1 year on CPAP - No progress: Lowenstein Prisma Smart

[phoen1kx]

In the sleep study, it says:
Total sleep time: 329min
Deep sleep: 93min(28,4%)
REM sleep: 20min(5,1%)

In regards to depression, I did visit two psychiatrists, they gave me advice but nothing else. 
I don't really feel "depressed", it's just kind of annoying to be not able to function, and my emotions are kind of neutral/dead. And I do feel sleepy during the day, but the brain fog's the bigger issue honestly.
I already did an MRI, the results were good.

I have another question: 
Should my CPAP be audibly leaking air where it's kind of annoying to listen to? And it's not even the rubber part that touches my face that leaks. 
The mask leaks at the front, at the edge of the seal that's connected to the part that connects to the hose. And it's leaking at multiple holes. As if someone poked it with tiny needles.

[Dormeo]

Well, it was just one night, but you didn't get a lot of REM sleep the night of your study. You might want to take a look at this article from a trusted web site:

https://www.sleepfoundation.org/stages-o...-rem-sleep

I'm not familiar with your particular mask, but all masks have vents so that the CO2 you exhale can be released. It may be the holes for the venting that you're seeing. Do you have any opportunities to try a different mask that might have a quieter vent?

[Stubert]

I am in slight the same situation as you, as my flowrate and results looks quite similar to you.

First you need to control the leaks to get better result. The slightest leak will affect treatment. Also your flow rate looks very unstable.
I am using Prisma Smart Max and tried a ton of settings.

Try increasing your min to 9 and set softpap to 1. Then it will decrease to about 7,5 when you breath out. On the Prisma machines, you do not need to bump up lower pressure, as you increase softpap. You do need it on Resmed machines with EPR, but softpap works different and you get the same "treatment" eventhough you activate softpap. There are several reports on this out there, comparing softpap, EPR, C-Flex and so on.

I think you have a lot of small arousals that the machine will not detect.

Also set it to dynamic insted of standard algorithm, then it will react quicker to flow limitation and reras.

Buy an O2 ring and monitor your O2. If you have a lot of O2 decrease during the night, print the report and bring to your sleep doctor, it helped me as you say they say everything is fine when an AHI of 2. If you can document O2 problems they will have too look into it.

I have just ordered a BIPAP Prisma 25s to try out, as I am also so confused about my own treatment and read a long thread about a guy succesfully treating small arousals when changing to BIPAP. I stopped contacting my doctor, as they simply cant help me, in my point of view. They dont know I ordered another machine, which is againt "the rules", but I dont care and need to take my health in own hands.

BTW, how did you get the data into OSCAR, as the machine is not supported??

[PeaceLoveAndPizza]

I have another question: 
Should my CPAP be audibly leaking air where it's kind of annoying to listen to? And it's not even the rubber part that touches my face that leaks. 
The mask leaks at the front, at the edge of the seal that's connected to the part that connects to the hose. And it's leaking at multiple holes. As if someone poked it with tiny needles.

There is typically a vent on masks in the front that leaks air to keep us from rebreathing our own CO2. From the online pictures of your mask that appears to be the case as well.

To your original query, you still need to increase pressure slightly and add some SoftPAP. I see Stubert made the same recommendation. His recommendation to also switch to dynamic mode is a good idea as well, but try to only make one change at a time.

[phoen1kx]

Alright so:
softPAP to 1
min Pressure to 9
Mode to dynamic
Should I adjust my max pressure or anything else?

And about the mask... It has a dedicated vent that's very visible, on the elbow part, but that's not where the air is leaking. It only leaks there if the CPAP is off.
When the CPAP is on, and if the pressure is high, it leaks on the edges of the grey circular part(the rubber/silicone) that's connected to the elbow part which connects to the hose. I'm not sure if that's normal? I might've experimented with higher pressures and I thought maybe it damaged something on the mask so that the air started leaking....?

@Stubert
I also thought the machine was not supported, but it is. The users on this forum told me that. I'm using version 1.5.1 of Oscar and everything works fine.

[phoen1kx]

My flow rate is like this every night... what the hell is happening?? I think it's making me feel like crap, despite the low AHI.
I tried so many different settings and I've posted here countless times, but nothing works.
Every pressure range, apap mode, cpap mode, EPR on/off... nothing helped
   

[PeaceLoveAndPizza]

What are your current settings for pressure and SoftPAP? OSCAR does not currently show all the data for the Löewenstein machines, 

Please post a few 3 minute zooms to see better detail in the flow rate. Most interested in 07:30 and 08:15.

[gainerfull]

Your flow rate looks normal to me - the more "messy" segments are REM and are supposed to look like that.

What was your diagnosis? How severe is your sleep apnea? Have you trialed constant pressure?

[phoen1kx]

Last night I experimented with CPAP mode at 14cmH2O, softPAP 1. Previously it was 13, softPAP off.
7:30
   

8:15
   

I saw photos of other people's flow rate and it looks so much more flat and stable, yet I have this unstable pattern.

[gainerfull]

7:30 reminds me of my flowrate behavior before I started wearing a soft cervical collar, you might try one.

8:15 is REM sleep and is normal.