Newly Diagnosed

[venno]

Hi All

After many years of suffering nights of bad sleep, always waking up tired with a headache and frequently waking up to go to the bathroom I finally did a sleep study and was diagnosed with severe obstructive sleep apnea. My AHI from the study was 67, not sure exactly how extreme that is but sounds pretty high.

Not knowing much about OSA I did some research and got a Lowenstein Prisma 20A with humidifer and 4G modem and coupled this with a Resmed F30i full face mask as I am a side sleeper and combined nasal/mouth breather (never mouth breathed before, it jus crept in over time as the OSA became worse I suspect). Went thru all the manuals and setup machine using CPAP reviews tutorial as a guide and starting point:

APAP with dynamic algorithm
Soft start 10mins 4cm H2O
Auto start/stop on
Pressure min 6cm max 16cm H2O
softPAP set to 3
SmartAqua on with humidty 3

Tested machine and then adjusted for mask fit, I would say I set the straps for a slightly tighter than medium feel. I plugged in the modem and it connected then downloaded something that took 10mins, I can't really find any control/settings/options for modem but I did download the Prisma app and pair to the modem. I parked anything further to do with modem as main goal was to test machine in real usage.

Put mask on and checked each side sleeping position for clearance and airline free from obstruction, also did a mask test to make sure it didn't leak too much in either position. I have purchased a side table mount hose holder to feed air hose down towards bed to try and prevent entanglement issues. Then tried to sleep, which was initially weird as I seemed to be fighting the airflow but I quickly got used to it.

I managed a solid 2.5hrs which is actually a good result as I usually wake up needing to go to bathroom on the hour. I did notice that when I took off my mask the machine went nuts and ramped the pressure, not exactly my idea of an auto stop. Back into bed put mask on and auto start did not happen, I had to wake machine up and press go again. This time I managed a solid 3.5 hrs, that hasn't happened in a long time, woke up feeling pretty good and no headache.

I may modify some settings for next sleep, will set humidity to 4, increase soft start time to 15mins and set APAP mode to standard.

I installed Oscar, created profile and then uploaded SD card data. The software can't detect my model but does recognize it as a Lowenstein and suggested it was similar enough to other ones and imported the data. On the daily view it comes up as an unknown Prisma line. The PAP mode was correctly detected as APAP dyn and the min pressure as 6 but the max pressure is showing as 6 also. All other parameters were correctly detected.

I have done minimal research on how to interpret the Oscar data but some of the obvious stats seemed very encouraging with the headline AHI being 2.83. I assume the following are important figures:

Hypopnea 2.47
OA 0.35
LL 0.14%
VS 24.03
FL 20.32
Deep Sleep 33.58%

I think with more understanding of Oscar and the data I will be able fine tune and track the therapy, I assume if all goes well over time the gains become a dimishing return and harder to eake out. For the monment I am just happy that I can use the device and mask to produce a good sleep outcome (compared to previous) and I at least won't face obstacles related to getting used to therapy and mask fit.

My O2 ring arrived today so that will be the next device to setup and configure in Oscar.

Appreciate any comments related to settings, measured results and machine integration. I'm thinking maybe the modem wasn't necessary but time will tell.

[Deborah K.]

I know nothing about Prisma machines, but I suggest you raise your starting pressure to 7. That's the lowest that works well for most adults.

You'll get lots of responses if you post an Oscar chart or two.  Those charts tell us tons about each night's sleep, and we base most advice on the charts.

Again, welcome, and best wishes for achieving great therapy and comfort!  

[venno]

Cheers Deborah K

Well second night was very different from first, got a longer sleep but woke up twice plagued by mask issues. Maybe I just fluked it on the first night but the second night I just couldn't seem to get a good fit, woke up feeling tired but at least no headaches.

I will drop the humidity back down a level, I found the increase to be a little uncortable and too warm. Unsure as to whether to stick with standard APAP or switch back to dynamic.

Figured out the auto start/stop, the stop behaviour is correct as observed. In order to auto start again you must refit mask and breathe before display screen times out, so breaks longer than a few minutes will require manually starting therapy.

On a plus it lloks like the O2 ring is working well and data import is realtively easy.

I have taken a few screen shots of last nights effort, I am slowly learning what each category is but as to what the normal/desirable bands are......?

   

   

   

[Deborah K.]

Your flow limits are extremely high.  Raise your machine's version of EPR to its highest setting.  If you are already there, you may need a bilevel machine.  If that is the case, I suggest you get a ResMed AirCurve 10 Vauto instead of another Lowenstein.  The ResMeds are the best. I had to make the jump from an AutoSense to the machine I suggest.  I did it with Sleeprider's help, along with others.  In case you are interested, my journey to getting the great machine is detailed in the very long thread I provide a link to below this post.

As to the air being too warm, you should be able to turn down your heated hose to a lower temperature setting.  That should help.

Standard and dynamic are Lowenstein lingo.  Maybe they are like Standard and Soft for ResMed, but that's just a guess.  Hopefully, someone else can advise you on that.

I hope things settle out comfortably for you soon.

[venno]

I still can't find anything definitive on functional difference between the 2 APAP modes but for me I think dynamic works best. I notice now that the machine screen stays on when removing mask and waits until turned off or breathing resumes, which would be the expected behaviour of auto start.

I am considering disabling soft start as I am unsure whether a low ramp up pressure time is beneficial. For whatever reason, the flow limits graph is not present in Oscar.

Last nights chart:

   

[venno]

Last nights sleep was pretty good, still can't seem to manage more than about 7hrs though. I had one bathroom break and also a one fitful period were I think I turned over and mask may have dislodged. Can I get some insight commentary on the stats/graphs, cheers:

   

[Deborah K.]

Your pressure charts confuse me. It's set at 7 to 7, yet your pressure goes way higher than 7. Set the pressure settings to 8 to 9 and post a chart tomorrow.

Again, I don't understand Lowensteins, but give that a try and see what happens, and if you sleep better.

[Jay51]

I am like Deborah, I don't know that much about the Lowenstein Prisma machines. 

But since you are already using SoftPap level 3, that is the highest it goes I think.  

About the only other 2 things that you might try would be 1.  raising pressure (Like Deborah suggested).  Or 2.  Maybe try some positional apnea techniques to try to lower your large amount of flow limitations.  You do have 2 Hypopnea clusters it looks like.

[venno]

Cheers Deborah and Jay

Oscar doesn't fully support the Lowenstein 20A and one of the parameters it doesn't read right is pmax, the machine is set to 16.5 cmH2O pmax.

I have also found out that the 20A doesn't produce graph data for flow limits it justs records these episodes as event flags and it would seem this is not always accurate.

The softpap setting of 3 is highest and I think this works quite well, although I have nothing to compare to as I have never used any other machine (such as a resmed with epr).

I think I am having mask leak issues as I turn over at points in my sleep causing slight dislodgements, I wonder if this would create so many flow limitations?

[Jay51]

Here are some tips from our Wiki:  something in here might help your specific situation: 

• 1Mask Primer