Healthy Jeena Sikho) to request a comfort setting adjustment — this is a routine request

Should EPR Be On or Off? How to Decide

This is the most common question about EPR — and the answer depends on your therapy data and how you feel. Here is a practical decision framework: Turn EPR ON if you experience any of these:

• Exhalation feels difficult or forced — like blowing against resistance

• You wake up with a dry mouth or throat (pressure may be causing mouth-breathing; EPR can help reduce average pressure and improve comfort)

• You feel anxious or claustrophobic when the machine starts — EPR makes the first few breaths feel gentler

• You are struggling to fall asleep with the machine on — EPR reduces the 'fighting the machine' sensation that disrupts sleep onset

• You are a new CPAP user — compliance in the first 90 days is critical; EPR significantly improves early tolerance

• Your Ramp period doesn't feel like enough relief — EPR extends the comfort benefit throughout the whole night

Keep EPR OFF (or turn it off) if:

• Your doctor has specifically instructed you to keep EPR off — follow their guidance first

• Your AHI increases when EPR is on. This can occasionally happen: EPR reduces exhale pressure, which in some patients (especially those prone to central apneas) can trigger additional breathing events. Check your data after changing EPR — if AHI goes up, turn EPR off or reduce the level

• You are on BiPAP therapy — BiPAP already sets separate IPAP and EPAP pressures, so EPR is not relevant. EPR is a CPAP-specific feature

• You have Complex Sleep Apnea (CompSA) — where treatment-emergent central apneas are present; your doctor may prefer lower EPR or no EPR

• Your therapy is working perfectly with EPR off — if AHI is < 5 and you are comfortable, there is no need to change

Symptom / Situation	Recommended EPR Action
New to CPAP, finding it hard to exhale	EPR On, Level 2, Full Time — standard starting point
Waking with dry mouth	EPR On, Level 2 — also check humidifier level and mask fit
Falling asleep is fine but waking mid-night	Check AHI data first; try EPR 1 or 2 if not already on
AHI increased after turning EPR on	Reduce EPR to Level 1, or turn EPR off; discuss with doctor
Aerophagia (gas/bloating from CPAP)	Try reducing EPR or check if pressure is too high overall
Therapy working well, no discomfort	No change needed — leave EPR as is
Mask leaks increased after changing EPR	Unrelated to EPR — refit mask; check cushion wear

Does EPR Affect Your AHI? The Data-Backed Answer

This is one of the most important questions about EPR — and the answer is: for most patients, EPR does not increase AHI. But for a small subset, it can — and you should check your data. Clinical research (including ResMed's own data) shows that EPR does not significantly affect AHI in patients with straightforward obstructive sleep apnea (OSA). The brief pressure reduction on exhale is not long enough to allow the airway to collapse — the full inhale pressure immediately prevents any obstruction.

However, in a smaller group of patients — particularly those with:

• Central sleep apnea (where the brain doesn't send a breathing signal)

• Complex/mixed apnea with both obstructive and central events

• Cheyne-Stokes respiration pattern

— EPR can occasionally trigger additional central apnea events. This is because the pressure fluctuation can disrupt the CO feedback loop that controls breathing rhythm in these patients.

How to check if EPR is affecting your AHI

1. Note your baseline AHI from your machine's daily screen or SD card data (average over the last 7 days before changing EPR).

2. Change your EPR setting and use the machine for 7 nights.

3. Compare the 7-day AHI after the change.

4. If AHI has increased by more than 2 events/hour, EPR may be contributing — reduce the level or turn it off and monitor for another week.

5. If AHI stays the same or improves, EPR is not causing any issue

EPR with AutoSet (APAP) — How They Work Together

If you are using an AirSense 10 AutoSet or AirSense 11 AutoSet — where the machine automatically adjusts your pressure between a minimum and maximum range — EPR works on top of the AutoSet algorithm.

The AutoSet algorithm determines your current inhale pressure (e.g., 9 cmH O at that moment). EPR then reduces the exhale pressure by 1, 2, or 3 cmH O from whatever the AutoSet pressure currently is. So if AutoSet is delivering 9 cmH O and EPR is set to 2, you exhale at 7 cmH O — regardless of what your prescribed minimum or maximum pressure range is.

There is one constraint: EPR will not reduce the exhale pressure below your prescribed minimum pressure. If your minimum is set to 6 cmH O and AutoSet is currently at 7 cmH O, EPR 3 will only reduce to 6 cmH O (not below it).

