[Treatment] Lowenstein Prisma OSCAR data: FL, RERA galore + extremely tired?

[anorthlow]

Hi everyone,

Just got diagnosed with an AHI of 13 after feeling very bad for years for no apparent reason.
Not enough to get a free APAP in Scandinavia unfortunately as you need an AHI of 20.
Luckily i could pay for a Lowenstein Prisma Max myself so i did! 

After 10 days of letting the doctor remote control my device i checked my own data after still feeling very bad and i've posted the data here attached.
My AHI is pretty low but i have constant events throughout the night and my breathing looks hindered? 

I've been complaning about feeling like i breath through a straw at all times more or less for years, and i wake up a lot, never rested, often panicked to which my doctors advice have been, "try to do some sports, destress, eat well" (all of which i do but it's hard with no sleep).

Zoomed in on constant flow limitations and clusters of RERA + apnea:
   
   

The many events can be seen on the attached image daily overview.
My doctor has not said anything to me so i guess he thinks the data is a-ok - is it really?

Thank you in advance!

[PeaceLoveAndPizza]

It is not that bad. The events you see are primarily flow limitations. 

Any chance you could scroll down on the left hand side table and repost so we can see the exact machine settings? It looks like you have softPAP=2, but I want to be sure of a few settings before suggesting options.

[anorthlow]

Yes it's softpap level 2 the prisma app says. Also attached a screenshot.

What makes me wonder about the flow limitations is that my breathing does not look like the "pretty" curves seen in the "normal breathing" flow limitation wiki page?

Mine never looks like that at any point? 

[PeaceLoveAndPizza]

Please read the link in my signature “Formatting your OSCAR charts”. We like to see specific charts on the main page as it makes it easier for us to figure out what is going on. Do not zoom in on a section unless requested unless you think there is something going on we need to see, but always first show the entire night.

Try the following:

Min pressure 7
Max pressure 12
SoftPAP 2 
AutoStart off
SoftStartTime off

If you must use softStart, then please do so. You get no therapy during the ramp window, but if it makes it easier to fall asleep then use it.

Give that a go for a few days and let us know how you feel. 

Also give some thought to sleep hygiene. Here is a good article to read: https://www.sleepfoundation.org/sleep-hygiene

If you have not switched to a flatter pillow give it some thought. The more you can keep the airway open the fewer flow limitations. Same thing with your nostrils. If you are congested try a neti pot and/or nasal spray like Flonase or Azelastine.

[BB37]

I was experiencing similar with my Lowenstein Prisma20A and achieved dramatic improvement by switching from "Standard" mode to "Dyn" mode (Dynamic).

[PeaceLoveAndPizza]

I am not sure about switching from standard to dynamic based on the one chart. It would be helpful to see how things go with just the pressure change before switching the mode.

This thread is a good explanation of the difference between the modes.

https://www.apneaboard.com/forums/Thread...vs-dynamic

[anorthlow]

Thanks for the feedback!

I've requested the changes to my sleep doc who controls my device remotely. I can't change it myself. Is this normal or will this get annoying in the long run for adjustments?

I already have implemented very strict sleep hygiene for years that's why the tiredness is so weird, but thanks for the pointers

Regarding the switch to dynamic mode - lets hope standard mode works, as my device seemingly does not have this mode. In the wiki i can see there is  SoftPap3 / Tri modes only available from 20A, i only have Prisma Smart 

[PeaceLoveAndPizza]

You can manage it yourself. You can request the manual from here: https://www.apneaboard.com/adjust-cpap-p...tup-manual

It is possible with the appropriate software you could get locked out of your own machine. I don’t know if this is the case, but you should ask your sleep doc about it. They may not want you mucking with it though as you would no longer need them.

[WisNaeMe]

Just at allay any concerns, the Prisma Smart Max does have dynamic mode should you find that you eventually need it - I have this model and it can be toggled between STD and DYN modes in the clinical menu.

As an aside, when setting up OSCAR for screenshots - if you slide the vertical bar/frame just a bit to the right.  (i.e. the bar that sits between the Daily Sidebar and the Graphs ...with a little dot half-way down), it will unwrap the text and should allow us to see more of the machine's settings.

Also if you right click near one of the 'y' axis labels, then select 'Reset Graph Layout', all your selected graphs should then fit properly into your screenshot. 

Usually we need to see - Event Flags - Flow Rate - Pressure - Leak Rate - Tidal Volume ...and in that order.  Lowenstein machines don't have a Flow Limitations graph you'll find described in the documentation about posting - FLs are instead reported in the Event Flags chart (but only when SoftPAP is set to slight or standard).

[anorthlow]

Thank you for the info. Just found the clinicians menu so i can change the pressure myself.

Incredible they don't just give this to you.

I'm pretty sure i have severe flow limitation and my breaths do not look good and round as they should so there's lots of room for improvement, just have to figure out the correct pressure. Everything over 12 forces my mouth open from the nasal mask though, even with chin strap because my tongue "falls back" when i sleep.

Do you guys breaths look like the "normal" breaths in the wiki or like square or like tooths like mine? I slept with PS 15 then 12 this night and it still happens?

I've seen a few videos on flow limitation and what good breaths should look like and mine continue to look weird. Maybe i have UARS, and the dynamic mode would help.