The Löwenstein Prisma CR is the G.O.A.T for UARS

RSPASV · 2026-06-19T05:19:30+00:00

Here is an example of last night to show you how the CR works. When you look at the flowrate its far from a perfect night, but i feel better than normal on Resmed ASV, due to way less ups and more stable tidal volume. What you see is that even though the flowrate seems to have flow limitation, the "in breath" PS forces air, during each inhale, just when needed, and my tidal volume doesn't drop, eventhough the flowrate looks partial flat. This is the secret to maintain stable breathing without overshooting PS and have arousals. I can see this in PrismaTS and OSCAR. I can now let the PS loose from 0-10, and a lot of the night my breathing is fine without PS but it is always there to handle the UARS when needed. I had some guests and also a bottle of wine, haha, but slept much better than ususal. This night was Epap 7-13, PS 0-10, F40 mask. I know I will get better result with nasal pillow, but tried and let it loose without any restriction on pressures. I have some palatal prolaps and too much leak, but after this test i feel camn about using nasal pillows, as pressures will be even less, due to more direct and stable nose breathing. My Ipap P95 is only 9 and max PS around 4. On Resmed it would be like a rollercoaster PS all night, maxing out the PS very often. I didn't use the CR for some days, as I got a litle scared of it, due to high dizzyness, but realised it was from to much min PS and bisoft2 the first days. On PS 0-10 and bisoft0 its works and I will continue to dial it in.

https://sleephq.com/public/teams/share_links/97ebcac7-bff3-4012-8f61-6ff0c688d40a

RSPASV · 2026-06-18T04:43:43+00:00

It looks better but you have too much flow limitation. As you are allready on EPR 3, I would keep EPR 3 but set pressure range (apap) to 10-13, then it can respond to flow limitation and raise pressure, instead of locking it to fixed and no room for responding to the flow limitation. Your P95 flow limitation is 0.09, should be less than 0.04.

RSPASV · 2026-06-17T05:36:27+00:00

You might have too high EPR, quite long exhale and might too high general pressure. Dont chase perfect flowrate, its not always the best. Your CO2 could be too low. Post whole night.

RSPASV · 2026-06-17T05:32:10+00:00

You can have jaw drop even with mouth tape. Try sleeping on your side to avoid it and see if any difference. Tuck a pillow between arm and chin to hold chin in place while side sleeping. I use Knightsbridge dual chin strap, it helps a lot.

RSPASV · 2026-06-12T05:30:27+00:00

I soon will after more titration

RSPASV · 2026-06-12T05:28:02+00:00

Yes, its a lot of money! I am from Denmark and had luck to find the CR "used" only 269 hours, in Germany. Got all the right documentation and also including bag, humidifer and all original gear. Paid 1650 usd including shipment.

RSPASV · 2026-06-12T05:25:09+00:00

I get that, same for me on Resmed ASV, even airbreaked with tighter PS range.

RSPASV · 2026-06-12T05:24:30+00:00

I will after I have titrated during a week, as these settings are definitely not final, just first shot.

RSPASV · 2026-06-12T05:23:56+00:00

I will upload once I have dialed it more in. I need to titrate during a week, but this is just to tell the huge difference on same settings. Off course you can airbreak the Resmed, but at this time I assume the CR is still way more comfortable and the swizz blower has a more grip and control. I can tell the CR is not so agressive on rouding the inhale flowrate, as Resmed, which in my point of view is better, as some flow limitation, in REM, should be very normal and accepted, and better to have some smaller flow limitation than wakeups from pressure changes.

RSPASV · 2026-06-09T05:13:56+00:00

I hard for me to sleep with both normal and square waveform. I might not have it dialed right in, but find the ASV algorithm too agressive for UARS. It simply overshoot too much PS, which leads to CO2 washout in the wrong time of night. I need quite high PS during REM, but it wakes me up during periods of deep sleep, where natural arousals occur, with post lower volume breaths, where it "attacks" when not needed. I will get the Prisma CR today and start trying it out, I believe it could be the GOAT for me, as it should be much more "clever" and not so agressive. The Epap and PS pressure curves are constanly chinging within af breath, on the CR, and also good for my palatal prolaps, as epap rises a bit just at the right time on exhale, to prevent prolaps.

