Bi-Level Help, Prisma 25ST
I have been using a Prisma 20A and feel I had it tuned the best I could. I was getting pretty decent deep sleep scores and low AHI, but I don't feel refreshed and feel like I get terrible REM sleep. I have several issues that have plagued me ever since I started. So, self funded as we are in Australia, I painfully invested in a Bi-level machine, hoping to improve a couple of things.
My therapy history and problems are these:
I was diagnosed with mild OSA and have no co-morbidities. My apneas are controlled around 8-9cm and hypopneas around 11-12cm. I can sleep on my back without affect, I dont chin tuck and my flow rate is sometimes great after a big night drinking. I cannot get rid of RERAS and flow limitations. I believe I have UARS.
I made no progress with therapy until I started using a vcom. I have tried everything to survive without one but it seems impossible. Here are 2 examples of with and without a vcom, exact same settings, consecutive nights. First chart is with a vcom, second without.
My deep sleep markers just vanished! The better chart is what I can consistently achieve with a vcom, but I am still plagued by arousals all night.
An issue I think with the vcom use is that in slowing down inhalation at the beginning, my exhalation is now half that of my inhalation. I feel like my minute vent is higher than what I would like also. When zoomed in my flow rate shows the inhalation is always very unstable, particularly during REM, which I know is normal, but I feel like I am constantly getting pulled out of REM by these flow limits. Without a vcom it is just crazy.
I now have this Bi-level and thought with a little extra pressure support I might be rid of these flow limitations. I tried it in Auto S/T mode with frequency set to 10 so it wouldn't trigger, but let me take advantage of the other adjustments. This machine can apply an auto-ranging pressure support, so I set pressure support from 4 to 8, without the vcom. It was a disaster. Tried a few different modes and adjustments, I didn't sleep for a week just trying things out.
I then set it to sort of match my previous settings on the Prisma20A for now, still in Auto ST mode and with the vcom in place. I am getting results same as I was able on the Prisma20a with softpap3, but am back to square one. What could I be trying with the bi-level settings?
This machine has a relative inspiration time which can be set Ti or Ttarget with a range 25% - 67%, also a trigger which can be set to auto or at three levels. There is also a pressure increase speed with 3 levels.
My therapy history and problems are these:
I was diagnosed with mild OSA and have no co-morbidities. My apneas are controlled around 8-9cm and hypopneas around 11-12cm. I can sleep on my back without affect, I dont chin tuck and my flow rate is sometimes great after a big night drinking. I cannot get rid of RERAS and flow limitations. I believe I have UARS.
I made no progress with therapy until I started using a vcom. I have tried everything to survive without one but it seems impossible. Here are 2 examples of with and without a vcom, exact same settings, consecutive nights. First chart is with a vcom, second without.
My deep sleep markers just vanished! The better chart is what I can consistently achieve with a vcom, but I am still plagued by arousals all night.
An issue I think with the vcom use is that in slowing down inhalation at the beginning, my exhalation is now half that of my inhalation. I feel like my minute vent is higher than what I would like also. When zoomed in my flow rate shows the inhalation is always very unstable, particularly during REM, which I know is normal, but I feel like I am constantly getting pulled out of REM by these flow limits. Without a vcom it is just crazy.
I now have this Bi-level and thought with a little extra pressure support I might be rid of these flow limitations. I tried it in Auto S/T mode with frequency set to 10 so it wouldn't trigger, but let me take advantage of the other adjustments. This machine can apply an auto-ranging pressure support, so I set pressure support from 4 to 8, without the vcom. It was a disaster. Tried a few different modes and adjustments, I didn't sleep for a week just trying things out.
I then set it to sort of match my previous settings on the Prisma20A for now, still in Auto ST mode and with the vcom in place. I am getting results same as I was able on the Prisma20a with softpap3, but am back to square one. What could I be trying with the bi-level settings?
This machine has a relative inspiration time which can be set Ti or Ttarget with a range 25% - 67%, also a trigger which can be set to auto or at three levels. There is also a pressure increase speed with 3 levels.
