unsteady on feet

[elmtree2]

My husband has been using an auto-pap machine for four months now with various settings. His apneas were getting better for a time, then they were worse again. lately they have been trending up. Looking at his overview, there appears to be no rhyme or reason.

Two nights ago, I propped him up on his side overnight, nudging him every time he started to roll on his back. His apneas nosedived. For the previous 10 days his AHI on Sleepyhead showed:

9.71
6.34
4.73
9.27
3.36
18.58
5.94
7.52
14.20
13.06

Then propping him up, the last two nights they were:

3.54
1.03

He sleeps for 10 hours every night and takes two naps each day.

He is also getting up anywhere from 8 to 10 times each night. In the beginning it was 5 to 6 times per night. This bothers me as much as the apnea index.

The waking up seems to be mirroring the pressure increases on his machine: pressure goes up, he wakes and gets up. Our sleep doctor today changed his auto-PAP machine from a range of 8 to 12 to a CPAP at 10 cmH2O. Hopefully this will cut down on the wake-ups.

My question is this.

The last week or so, he has begun staggering around after being up for an hour or two. I've had to help him get back in the house a couple of times and help him upstairs for his nap. Once he naps, he walks upright again.

I took him in to our regular doc, and he said he can find no other reason for this other than he is not sleeping.

This is really scary and I can find no mention in any of the forums of exhaustion looking like this. Has anyone else experienced this?

[Pugsy]

Sounds like his sleep apnea isn't being well treated when he sleeps supine meaning the pressures may not be optimally set to deal with increased apneas.
When he sleeps upright...the airway collapse isn't as pronounced. Not as much pressure is needed..not so many apnea events.
What are his pressure settings?

Can you post an image of a typical "bad" night and one of the "good" nights? This would be the detailed daily graphs to include the AHI breakdown information on the left side of the SleepyHead daily detailed report and these graphs on the right
Events
Flow rate
Pressure
Leak

don't need AHI graph or if this is a S9 machine the mask pressure graph ...turn them off in Preferences/Graphs tab by removing check mark. This allows leak to come up into view.

[elmtree2]

Thanks for the response, Pugsy.

Yep. He is not being well treated, but we’re working on it. We have a new sleep doctor who is moving through changes.

I am hopeful that the change we made today to a CPAP setting of 10 cmH2O will keep him from being awakened so often in the night.

When I said that I had him propped up on his side – I meant just on his side. He is still sleeping flat, just on his side. The difference that has made the last two nights seems significant. Of course, two nights doesn’t make a trend.

For now I am happy keeping him on his side and seeing if the new pressure settings help alleviate the getting up so often. If that happens, then I’ll let him roll around a bit and see what happens there.

My concern today is the exhaustion and his staggering. I’ve not read anywhere that this is common in sleep deprivation and I don’t find any mention of it in the forums.

[kaiasgram]

elmtree, I may have missed some info along the way -- what is the breakdown of the high AHIs (Obstructive, Hypopnea, Central or "Clear Airway" ? I saw in the initial sleep study results that your husband had way more central events than obstructive (whether supine or side sleeping). During titration there were no central events recorded, but I'm wondering now what percentage of the recent AHIs are obstructive vs. central events.

[elmtree2]

Kaiasgram:

AHI Hypopnea Obstructive Clear Airway RERA

9.71 1.35 5.80 2.56 7.55
6.34 0.72 4.67 0.96 6.58
4.73 1.53 2.36 0.83 4.59
9.27 3.17 6.10 0.00 8.30
4.02 0.60 3.13 0.30 3.13
18.58 3.08 12.42 3.08 4.07
6.63 0.95 4.62 1.07 4.73
7:52 2.77 4.39 0.35 4.86
15.20 1.43 12.12 1.66 8.67
13.08 1.85 9.76 1.45 11.48
3.54 2.19 1.18 0.17 18.88
1.07 0.59 0.36 0.12 18.49


These are the previous 12 days. For the 94 days before this time, the obstructives averaged 2.83 and the clear airways averaged .69.

I admit to being a bit anal - I have a spread sheet.

[elmtree2]

it looked better in the preview.

[elmtree2]

i'll try again.

..AHI….Hypopnia…Obstruc…..Clear……RERA
..9.71…....1.35…....5.80…....2.56….…..7.55
..6.34…..…0.72…....4.67…....0.96….…..6.58
..4.73…....1.53…....2.36…....0.83……...4.59
..9.27…....3.17…....6.10…....0.00……...8.30
..4.02…....0.60…....3.13….....0.30…....3.13
18.58…….3.08….….12.42…....3.08……...4.07
..6.63…....0.95…....4.62…....1.07….…..4.73
..7.52…....2.77…....4.39…....0.35….....4.86
15.20…....1.43…....12.12…...1.66……....8.67
13.08…….1.85…......9.76…....1.45…....11.48
..3.54…….2.19…..….1.18…....0.17…....18.88
..1.07…....0.59…..…0.36..…..0.12…....18.49

[Pugsy]

The board format totally trashes any spread sheet data...as you found out but that is okay...we can figure it out.

Side sleeping (sorry I misunderstood the upright thing) also lessens the chance of the airway collapse similarly to sleeping upright and also lessens potential pressure needs which might account for the improved AHI when side sleeping.

I don't know about the daytime unsteady on the feet thing. All I would know to do is fix what obviously needs fixing and see what happens or remains that needs fixing and then work from there.
Poor sleep quality could be a factor...but then so could be other ailments.

[kaiasgram]

Thanks elmtree -- The question in my mind was whether centrals were a big percentage of the total AHI, and it appears they are not. Thanks for clarifying that.