Moderate UARS about to start treatment

[Geniale]

Hello, I've just been diagnosed with moderate Upper Airway Resistance Syndrome and it was recommended that I try a CPAP. I am meeting with a respiratory therapist in a few days in order to set me up with a rental device. As I have no insurance, so all costs are out of pocket for me (and we are fairly low income), I want to make sure I make the best choices for my situation, so any and all advice is appreciated!

Here are the results for my sleep study:

AHI -- 0.4 events/hour
RERAs -- 18.2 events/hour
Global index -- 18.6 events/hour

Desaturation index -- 0.2 events/hour
Average saturation -- 97%
Minimum saturation -- 94%
Snoring -- light

Impression -- Obstructive Sleep Apnea (Upper Airway Resistance Syndrome > 50% RERAS)
CPAP recommended pressure -- 5-20 cmH2O

[OpalRose]

Hi, Welcome to the forum Geniale,

How long is the rental period for? Just make sure your are trialing an APAP machine.

Before you purchase anything, do your research as to the machines available.

Here is a link that can help you know which machines to avoid.
http://www.apneaboard.com/wiki/index.php...ne_Choices

Another thing, you may be better off "not" buying through your DME because they will probably over charge you.

Don't know what your budget is, but you can check out the suppliers list above. Supplier #2 offers gently used and also open box new machines.

Also, the Phillips Respironics 60 Series machines are discounted to around $400.00 on some of the suppliers lists.

Good luck and let us know how you are doing during the trial.

Just noticed you are from Canada, and I know they have different rules than the US.
There are many members here from Canada and are not able to qualify for an APAP machine, but if you are paying out of pocket, then you should be able to get what you want.

[Sleepster]

CPAP recommended pressure -- 5-20 cmH2O

That indicates an auto-adjusting CPAP machine (APAP) which is good. If it turns out that that works for you you can eventually buy a new or used one from an online provider, or even on craigslist. Best to make sure it does work for you first, though.

You will need to install free software and monitor your therapy yourself, so I do not recommend renting a DreamStation because meaningful and free software is currently unavailable.

[vsheline]

Just make sure your are trialing an APAP machine.

Actually, if you are paying out-of-pocket then I strongly suggest skipping the trial (saving a lot of money) and simply buying a bilevel Auto machine. Because a bilevel Auto machine can be set up to operate like an APAP or even a fixed-pressure CPAP machine, a new prescription is not strictly needed. You can buy a bilevel Auto from Supplier #2 using your present prescription, and the machine will auto-adjust itself, and for further improvement you can tweek the settings with help from fellow members.

Bilevel Auto machines are the optimal machine for treating UARS.

Specifically, an APAP machine is not able to optimally treat UARS.

Certainly, if you decide to go forward with a rental trial (a waste of money in my view) do please at least completely refuse to accept any machine on trial that is not a bilevel Auto.

I recommend the economical Philips Respironics System One BiPAP Auto (DS760 in USA or DS761 in Canada).

On Philips bilevel Auto machines Pressure Support is self-adjusting (in addition to EPAP, the pressure during exhalation, being self-adjusting), which is a neat feature which the others lack. Pressure Support is the amount the pressure is boosted during inhalation to help overcome UARS. On bilevel Auto machines from other manufacturers EPAP self-adjusts (to automatically minimize how many obstructive apneas are occurring) and Pressure Support is fixed (manually adjusted).

Supplier #2 offers gently used and also open box new machines.

Right. For example, from website of Supplier #2:

Gently Used Respironics System One DS760 BIPAP Auto Machine
Your Price $649.00
Low hour, gently used, 6 month warranty.
Heated Tubing Optional.

By the way, it is worth it to include the heated hose option (the option includes the heated hose, an upgraded power supply and different humidifier lid) and pay a little more up front.

Take care,
--- Vaughn

[Sleeprider]

UARS is best treated with bilevel therapy, with a low exhale pressure and higher inhale pressure. This takes a lot of effort off of you and results in the best result. So, I'm in agreement with Vsheline. With limited funds and no insurance, you really need to steer clear of local brick and mortsr DMEs. I'm guessing you could own a machine, for the price of rental in short order.

Getting a mask that fits and is comfortable to you is the biggest challenge. Best of luck.

[trish6hundred]

Hi Geniale,
WELCOME! to the forum.!
I wish you much success as you start your CPAP journey.
Hang in there for more responses to your post.

[Sleepster]

Why is auto-bilevel therapy better than auto-CPAP therapy for treating UARS?

[vsheline]

Why is auto-bilevel therapy better than auto-CPAP therapy for treating UARS?

Because with bilevel the Pressure Support (the difference between the inhalation pressure "IPAP" and the exhalation pressure "EPAP") can be much larger than 3 cm H2O. Some prefer 5 or more.

With ResMed EPR (the exhalation pressure relief available with ResMed APAP) the max pressure increase during inhalation is about 3; with A-Flex (the exhalation pressure relief available with Philips APAP) the pressure increase during inhalation is about 2.

UARS is caused by difficulty while breathing in. The larger the Pressure Support is, the easier it is both to breathe in and to breathe out. When PS is about 5, PS is doing for us about half the work of breathing.

[Sleeprider]

The effect vsheline talks about is not only something you feel as easier breathing, it is measurable as increased minute vent and tidal volume. As pressure support increases, the tidal volume of most people will increase. This improved ventilation is important to UARS patients, just as it can actually lead to centrals by CO2 washout, if the pressure support is raised too high.

I personally enjoy a PS between 4 and 6 cm. If I use a PS higher than that, I will record centrals through the roof. Everyone is different, and patients with UARS or COPD or other restrictive lung disease, need higher PS just to ventilate normally.

[DariaVader]

UARS question for you experts.... is UARS correlated at all with Asthma? What about UARS in a person with a naturally high TV - is it mutually exclusive? or would that make it harder to detect?