Need help on how to sleep on my back

[BigMoose]

This board was a life saver to me 14 years ago when I first started my CPAP journey. Now I need to tap into the "hive mind" of CPAP advice again as I near 70. I fell two weeks ago and did substantial rotator cuff damage to my left shoulder. I will be seeing the surgeon in early May. I have become a side sleeper for these 14 years as a way to keep a good mask fit during the night.

To get ready for surgery I have been forcing myself to attempt to sleep on my back. I am having significant trouble, and need your advice.

My current equipment:
Respironics REMstar Auto M series with A-Flex set to 10cm H20
Respironics M series heated humidifier
ResMed Ultra Mirage™ II Nasal CPAP Mask (my 14 year mask of choice)
ResMed F20 AirTouch Full Face Mask

My first attempts at back sleeping saw my jaw drop. So I secured a chin strap and tried again. This resulted in my chin staying up, but my lips would puff out when I fell asleep and relaxed.

I then secured the F20 AirTouch full face mask, a very comfortable mask by the way. This is working well for mask leaks, but when I fall asleep, part of my internal air passage anatomy seems to relax and fall, and blocks and awakens me. I have tried turning my head on the pillow and some more head elevation with my torso still flat to no avail. I have also tried the chin strap again to no avail.

What is crazy is if I lay in the same position and nap during the day, I seem to be able to do it fine, even with just the Ultra mirage nasal mask. My wife says there are little to no air leaks.

If you can help me understand what is going on, and how to get back to clear airways, it would be appreciated.

All the best,
Dave

[Julie]

Two questions - why do you want to back sleep - because of the problem requiring surgery? The position is otherwise known to be the worst in provoking apneas.
Have you tried a soft cervical collar to keep your head more 'up' and jaw (if not lips) more closed?

And why do you "want to get back to clear airways"? Again, something most people try to get rid of.

[BigMoose]

Thanks for the response Julie. My left shoulder is destroyed with two rotator cuff tendons, and one bicep tendon detached and retracted. It hurts like the dickens now. After surgery I will be in an immobilizer sling that is bulky, finicky and must be protected at all costs for 6 to 8 weeks to let the tendons heal and reattach. Sleeping on the right side is what I do now after failure on my back, but after surgery, especially the first few weeks it is not advised.

I have not tried a soft cervical collar, but have used the chin strap and propped a pillow under my chin at the same time, with the same results ... for info.

Your question: "And why do you "want to get back to clear airways"? " Perhaps I stated it wrong. When I am on my side, the CPAP works fine. When I am on my back, I fall asleep, something relaxes, and I wake back up. This happens now after solving the mouth opening and lips fluttering problem with the full face mask. (which does not happen with my side sleeping)

Thank you again.

[ChicagoGranny]

Respironics REMstar Auto M series with A-Flex set to 10cm H20

Does 10cm mean you are using the CPAP feature and not allowing the APAP feature to increase the pressure as needed?

This is working well for mask leaks, but when I fall asleep, part of my internal air passage anatomy seems to relax and fall, and blocks and awakens me.

It's common to need more pressure on the back as compared to sleeping on one's sides. If you are running straight CPAP, I would switch to APAP. Set the minimum pressure at 10 and maximum at 20. If you are already using APAP, you may need to increase the minimum pressure and the maximum pressure. (Gravity directly pulls the soft palate and tongue into the airway when back-sleeping. On the sides, the effect of gravity is not as direct.)

It's also standard advice to use OSCAR for analyzing and optimizing your CPAP therapy.

[zonker]

sorry you have to go through the surgery. hope everything goes according to plan and you have a speedy recovery.

i use two things to keep my yap shut and avoid chipmunk cheeks. i use a firm foam cervical collar. this keeps my jaw up. in conjunction with that, i use the scunci method that i found out about on the forum. here is the link-
https://www.cpaptalk.com/viewtopic.php? ... s#p1086296

i've had to modify it a bit to bolster it's effectiveness for me.

you might try it "as is" and see how it goes.

good luck!

[chunkyfrog]

Although normally a side sleeper, I had to sleep exclusively on my back
for several months after my double mastectomy.
An extra pillow helped, with a portion extending under my shoulders,
soft enough to relieve pressure on the incisions 2/3 across my back.
Lying on my side, I need to be perfectly level,
but a very slight incline helped me sleep on my back.
I wore my P10 mask exclusively, with no extra apparatus.

[BigMoose]

It's common to need more pressure on the back as compared to sleeping on one's sides. If you are running straight CPAP, I would switch to APAP. Set the minimum pressure at 10 and maximum at 20. If you are already using APAP, you may need to increase the minimum pressure and the maximum pressure. (Gravity directly pulls the soft palate and tongue into the airway when back-sleeping. On the sides, the effect of gravity is not as direct.)...

