[CPAP] PRISMA SMART MAX PROBLEMS WITH SOFTPAP LEVEL 2

[rretamalt]

Note that i have talked with other People here in chile and no all of them report the same. It seems it depends on the sensibility of the patient, if you are a New patient you Will think that this is normal, but for People coming from philips or resmed machines, its feel different....and also there are persons coming from these machines that only feel a little leap.....
I strongly suggest before to buy a cpap, ask for a trial or rent by 1 of 2 weeks one machine. Between the same brand , softpap 2 level is different between prisma smart, prisma smart max and prisma 20a, for me the last machine is great.

Lowenstein support here in chile is great !!!

[OGBF]

From what I have read in another post, the turbine in the Prisma Smart series is always running at full (or perhaps high) speed and the pressure is controlled with valves, compared to other XPAP machines where the turbine increases and decreases in speed when EPAP is engaged. I think this gives that feeling of a slight 'jump' in pressure when using softPAP on setting 2 which according to my Oscar data is a 2.5 cmH2O difference between inhale and exhale. As the Smart Max is my first CPAP I guess I just thought this was normal and doesn't bother me but it's true, I didn't feel the same 'jump' when SP was set to 1.

[clan]

I am new to the Löwenstein Prisma as well. I am in the process of finding the optimum settings for myself. I tried the SoftPAP for the first time tonight. I am looking for a better sleep quality as the AHI in itself tells me nothing.

I am not sure I would describe it as jumpy - I did not really notice anything as such. You only state that you do not like it is jumpy. Is that a principle? Does it feel uncomfortable? Or does it effect your sleep (you sleep badly)?

Let me show you a fresh  example from this night:

   

After 4 hours I woke up with a jolt and felt really bad. It marked an Hypopnea at the time.

All sessions APAP dynamic, Pmin 7 and Pmax 16


Session 1: Mouth tape. SoftPAP: ON - felt bad
Session 2: Mouth tape. SoftPAP: OFF - felt better
Session 3: Chin strap. No Mouth tape. SoftPAP: OFF - now feeling reasonably rested and as a human being.

05:40 was a sneeze so disregard that.

So I only have about 4 hours with SoftPAP so it is too soon to make any firm conclusions in my case. So why am I showing you this?

1) To show you that Oscar now nicely display Prisma data.
2) To show you it displays data not directly shown in your Prisma TS report (I have not tried Prisma TS myself yet!)
3) That I noticed a lot of flow limitations (FL) while in SoftPAP while the rest looks reasonably good.
4) I have had the Prisma for 8 days. Slept very well (comparatively). 41 FL events for 4 hours while using SoftPAP. None for all the rest of the time.

I think it would be interesting if you imported your data into Oscar.

[OGBF]

I did notice a difference between SoftPap 1 and 2, it doesn't bother me in the slightest but I can kind of understand what the OP means and my theory is that it depends on the mask. My nasal mask has a double layer of silicone to make a seal and it kind of inflates on each breath, more of a pulse than a jump, it's very slight. I didn't feel that on SoftPap level 1. I also use Oscar now my machine is supported, I liked the Löwenstein software but I feel Oscar is easier to use and presents data more clearly. Good luck with dialling in your settings, there are a bunch of helpful people here who can help if you need it.

[motivationalGust]

Has anyone managed to get any replies from Lowenstein on this issue?

I recently got the prisma smart max and noticed this issue too.  I'm pretty sure it's a bug because if you inhale in just the right way, you can get the softPAP algorithm to actually ramp down smoothly.

What's the right way?  It seems like there's a simple threshold that you have to be over and then under before it kicks in.  The problem is that once it does kick in it takes way too long to ramp down (~3 seconds) on softPAP 2.  So you have to sharp inhale, immediately back off to light inhale, then hold it for 3 seconds, then finally you can exhale.  This will give you a smooth pressure ramp-down but obviously no one breathes like this.

It's very eager to bottom out though; any momentary flow stoppage (or at least below a certain threshold) will immediately lead to it  bottoming out.  What's funny is that while the ramp-down is super gun-shy about triggering (sometimes failing to entirely) and always gives way to bottoming out, the ramp-up is completely uninterruptible - try exhaling while it's ramping up and it'll just ignore you and keep going.

The fix is pretty simple: make the threshold adjustable and make the ramp down speed also adjustable.

I emailed Lowenstein but got no response so far; maybe they only read German emails?

[Sleeprider]

Have you seen this Apnea Board Wiki article? https://www.apneaboard.com/wiki/index.ph...timization

[motivationalGust]

Yeah, what about it?

I'm referring the implementation of softPAP in the actual unit, not with OSCAR. The algorithm explanations further down are general descriptions.

There's no way to configure these algorithms at the moment other than selecting 1 or 2 for less or more pressure relief.

[clan]

Have you seen this Apnea Board Wiki article? https://www.apneaboard.com/wiki/index.ph...timization

Thank you so much for posting this. A lot of good and new information for me!

[motivationalGust]

You might like this one too which describes what standard vs dynamic does but also what eFL, eMO, eSO and eS are.

(I can't post links yet)
forums/
Thread-Weinmann-Löwenstein-Prisma-20A-Auto-CPAP-APAP-settings-standard-vs-dynamic

Also, if you're following that optimization guide, you might want to have all of those e-ones on as well since those are what the machine is using to trigger pressure actions.

Also-also if you use softPAP, you're going to get FL markers littered all over your graph. My guess is it's related to the whole ramp thing. I notice on my graphs that when I'm deep sleeping (according to the machine) I actually have no FL markers; I have no explanation for it. If you turn off softPAP, FL markers seems to turn off as well or is consistently zero. All in all, eFL might be the better indicator of flow limitations for lowenstein machines (but I don't really know).