Need help with minimizing flowlimitations

[Søvnig]

Could anyone help me decipher what is going on in my OSCAR-charts? They differ very much from night to night. Some nights (not so many, unfortunately) they look fine (to me, at least). But most nights they look very "messy". Not so many apnoes, but many, many flowlimitations.

In periods I feel a kind of light, brief "blocking", mostly during inhalalation, but also sometimes during expiration. It is annoying and disturbs my sleep. I never experience this without the APAP, so I don't think it is apnoes, but caused by the machine. But they seem to make the pressure immidiately go up - see the end  of the night in the screenshot. What could cause these  light blockages?

Sometimes my breathing seems to get into a kind of "fight" with the pressure - as if they are out of sync.

I have been on APAP for 4 months, but I'm still tired, although it has helped me some.

I sleep almost only on my right side. Started at this at the same time as the APAP (AHI 16), and it has reduced the apnoes to almost none. Could I still benefit from a soft servical collar?

CPAP Pressure 6-11 (haven't figured out how to edit my profile yet.)



   

[PeaceLoveAndPizza]

First, please read the link in my signature “Formatting OSCAR Charts”. Those are the charts we want to see as well as the entire left-hand table. With all the flags available on the Löwnestein, it takes up a lot of screen real estate, so if you need to add a second image just of the left-hand table that is fine.

As we cannot see all the settings or charts, the best we can do is take a SWAG and recommend more pressure. Try something like

Mode APAP
Min pressure 8
Max pressure 15
SoftPAP 3
No ramp

Getting more pressure support via SoftPAP should help with the flow limitations that are causing the pressure to rise, but the dynamic nature of the Löwenstein algorithm makes it difficult to guess how it will work. It works well for most, but is a bit difficult to know what its magic is under-the-hood.

[Søvnig]

Thank you so much for your suggestions. I have added the charts from an other bad night, and a 2 min "zoom in" at one of the apnoes.

My settings are done from a hospital sleep clinic (telemedicin), who have also decided the Löwenstein, so I will have to negotiate your suggestions about pressure with them. Unfortunately they are quite "old fashioned"  - according to them my apnoe is absolutely well regulated, as the AHI and leak percentage are so low. Flow limitations (and OSCAR) seems to be unknown, and considered absolutely irrelevant, even though it disturbs sleep considerably (no deep sleep), so it will probably take some days, before I hopefully have convinced them to try your suggestions.

If you have any other thoughts about the new charts, please share.

           

2  more charts in the next post.

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2 more charts to my post above.
       

[Jay51]

Here is a great article in our wiki about optimizing the Lowenstein:      1OSCAR Optimisation for Lowenstein

[Søvnig]

Thank you very much, Jay51.

[Søvnig]

I how now tried your suggestions for some days. My machine unfortunately does not offer Softpap 3. 

I have attached screenshots for three nights - they look very different, I don't know why. Some nights are absolutely horrible, the pressure goes rampant, and collides with my naturel breathing rhythm, and there are a lot of "blockages" with very short feelings of airsupply stopping (feeling choked). I've seen this described by others as "someone stepping on the hose". Other nights are more peaceful, but either way - almost no deep sleep. 

Can the recordings of deep sleep be trusted?

Also the last days have shown a growing number of "clear airways" (i.g. central apneas). Can this be trusted, or could it just be artefacts?

The mode is now "Standard".

           

[Jay51]

It looks like you are still having a huge number of flow limitations.  I am still learning about optimizing Lowenstein machines.  

Great question about deep sleep.  I don't know if the statistics and reporting from the Lowenstein are accurate on this or not?  

Here is a great thread that I found that explains dynamic vs. standard mode (you are in standard mode right now).  I hope this helps.  

Weinmann / Löwenstein Prisma 20A Auto CPAP: APAP settings: standard vs. dynamic

Costas P

[Søvnig]

   
Thanks, Jay51.

I must put some more time into optimizing my Prisma according to that article - it's just hard to find the energy with so little good sleep.

I have problems with fitting all the tables into a single screenshot, as I can see others are able to.

I have added this nights tabels. Slept until 2 o'clock (no deep sleep though), pause for going to the toilet, not much sleep after that, lots of hissing noise from the fitting for the hose to the mask (don't know the english word for that). Tried to move the hose around in different positions - that made no differense, so I guess its just the high pressure that "hisses". About 4 o'clock (I think) tried to blow my nose, that didn't help, tried ramp, that didn't help (this has seemingly not been disabled yet- but I use it very, very seldomly). No sleep after about 4 o'clock -  less flowlimits, but instead lots of obstructive apneas/bad obstructions. That is strange...?

It often fels like it is the pressure, that creates the obstructions - kind of like a valve closes for a millisecond, so I am unable to finish my inspiration. Also often when I'm about to doze off it's as if something happens in that moment, that makes me wide awake again. As if the expiration gets longer and slower as I relax, and then the pressure immidiately intensifies and wakes me up - or it just gets out of sync with the breathing. It's quite stressful.

Thanks for the link about "standard/dynamic". Perhaps I should try "Dynamic" again?

[Jay51]

Thank you for all of that.  You are still having a significantly large number of flow limitations.  You have an apap machine (it has an epap feature that has a range.  The epap stops major obstructive apneas (OA's).  But it can't do that much for the huge number of flow limitations that you are having. 

Curiously, I went online and did a search on your machine.  It said that your machine does have softpap.  Using softpap would be the single best thing to stop all of your flow limitations.  You have stated that you don't have softpap.  

You can click on the link at the top of the page, "Cpap Set Up Manuals".  I saw the Lowenstein PrismaSmart manual.  This may help you with your settings.  Worth a try.