Positional Apnea - Left vs Right side sleeping

[cinco777]

Since restarting my CPAP sleep therapy in late March, I have observed that I experience fewer Apneas and Hypopneas when sleeping on my left side vs sleeping on my right side (I trained myself not to sleep on my back as my sleep studies for REM sleep showed a 6X increase in OA & Hypopneas when sleeping on my back vs sleeping on my left side). I only slept on my back (required by technician) and my left side for my two sleep studies so have no sleep study data for sleeping on my right side.

I commented on these continuing observations in some of my earlier posts. Last night's sleep results showed the most dramatic difference that I have observed to date. I have included two charts, one that shows the full night: 11:17 PM to 7AM (7.40 Therapy Hours), and another that shows only the time period from 4:35AM to 7AM. I have annotated both charts to indicate when I was sleeping on my left side and when I was sleeping on my right side. I slept entirely on my left side for my first session/sleep period (11:17PM - 4:20AM) and experienced no Apneas or Hypopneas (4.99 THrs). I did have 10 FlowLimitations during this sleep period. For my second session/sleep period, I initially slept on my right side from 4:35AM to about 6AM (I noted and remembered the time on the alarm clock that I changed from right to left - I did not get out of bed). My right side sleeping numbers were 8 Apneas and 2 Hypopneas - I subsequently had only 1 Apnea and 0 Hypopneas while sleeping on my left side from 6 to 7AM. I also had 4 FlowLimitations from 6 to 7AM. The reason that I have been sleeping on both sides is that sleeping on one side all night usually leads to my having a sore neck.

I have considered other possible reasons for my having more Apneas and Hypopneas when sleeping on my right side such as a higher leak rate but have not seen a correlation. Has anyone else seen such results for left vs right side sleeping and have thoughts on why?

[mars]

Hi Cinco777

This may well be a shot in the dark but when I was learning about Gastroesophegal Reflux Disease (GERD) I read that acid reflux was less likely to happen if I slept on my left side, due to the position of the lower esophegal sphincter and the stomach. The reflux would have to move up against gravity.

Many of us with OSA also have GERD, so you may want to look into this.

cheers

Mars

[RiverDave]

How you you know you were on the left side for the 5 hours? As I recall, people tend to shift sleeping positions on a regular cycle (maybe 90 minutes?)

Might also be that your mask fits your face better when you are on the left side. I know my mask shifts positions on my face when I switch from left to right.

[cinco777]

Mars wrote

This may well be a shot in the dark but when I was learning about Gastroesophegal Reflux Disease (GERD) I read that acid reflux was less likely to happen if I slept on my left side, due to the position of the lower esophegal sphincter and the stomach. The reflux would have to move up against gravity.

Thanks for providing a credible explanation for my observations. My son (not in the medical profession but very well read on many subjects) visited the end of June and mentioned the same thing (GERD and gravity and right side sleeping) as a possible reason for my having lower numbers when sleeping on my left side vs my right side. I'll do some more research and also try some more experiments/changes - I sign myself up quite often as the chief "guinea pig tester". A month ago, I started taking two Tums after dinner each night and that seems to have reduced my bloated and gaseous feelings of discomfort when I awake during the night and again in the morning. I read your latest post (I'm so pleased that you are finally making some progress in getting answers and recommendations) and noted your comments about GasX and how it has helped. Tomorrow, I'll buy some and give it a try (I'll quit taking Tums for a week or two) and see if I can sleep on my right side and get numbers similar to what I experience when sleeping on my left side. Because of my tendency to get a sore neck while sleeping, I sure would like to continue alternating my sleeping sides during the night. Thanks again. Like many others on this forum, I'm pulling for you continuing to get answers and good advice, and helpful recommendations that start to make a difference in your treatment.

[Jason S.]

Hi Cinco777

This may well be a shot in the dark but when I was learning about Gastroesophegal Reflux Disease (GERD) I read that acid reflux was less likely to happen if I slept on my left side, due to the position of the lower esophegal sphincter and the stomach. The reflux would have to move up against gravity.

I have found this to be true. My incidents where acid rises up in my throat and chokes me have been either back or right side sleeping. Never had an issue on my left. I typically sleep on my left side but sometimes you need to change positions to avoid stiffness.