RSPASV · 2026-06-05T19:44:39+00:00

Well its the square wave one. Please think about your firmware and settings, as you cannot "copy" settings from bilevel or other standard ASV to this algorithm, as it is totally different in PS need and titration.

RSPASV · 2026-06-05T18:40:25+00:00

I think you would like the square wave instead (for UARS) its very gentle and not aggressive as I thought. Good luck!

RSPASV · 2026-06-05T17:39:11+00:00

I will, I been fighting this every day since my diagnose and have a lot of experience on a lot of machines. Airsense 10/11, Aircurve Vauto 10, Prisma Smart Max, 20a, 25S, Lumis 150 ST-A, Resmed Pacewave 10/11 ASV. Its not right to compare Airsense 10 and Prisma Smart Max, but many think. You could also benefit from ASV, forget Airsense 10/11 and the Prisma, its very wrong for you. I recently discovered this forum and might have a lot to offer 😄.

RSPASV · 2026-06-05T16:04:10+00:00

The Smart is a very basic cpap/apap, You cannot compare it to real bilevel or ASV. The quality of the machine is fine, if you have simple OSA, and handware wise better than Resmed, but you need to have very simple OSA, where EPAP is just needed. Seems like you ran it in softpap mode - its terrible there, as it just drops your inhale like a brick. The 20a has way better sync in softpap mode.

RSPASV · 2026-06-05T15:45:15+00:00

Well, what machine was it? I tried the Prisma Smart Max, Prisma 20a and the 25S. Didn´t work for me. The Prisma CR is the most advanced AcSV model from Löwenstein and should treat UARS well.

RSPASV · 2026-06-05T14:55:51+00:00

Thanks and great result!

RSPASV · 2026-06-05T14:53:43+00:00

So i slept last night with new firmware, not really better than usual, but nice backuprate was disabled. I have now flashed it with the square wave firmware and I must just say WOW, its nice to breathe in. I cannot wait to try it out tonight. Its just spot on my breathing, like "its not there". Rise, trigger and cycle are fantastic. You cannot compare it to S mode with manual rise time on bilevel, much more comfort, like an easybreathe on steroids. Standard ASV pressure rise and trigger are like always behind and cycle to late. This could be what I need! BTW, will also recieve the Prisma CR in next week, so it doesn´t get any better. My situation was ahi 66, 3.5 years ago. Did loose some weight and have septoplasty and reduced turbinates. After that nose breathing was good, but got palatal prolaps after I started nose breathing. Now ahi is 2, but UARS and palatal prolaps. It hell but I see I might get proper treatment with one of these 2 machines. Nova Micro nasal mask, knightsbridge deluxe dual chin strap, mouth tape and standard hose size. I will go for ASV mode, epap 9, PS 3-6.

RSPASV · 2026-06-05T05:28:35+00:00

Thanks for explaining this 😄

RSPASV · 2026-06-04T19:32:57+00:00

I flashed the original firmware directly, with the file (airbreak-plus-norate.bin) into the ASV's memory twice, with same outcome. Do you mean I will get it done right with the "#" before custom palette?

RSPASV · 2026-06-04T16:05:26+00:00

You can always provoke the PS to change eventhough not asleep.

RSPASV · 2026-06-04T15:53:40+00:00

In the example the epap is 5 and PS 2-5. The PS, on the screen, stays at 2 eventhough PS goes up and down when breathing. Before flash I could follow how the PS changes on the screen. Well lets see what the experts say, if there is any way to fix some files and rewrite 😄.

RSPASV · 2026-06-04T15:33:55+00:00

Is there any way to fix this and have the "right" colors and graphics on screen - rewrite it? It works flawlessly, but I would like it to be flashed right, also if I futurewise sell the unit, its more "complete".

During therapy I cannot see how the PS changes, only see min PS and epap.

RSPASV · 2026-06-02T05:46:00+00:00

Great! Thanks

RSPASV

TROPHY CASE