[CPAP] OSCAR help adjusting pressure - Prisma smart

[georgesadam]

LAB Sleep Study: AHI of 52
Current AHI with CPAP < 4
CPAP Machine: Löwenstein Prisma SMART Max APAP 5-11 cmH2O softPAP level 2 (using ResMed AirFit F30) with a humidifier set at level 2.

I've been using a CPAP machine for nearly a month now, and my AHI has consistently been under 4. I started feeling better after just three days of CPAP therapy and have since gotten used to it.I need your help understanding whether the pressure settings prescribed by my doctor are adequate or can be improved based on my OSCAR data.

Initially, my doctor lowered the maximum pressure from 12 to 11 after noticing that my median pressure was 9.8. However, after reviewing the data myself through OSCAR, I noticed that the IPAP 95% is at 11, and the maximum IPAP is also 11.

I feel like my pressures could be optimized further. Currently, the minimum pressure is set at 5, which feels low to me, and the maximum pressure is set at 11, which might not be sufficient (please correct me if I'm wrong).

Additionally, I see that I have a lot of flow limitations. Should I be concerned about these, or should I focus only on the apneas?



Thanks for your help!
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[Jay51]

It looks like you have a lot of flow limitations.  A good way to try to stop these is to increase the difference between your EPAP and IPAP (increase the Pressure support).  I am not sure how to do that on your machine (it looks like you may need to choose a different softpap level - yours is at 2 currently.  The difference in your charts between EPAP and IPAP is only around 1 or 1.5 (going by your median pressures).  Resmed machines have an EPR feature up to 3 that can help flow limitations. Bilevel machines can do greater than 3 pressure support.

Here is some reading on the Prisma line of machines:    Lowenstein PrismaLine optimization

[georgesadam]

The maximum soft PAP setting is 2 on my machine (referred to as EPR in ResMed). I have adjusted my pressures to 7-12. Could you please take a look? I have a lot of flow limitations and RERA. I also used your link to enhance the graphs and make them more understandable.

[Jay51]

Thank you for posting those charts and explaining your situation.  It is good that you have maxed out your softpap (2).  That should help decrease flow limitations.  

2 other things might help.  1.  Of course is raising pressure.  You can raise the minimum pressure.  Also, you can raise the max pressure if you are hitting it during the night.  

2.  You can try sleeping on a thinner pillow, side sleeping instead of back sleeping, and possibly even trying a soft cervical collar.  These are strategies for positional apnea, but there is a chance they could help in your situation. 

If you try all of these and they don't significantly reduce your flow limitations, I can't think of any more suggestions to optimize your therapy with this particular Lowenstein machine.

[georgesadam]

Thanks for your input. I will definitely try increasing the minimum and maximum pressure and see how it goes from there.
Is it normal to use this CPAP machine in its current condition for 1 or 2 more years? I'm afraid I can't buy another one at the moment.

[Jay51]

Absolutely great and practical question you ask.  It depends on how you are feeling in the morning after sleep.  Your 2 or so AHI is good.  You do have very high flow limitations though.  Flow limitations can disrupt sleep, but they are not as severe as apneas.  

A compromise would be to use this machine as long as you have to (if it is acceptable to you) until the opportunity arises to get a different machine.

[georgesadam]

really really thank you
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[Zombie on my Lawn]

Regarding FL (flow limitation) events, I noticed another forum member mention in this thread entitled "Help with OSCAR Report from Loewenstein Prisma Smart"
Quote:
"Also I asked around on the german apnea forum, and got some advice that apparently OSCAR doesn't evaluate the FL properly on Löwenstein prisma devices when softPAP is on (which it is - on low). However, I also tried evaluating with the prismaTS software and there are some RERA and eFL events showing as well as some obstruction events, though i'm not sure if this is enough to explain my issues."

I also noticed in the wiki article on "Lowenstein PrismaLine optimization" that it says: "Lowenstein PrismaLine machines produce a lot of overlays and event flags."

I am curious whether anyone else using Prisma SMART has noticed a lot of flow limitations in OSCAR?
If so, does this mean:
a) it just notices more detail and reports things more often than other machines?
b) the user is actually experiencing more flow limitations than they would on another machine with a different algorithm?
c) both?

[Crimson Nape]

It can be several possibilities.
1. The Prisma is reporting these events in a data stream that is not present when the Soft option is off. If this is the case, the person who wrote the code may not have been aware of this, and that is why it is not included in the OSCAR loader code.

2. These values are being calculated by the Prisma software and not being reported by the CPAP.
- Red

[Zombie on my Lawn]

Thank you, Crimson Nape.

I am looking back at my data from previous nights now, trying to see if I notice a pattern. It seems for me, the nights I have softPAP "OFF", I get 0.00 flow limitations average. But when I have softPAP on, I have numbers like 12.xx (softPAP level 1) and 16.xx (level 2) on average per hour showing in OSCAR.

I'm not sure if that is helpful or relevant...still trying figure this all out. Thanks again.