[cinco777]

Jason wrote

I have found this to be true. My incidents where acid rises up in my throat and chokes me have been either back or right side sleeping. Never had an issue on my left. I typically sleep on my left side but sometimes you need to change positions to avoid stiffness.

Jason, you and Mars are confirming/explaining what I have observed. Thanks. Now I have to figure out what I can do to resolve my problem. First, I'm going to try taking Gas-X after dinner and see if my right-side sleeping #s will decrease to the level of my left-side sleeping #s (< 1 AHI consistently). If that doesn't work, I'll try a week or two of just sleeping on my left side and see if I can figure out ways to keep from getting a sore neck (maybe a different pillow?).

I wish that I had some right-side sleeping #s from my two sleep studies but, as I mentioned, I only slept on my back (required by technician) and my left side. Maybe someone reading this thread has a sleep study showing both left-side and right-side sleeping #s and will share them (images of the results) via a post to this thread.

[cinco777]

I slept all last night on my left side and experienced an AHI of 0.1 (only 1 Apnea and 8 Flow Limitations total for the night: 7.41 Therapy Hrs). My weighted average Leak rate (w_Lavg) for the night was 33.6 LPM. My mask intentional leak rate is 33 LPM at my pressure of 8cmH2O. I got up twice for bathroom "visits". I woke up this morning with a somewhat sore neck from sleeping on just one side (left) all night but my discomfort disappeared rather quickly (maybe 10 mins or so) after getting up and moving about. I also observed that my stomach didn't feel bloated at all and I didn't burp any air during any of my "up" times nor this morning after getting up. I did take my 2 Tums after dinner last night and also my usual two Tylenols (500mg) - one before bedtime and another on awakening for my 1st bathroom "visit". The Tylenols, definitely, have helped me have a more restful sleep. They take the edge off any discomfort (I don't have any pain) while I am lying in bed waiting to fall asleep. I think they make a really big difference in how my neck feels during the night - I feel comfortable resting my face on the edge of the pillow (I wear a FF mask). As added background on my bedtime setup, I have my 6' hose connected with a clip to a cord hanging down from a slat in the canopy of my bed (4 poster King). With this attachment, the hose doesn't touch me nor does it cause the mask to shift position.

My next step in my left vs right sleeping experiment is to sleep all night on my right side and compare the results, both the sleep event #s and my overall feelings re a restful sleep and physical discomfort (burping air, sore neck, ..).

I've included an annotated chart showing last night's results (where I slept only on my left side).

PS: The 1st sleep session on the chart (only 5 minutes long) was with the Nasal-Aire II mask (Babette's mask tryout program) that I received yesterday afternoon. I wanted to see what it's leak rate was as I plan to use it as my mask tonight. My nose architecture (slotted, prior surgery) doesn't work with the regular nasal pillows masks (can't control the leaks) and I am hopeful the Nasal-Aire II will work as I would like to take a break from my FF mask now and then.

[feeling_better]

While one or more of the possible causes posted above may apply to some of the people, the asymmetrical position of the stomach does not make left side always better from sleep point. There are people who have fewer apnea on the other side! I had mentioned this a while back here in one thread. The other cause is the asymmetry of the two nostrils and passages (deflected septum). If a side is more constricted, sleeping on the side of the more open passage results in higher nasal blockage! It is well established that one of the causes of apnea is nasal blockage.

There is also a normal physiological condition/reaction -- the name of which escapes me now -- which, when one puts pressure on a side of the nose/face, say the right side by sleeping on the right side, opens up the passage on the other side disproportionally. This reaction is not truly symmetric for most people -- one side opens/constricts much more than the other, and I believe this is normal too.

[cinco777]

Feeling_Better wrote

There are people who have fewer apnea on the other side!

I would be interested in hearing from folks who have better "quantitative" results - more restful sleep and lower #s - sleeping on their right side. I'm also interested in seeing the results for anyone who has sleep study results for sleeping on both their left and right sides - my sleep studies only reported on back (supine) and left side sleeping.