AutoSet Pressure at Moment	EPR Level	Resulting Exhale Pressure	Note
10 cmH₂O	EPR 1	9 cmH₂O	Normal operation
10 cmH₂O	EPR 2	8 cmH₂O	Normal operation
10 cmH₂O	EPR 3	7 cmH₂O	Normal operation
7 cmH₂O (AutoSet near minimum)	EPR 3	6 cmH₂O (capped at minimum)	Minimum pressure floor applies
6 cmH₂O (at minimum)	EPR 3	6 cmH₂O (no reduction)	EPR has no effect at minimum

EPR and the Ramp Feature — Using Both Together

The Ramp feature starts your therapy at a low pressure (e.g., 4 cmH O) and gradually increases to your full prescribed pressure over 15–45 minutes as you fall asleep. EPR and Ramp work independently and can be used at the same time.

If EPR Type is set to Full Time, EPR applies during the ramp period as well. During ramp, when pressure is already low (4–6 cmH O), EPR will have limited or no effect (since it cannot drop below the floor). As pressure rises during ramp, EPR begins to provide more relief.

If EPR Type is set to Ramp Only, EPR is active during the ramp period and then switches off once full pressure is reached. This suits patients who only struggle to fall asleep but are fine throughout the night once asleep.

AutoRamp (AirSense 10 and 11)

AutoRamp is different from standard Ramp: instead of starting at a low pressure for a fixed time, AutoRamp detects when you are actually asleep (using flow pattern analysis) and only then applies your full pressure. Until sleep onset is detected, it holds at a low, comfortable pressure. EPR Full Time works with AutoRamp — it applies once the machine ramps to full pressure.

EPR vs C-Flex vs A-Flex: What Is the Difference?

If you have researched CPAP pressure relief, you may have come across different brand names for what is essentially the same type of comfort feature. Here is how they compare:

Feature	ResMed EPR	Philips C-Flex	Philips A-Flex
Available on	AirSense 10, AirSense 11, AirMini	DreamStation, REMstar	DreamStation Auto
How it works	Reduces pressure by a fixed amount (1–3 cmH₂O) at the start of each exhale	Reduces pressure at start of exhale, with contour shaping throughout the exhale phase	Like C-Flex but also at the start of inspiration — slightly different feel
Settings	EPR 1, 2, or 3 (fixed drop)	C-Flex 1, 2, or 3 (1–3 cmH₂O, contoured)	A-Flex 1, 2, or 3
Can increase central apneas?	Rarely — same as C-Flex	Rarely — similar mechanism	Similar
Overall feel	Clean, consistent reduction — very predictable	Slightly smoother, contoured feel during exhale	Softer at both transitions

All three serve the same purpose and the clinical outcomes are equivalent. If you are switching from a Philips machine to a ResMed AirSense, setting EPR 2 is roughly equivalent to your previous C-Flex 2 setting.

How to Read Your AHI Data After Changing EPR Your AirSense 10 or 11 shows your previous night's AHI on the home screen each morning. Here is how to interpret it after making an EPR change

AHI Reading	What It Means	Action
< 5 events/hour	Excellent — therapy is effective	No change needed. EPR setting is working well.
5–10 events/hour	Borderline — therapy partially effective	Check if this is higher than your pre-EPR AHI. If it increased after changing EPR, try a lower EPR level.
10–15 events/hour	Suboptimal — therapy needs adjustment	If EPR was recently changed, reduce the level. Also check mask leak rate.
> 15 events/hour	Therapy not controlling apneas adequately	Contact your doctor or supplier. Do not adjust pressure yourself.

Where to find your AHI on each machine:

AirSense 10: Press the dial once from the home screen → select 'My Therapy' → 'Daily' to see last night's AHI, leak rate, and usage hours.

AirSense 11: Tap the home screen → tap the therapy summary tile (shows AHI, score, hours). Or view in the MyAir app under 'Sleep Report'.

Quick Reference: Recommended EPR Settings by Patient Type

Patient Type	Recommended EPR	EPR Type	Notes
New CPAP user (first 3 months)	EPR 2	Full Time	Prioritise comfort — compliance matters most early on
Fixed CPAP, exhalation uncomfortable	EPR 2 or 3	Full Time	Start at 2, move to 3 if still uncomfortable after 1 week
AutoSet user, established therapy	EPR 2	Full Time	Standard setting — review AHI after 7 nights
User with central apnea history	EPR Off or EPR 1	Full Time	Monitor AHI closely after each change — central events can increase
User with aerophagia (air swallowing)	EPR 1 or Off	Full Time	High EPR can worsen aerophagia in some patients
Switching from Philips C-Flex 2	EPR 2	Full Time	Equivalent comfort level
Using Ramp mode, fine once asleep	EPR 2	Ramp Only	EPR off once full pressure reached — for patients comfortable during sleep
Doctor says keep EPR off	EPR Off	—	Follow doctor’s instructions — do not override without consultation

Frequently Asked Questions

Q: What is the best EPR setting for ResMed AirSense 10?

For most patients: EPR 2, Full Time. This provides meaningful exhale relief without being so aggressive that it risks increasing central events. If EPR 2 isn't comfortable enough after a week, move to EPR 3. If you notice AHI increasing after turning EPR on, step back to EPR 1 or off.

