[Equipment] UARS diagnosis - Which machine should I get?

[Geer1]

If you know you never actually fell asleep OSCAR isn't as useful. I didn't realize when you said kept you from falling asleep you meant at all, thought you meant struggled. I would have stopped using it far earlier than 3 AM if I couldn't fall asleep at all.

Try wearing it for a while before you go to sleep to get used to it trying to boss you around and allow you to adapt to it. Might take a few weeks to start getting comfortable with it but hopefully will only be a few nights of really struggling.

EPAP min at 4 cm is fine. PS range of 3-15 is standard and would be most effective against centrals. If you absolutely need to you can try handcuffing the machine to a lower max IPAP and lower PS range (for example IPAP max of 16 and PS 2-10 range) to try and make it more comfortable and avoid really high pressures but this will reduce the effectiveness against centrals and the machine may not be able to maintain the ventilation it is targeting.

[cinematic6436]

If you know you never actually fell asleep OSCAR isn't as useful. I didn't realize when you said kept you from falling asleep you meant at all, thought you meant struggled. I would have stopped using it far earlier than 3 AM if I couldn't fall asleep at all.

Try wearing it for a while before you go to sleep to get used to it trying to boss you around and allow you to adapt to it. Might take a few weeks to start getting comfortable with it but hopefully will only be a few nights of really struggling.

EPAP min at 4 cm is fine. PS range of 3-15 is standard and would be most effective against centrals. If you absolutely need to you can try handcuffing the machine to a lower max IPAP and lower PS range (for example IPAP max of 16 and PS 2-10 range) to try and make it more comfortable and avoid really high pressures but this will reduce the effectiveness against centrals and the machine may not be able to maintain the ventilation it is targeting.

I think what I'll do tonight is follow your advice, but start off with a PS of 2 and then, night after night, work my way incrementally up to 3. It won't help the centrals at first, but it might make it easier for me to get acclimated to how the pressure feels. I'll report back tomorrow.

[Geer1]

Min PS of 2 doesn't have much effect on centrals. Min PS is used to treat restricted airways, PS is the differential pressure between exhale and inhale the higher it is the faster the flow during both inhalation and exhalation.

Max PS (and therefore IPAP since EPAP + max PS = max IPAP) is what treats centrals. It does this by creating the larger pressure differential which pushes air into your lungs attempting to kickstart spontaneous breathing effort.

Edit: Backup rate is actually the main thing that treats centrals as it is required to trigger the transition to max PS. Backup rate isn't a setting you can change on these machines.

[cinematic6436]

That's good to know. Would I be able to lower Min PS down to 1 or even 0 without much of an adverse affect? 2 is noticeably more comfortable than 3, but 1 or 0 would mean I wouldn't have nearly as much trouble falling asleep tonight.

[SarcasticDave94]

You could try ps of 0 if you want, but to me it seems counterintuitive if you have any exhale issues, lower min ps might make exhalation effort more uncomfortable.

[Geer1]

2 is fine if that is what is comfortable. Best to try some level of PS because that is in theory what would treat your diagnosis of UARS.

Dave, I assume ramp works the same on ASV and only affects EPAP and wouldn't be of any help in this situation?

[cinematic6436]

I'll try 2 out tonight and we'll see what happens. I've heard bad things about the ramp feature (Dave included).

[SarcasticDave94]

Ramp tends to be more disruptive and does lock pressure increases to whatever lower setting one chooses. I found Ramp disruptive for me, is probably how I should state it. I found it made ASV less bearable.

PS you could always try it and note the results, good or bad. I'd suggest a fairly short time and reasonable pressure, maybe equal to your Min EPAP. Your choice.

[SarcasticDave94]

BTW I'd rather you try Ramp and get past the early ASV teething stage than that you quit or fail therapy.

[Geer1]

Ok so it does limit IPAP (and therefor PS as well), wasn't sure about that.

Ramp may or may not help. Best to try and avoid it if you can but if you can fall asleep set ramp to auto and ramp pressure of 6. I believe that would give 2 PS which will feel more like vauto did, once the machine determines you have fallen asleep it will go to work.