trend for high AHI in early AM hours

[KallyA]

Greetings to all and thanks in advance for your dedication in helping those of us who are struggling.
I have not been on for awhile and I have a fairly specific question, so I am going to start a new thread here.

I have a trend of four days this last week where my last sleep segment on my charts has a high AHI, much higher than earlier in the night. My question is why my sleep would be so different during this time. I have wondered if the medications I take at night stop having an effect by morning (this includes progesterone and melatonin). I tried dual release melatonin with no change. I wondered if the room getting colder through the night might be a part of it ...can pulling a blanket up over the mask cause this?? I have wondered if mask slippage could cut off partial airflow around the mouth and cause this. Otherwise, I'm out of ideas.

I know I do have a problem with leakage, but that has not been so during these segments. Here is a sample of what I am talking about ... first chart is the whole night, second is the segment in question, third is a close shot of a portion of that segment, in case you can see something of value in it.

   
   
   

I feel pretty bad after waking up from a session like this and I am horrified by the numbers. Obviously it's very important to me to get control of this. Any insights would be greatly appreciated.

[SarcasticDave94]

Had you tried ASV Auto mode yet? If so, was there something that made that not a good choice? If you can use the ASV Auto mode, I'd set that. This will give an EPAP range instead of the static 12 you have now. At first, while reading your AHI issue, I was thinking it may be a SWJ / sleep-wake junk phase near the end of sleep sessions. Looking at charts, however, I am less inclined to think SWJ. Or at the least, not normal SWJ stuff.

Again, I'd like you to consider activating ASV Auto Mode. You could try EPAP Min 10 and EPAP Max 14 (which is 2 below and above your static 12), or some variant around that. You may need to experiment with a bit of trial and error to find your EPAP range. I have an idea you are getting Flow Limits and Hypopnea.

PS On one of your next charts push Flow Limit up on the OSCAR so it's visible OR alternate is to squish the graphs on screenshot you've got now to fit it in.

[jaswilliams]

To me it looks like your ASV is blowing as hard as configured an still not encouraging a breath. Increasing the max PS to 15 may help but it could also be positional with you chin tucking a soft cervical collar would help that.

[KallyA]

Thank you for your quick responses,

Here is a shot with the flow limits ...doesn't look like that's the problem

   

I had my doctor change my pressure up and down prior to this with terrible results each time. I'm pretty sure it is optimized and it works fairly well the rest of the night.

Allergy season is upon us, but I don't see how it could make a difference only in the morning hours. 

No chin tucking as I was lying pretty flat without a pillow.

Any other ideas???

[KallyA]

I am wondering if using an oral device that bring the lower jaw forward to open up the airway would be helpful. Has anyone used something like this along with their mask???

[SarcasticDave94]

I don't recall specifics on the oral devices, but it's seemingly hit or miss. More miss than hit though.