LAB sleep study help - feeling hopeless and lost

[georgesadam]

I've been using an APAP machine for nearly a month now, and my AHI has consistently been under 4. My oxygen levels are staying above 90%, so I can see that the CPAP is definitely helping. However,  I’m seeing a lot of flow limitations on OSCAR, and I feel that wake up a lot at night.

While I feel better than I did before starting CPAP, I still wake up frequently and feel like I’m not getting the restful sleep I need. My sleep study was done last month, and it mentioned I have central apneas, but on OSCAR, I only see one central every 1 to 3 days. This difference has left me confused about whether I should trust the lab study or the OSCAR data.
I’d really appreciate it if someone could help me interpret my sleep study and OSCAR data to determine if a Bi-level or ASV machine might be necessary.

• Lab sleep study: https://imgur.com/a/mbqRViP
  
• OSCAR data: https://imgur.com/a/Jy5Lozc
  
• Pressure 8-15 APAP
  

Thanks so much for your help!

[Sleeprider]

Georgesdam, I find that optimizing the Lowenstein Prisma Smart is very difficult, and I don't have personal experience with that device. I do know that many other share your experience of very high flow limits and RERA with the Prisma Smart CPAP have found much better therapy with the bilevel version. Optimization of the Lowenstein Smart series is the subject of a wiki article written by a member here with the user name Macka. https://www.apneaboard.com/wiki/index.ph...timization Reading that wiki should be a good start. For individuals with the problems I very much prefer to use the Resmed Aircurve 10 Vauto bilevel device. That machine is far more capable of treating flow limitation and has controls for pressure support and respiratory trigger sensitivity and timing that seems to be very helpful. Anyway, start with the wiki and consider reaching out to Macka who has a broader understanding of working with your device.

[georgesadam]

I will definitely reach out to him. Did you have time to look into my lab sleep study result ?

Thanks Alotttt

[Sleeprider]

Other than the fact you had mixed central and obstructive apnea, I did not see the data in your sleep study as very helpful. The CA activity is not apparent in you Oscar data with PAP therapy. Your sleep study shows all events in supine position, and you do much better left or right. My suspicion is that you have severe flow limitation which in Oscar will appear in zoomed images of the flow rate as flat or down-sloping inspiratory peaks, rather than normal rounded peaks. I would not rule out that your high levels of flow limitation may be positional. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[lazyzyf]

I am using prisma smart machine as well, when I enable the softPAP, it always causes a lot of flow limitations. Can you try turning off the softPAP to see if the flow limitation goes away?

[georgesadam]

oh wow, its worth to try softPAP off . Thanks for the info.