[Treatment] 6bez8dF5lf - Therapy Help,

[6bez8dF5lf]

Hello everyone,
I just wanted to post an update.
I turned off softPAP/pressure support on my Lowenstein Prisma Smart machine (thats the same as EPR on Resmed machines) and it totally eliminated the flow limitations.
I read in a few places that to reduce flow limitations you have to INCREASE pressure support, but I found the opposite to be true in my case.
I have attached three days of data as proof.
Also I'm playing with the pressure range to try to further lower my AHI.
Tonight I'm planning to do a constant pressure of 15.

[WisNaeMe]

I should probably flag up that Lowenstein machines do not display Flow Limitation data in OSCAR when SoftPAP is turned off (nobody really knows why) - so regrettably, you probably haven't eliminated FLs, they're just hiding!

To get some idea as to the true extent of your FLs, you can look at a combination of your Flow Chart (zoomed in, it should show flattened inspirational peaks); the Resp Rate Chart (calm vs busy) and the epoch Flow Limitation value (eFL). Alternatively, you can turn SoftPAP back to 1 - (a drop in EPAP of 1.3 cmH2O, given your Pmin of 8cmH20) and they will be displayed again.

If you look at the following OSCAR wiki it will give you some pointers on optimising your settings and a bit more information about these machines.

https://www.apneaboard.com/wiki/index.ph...timization

My own experience of using SoftPAP (both 1 and 2), was that it actually doubled my flow limitations! I have a suspicion that the Prisma machines might not be ideal for treating UARS and that a true bi-level machine with proper pressure support would better tackle the residual FLs and RERAs. I think the machine's response might be just a bit too subtle to control these lesser obstructions and Lowenstein do state that SoftPAP is specifically a comfort feature and has negligible therapeutic benefit - we should maybe take them at their word, rather than expect it to perform like a Resmed.