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Newbe , ASV and min EPAP.
#11
Hello Mongo,

is it Uelzen or Uelsen?
The first one is near Hamburg, the other one is near the Dutch border.
People mix them up very often. Have you been there?

Yes, my results are very good. Thats one advantage of the ASV machines. They work like a swiss cronometer and it is very comfortable to use them.
On the other side I have done a lot to get my body in a good shape.
I do a lot of sports, at least one hour a day, startet to cook my meals with fresh produkts(no more junk food), don´t drink, don´t smoke and got married to a wonderful ukrainian girl.

Greatings from Germany
Hermann

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#12
It's Uelzen. Located in Niedersachsen. It's a north-south and east-west rail hub.
The district includes towns like Rosche. And, they have a Nordzucker plant.

My friend is retired from the railroad. He helped me research the shootdown of a B17 bomber that came down in Wittingen, 18 March 1945.
He is one of the authors of the book: Uelzen und die Eisenbahn.

This Veteran is medicated for your protection.
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#13
Hermann, I read your original post and the symptoms you have been suffering. ASV Auto is a wonderful technology, and it can be a bit intimidating. I know of some people that obtained zero AHI, yet remain uncomfortable. You can make some adjustments to the therapy pressures and observe the results and comfort level and this trial and error approach can improve your results, and your comfort. The best part is, you can conduct these experiments safely, and if the results are not in the right direction, you can revert to the last settings that worked.

So, looking at your graphs and pressure results, a few things stand out to me. While there are no "events", your machine is quite active, which means it is frequently providing higher pressure to prevent centrals. You also have considerable flow limitation. Neither of these are hurting the efficacy of your treatment, and are more than an acceptable trade-off for the increase in comfort that your lower EPAP has allowed.

I think it's great when patients can make small changes, and observe the results. In your case the results are certainly for the better...stick with it. I'm sure the doctor would agree.
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#14
(02-05-2016, 10:08 AM)Sleeprider Wrote: So, looking at your graphs and pressure results, a few things stand out to me. While there are no "events", your machine is quite active, which means it is frequently providing higher pressure to prevent centrals. You also have considerable flow limitation.
Thank you Sleeprider for your reply.

Of course my machine is quite active. I believe that is the reason why I need it and why my insurance is paying for this very expensive piece of high tech.

I swiched the machine to straight CPAP 2 month ago. Just out of interest what would happen. Since the first sleep study there has been a lot of changes to me and my body. I was courious if I still need the ASV.
During this test I had a lot of obstructiv apnoes with pressure below 11 and above that it changed more and more to centrals.
The total numbers of apnoes stayed nearly unchanged.

The reason for that is unknown. My heart is ok and I don´t suffer from any other desease.
So I think the machine is doing what it is supposed to do and as long as I have 0 events and I am feeling ok.
I will slowly adjust the pressure to get the best comfortlevel that is possible.
Do you agree with that?

greetings
Hermann
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#15
(02-05-2016, 10:49 AM)HermannTheGerman Wrote: I will slowly adjust the pressure to get the best comfortlevel that is possible.
Do you agree with that?

greetings
Hermann

I'm pretty sure that's what I said. Thinking-about

Good work, nice to have you on the forum. Perhaps you can help others with questions about their ASV. Your personal experience will be valued by those with little of their own.
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#16
(02-05-2016, 10:49 AM)HermannTheGerman Wrote: I swiched the machine to straight CPAP 2 month ago. Just out of interest what would happen. Since the first sleep study there has been a lot of changes to me and my body. I was courious if I still need the ASV.
During this test I had a lot of obstructiv apnoes with pressure below 11 and above that it changed more and more to centrals.
The total numbers of apnoes stayed nearly unchanged.

A few suggestions/guesses for you to consider.

Not sure what your Min PS setting is, but you could try increasing it to see if that might help avoid the sweating.

Conceptually, if obstructive apneas are occurring below 11 when in standard CPAP therapy mode, I would think EPAP should be 11 or higher when in ASV (non-Auto) therapy mode, and should be allowed to raise itself to at least 11 when in ASVAuto therapy mode.

Might be interesting to gradually increase Min PS near to your median PS, and then try gradually increasing the Min EPAP and Max EPAP.

But, on the other hand, after gradually raising the Min PS at least to 2, perhaps it would be best to leave EPAP alone and, instead, make sure you will not roll onto your back while asleep.

Obstructive Sleep Apnea is usually strongly positional, and sleeping flat on our back "supine" usually requires higher pressures to treat, which can aggravate complex/central sleep apnea.

If we take measures to prevent the possibility of rolling onto our back while asleep, this will usually lower our pressure needs, which often lowers the number of CA events we get, too.

Some 'PAP users have found marvelous improvement by making sure we won't roll onto our back while asleep. Some sleep wearing a light knapsack on our back with something light but bulky in it. Others sew a sock or pockets onto a teeshirt with a couple tennis balls inside, between the shoulder blades along the spine. Others use long body pillows under the sheet to help remain on their side. Others sleep in comfortable recliner chair so the head and neck are elevated but stay aligned. Whatever it takes.

Take care,
--- Vaughn


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#17
(02-06-2016, 05:57 PM)vsheline Wrote: Not sure what your Min PS setting is, but you could try increasing it to see if that might help avoid the sweating.

min PS is 2 and max PS is 15.

(02-06-2016, 05:57 PM)vsheline Wrote: Conceptually, if obstructive apneas are occurring below 11 when in standard CPAP therapy mode, I would think EPAP should be 11 or higher when in ASV (non-Auto) therapy mode, and should be allowed to raise itself to at least 11 when in ASVAuto therapy mode.
I want to raise the max EPAP in smal steps to 11 or above.
Went to 10 last night in autoASV.
The EPAP Pressure stayed around 6.6 med and 7,8 95%.
I will contiue to raise the pressure, but if the machine doesn´t use the possible higher pressure, I don´t believe that there will be any change.

Hermann



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#18
Welcome to the forum, Hermann. Your story is absolutely amazing. I felt like I was out of breath when I finished reading it.

Best Regards,

PaytonA
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#19
Here is a screenshot of my last night.
I kept the min EPAP at 6, because most of the time I am laying on the side and pressure is enough at 6.

Max EPAP is at 10 at the moment, but I believe that this is still not enough.
When I lay on my back there is lots of snore and flow limits.
The EPAP increases to 10 and stayed there for nearly 30 minutes because of the snore and flow limits.

I am going to increase max. EPAP and find a way not to lay on my back.

Screenshot

Hermann
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#20
Looks to me like you are on the right track but I am not an ASV user.

Best Regards,

PaytonA
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