carnuntum - Switching from Prisma APAP to Aircurve bi-level therapy

[carnuntum]

Hello everyone,

I have longer issues (8 months on APAP), my AHI is low but I still sleep poorly apparently due to quite a lot of RERA. I was using a Nasal Pillow mask but the air was leaking through my mouth so I changed it to a F&P Evora FFM.
I had the original pressures set at 6-16 cm H2O. If I let minimum pressure at 6 I'm hungry for air. I have found that a good minimum pressure is 10. I'm trying different pressure settings to get rid of the RERA. Recently I tried both APAP mode 10-13, then CPAP 10 cm H2O + EPR 3 (called SoftPAP on Prisma machine). You can see on the charts that when the pressure is higher, there are more RERA events. Sometimes I fall asleep on my back but later turn over on my left side. Could this also be related to sleeping position or is it about the amount of pressure? Do you think the minimum pressure needs to be raised further?

[OpalRose]

There's not too much difference with your numbers between Cpap mode or Apap mode, but I don't see higher pressures being your friend.  

I would stay with the Auto mode with minimum 11, maximum 13 and EPR (soft Pap) set at 3.  

With that said, the Rera's may be triggered by your sleeping position, since they seem grouped together. Re-examine how your sleep.  If on your back, be sure you're not using a big fluffy pillow that can push your head forward causing "chin tucking".

This is called Position Apnea.  
https://www.apneaboard.com/wiki/index.ph...onal_Apnea

It's better to use one less fluffy, but supportive pillow.  Try to make a conscious effort to sleep on your side as much as possible.

[carnuntum]

Thank you for your valuable advice and information about Position Apnea. I didn't know about it, that it has its own definition. I just thought of something so vague regarding the use of cervical collar. When I don't use it, my AHI is a bit worse. Also, when I don't use it, my neck and head has sort of tilt more towards my chest.

One other thing I would like to note is that the Prisma machine, when set to SoftPAP 3 and the pressures are set to e.g. 10-13, shows 11 to 14 on the machine and on the chart. With SoftPAP 2, it doesn't raise those set pressures by 1. I don't know what the average pressure there actually is.

[OpalRose]

I don't know too much about the Prisma and Soft Pap.  I was assuming that Soft Pap worked similar to ResMed's EPR.  

You can order a clinician's manual Here

[carnuntum]

Hi,

I have a little update on my status. As I am using a 19mm hose, the hose thickness in the machine setup was set to 19mm. What I haven't taken into account so far is that Evora Full Face mask has it's own 15mm hose outlet. So I thought that because of this short (about 50 cm long) 15 mm outlet I would change the setting to 15 mm also in the APAP machine setup, even though the main 1.8 meter long hose is 19 mm in diameter. And this has changed: The mask started to inflate a bit when inhaling at the SoftPAP3 setting (EPR3 equivalent on the Resmed) and my RERA events decreased to 1/hour. What I didn't want though, it increased my AHI a bit to 6. I use a cervical collar and a 3 cm low flat pillow backed with a towel.
Maybe I should adjust the pressures some more. Apparently the minimum pressure. I'm not sure. It's going to take a little further experimentation.

[carnuntum]

Hi CamilleKH!,
The prisma20a is supported, with a few minor misreported figures in the therapy settings which is inconsequential as you will see. I think flow limitations may not flagged when softpap is off either.

Oscar is far superior IMO than the Prisma official clinician software for viewing your therapy data, so you are on the right track. You will see once you have it running, that there are many events and overlays on your graphs with a Prisma that will need turning off to see your breath data clearly. You should be able to find a few recent posts on the Apnea board to show you how to make it clearer if you search Prisma or Lowenstein.

Hi Macka! I have Prisma 20A for over a year and when I use SoftPAP 1 to 3, the flow limitations jump to 10-40 percent or whatever it says. If SoftPAP is turned off the flow limitation (FL) are always 0. So they are just not flagged when SoftPAP is off. I naively assumed that's when SoftPAP was turned off, the flow limits are 0.
There's one more chart - Obstruction level (0-100). Is this something similar to Flow limitation (FL)?
       

[Crimson Nape]

carnuntum - I moved your post from the Software Forum into your therapy thread. I changed your thread's title to be more inclusive, I have renamed it to, "carnuntum - Therapy Help Using a Prisma20". I will send you a PM confirming this, too.

- Red

[carnuntum]

Hello!
My pressures increased in APAP mode up to 16 recently when I stopped using the cervical collar because it had been giving me back pain for a couple of weeks. I also tried a different collar size and other pillows, that back pain stayed there for 3 weeks. I start to wake up more around 5:30 am. Overall, I wake up about 15-20 times throughout the night when I realize it. I don't feel well slept. I don't have as much energy as I did with that cervical collar, but even then it wasn't ideal sleep. My pressures are now 11 to 16 without EPR. Could a Bi-Level machine help me sleep better?

[carnuntum]

Hey, guys!

I have changed my machine from Prisma 20A to AirCurve 10 VAuto.  It's made a big difference both in comfort and overall less flow limitations that the Prisma 20A couldn't address. Right from the first night on the bi-level I am sleeping better. I still wake up a few times here and there, but that sleep is much better than it was with the Prisma. Aircurve made a big shift in breathing comfort. Is there any way to tweak this (increase PS) so I don't wake up at all, or is that a naive expectation? Still have flow limitations 99.5% 0.14. Using soft cervical collar.

My settings:
IPAP 13.2
EPAP 8.2
PS 5.0
Cycle Medium
TiMax 2.3
TiMin 0.3
Trigger Very High (I had centrals, on lower settings)
Ramp Off
Mask Vitera Full with Full face settings in menu.



       
Here's what my Flow limits looked like with Prisma: