Update - Positional Sleep Apnea Therapy

[mars]

Hi All

There is no doubt that many of us are using cpap machines unnecessarily, because we have positional sleep apnea, but do not know it.

An interesting study has been out for some years -

http://www.medscape.org/viewarticle/514608

and the large print version is below -

Positional Sleep Apnea May Be Common

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

CME Released: 10/17/2005; Valid for credit through 10/17/2006

Oct. 17, 2005 — Positional sleep apnea is common and not usually diagnosed on split-night testing, according to the results of a retrospective chart review published in the October issue of Chest.

"Body position during sleep influences the frequency of apneas and hypopneas in 50 to 60% of individuals with obstructive sleep apnea (OSA)," write M. Jeffery Mador, MD, from the State University of New York at Buffalo and the Veterans Affairs Western New York Healthcare System (VAWNY), and colleagues. "Various estimates indicate that positional therapy alone could be used to treat approximately 30 to 50% of all patients with OSA."

The primary objective of this study was to determine the prevalence of positional OSA, defined as a total apnea-hypopnea index (AHI) greater than 5, with a greater than 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI less than 5) in the nonsupine posture. The secondary objective was to determine if positional sleep apnea could be accurately diagnosed during a split-night study.

The investigators reviewed records of 326 patients, including 57 patients who underwent a split-night study and 242 patients who underwent polysomnography.

Positional sleep apnea was diagnosed in 49 (49.5%) of 99 patients with mild sleep apnea (AHI, 5 - 15/hour), 14 (19.4%) of 72 patients with moderate sleep apnea (AHI, 15 - 30/hour), and 5 (6.5%) of 77 patients with severe sleep apnea (AHI greater than 30/hour). Sleep time did not exceed 15 minutes in both postures in 104 (38.7%) of 269 patients at the VAWNY and in 80 (33.1%) of 242 overnight studies at the Associated Sleep Center nor in 47 (82.5%) of 57 split-night studies. The percentage of studies with insufficient sleep time in both postures was greater for split-night studies ( P < .0001).

"Positional sleep apnea is common particularly in patients with milder disease who have smaller neck circumferences," the authors write. "Positional therapy has the potential to be an effective therapy in a significant proportion of patients with sleep apnea. Rigorous outcome studies evaluating the efficacy of this treatment modality are urgently needed in patients with mild-to-moderate sleep apnea."

Chest. 2005;128:2130-2137

Extremely important is the statement that

Positional sleep apnea was diagnosed in 49 (49.5%) of 99 patients with mild sleep apnea (AHI, 5 - 15/hour), 14 (19.4%) of 72 patients with moderate sleep apnea (AHI, 15 - 30/hour), and 5 (6.5%) of 77 patients with severe sleep apnea (AHI greater than 30/hour).

Experimentation with an oximeter and different sleep positions is the way to find out, and then get confirmation by a sleep study. Sleeping on your side, with no back sleeping, is probably the the most likely position to avoid sleep apnea for those who do have positional sleep apnea, but it always needs individual experimentation.

The fact that this study, and other information about positional sleep apnea, tends to be ignored by the mainstream sleep disorder professionals, and also by many who have OSA, , only reinforces the truism that we have to be self-affirmative in getting the best treatment for ourselves, and sometimes have to go against current majority opinion.

My own positional sleep study is now set for the 6th October 2011, having been delayed because of other serious health problems. I use a back wedge and a thigh wedge to keep me on my side.

cheers

Mars

[jamiswolf]

Thanks for posting that Mars...
I'm convinced that my apnea is only when I sleep on my back. I need to verify that with oximetry and perhaps even a follow-up sleep study.
Jamis

[sonogo]

Before I was diagnosed with apnea, I was told my "insomnia" was purely psychological. Took various meds, saw therapists to complain about everything wrong in my life, and still no change. The only change I did notice was that when I slept on my couch (passing out watching TV at night), I woke up remarkably refreshed. I also had a sore back, but felt better in spite of it. My couch is such that it forces a person to sleep on their side with pillows forming a steep incline to the armrest, and the back of the couch keeps you in that side-sleeping position all night. So of course this was interpreted that I had a fear of my bedroom from some traumatic episode and that's why I couldn't sleep in my bed.

Anyway, finally got the apnea diagnosis, am no longer afraid of my bed (well, I never was), and after much practice, I can pile up pillows to sleep on my side. Caused back pains at first, but they went away. Can I stay that way all night? Alas, no. Can I just sleep on my couch every night? I've tried, but on a regular basis, I find that I wind up close to being on my back (how the sleeping body will adapt!).

Just a long story that sleep position does matter for some of us, which I think gets discussed here a lot. But I should underline that sleeping on my side, couch or anywhere else, didn't eliminate my apnea, just reduced it--it remained a big problem.