As you commented, left side sleeping may not, for everyone, result in the most restful sleep (with lower AHI, etc.). However, if most CPAP folks would have more restful sleep and lower #s when sleeping on their left side vs their right side (or vice versa), this subject is worth investigating in a quantitative way rather than just via anecdotal evidence. For example, I believe that it is a proven fact that the majority of CPAP users get better sleep and lower AHI "side sleeping" vs sleeping on their back. If there is a clear majority for left (or right) side sleeping giving the most restful sleep (with lowest AHI, etc.), we could all benefit from knowing this. My results, which show me sleeping better on my left side vs right side, are, obviously, only one data point. Earlier postings by Mars and Jason are supportive of my observations. Maybe someone that sleeps "better" on their right side will post to this thread and provide some quantitative numbers of the difference(s) they are observing.

Thanks for your comments re nasal obstructions/architecture possibly contributing to differences when sleeping on one side or the other, especially when resting one's head/face against the pillow while sleeping. This may not apply in my case because of nose surgery (due to frequent sinus infections) that I had when a "youngster" (over 40 years ago).

[roster]

........ This may not apply in my case because of nose surgery (due to frequent sinus infections) that I had when a "youngster" (over 40 years ago).

You still might want to consider an otolaryngologist check you using a flexible fiberoptic pharyngeal scope. I had this done in an initial office visit. It was easy, took five minutes and I only paid $50 co-pay for the office visit. You and the doc will get a good look at your airway from the nostrils down to the vocal cords. I know you had surgery way back, but your turbinates may have enlarged in the meantime or maybe your septum took a blow again.

If you are not having even minor congestion, GERD is more suspected. You can see from the illustration how the stomach is more likely to dump acid into the esophagus while sleeping on the right side as compared to the left side.



I solved a lot of issues by learning to sleep using the wonderful Falcon position, viewtopic.php?f=1&t=36738&st=0&sk=t&sd=a&start=15 .

Regarding RiverDave's comments about how do you know which position you are sleeping in? I learned from my first PSG that you can tell what position you wake up in, but it is easy to be fooled about what positions you have been sleeping in. Afterall, you were asleep!

BTW, if you decide you want to sleep exclusively on your left side, consider investing in one of these mattresses.

[Raj]

One extra confound here could be a change in your hose position from side to side. Is your hose suspended such that after you turn, there is no change in the forces acting on your mask?

[feeling_better]

BTW, if you decide you want to sleep exclusively on your left side, consider investing in one of these mattresses.

rooster, I cant resist to doube check You sure you are not pulling our legs? There is a real bed shaped like this and people have successfully slept on them, and have not broken their backs (falling off) ? Simply amazing !

[roster]

rooster, I cant resist to doube check You sure you are not pulling our legs? There is a real bed shaped like this and people have successfully slept on them, and have not broken their backs (falling off) ? Simply amazing !

There are some beautiful bedspreads and sets of fitted sheets but I can't get the link to work now.

I love you!

[cinco777]

Rooster wrote

If you are not having even minor congestion, GERD is more suspected. You can see from the illustration how the stomach is more likely to dump acid into the esophagus while sleeping on the right side as compared to the left side.

Thanks for the diagram. Its a keeper re showing how sleeping on the left may lessen, via gravity, GERD symptoms. My GERD is minimal when sleeping on either side but disappears almost completely when I sleep on my left side. Based on Muffy's sleep hygiene recommendations, I now try to eat dinner by 7PM (for a 11PM bedtime) and not snack any after dinner. This change in eating schedule also seems to have reduced any nightly or next morning bouts of burping air, etc.

I like the side sleeping bed. However, it only sleeps one. What is one's spouse to do?

Re nose "studies" by doctors/specialists, mine has been seen by a few. Nose surgery 40+ years ago is much different than done today. Back then, there was no standard procedure - today there is. Back then, it was ?whatever? the surgeon thought might work!

I plan to try the Falcon position in the next month or so. It is moving up in priority on my list of To Dos. Thanks for being the one that called it to my attention in your earlier postings. I count on you, Rested Gal, Muffy, and a few others to keep me pointed in the right direction re things to try to improve my sleep therapy.

[roster]

...........
I plan to try the Falcon position in the next month or so. ........

I get bad CPAP-produced aerophagia on either side. The Falcon position eliminated it.