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thanks for your insights and analysis. What is particularly interesting to me is what you write about Flow limitation in relation to SoftPAP modes. I guess there is something to it. I reduced SoftPAP from 3 to 1 and the PrismaTS software shows that I slept up to 42% in Deep Sleep (3:19h) last night and I seemed to wake up less times and slept harder. I'll try it like this for more nights and see if it continues to work in my case. So thanks, no need to apologize, your insights are welcome.
The other thing about the OSCAR and Prisma 20A, it doesn't show the max pressure correctly. I'm using 10.5 min and 13.5 max and the OSCAR shows both as 10.5. I'm attaching here a screenshot from the PrismaTS software as proof.
Machine: Löwenstein Prisma Smart Plus Mask Type: Nasal pillows Mask Make & Model: ResMed P10 Humidifier: Not using CPAP Pressure: 6 mostly - up 9-10ish CPAP Software: OSCAR
That is great. Did you choose SoftPAP 1 because you could not tolerate it off? Or was it "just" a test?
The Prisma TS software looks good. I should get around trying that.
Be aware you can see Deep Sleep in Oscar as well. Below the graphs on the daily page there is a drop down (up actually :-)) which filters the graphs shown. DS is disabled as default. Enabling it will add it to the event graph on top and overlay with a colour on the flow rate.
You are right, I don't feel comfortable exhaling without SoftPAP. I was on SoftPAP 2 with Dreamwear Nasal Cushion for half a year, but the treatment was not effective because my mouth was opening at night and air was escaping through it. I changed to the Evora Full Face Mask and gradually increased minimal pressures to 10.5 and stopped having the severe nocturnal reflux that I was having with the Dreamwear mask with APAP pressures of 6-16 cm H2O. That mask was very noisy and woke me up at pressure 12 (probably air escaping through the mouth, noise of the mask at the ears). Later with the Evora I tried to raise the pressures and at the same time not have RERA events. I figured that 10.5 is a good minimum for me. I'm not sure about SoftPAP 3. I also wondered now and then if the expiratory pressure of 7.5 cm H2O with SoftPAP 3 (10.5-3) is enough? And apparently it wasn't.
I'm glad you wrote me also your experience how was your sleeping with those different SoftPAP settings. Such experiences and insights are always welcome. Thank you!
One more note about OSCAR. Prisma 20A is still not fully supported, so I will have to view the results via PrismaTS software. If the developer would like to send data from the card and also data from PrismaTS, I will be happy to send it to him.
Machine: Löwenstein Prisma Smart Plus Mask Type: Nasal pillows Mask Make & Model: ResMed P10 Humidifier: Not using CPAP Pressure: 6 mostly - up 9-10ish CPAP Software: OSCAR
Can I push you a little futher? With your Pmin at 10,5 you state that your exhale is not comfortable without SoftPAP. With the relief your EPAP will then be 7,5. You have now found that Pmin 10,5 but with SoftPAP 1 (to keep it tolerable) is more comfortable which is EPAP 9,5. So you should actually be comfortable exhaling at a pressure of 9,5.
I would try surely try Pmin 7,5 with SoftPAP off. You might find that you need less IPAP pressure than you think and it has gone higher to compensate for the narrowing of your airways during exhale and lower EPAP.
I had already tried such lower pressures when switching from the Dreamwear mask to the Evora FFM, but I still (for over half a year) had unbearable nighttime reflux (GERD) and woke up regularly between 3:00 - 4:00 AM and couldn't fall back asleep for an hour or more. When my pressure is below 8-9 I feel starved for air. Because of this, I need to have this pressure up to 10.5 cm H2O. In addition, I wear a cervical collar while sleeping. Without the collar my AHI is noticeably higher (around 5-6 AHI).
Machine: Löwenstein Prisma Smart Plus Mask Type: Nasal pillows Mask Make & Model: ResMed P10 Humidifier: Not using CPAP Pressure: 6 mostly - up 9-10ish CPAP Software: OSCAR
But that was with the SoftPAP on at the time? If not Pmin 7,5 then maybe 8 or 8,5. With SoftPAP at 1 and your Pmin at 10,5 your EPAP is 9,5. So even try Pmin 9,5 with SoftPAP off. If reducing SoftPAP made things better. Then reducing it the last bit might actually be even better.
I understand that reflux is not nice. But it would be a simple test.
It's turned in a slightly different direction from the original meaning of this thread, so just to finish it off. I tried sleeping with SoftPAP 0 and a pressure of 10.5 last night and already around 4:30 I started to wake up and I was not feeling well, I felt reflux (GERD). Around 5:00 I had to change it to SoftPAP 1 and I was sleeping fine after that. I didn't even feel the reflux when I woke up.
Your advice about setting a lower SoftPAP was useful. I have also changed my old extension collar from latex 8cm in height to a thicker foam collar also a bit higher (10cm) and I use a pressure of 10 - 16 cm H2O with SoftPAP 1 and sometimes for the whole night the pressure doesn't even go up. I've had about 2 nights like that :-) Deep sleep percentage has also increased to around 40% or more. Once it was 49% deep sleep. I've never been able to do that before on SoftPAP 3 or 2. So thanks again for getting in touch about your experience with the SoftPAP setup.
Hi, I am another user of Prisma 20A and trying to make sense of my therapy also. Just a quick note that I believe softpap 3 does not lower epap by three but instead lowers epap by 2 and momentarily increases Ipap by 1. So you were only lowering to 8.5 epap previously. On softpap 1 @ 10cm you're lowering to 9 and getting better results so you must be hovering close around your ideal min pressure going up in increments by lowering softpap. I have noticed also that a 22mm hose and/or vcom softens the flow delivery and may allow you to tolerate slightly higher pressure without discomfort. The prisma has a strong pump and is very reactive IMO
