Early morning events

[RRR]

Since starting ASV recently, I find I have very few events during the night until the early morning hours, about 1-2 hours before awakening. Then there is periodic breathing with episodes of hypopnea. The ASV appropriately increases the pressure during these episodes to avoid apnea but the flow rate is decreased. I wonder if this results from REM sleep in the early morning hours. Are there adjustments in my settings that might prevent the periodic breathing and hypopnea in the early morning?

Thank you,
RR

screenshot-20200708-094400.png

[RRR]

I forgot to include my current settings:

screenshot-20200708-102719.png

RR

[Pugsy]

Can you show the flow rate just prior to the start of the clustering so that the cluster beginning is more on the right side of the zoomed in image. Maybe make it a 4 to 5 minute segment instead of 3 minute.

The 05:38:00 to 05:38:30 flow rate looks more like arousal or awake breathing to me but it's hard to say without seeing the flow rate immediately prior to that time frame.

[RRR]

Pugsy - This is a shot of the flow rate just prior to the clustering:

screenshot-20200708-123816.png

RR

[Pugsy]

zoomed out too much...that's 45 minutes and everything is too scrunched together.
how about 4 or 5 minutes just prior to the 05:38:00 time frame.
No rush...I am off to a doctor appt and won't be back online until later.

[RRR]

Pugsy - here are some tracings just before and after the clusters. Maybe I was awakening and then fell back to sleep for a while before getting up for the morning.

RR

screenshot-20200708-133027.png

[Pugsy]

Man I hate hyponeas...so hard to evaluate sometimes. I tend to think awake/semi awake breathing irregularities are what we are seeing and not real asleep events.

Looks to me like you started having some arousals around 05:18:00 and not entirely sure you were totally asleep just prior to that time frame.

If you are seeing these every night...might try a little more minimum EPAP and see what happens but if they are awake/semi awake breathing irregularity flagging it won't help.
I once had 17 centrals in 17 minutes...one a minute and they looked classic periodic breathing as in Cheyne Stokes Respiration looking. It was about 90 minutes before I woke up. Very similar to the time frame where your clusters are happening. It's possible that it's a REM worse OSA thing (I have that myself) but it is also possible that they are arousal related and you just don't remember the arousal. When I had my cluster I didn't remember being awake but that doesn't mean much because we don't remember arousals more often than we remember them. Since what happened to me didn't become a habit I just shrugged my shoulders and moved on. If I had seen it happen every night I would have investigated further.
Even now I will sometimes have arousal related clusters of either OAs or hyponeas at about the same time frame...they aren't big clusters and they don't happen every night so I just chalk it up to being half awake. Since I have crappy sleep anyway from the back pain stuff I have....I always have more SWJ flagging than I do real asleep flagging.

Your choice as to what you want to do about them. It won't hurt you to try a little more EPAP if you want to. I don't think it is anything critical though as long as you feel that you are sleeping well in general and feeling okay during the day.
You might also try a small increase in the PS and see if that helps or not....like around 0.5 cm increase in PS.
Hyponeas are usually fairly easy to kill off (assuming they are real asleep hyponeas) with either a little more EPAP or PS.

If that were my report and it wasn't an every night thing....I would just shrug it off because it is so iffy in terms of whether or not you were actually asleep or not. It looks more arousal related to my eye but it wouldn't hurt to try a little change in the settings and see if it eliminated those little clusters or not.

[RRR]

Thanks for your advice Pugsy - Since these are not really interfering much with my sleep or causing daytime somnolence, I'll see how it goes for a little while. If they persist or cause more symptoms I'll increase the EPAP and PS as you suggest.

Thanks again!
RR

[zonker]

Man I hate hyponeas...so hard to evaluate sometimes. I tend to think awake/semi awake breathing irregularities are what we are seeing and not real asleep events.

man, do i agree! i KNOW why i get obstructives(for me, lying on my back) and i can even make a guess that a central is false or maybe turning over in my semi-sleep.

but hyponeas! what the....