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Machine: Lowenstein Prisma Smart Max Auto Mask Type: Nasal pillows Mask Make & Model: F&P Brevida Nasal Pillow Humidifier: unsure (standard one that comes with prisma cpaps) CPAP Pressure: 7.0 - 7.5 CPAP Software: OSCAR
I've been using an auto CPAP machine for a few months now and have adjusted to using the machine. I'm using a Lowenstein prisma smart CPAP which honestly has a terrible app to view data that I had been using for a while to gauge how the therapy is going (it only gives you AHI, time in use and leak rate). More recently I've started using OSCAR data to get a better idea as I'd find on some days I'd feel tired even when my AHI was low.
One of the main things I'm noticing from my OSCAR data is that my flow rate graph deviates from the smooth peaks and troughs that I've seen from 'normal flow' graphs online. I've attached some pictures but occasionally I'll notice periods where the peaks are quite flat rather than smooth and other moments where it just appears to go all over the place.
I've been slowly bumping up my pressure to see if it helps but would appreciate some advice on settings I could try. Note I've reduced the range between my min and max pressure as I would occasionally experience 'chipmunk cheeks' (wearing mouth tape) or leaks if the pressure got too high (but also not a fan of having a big variation of pressure throughout the night which occasionally does wake me up).
Let me know if more information / data is needed, Thanks!
Lowest hanging fruit is just increase pressure. The CA pic is a post-arousal CA set on by obstruction, and the other pic is clear flow limitation. EPR / pressure support has a place in this conversation too, but first just try increasing your pressure so long as you can tolerate it.
Machine: Remediated Dreamstation APAP-CPAP Mode Mask Type: Full face mask Mask Make & Model: Airfit F20 Humidifier: Built In CPAP Pressure: CPAP 15cmH2O CPAP Software: OSCAR
Raise both min and max pressure or set both the same pressure to 10cm on the machine. You're not getting full inspiration with these settings, the flat tops are indicative of this-abnormal waveforms.
Machine: Lowenstein Prisma Smart Max Auto Mask Type: Nasal pillows Mask Make & Model: F&P Brevida Nasal Pillow Humidifier: unsure (standard one that comes with prisma cpaps) CPAP Pressure: 7.0 - 7.5 CPAP Software: OSCAR
Thanks for the responses! Have been experimenting with bumping up the min and max pressures but that has resulted in more leaks and waking up in the middle of the night to adjust my mask, have since sized up the mask which seems to be a better fit but still occasionally get leaks that wake me up in the middle of the night. I have a chin strap I haven't made much use of since I've been mouth taping but was thinking of trying that on top to see if it helps with the leaks.
I did manage to avoid leaks last night with min 7.5 max 8.0 but still seem to have flow limitations. Will try bumping the max to 8.5 again tonight and increment from there if it doesn't cause issues with waking up. My CPAP also has a soft pap feature which seems equivalent to EPR, would there be much benefit to trying that out?
Machine: Lowenstein Prisma Smart Max Auto Mask Type: Nasal pillows Mask Make & Model: F&P Brevida Nasal Pillow Humidifier: unsure (standard one that comes with prisma cpaps) CPAP Pressure: 7.0 - 7.5 CPAP Software: OSCAR
10-18-2024, 09:34 PM (This post was last modified: 10-18-2024, 09:38 PM by sploomb.)
RE: Advice with OSCAR Data
Hi guys, thanks again for the responses. Just wanted to update as I've been experimenting with some of the suggestions here including removing a pillow (I have one thin one now) to try avoid chin tucking (positional apnea clusters) and bumping up the pressures further for improvements. It seems my nights tend to vary so its hard to pin down whats ideal for me.
For the pressures I've attached 3 different nights:
- Fixed pressure 9.0 gave a good result one of the nights but not so well on following nights so I tried bumping the pressure further
- Fixed pressure 10.0 still saw some flow limitations (tried 10.5 but woke up feeling quite uncomfortable in my stomach which I believe may have been due to Aerophagia from the higher pressure)
- Then tried going back to APAP with 9.0-12.0 since I wanted to try higher pressures but avoid the discomfort from having it on the entire night. I also set the EPR equivalent on my machine (Prisma SoftPAP to 1) to help tolerate the higher pressures if needed. I might keep this on for a few more nights to get more data but is the rule of thumb to keep increasing the max pressure until you don't hit it over the night?
The varying results makes me think I need to try sticking with a certain setting for a few more days to get more data to know if its actually an improvement for me or not. So will try that going forward.
Another thought I had is my apnea seems to be worse in supine position. Even though I fall asleep on my side I tend to move around quite a bit while sleeping, and occasionally have woken up on my back, so will try to see what I can do about staying in a lateral position to see if that helps. Appreciate the help so far!
Something else I forgot to add was changing the APAP mode on my Prisma Smart Max to Dynamic which I've read is a more aggressive algorithm to respond to apnea events that other users have reported some improvements for.
Another difference is that setting SoftPAP to a non 0 value on my machine seems to make the flow limitation events appear all over the place, where as they weren't there on fixed pressure settings despite clear flow limitations in the graph, I think this may be a bug of some sort but have colored them yellow to make them less noisy.
Have also adjusted my OSCAR settings according to the "Lowenstein PrismaLine optimization" wiki page