Q: Does turning EPR on affect my CPAP therapy effectiveness?

For most patients with obstructive sleep apnea: no. EPR does not reduce your inhale pressure, which is what prevents airway collapse. The exhale pressure reduction is brief and does not allow the airway to collapse in OSA patients. Your AHI should remain the same or improve because better comfort leads to longer usage and fewer unconscious mask-offs.

Q: Why is my AHI higher after I turned EPR on?

A small subset of patients experience more central apnea events with EPR on. This is because the pressure variation can occasionally disrupt the CO feedback loop that regulates breathing in susceptible patients. Try reducing EPR from 3→2→1→Off, waiting 7 nights at each level, and comparing AHI. If AHI normalises when EPR is off, keep it off and inform your doctor.

Q: Can I change EPR myself or do I need my doctor?

EPR is classified as a comfort setting, not a therapeutic pressure setting. ResMed's guidance recommends consulting your healthcare provider before changing settings. However, EPR 1–3 adjustments to find your most comfortable level are generally considered safe to trial yourself — provided you monitor your AHI for 7 nights after each change and contact your doctor if AHI increases significantly.

Q: Is EPR available on all ResMed CPAP machines?

EPR is available on: AirSense 10 AutoSet, AirSense 10 AutoSet for Her, AirSense 10 Elite (some versions), AirSense 11 AutoSet, AirMini (via app). EPR is NOT available on: AirStart 10 (ResMed's entry-level machine). This is one of the key differences between AirStart 10 and AirSense 10.

Q: What is the difference between EPR and AutoSet?

They are separate features that work together. AutoSet adjusts your overall pressure (up when obstructions are detected, down when your breathing is clear). EPR adjusts within each breath cycle — reducing pressure on the exhale phase of every breath, regardless of what pressure AutoSet is delivering at that moment. AutoSet controls how much pressure you need; EPR controls how comfortable the exhale feels at that pressure.

Q: My AirSense 10 doesn't show EPR in the menu — why?

Possible reasons:

(1) The clinician menu may be locked — you may need the setup passcode.

(2) Your device may be a version that has EPR disabled by your prescriber.

(3) You may be looking in the wrong menu — EPR is under Therapy in the Clinical Menu (hold Home button 3 seconds). Contact your supplier or sleep clinic for assistance unlocking comfort settings.

Q: Does EPR help with CPAP dry mouth?

Indirectly — yes. Dry mouth on CPAP is often caused by mask leak (air escaping through the mouth). High therapy pressure can worsen leaks. EPR reduces average pressure (lower exhale pressure for half the breath cycle), which can slightly reduce leak. However, the primary fixes for dry mouth are:

(1) check mask fit and cushion seal,

(2) increase humidifier setting,

(3) add a chinstrap or switch to full-face mask if you are a mouth breather.

Q: Does EPR help with aerophagia (air swallowing/bloating)?

Not always — and in some cases EPR can worsen aerophagia. Aerophagia is caused by high pressure forcing air down the oesophagus. While EPR reduces exhale pressure, the inhale pressure (which is more likely to cause aerophagia) remains unchanged. If you have aerophagia, the primary fix is asking your doctor to lower your overall CPAP pressure or switch to an auto-adjusting machine (AutoSet) which delivers lower average pressure.

Q: Can I use EPR with the ClimateLineAir heated tube?

Yes — EPR and the ClimateLineAir heated tube are completely independent features. The heated tube controls temperature and humidity; EPR controls pressure relief. They work together without any interaction. Using both simultaneously is standard and recommended for maximum comfort

Summary: EPR at a Glance

Question	Answer
What does EPR do?	Reduces pressure by 1–3 cmH₂O during exhalation only — inhale pressure unchanged
Should I turn it on?	Yes, for most patients — especially new users. Start at EPR 2, Full Time
What if my AHI goes up?	Reduce EPR level or turn off; monitor for 7 nights at each change
Full Time or Ramp Only?	Full Time for most — Ramp Only if you're fine during sleep but struggle to fall asleep
AirSense 10: how to change?	Hold Home button 3 sec → Clinical Menu → Therapy → EPR
AirSense 11: how to change?	Touchscreen: Menu → My Options → Pressure Relief
Does AirStart 10 have EPR?	No — EPR is exclusive to AirSense 10, AirSense 11, and AirMini
EPR vs Philips C-Flex?	Same purpose, slightly different pressure curve — EPR 2 ≈ C-Flex 2

Need help setting up your ResMed AirSense in India? Healthy Jeena Sikho provides ResMed AirSense 10 and AirSense 11 machines for rent and sale across Chandigarh, Delhi, Jaipur, and Lucknow — with setup support and door delivery. Our team can help you with initial EPR configuration and therapy monitoring. A doctor's prescription is required for new therapy initiation.