[CPAP] Prisma 20A - Change of machine and regression

[elliott.981.]

            Hi there fellow friends,

I've recently been diagnosed with Sleep Apnea. Initial sleep study had an AHI of ~20.

The pharmacist put me on a 4 week trial with the Lowenstein Prisma 20A with a 15mm hose, with an APAP pressure setting of 8-16 with a SOFTPAP of 2. The first few weeks were horrible... I started with a nasal mask, however had a lot of leaks due to mouth breathing. Then went to a hybrid, but I had issues with leaking. Then went to a silicon F20, which gave me a rash; and have finally settled on a memory foam F20.

AHI was ~11, then dropped to ~6. During the 3rd-4th week of the trial, it dropped to ~2-3 and i had noticed significant improvement - which also coincided with the change of masks. Brain fog seemed to disappear etc. Settings were Min 8 Max 18 SOFTPAP 1.

The trial was up, and i bought a brand new Lowenstein Prisma from them, with a 19mm hose. Instantly, i began to have issues... Having less hours compliance and higher AHI. The machine settings are also changed to accomodate the larger hose, but i'm still having issues. 

Settings in the images are Min 8 Max 18 SOFTPAP 1


Thank you - and would appreciate any help.

[PeaceLoveAndPizza]

Two things to try are increasing your pressure to a fixed 9 or 10 and setting SoftPAP to 2. Both should hopefully help with comfort.


You have a lot of flow limitations (almost 50% of the time at some level) which is causing the pressure to increase. Some extra SoftPAP should help a bit with that.

[DenMan]

You have a lot of flow limitations (almost 50% of the time at some level) which is causing the pressure to increase. Some extra SoftPAP should help a bit with that.

Is it possible that SoftPAP can cause flow limitations for some patients?

I have a Prisma Smart and deactivating SoftPAP gets rid of my FLs. I tried that with multiple min pressures and it's always the case. Pretty confusing.

Switching APAP mode from standard to dynamic also helped me a bit but is uncomfortable.

[elliott.981.]

Hi The replies are much appreciated!

I’ll try these suggestions over the next few days and report back. Just a query Peaceloveandpizza; is the fixed pressure of 9-10 okay, if my 95% pressure can reach 18 at times?

[PeaceLoveAndPizza]

Apologies, the poor wording is my fault entirely. I was thinking you should use the same settings as currently with min/max = 8, but increase min/max by 1 from 8 to 9 and SoftPAP from 1 to 2. I cannot see the entire left hand column, so not sure about the other settings. 

Would you please share the entire configuration? Photo(s) or just typing it in would be excellent. I want to be sure it is set as I think it is based on the chart.

[elliott.981.]

            Not a problem. Thanks for the reply (:

The OSCAR settings dont reflect the actual settings im using on the Prisma for some reason...

Im using min 8 max 18 with a softpap of 1 / Ramp time 15 mins with starting pressure of 7.5.

[PeaceLoveAndPizza]

Brilliant! Thanks for that. It is difficult to divine the settings from a chart for a Löewenstein device. At least for me.

Turning off ramp would be a good start, unless you absolutely need it. That and SoftPAP to 2. For now leave the pressure range 8-18.

We’ll see how those changes help and go from there.

Note to self: Be sure to ask for the settings first!

[elliott.981.]

Thank you. I’ll give it a shot (:

[elliott.981.]

            Hi All!

My results from last night... I felt really sharp mentally today and had minimal (if any)brain fog. 

Results aren't the best and I still have a lot of improvement to make.

Min 9 Max 20 / No ramp time / SOFTPAP 2

Can someone please help?

[PeaceLoveAndPizza]

Looking better. There are quite a few session start/stops. Why is that? 

Most events are being handled, but there are still a lot of flow limitations driving up pressure. 

How about increasing the pressure a bit, maybe 10-18 or 11-18, and seeing how that works.

You can also try a SoftPAP of 3, but only change one thing at a time.