First month with CPAP, looking for guidance

[alkaliusmaximus]

Hey,

I received a Löwenstein Prisma 20A roughly a month ago after having my first sleep lab visit. My initial home screening showed AHI 17.5, they did not re-check at the lab but immediately started me on a CPAP trying to find some settings for two nights. First night I slept for 2 hours max, second night was better. 

Prescription was a Prisma Smart Max in CPAP mode at 8mbar, softpap 2. They also set me on a 20min ramp that I turned off after two nights because I felt like suffocating with the P10 at 5mbar. 

I own a Wellue O2 ring so I had more than enough O2 graphs from before treatment and noticed that despite low AHI, my O2 graphs at 8mbar did not look much different than before. 

At the moment I am using mouth tape and a Futuro soft collar, also own a knightsbridge chin strap but I don’t feel it makes any additional difference when using the collar. 

Sleep lab prescribed a P10. They also gave me a N30i because in size I am between M and L where L leaks and M irritates my nostrils like crazy. N30i leaks for me unfortunately even with the dreamwear strap. 

Both masks wake me up regularly with chipmunk face, do you think I should give FFM a try?

At the moment I am playing around with APAP mode around 11-14mbar, softpap 2-3, last night I even had it off. That was the first time PrismaTS showed zero eFL and AHI. SleepHQ and Oscar still show AHI close to 2. O2 graphs is better but still shows regular dips above 90%. I will add a screenshot of last night without softpap as an example. I will also add a link to my SleepHQ data. 

Could you give me any advice on how to proceed? Do you think I need more pressure to treat flow limitations that my Prisma doesn’t show? 

Edit: with less than 4 posts I am not allowed to post links, will add these asap, but I’m usually not one to spam stuff just to reach minimum post count.

[Jay51]

Here are some tips on setting up the PrismaLine machines: 

1OSCAR Optimisation for Lowenstein


Please to upload some OSCAR charts here when you can.   

You can use the remaining posts that you need to post before you can upload OSCAR to ask any questions about the above articles on the Lowenstein PrismaLine machines.  The minimum post requirement is necessary to help stop spam, etc.

[alkaliusmaximus]

Thanks for your advice.

I read that article some time ago but didn’t really use OSCAR since it gave me a warning about my 2024 model Prisma 20A being unknown and I wasn’t sure if it was to be trusted that much. I thought maybe SleepHQ public link would be easier but I can do some OSCAR screenshots of course.

I also wasn’t sure if OSCAR and SleepHQ FL flags are to be trusted since Löwenstein uses eFL markers and as soon as softpap is turned off - no more FL flags in OSCAR/SleepHQ. But I feel PrismaTS is quite lacking. Rounding AHI and such.

[Jay51]

Good points.  Everything may not be flagged 100% correctly, but by uploading the OSCAR charts, we might be able to see something that we can give suggestions to try to help.   More eyes looking at your data will give better analysis and suggestions.  Many, many members here with experience looking at charts and helping others.

[alkaliusmaximus]

Here are my last three nights in OSCAR. Pressures are not displayed correctly, they were set as followed:

Friday: APAP 12-14, Dynamic, softPAP 3
Saturday: APAP 11-14, Dynamic, softPAP off
Sunday: APAP 13-14, Dynamic, softPAP 3 (for EPAP of 10mbar min. since softPAP off the previous night showed 0AHI on the machine itself).

And yes, I know I'd have to stick to specific settings for quite a while to have comparable results.

           

[Jay51]

Thank you for posting those.  

Fairly similar each of your 3 charts IMO.  

Some leaks on all 3 charts.  

• 1Mask Primer
  

A few H's scattered across all of them.  The usual remedy is increasing softpap as much as possible.  Can also raise epap more. 

Which of the 3 night's did you feel the best?

[alkaliusmaximus]

           

I can’t tell which night out of these three I felt best honestly. I feel like with a nasal mask these pressures are too high for me already since even with collar + strap + mouth tape I get regular chipmunk cheeks that wake me up, no matter if I lay on my side or back. Also, as you mentioned, leaks start to get noticeable. SoftPAP 3 is the highest there is which gives a short boost at start of inhale on top of set inhale pressure.

[Jay51]

It seems like you are getting close to maxing out optimization on this particular machine.  

2 possible ways to go here IMO. 

1.  You could raise pressure a bit more (epap) to see what happens.  You may have more leaks and disomfort. 

2.  Since your chart is pretty clean (some random H's) you could even try lowering pressure a bit (epap) just to see if you can get away with it (you don't start having an increase in events (OA's, H's, etc.).

[alkaliusmaximus]

Here is my SleepHQ btw.
SleepHQ Link

I got a cold beginning yesterday and did not want to hassle with leaks and such, so to get some rather undisturbed sleep I gave APAP 8-12 another try. Strangely resulted in a good night. Even O2 graph looks clean, but it was not that way previously with lower pressures. I tried it recently as well and O2 was worse than the 3 example graphs I posted. So I don't know if this is just my recovering body sleeping deeper and better or if that's the way to go forward with. Obstruction level is higher though and I believe that is the Löwenstein equivalent of the flow limitation graph.

   

[Jay51]

Your cold may have something to do with your results last night. 

Try a couple of more nights like this to see a pattern (or even wait until your cold is completely gone to start).