Lowenstein wants higher pressure than ResMed-how high can I go?

[Poolboy]

   

Hi people.

I finally got my new/used Lowenstein Prisma Smart APAP/CPAP machine back from repair and am trying to optimize its settings. 

 At first  I set it up the same as my ResMed As 11,  Auto, P Min 12.5 Cm, and P Max 15.5 Cm., Epr 2.  (I have used the ResMed for 1.5 years).  At that Auto pressure range and similar Epr setting, the Lowenstein held Max pressure all night, rather than providing the ResMed's Automatic response of Median pressure 13.23 and P 95% 14.5, at the same settings.  Since then I have played with the Lowenstein's pressures and now it's set to Min 9, Max 17.  Epr is still 1.5 Cm relief.  The Lowenstein is still keeping me on the ceiling most of each night,  right at the Max pressure I've set.   

With the Lowenstein my AHI is typically 1.5 or less, so I think it is running higher pressure in response to my flow limitations and Respiratory Effort events.  They are indicated in the Events Flags as FL and RE,  and there are a LOT of them.  My screen shot includes a chart called Obstruction Level,  which must be Lowenstein's way of showing Flow Limitation severity. 

When using the ResMed, which is set at EPR 2, it keeps my AUTO pressure below its Max setting of 15.5 Cm.  That tells me it is satisfied with the residual flow limitations,  and it does not "want" to apply more pressure to try to eliminate them. (My ResMed FL is typically Med=0, 95%=10, 99.5%=24 )  My Flow Rate chart also looks jaggy with the ResMed.

** I am currently trying a Soft Cervical Collar but it's not improving my flow restrictions. 

Question 1 - I want to increase the Lowenstein's Max pressure to deal with these flow restrictions, but I don't know if there is a pressure I should not go past, 20, 21, 22 Cm, . . . ?) without  medical oversight ??

Question 2 - My Flow Chart looks so jagged compared to many, or most, I see posted here.  I suspect this is caused by my flow restrictions. Does that jaggedness need correction?  (The Lowenstein machine reports deep sleep, and I have seen significant amounts of it on other Lowenstein users screen shots,  but I have almost none. I think my jaggy flow rate and Respiratory Effort events may be the cause).

Question 3 - Have other Lowenstein users who switched from ResMed found that the Lowenstein unit needs very different settings from the ResMed in order to achieve similar results?

Thanks for your time to read this, and for any feedback.

[tpone]

I have switched the other way from Lowenstein Prisma Smart to Resmed Aircurve 10 Vauto. Pressures were a lot higher than Resmed and Resmed managed better AHI. I don't know if we can make this a generalisation about the machines in all cases because there are many people happy with what Lowenstein does for them.

However, Lowenstein also handles EPR differently to Resmed. It gives only momentary pressure relief and then starts building up pressure immediately regardless of inspiration patterns. Resmed seems to match your breathing pattern more closely which I found a lot more comfortable. One other issue that affected me was that Lowenstein was often out of sync with my breathing - ie it did the exhale thing while I was trying to inhale. There are no adjustments to change its timing and the only option being to disable soft pap ( EPR)

[Jay51]

I think I understand your dilemma.  You are trying to optimize your therapy with the Lowenstein machine, but the softpap is not working that well for your.  

In regards to question #1 - My Pulmonologist gave me a general rule with ventilators (I have one, but you just have the CPAP/APAP machine).  If you ever experience any chest pain or lung pain when/if you decide to increase your pressure more, then stop.  It looks like you are around 17 or so right now.  

If you go up in pressure, go slowly and use the rule above.  Carefully note any changes to your body, etc.

[Poolboy]

Hi Tpone.  Thanks for your feedback. I agree the Loewenstein EPR feels very different. The low level helps reduce my flow limitations, but the high level actually makes them worse.  With the Resmed my flow limitations continue to reduce as I move up to the highest EPR level, but the highest level increases my CA events, so I keep it set at 2.

Jay51.  Thanks for that information. It  seems like a very good guideline I will pay attention to .