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08-23-2024, 07:36 AM (This post was last modified: 08-23-2024, 07:37 AM by crunchy92.)
Help with OSCAR Report from Loewenstein Prisma Smart
Hi all,
I've been using a Loewenstein Prisma Smart APAP for 4 years now with a nasal mask and pressure settings @ 7-10 cmH2O. So far I've had slight improvement of some of the more severe symptoms - like waking up with frequent headaches and my brain feeling completely "fried" / foggy after waking up (and mostly the whole day after). But I still wake up tired every day like I barely slept a few hours and I'm fatigued and unfocussed all day. I've brought this up to my treating physician multiple times and he always waves it off by telling me to just stick to the therapy. So now i'd finally like to tackle this issue and started looking into evaluating the data myself with OSCAR.
I'm still very new to this so I'm gonna need some help here, but from what I can see my AHI seems to be fine, but the flow limitations might be an issue. I also see some RERAs here and there but nothing to crazy I guess. Can anyone give me a bit more insight into what might be going on here?
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
RE: Help with OSCAR Report from Loewenstein Prisma Smart
Welcome to ApneaBoard, crunchy92.
I think I may have a partial answer. Very briefly, I recently received a Lowenstein Luisa ventilator. I have had similar problems as you have had. I am not well versed on the Lowenstein machines and algorithms yet, but I am trying to read and learn more about them.
Basically, it seems like the algorithms use a very slow transition from IPAP to EPAP; and the decrease in pressure doesn't actually go down all the way to EPAP, but a little higher than EPAP. This can make it harder to exhale; which in turn can cause more CO2 retention; which can cause headaches. It acts kinds of like a Vcom device (keeps the exhale pressure higher than normal).
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
RE: Help with OSCAR Report from Loewenstein Prisma Smart
Thanks, that is really interesting. I had a quick look through the article, if I am really dealing with some form of UARS, sounds like I would need a different device if I understand it correctly. I guess I'll have to see if my doc will play ball if it comes to it. But before that I'd like some better understanding of the recorded data before I'll bring it up, otherwise I don't think he'll hear me out. I would really appreciate if anyone can take a closer look at the report.
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've attached the prismaTS reports as well.
It's in german although I guess most of it should be obvious what it means. In the "Schnarchen / RERA" row, you'll see snoring epochs in green and RERAs in yellow. In the rMV row, you'll see severe obstruction in dark red, medium obstruction in bright red and flow limits in yellow. Let me know if I should translate anything else.
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
RE: Help with OSCAR Report from Loewenstein Prisma Smart
I am still looking at your charts trying to figure things out. I have not been diagnosed with UARS, but the last ventilator had would go back and forth quickly from EPAP to IPAP using high pressure support. It seemed pretty natural. I am trying to get use to the algorithm that the Lowenstein machines uses.
There are other Lowenstein machine members here at ApneaBoard. If any can decipher the 3 charts posted above, please post.
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
RE: Help with OSCAR Report from Loewenstein Prisma Smart
Dear crunchy92,
I'm sorry to hear about your persistent symptoms. That sounds really frustrating.
That is interesting to hear that FL (Flow Limitations) may not be getting evaluated right in OSCAR for Prisma SMART.
I am wondering if you have made any progress in your search for answers? I don't see anyone helping you with looking at your charts and I'm afraid I can't be of much help either as a newbie.
I am also trying to work on settings for Prisma SMART and seem to be running into some data irregularities, for example, it seems to count twice as much deep sleep as I get using other indicators, including Prisma 20A which I had tried before SMART.
Looking forward to hearing about any insights you may have had. I hope you experience improvement soon.
