Individual tutorial documents are available at request for detailed information on setting up devices. In addition, refer to “Instructions for use” for patient guide, and “Additional information for experts for WM 100 TD devices” for clinician guide.

SOMNO: Pull away the white plastic cover at the rear of the device to reveal the filter
compartment.
Prisma SMART/SOFT & Prisma20C/20A: The filter compartment is located just above the power port at the rear of the device.

SOMNO: Serial number is 6 digits and is directly on the bottom of the device,
designated by “SN:”
Prisma SMART/SOFT & Prisma20C/20A: Face the screen and look on the right triangular side of the device, the serial number is 6 digits (Prisma SMART/SOFT) & 8 digits for Prisma20C/20A.

SOMNO: The SD card port is mounted on the side of the device, to the right of the
screen and buttons. It has a rubber cover.
Prisma SMART/SOFT & Prisma20C/20A: Face the screen and look on the right-side triangular face of the device. There are 2 rubber covers, pull away the lower one to extract the SD card.

Firm touch and hold is required when using the Prisma20C/20A touch screen. The screen is thick and durable compared to the more sensitive and fragile smart phone screens.

Connect the device to the computer by either micro USB cable (Prisma20C/20A), or by inserting SD card into the computer (all models).
• Detailed statistics can be viewed, and a report generated online using the URL: https://www.prismajournal.com/?lang=en (Tutorial available on request)
• High resolution therapy data and reporting requires the use of PrismaTS software, downloaded to the computer. (Tutorials and software setup files available on request).

Yes, all APAP devices (SOMNObalance e, Prisma SMART, Prisma20A) also have CPAP mode.

SoftPAP is the Löwenstein name for pressure relief which provides reduced pressure during expiration. 1 is mild relief, 2 is moderate-high relief. 3 is available on Prisma20C/20A only and provides additional support on inspiration as well as moderate-high relief.

Per title, softSTART is the Löwenstein name for ramp. A ramp pressure can be applied which is the starting point, as well as a timeframe. The device will then gradually work its way up to prescribed therapy parameters over the course of the timeframe.

If the clinician has not deactivated ramp, ramp can be deactivated with one touch once therapy has commenced. The same one touch can reinstate ramp if the ramp timeframe expires and/or the patient wakes up and feels the need of putting on ramp to fall asleep again.

SOMNO & Prisma SMART/SOFT:
Press the ramp button once (indicated by the symbol below), the
symbol will disappear from the display and ramp is deactivated. Press
the button once to reactivate ramp.
Prisma20C/20A:
Ramp is on when the symbol is lit up green with a number which is the remaining ramp cracked or damaged components of the humidifier.

2 different algorithm modalities available in Prisma SMART & Prisma20A. Standard is gentle compared to dynamic, especially useful for a new user becoming accustomed. Dynamic is more responsive to mild flow limitations therefore optimising the result. Some users have a preference one way or the other.

The question is subjective, review the individuals needs, severity of apnoea and decide whether a gentle treatment will suffice for the beginning or if the more responsive treatment is appropriate. Change according to feedback signals from patient, see:
• Patient says they need “more air”, what should I do?
• Patient says they need “less air”, or says pressure is too jumpy/waking them up,
what should I do?
• Patient is complaining of chest pain, what should I do?

Yes, the dark grey air filter is washable and should be washed monthly. It has a service life of 6 months before replacement is advised. Pollen filters are not washable and have a service life of 1 month before replacement is advised.

There is no specific recommendation for pollen filters. Pollen filter comes as standard in the SOMNO device only. It is an optional accessory for Prisma devices and is often not used.

Refer to “Instructions for Use” for each model for detailed cleaning and replacement advice. Below is a generic cleaning and replacement schedule:
Weekly – clean device, respiration hose and humidifier.
Monthly – clean air filter, replace pollen filter if installed.
6-monthly – replace air filter.
Annually – replace respiration hose.
As necessary – descale the humidifier, disinfect the respiration hose, replace any cracked or damaged components of the humidifier.

Available with Prisma20C/20A. Device must be on and humidifier connected and filled with water. Press humidifier symbol once so that it lights up green, the humidifier is now preheating.

SOMNO
Either: a) remove humidifier tub and replace with white cover, b) press the humidifier button once while therapy is active, the humidifier symbol will disappear.
Prisma SMART/SOFT
Either: a) remove humidifier tub and replace with black side cover, b) press the “-“ button while therapy is active and reduce humidity level to “0”.
Prisma20C/20A
Either: a) remove humidifier tub and replace with black side cover, b) press the humidifier symbol so that it goes grey instead of green, this means the humidifier is deactivated.

Sensors will switch off the heating element to avoid overheating. The device will continue to run without issue.

Generally, yes. Patients are responsible for ensuring they select water of appropriate quality and wash the humidifier components frequently as per cleaning instructions.

