Prisma 25ST report

[dradutoi]

I took possession of Prisma 25ST this first night and with the settings from Sefam DreamStar Duo I got the report generated by PrismaTS which I converted into PDF file because Oscar can't import it. The settings were prescribed by a known doctor, but I see that there are quite a few CAs and the question is what to do next?

[Sleeprider]

ST technology is inferior to treatment of central and complex apnea as compared to ASV. I'm not familiar with the Prisma 24ST capabilities, but most ST machines operate on fixed EPAP and IPAP pressures on every breath, with a timed backup in the event the spontaneous pace is not maintained. That means for the treatment of CA, the machine must provide sufficient pressure support to do all of the work of respiration on every breath. Compare to the ASV which allows for spontaneous breathing and provides variable pressure support to resolve apnea, hypopnea and variable breathing on a breath by breath basis, to maintain the tidal volume or minute vent target. So the real answer to your question is to switch to a technology more appropriate to the treatment of your condition.

I realize that is not possible in all parts of the World, so standard titration protocols are always the same. To resolve obstruction, increase EPAP, and to resolve CA, increase IPAP or pressure support. If you are using a fixed pressure of 11.0/6.0 (IPAP/EPAP), then the next logical step is 12.0/6.0.

[dradutoi]

Can see 3 files from 8 converted!            

[Sleeprider]

You still have significant obstructive apnea as well as centrals, and positional apnea may be contributing to the OA events, as described in this wiki http://www.apneaboard.com/wiki/index.php...onal_Apnea For the OA events you either need higher EPAP pressure or a soft cervical collar, then for the machine to have enough pressure support to cause a timed breath, you need more pressure support. The next change is to try EPAP 7.0 and IPAP 13.0. This will provide PS 6.0 for any triggered breaths. It typically can take anywhere from 8.0 to 12.0 pressure support to treat central apnea. That is a lot on every breath, and the reason we prefer ASV.

[dradutoi]

Thank you dear sir and I will take your advice into account.
Prisma25ST can also be set to ST auto mode , it is only a German device.

[cpaper101]

Is this on the right mode to even attempt to resolve central apnea? On the picture with charts in the top right hand corner it says “Mode overview: S - 6:59h”

[Sleeprider]

Good point CPAPer101. This needs to be in ST or ST auto mode, or it does nothing during CA. In S-mode the pressure support will actually suppress spontaneous respiration by reducing CO2, then just sit there waiting for a spontaneous breath...no timed backup.

[dradutoi]

On the first night with ST therapy, central apnea disappeared, but hypoapnea and RERA increased. I still don't understand the Ti / T ratio and also the Ramp IN how this procedure affects. I confess that I felt some heartache that stopped after stopping the therapy. Maybe I need to make changes to the therapeutic parameters. Attached below is a shotscreen during therapy. Best regards.

[Sleeprider]

As you can see, the ST at 11/6 pressure and 13 BPM, provides the same pressure for every breath. The events we see above show a slow decrease in respiratory volume with a sudden arousal and recovery breathing, and the pattern repeats. If this is obstructive, we recommend increasing EPAP and IPAP together to prevent obstruction and keep the airway patent. If it is central, only IPAP increases to give more pressure support. ST is not ideal for central apnea as I said earlier. The question is, do you have obstructive or central apnea? What was your diagnosis?