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+--- Thread: New APAP machine: Lowenstein Prisma Smart Max (/Thread-New-APAP-machine-Lowenstein-Prisma-Smart-Max)
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RE: New APAP machine - WisNaeMe - 03-21-2024
Might be worth tweaking your OSCAR settings so we can see a bit more information.
Turn off the Calendar and Pie Chart - that should allow us to see your daily Statistics and Device Settings.
Turn on the Event Flags - FL (Flow Limitations), DS (Deep Sleep) and possibly the Epoch flags too - (you will need to tick the appropriate boxes in the ‘Event Type’ dropdown (lower left of graphs) to get the added flags to show in the Event Flags chart.
Epochs are peculiar to Lowenstein and used to determine where pressure changes are needed. At a basic level, they point to the peaks and durations in the session that are triggering Lowenstein’s algorithm to adjust pressure. The OSCAR Wiki / Lowenstein thread gives more detail on this.
On the graphs, it would be useful to see the ‘Tidal Volume’ and ‘Resp. Rate’ charts. Lowenstein does not provide a ‘Flow Limitations’ graph, but the ‘Resp. Rate’ graph seems to act as a good proxy in its absence.
Prisma machines also import an ‘Obstruction Level’ graph into OSCAR, but this seems to be an aggregate of all obstructive activity, plus a bit of noise. It does seem to figure quite prominently in Lowenstein’s therapy model (it appears in their clinical app - PrismaTS, whereas FLs don’t), but it’s not clear how to make use of it or what the therapeutic rational for it is.
Turning on the FL and DS Flags, will give you a good indication of the spread (or clustering) of any flow limitations and give an account of when you were asleep, through ‘Deep Sleep’ might be better described as - stable respiration. It doesn’t necessarily correlate with AASM sleep stage definitions.
However, OSCAR does not display Flow Limitations when SoftPAP is off. So here, a combination of epoch flow limitations (eFL) and the Resp. Rate the graph, should give an indication as to their spread and intensity.
From the statistics in the chart you posted, Flow Limitations (FL) are reported at 0% - so SoftPAP is off, but your Epoch Flow Limitations (eFL), are reported as 30.33%, which suggests you might actually have quite a lot of FLs. But with your leaks rate currently so high, it is likely the stats are not particularly accurate or representative.
Making the changes (above), would allow you to establish what the actual FL situation is. As would simply turning SoftPAP on to setting = 1 (slight), which on your current IPAP of 7 would drop your EPAP pressure by 1cmH2O.
But it looks like your first port of call is addressing the mask leaks, as it is clouding the overall therapy.
As Sleeprider suggested, starting a new therapy thread incorporating ‘Lowenstein’ in the thread name should attract interest from those more familiar with Lowenstein machines.