Newbie from Greece

[ajack]

I think you need more minimum pressure too. looking at your 'splitting pressure' chart, your median rate runs about 9-10. That is where I'd put your minimum pressure and see how it goes.
you are still getting a few centrals, I would turn off any pressure relief on exhale until they settle. I don't know what that is called on your machine.

[Costas P]

for your replies my friends!...

So, judging by the answers, from both quiescence at last and ajack, perhaps the following settings might be better:

min Pressure: 10 cmH2O
max Pressure: 14 cmH20
softPAP: 0 (none)

Is this right? or perhaps this might be better:

min Pressure: 9 cmH2O
max Pressure: 15 cmH20
softPAP: 1 (one)

Would the softPAP setting to 0 (zero) make my overall breathing comfort unbearable, by waking me up at night, or do you think it would be OK?... You see, I wouldn't like to lose the ease of breathing - especially in expiration, during my night sleep.

Please note that possible settings for the softPAP, as explained in the prisma 20A CPAP Auto, are:

• Setting 0: Off
• Setting 1: Low breathing relief
• Setting 2: Normal breathing relief
• Setting 3: Breathing relief with inhalation assistance

Settings 1 and 2 of the softPAP breathing relief function are intended for patients who find exhaling against high pressureuncomfortable. The breathing relief function reduces thepressure early during the transition to expiration, allowing you to breathe out more easily.
Setting 3 is suitable for patients who experience respiratory distress with a low pressure setting. The pressure is raised slightly during inspiration.

I'm a bit confused, so please advise...



Costas

[ajack]

some find that in the beginning, the pressure relief aggravate central/clear airways, so it's generally advised not to use it, until the CA settle down. you don't have to, I think the CA will settle either way, you could try a lower setting for now if you need to

if 9-14 or 15 lowers the obstructive, then it's fine, if not try 10-14 or 15,
you want the max to be 1-2cm above your 95% which will make it 14-15, you could have 16. The machine will only raise it to what it needs while you are using it. They say the algorithms work better when the min is close to the median and the max is a couple above the 95%

I would keep raising the minimum pressure until the obstructives are under control

[Costas P]

Great! and thanks a lot for the advice ajack!...

Tonight I will try 9-15 with softPAP @ 1 and see what happens with my obstructives and my CAs for a couple of nights or more.
I hope I will handle the exhilation at this setting, although I must say - as I've already written in previous post of mine - that it was surprisingly easy for me to breath at 13-14 - as this has happened some mornings while I was waking up and before I took off the mask. Perhaps this was due to the softPAP @ 3, I don't know... 

Let's see then how it goes... Of course I will keep you posted!...

 

Costas

[Costas P]

During the last 2 nights I slept with softPAP set at 1. Horrible...

Lots of pressure at, I felt like I was pumped with air.

Tonight I'm gonna change softPAP at 2. I hope it will get better...

By the way: during 1st night I had 4 AHIs and during the 2nd one... 7!... What's going on?...


Costas

[ajack]

you will get use to the pressure, but increase the softpap if you want to. Being able to sleep is important.
it's normal to nightly fluctuate with the AHI numbers, go by the averages. How was the median and 95% pressure? you may need to move to 10/14

[Costas P]

Last night with softPAP at 2 my sleeep was indeed much better!... Still overall AHI was 8!...

This morning I received a call from the Weinmann seller, from which I purchased my equipemnt.
He is a Biomedical Engineer. He studied the therapy file I've sent him and his suggestion was to setup the CPAP at the following:

minPRES: 7cmH2O
maxPRES: 16cmH2O
softPAP: 2

This suggestion was based on the last 14 days of detailed data, on which he saw a raise of obstructive AHIs during the last period of each night's sleep, while reaching the top (14cmH2O) setting, showing the luck of higher pressure for dealing with these events.
Also, he insisted that the major scope of this therapy is to achieve a combination of low AHIs (fewer than 5 as a median value) while maintaining at the same time a high quality of sleep. Having this last parameter in mind (quality of sleep) he insisted on lowering the minPRES at 7, based not only in my 3 last nights experience at 9, but also evaluating my other biometrics such as weight, height etc.

So, I think I'll follow his advice, after all they sound to me more "comfortable", and we'll see in the next couple of weeks how am I doing with this new schedule of therapy.

As far as softPAP at 3, he mentioned that perhaps some central AHIs, counted in my therapy recordings, might be "artifacts" due to the way this CPAP is acting at softPAP 3. In this setting, the CPAP makes some "steps" on inhale / exhale stages, which could then "trigger" an event that might appear as an AHI. So, he suggested to turn into 2, keeping a high comfort level and also minimizing the possibility of these "artifacts". We'll see. Only time will tell.

Of course I will keep you posted on anything new, and of course your suggestions - comments are as always welcome.



Costas

[TBMx]

I heard that the 20A should have 2 APAP-Modes - standard and daynamic.
I have not read anything about the difference so far .. or anything at all.

regarding the SoftPAP 3 - setting: I'm not sure if it got lost in translation or just isn't clear enough.
Was he telling you that with softPAP 3 the device sores events (which should than be central hypopneas?) which aren't there - thus "artifacts"
Or was he more trying to say that with softPAP 3 it is more likely that the device will induce central events? (as the pressure during inhalation gets raised by 1cmH2O)

this might not make a difference for you - but actually the difference is really interesting.

[Costas P]

I heard that the 20A should have 2 APAP-Modes - standard and daynamic.
I have not read anything about the difference so far .. or anything at all.

regarding the SoftPAP 3 - setting: I'm not sure if it got lost in translation or just isn't clear enough.
Was he telling you that with softPAP 3 the device sores events (which should than be central hypopneas?) which aren't there - thus "artifacts"
Or was he more trying to say that with softPAP 3 it is more likely that the device will induce central events? (as the pressure during inhalation gets raised by 1cmH2O)

this might not make a difference for you - but actually the difference is really interesting.

As far as I know Prisma 20A can operate in either CPAP or APAP mode. I haven't seen any selections available in the APAP mode. This information comes from the "doctor" setup menu, where all available options are shown.

As far as the softPAP level 3 is concerned: as I understood from his words, he said that with this setting the algorithm is providing a "pulse" of +1cmH2O during inhale and -1cmH2O in exhale, which might give the software the "impression" of a central event. This is what I understood, and it seems to me that it looks like it belongs to your 1st "explanation": scoring events which aren't there = artifacts.


Costas

[ajack]

I still think min 9-10 and max 14-15(1-2cm over the 95%) going by the averages you put up and allowing for the CA that are present.
I guess that's why I'm not on anyone's payroll