UARS

[ZSleepN]

Hello I am brand new to the boards.  I have an AHI of 1 and an RDI of 8. Mostly RERA's.   I believe that I have UARS and my sleep doctor does not want to do anything about it... I have a brand new ResMed Aircurve 10 ASV.  Is this the proper machine to treat UARS or does it have to be Bi-level?

[jaswilliams]

It is not typical to treat Uars with an ASV normally it is normally treated with a Resmed VAuto how did you end up with the ASV ?

[Sleeprider]

The ASV is an expensive machine designed to treat complex apnea where both obstructive and central events are present. It is not appropriate for treatment of UARS, although you can try. I agree with the post above that the Aircurve 10 Vauto is the preferred choice. Here is a wiki article to consider http://www.apneaboard.com/wiki/index.php..._and_BiPAP

ASV (adaptive servo ventilator) is going to pace your breathing. It will provide bilevel pressure support, but the pressure support capability greatly exceeds your needs. If you want to try this machine, I would suggest setting it up at EPAP min 6.0, EPAP max 8.0 and PS min 3.0 and PS max 6.0. The maximum pressure with that setup is only 14 cm (8 EPAP + 6 PS). This should help allieviate the upper airway resistance by providing pressure support, but it is going to change pressure support on a breath by breath basis and trigger IPAP, based on your normal breathing rate, even though you don't need this feature. You have a machine that costs thousand$$ more than what you need.

[ZSleepN]

Thanks for the advice guys.   I will see if I can return this unit.  I may not be able to get an s10  How is the s9 vpap Auto?

[Sleeprider]

How did you acquire the ASV? The Airscurve 10 Vauto is very common, and the S9 has been discontinued since 2015. Other than that, the S9 VPAP Auto is essentially the same machine, but lacks the compact integrated humidifier. If you look around, the Aircurve 10 Vauto costs about $1250 from Supplier #33, and is a bargain at $799 from Supplier #2. Typical retail is $1726 from Supplier #1. The Aircurve 10 ASV is $2149 new from Supplier #2 and $1749 used. It is not uncommon to see the ASV sold at $4000 at retail.

I assume you are self-financing without insurance since you are treating UARS and have a very low AHI. The machine from Supplier #2 is definitely where you want to look.

[ZSleepN]

I had a friend that passed away there is only 30 hours on the s10 Aircurve ASV.  I have experimented with it and the machine keeps waking me up. My UARS is very sensitive. I will look into getting the S10 AirCurve VAuto.. Does the s10 Vauto record RERA's on sleepyhead? Can it function as an APAP if need be?

[Gideon]

The VAuto is normally used in VAuto mode which you can think of as an APAP on steroids.  It is a bilevel It manages based on EPAP and adds PS to get IPAP It has no EPR (which subtracts pressure from IPAP) It also has a bilevel manual mode called "S" for Simultaneous, and CPAP mode.  We can help you with your settings.

[Sleeprider]

A less expensive option is the Airsense 10 Autoset. This is an APAP machine that has up to 3 cm pressure difference between IPAP and EPAP using EPR, so it is also a limited bilevel. These machines will cost less, and we have seen excellent results on UARS at fairly low pressure and using EPR. The Airsense 10 Autoset records RERA, the Aircurve 10 does not. The Airsense 10 will cost $625 from Supplier #33 new, and will not require a prescription. I would suggest the Airfit P10 nasal pillows mask with either one.

The upper airway restriction you have is manifested as "flow limitation". Without flow limitation, there is no RERA. The reason is that RERA is a by definition, an increasing flow limitation that ends in an arousal with recovery breathing. Control the flow limits, and RERA is not an issue. I previously linked to an article that recommends bilevel therapy for this problem. Although the Aircurve 10 Vauto does not record RERA, it does chart flow limitation, and you can see it in the flow charts. In my opinion, either machine will treat your condition well, and will not disrupt your sleep like ASV. We have many articles dealing with flow limitation on the Wiki, just search the term. Flow limitation responds to pressure support or EPR because the higher inspiratory pressure supports a full breath, while the lower pressure during exhale is comfortable and allows an easy exhale. It is the contrast between these pressure that people with flow limitations and hypopnea respond to.

Incidentally, you cannot sell a machine on this forum, but that machine will be extremely valuable to someone that actually needs it.