PS. There have been other recent posts about weight causing apnea. Someone at work was obese, got their stomach stapled, lost 100 lbs, and no longer has apnea. I, however, started apnea as a skinny 20-year-old at 6 feet tall and weighing 120 pounds. I do have a narrow throat, which seems a contributing factor.

[Pugsy]

I wish mine was just positional. I am in the 5% category and I also have small neck (11 inches around) but severe AHI in REM only and barely diagnostic in nonREM sleep. Position doesn't seem to make any difference as I still have REM and rock and roll in the event category while on my side (my preferred and usual sleeping position). While I might be able to control position, I cannot control REM nor would I want to eliminate it.

[Kody]

Thanks for bringing all this up again and the link. I had never heard of Positional Apnea until you guys pointed it out. I do know in my case I had zero events while trying my very limited sleeping experiment. However the next day my back felt tweaked all day, was pretty sore, and I was real tired. Years of heavy lifting has done a number on my lower back, so I always sleep on my back instead. "If" I could find a way to sleep on my comfortably on my side maybe I could toss the machine. Soon when I have some off time and don't have to work the next day I will try it again and see if I can do the side sleeping all night. I think it would also be helpful if I bought an oximeter to check that part also.

If any other back only sleepers try side sleeping and check their data the next day it would be interesting to post your results.

[jnk]

Events may appear to be positional during the night of the PSG, but that doesn't prove the problem is always that positional every night. Some factors may increase or decrease the effect of position on breathing and on sleep. (Food, beverage, tiredness, state of nasal passages from allergies, etc.)

A home oximeter tells us nothing about how well we sleep and how many arousals we have that may be ruining our sleep. Treating SDB is about sleep, not just O2 saturation.

There is no way to guarantee that you are sleeping in only one position all night or are avoiding any particular position unless you film yourself all night every night. There are things you can do to decrease the likelihood of sleeping in a particular position, but it is amazing how the body (some bodies, anyway) can end up sleeping on top of tennis balls and backpacks and whatever else when it wants to and then can roll right into the position you expect to wake up in just before you wake up.

PAP should be titrated to work in all positions. That is the safest, most effective approach, even if some people would like to save money by denying PAP to those with "positional" apneas.

So, in my opinion, even when positional apnea is clearly evident in a patient, PAP should be given the full shot before inferior methods of reducing sleep distrubances are tried.

I'm no doc, but I can be just as opinionated as one when I work at it.

[2flamingos]

Based on my study, mine is not positional - the only position i did not sleep in was on my stomach (never have), and I had events on back and on either side. I was lucky in that while my longest event was 58 seconds, my O2 never went below 90%.

I do remember with my dad though, the only time he snored was on his back - and we are sure he had OSA, but DX back then was rare.

[moresleep]

A lot of OSA is to some extent positional, as makes sense if you consider the body parts involved. But, while side sleeping probably helps a bit with a lot of cases, I would be surprised if sleeping on the side could "cure" more than a small minority of sufferers. Speaking of "positional" solutions to sleep problems, I have found that raising the head of my bed about 8 inches helps significantly to keep GERD under control at night. Perhaps at some future date, we'll all be sleeping like the Borg, standing up

[ems]

I only sleep on my side, left or right, but never on my back or tummy.... that I'm aware of, anyway. At sleep study my 02 was 85%, so...

[Kiralynx]

Alas, I only sleep on my side.... and the hip pain from low oxygen was hideous.

[NightMonkey]

So of course this was interpreted that I had a fear of my bedroom from some traumatic episode and that's why I couldn't sleep in my bed.

That takes the f#$%ing cake! Now I am sure talk therapy is horsesh$%!

Sorry you had to go through that before getting a CPAP,

[ems]

That takes the f#$%ing cake! Now I am sure talk therapy is horsesh$%!

Sorry you had to go through that before getting a CPAP,

It all depends on the therapist. Some are good at what they do, some don't have a clue.

[NightMonkey]

ems, Show me one therapist who screens all patients for sleep disorders upfront and sends the positives to sleep doctors and it will give your statement some credence.

I have done a lot of reading of new and old threads here and the site is littered with dozens of people who went through extended talk therapy without ever being screened for sleep disorders.

[jnk]

On the other hand, this site is staffed with dozens of people who provide extended talk about therapy without ever being screened upfront for emotional disorders.



Cuts both ways, don't it!

[Cuda]

It may cut both ways but one happens a lot more than the other, at least it did with me. I was told I had anxiety, depression, bi-polar, needed a shrink and on and on for 25 years never once did they mention a sleep study despite wicked insomnia. When CPAP works every problem I had over all that time just vanishes. If I would have stuck with the CPAP settings from the sleep doc I would still be sick. Thanks to this forum and taking control over my own therapy I am getting SOME relief and expect more as time passes.

I have also noticed OSA is much worse on my back than on my side.