Adjusting it now. I was on APAP with 9.5cm Minimum and 13cm Maximum. My original sleep study 14 years ago was for 10cm on CPAP. When I got this APAP machine and looked at the data after a few years it looked like I needed to up the pressure some. My 95% pressure level data point is 12.6cm. I am not sure if that is an average pressure, or a maximum pressure the APAP is producing. Do you think 12cm Minimum and 20 cm Maximum a good place to start?

Looking into OSCAR too.

Thank you ChicagoGranny!

sorry you have to go through the surgery. hope everything goes according to plan and you have a speedy recovery.

i use two things to keep my yap shut and avoid chipmunk cheeks. i use a firm foam cervical collar. this keeps my jaw up. in conjunction with that, i use the scunci method that i found out about on the forum. ...
good luck!

Thank you zonker. I ordered a cervical collar, and we will get the scunci's the next trip to town. These suggestions are priceless!

Thank you chunkyfrog. Am acquiring various pillows, and am borrowing a bed sized foam wedge to try.

[ChicagoGranny]

My 95% pressure level data point is 12.6cm. I am not sure if that is an average pressure, or a maximum pressure the APAP is producing.

This means that 95% of the time, your pressure is at 12.6 cm or less.

Do you think 12cm Minimum and 20 cm Maximum a good place to start?

If it were me, I would set min 10, max 20. Having the min setting two or three cms below the 95% pressure often works well. As far as the max, the machine will not go any higher than needed. The OSCAR Daily Details chart can be a big help in setting optimal pressures.

[Okie bipap]

I had similar surgery several years ago, before I started using my bi-level machine. I had to keep my arm immobilized for over six weeks. ended up sleeping sitting up on the couch with my feet on a foot stool. I could not get comfortable laying on my back in a bed. Maybe an adjustable bed would work for you. I have one now, and I think it would work with my arm strapped to the pillow I wore after the surgery. I wish I had the adjustable bed back then. It would have make sleeping much easier. A recliner would not work since the pillow would hit the arm of the chair and cause the arm to move.

[zonker]

please come back and let us know how it goes!

[BigMoose]

My 95% pressure level data point is 12.6cm. I am not sure if that is an average pressure, or a maximum pressure the APAP is producing.

This means that 95% of the time, your pressure is at 12.6 cm or less.

Do you think 12cm Minimum and 20 cm Maximum a good place to start?

If it were me, I would set min 10, max 20. Having the min setting two or three cms below the 95% pressure often works well. As far as the max, the machine will not go any higher than needed. The OSCAR Daily Details chart can be a big help in setting optimal pressures.

Great explanations! ... and thank you for the explanations on pressure.

Turns out OSCAR is not compatible with my old RemStar M series data card. I rummaged through my old computers and found the laptop and the proprietary card reader that I was using when I started this journey so many years ago... Thankfully it booted up and I was able to read my data card. The problem was in fact that I was hitting the max pressure when trying to back sleep.

Last night I changed my machine settings to 12 cm min, 16 cm max, with Cflex on 3 (where I usually run it). I started with the full face mask and my chin strap on my back. I almost made it for an hour. After that I turned on my side with full face mask and chin strap. Midway through the night I woke for an hour or so. Then switched to my nasal mask with no chin strap (my go to configuration) on my right side for the rest of the night... as I needed some sleep as I have to go for CT scan today. My nasal mask at the higher min pressure (12 vs my usual 9.5 cm) was no where near as comfortable, but did "work."

I analyzed the data card this morning and had interesting results. On my back with the full face, I maxed out at 16cm at the beginning and end of the hour. The rest of the time I was running at 15 to 15.5cm. ... so I must have slept for about an hour on my back. ...but 16 cm max is not high enough. (need to listen to ChicagoGranny!)

Side sleeping with the full face and chin strap was populated with many vibratory snores but ok otherwise. Pressure was running around 14.5 to 15cm.

Side sleeping with the nasal mask and no chin strap was wonderful. The vibratory snores were gone, there were very minimal other anomalies. The pressure was right at 12 cm minimum the entire time with only 3 or 4 little pops to 13 cm. (this is my go to configuration, but at a higher minimum pressure.)

So game plan for tonight is to listen to ChicagoGranny, and reset to 10cm min and 20cm max. I will use Cflex 3 unless you have advice there. I will start with chin strap and full face mask.

Thanks Okie biPap, a couple questions if I may. When you had the surgery, were you anywhere near my age (69), or much younger? Were you a side sleeper before? When sleeping propped on the couch, did your old CPAP protocol work without modification?

Thanks zonker, will do. If I get this solved, it may help others.

Funny in retrospect I didn't recognize what was happening... duh ... it was "sleep apnea" exposed again by the sleep position, going from side to back.

I'll try to post the graph off the data card from tonight.