Use the heated tube which came with the device or purchase one. If already using a heated tube, check it is working. If the problem persists or you do not want to use a heated tube, reduce humidity level.

Cease using heated hose. If it is still too hot, reduce humidifier level. If it is still too hot, try therapy without the humidifier.

Increase humidification level. If problems persist review leakage as humidity escapes during leakage. High leakage warrants adjusting the mask fit and/or changing mask. If leakage is unremarkable and increased humidification does not work or causes unwanted side effects, consider using Prisma20C/20A with Smart Aqua Control feature which compensates humidity during leakage.

Check the patient’s apnoea’s, hypopneas, RERA, snoring and flow limitation. If obstructive apnoea’s, hypopneas and/
40 years
99 minutes
84 minutes
Age
Women
Men
or RERA & snoring are high,
incrementally increase one or
both pressure setpoints (APAP)
or fixed pressure (CPAP) and
review improvement. If flow
limitations are high, either increase pressure slightly or change to APAP dynamic. If central apnoea/hypopnea is high, ask the patient if they feel like they need “more air” or “less air.” If yes, follow the steps below for “more air” and “less air”. If not, consider changing to a BiLevel device.
If AHI and events are acceptable, review the deep sleep indicator according to
below charts for age. Consider looking more deeply into patient comfort factors (i.e. humidity, pressure relief), comorbidities (i.e. other conditions or diseases) and lifestyle factors (i.e. sleep hygiene) to try and improve the deep sleep indicator.

Do not disregard the feedback, comfortable treatment and patient adherence and tolerance carries over to good health!
Ask the patient when they need more air, is it:
1. At the start of therapy?
2. After a few mins in (during or at the end of the ramp timeframe)?
3. When they wake up during the night or in the morning and feel like they need air? 4. A combination of 1 or more of above.
Any changes made should be incremental, and the new data carefully reviewed again before changing too much all at once.
If 1, we recommend trying the following in this order until satisfactory result is achieved: increase ramp pressure if ramp is activated, deactivate ramp, increase the P min (if APAP) or set pressure if CPAP.
If 2, we recommend trying the following in this order until satisfactory result is achieved: reduce ramp timeframe if ramp is activated, increase P min (if APAP) or set pressure if CPAP, deactivate ramp.
If 3, we recommend trying the following in this order until satisfactory result is achieved: change APAP to “dyn” or increase rate of pressure rise on SOMNO, increase P max (if APAP) or set pressure if CPAP, increase P min if APAP.
If a combination, apply a combination of above recommendations.

Do not disregard the feedback, comfortable treatment and patient adherence and tolerance carries over to good health! But remember it is quite normal for a patient to take a little time to become accustomed.
Ask the patient when they need less air, or when it is too jumpy, is it:
1. At the start of therapy?
2. After a few mins in (during or at the end of the ramp timeframe)? 3. When they wake up during the night feeling like they need air?
4. A combination of 1 or more of above.
Any changes made should be incremental, and the new data carefully reviewed again before changing too much all at once.
If 1, we recommend trying the following in this order until satisfactory result is achieved: activate ramp if deactivated, decrease ramp pressure if ramp is activated, decrease the P min (if APAP) or set pressure if CPAP.
If 2, we recommend trying the following in this order until satisfactory result is achieved: activate ramp, increase ramp timeframe, decrease P min (if APAP) or set pressure if CPAP.
If 3, we recommend trying the following in this order until satisfactory result is achieved: change APAP to “std” or reduce rate of pressure rise on SOMNO, decrease P max (if APAP) or set pressure if CPAP, decrease P min if APAP.
If a combination, apply a combination of above recommendations.

Enquire whether the chest pain is a definite consequence of treatment pressure, if unsure they should consult their doctor or a specialist. Remember it is quite normal for a patient to take a little time to become accustomed.
In the meantime, we recommend trying the following in this order of precedence, through incremental adjustments:
• If CPAP is being used, change to APAP with a P min 2 units less than the CPAP set pressure and a P max 2 units more than CPAP set pressure.
• Change APAP mode to “std” if previously on “dyn” or reduce rate of pressure rise on SOMNO.
• Reduce P max.
• Reduce P min.
• Motivate patient, issues like this go away with long term adherence.

Check instructions for use for error code and apply any rectification steps.
• If there is no clear path to rectification, check for any visible damage.
• With Prisma devices, take off the side cover/humidifier and feel the foam inside
the rear air outlet for any moisture. If moisture is present, leave the device on it’s side for 2-3 days to dry out. Ask the patient if they have transported the product with water inside it.
• Check the breathing tube and/or mask is not blocked or kinked. If so, clear the obstruction and try again.
• Once all items have been checked, contact the company you purchased the device off and provide a detailed outline of the circumstances and the issue.

• CHECK