No N3 'slow wave sleep

[raffles97]

Finally received the full report on my recent sleep study. For past few months have been tired during the day and had to take nap on getting home from work. This is unusual and main reason for getting sleep study.

Thanks to all the information on this website I did know enough to interpret the study although a few items cause me to scratch my head and wonder.

Primarily the study pointed out sleeping on back caused most of my problem with AHI of 4.4 for side sleeping and 66.6 for back sleep (67% of sleep done on side and 33% on back). Mind you my wife has over 40 years of training me to sleep on side and I've the bruises to show it. My meeting with sleep doc to discuss this report isn't for another month but it's obvious his first recommendation is 'don't sleep on your back'. Also qualifies this by indicating the presence of snoring while on side could indicate UARS .

Now for what he doesn't comment on but I suspect might be significant. Like 0% N3 sleep period and only 10.4% REM during sleep period of 6.9 hours and actual sleep time of 5.8 hours. Time on back (supine) also related to bit of hypoxemia (2% of sleep time at 89% all experienced when on back).

OK also some periodic leg movement with TST index of 5.2 (30) which I knew about (my wife certainly complains). Arousal Analysis shows a TST index of 27.1% (147) for respiratory arousal and 8.5% (45)for spontaneous

Now I'm prepared to sew a tennis ball or whatever to a tee shirt and see if that can keep me on my side but frankly if my wife hasn't managed in 40+ years to do this I'm not sure a tennis ball will.

I suspect that if I push the doc will prescribe nasal CPAP and I'll pay 25% of the cost which is cheap if more daytime energy results.

Any comments?

[chunkyfrog]

Hubby's apnea is almost entirely on his back.
He needs the cpap, because at his age, sometimes it hurts to lie on his side.
Having an autoset (like mine) means he will not get extra air pressure whan he doesn't need it.
It's amazing how easy it is to sleep on a tennis ball.
--But that means waking up with a whole lot of hurt.

[Julie]

Here's something for you to look at from a member who has not been posting in a while (and you'll see why)...

Hi Everybody,
As most of you know, I have been experimenting with myself, and using positional sleep apnea therapy for my obstructive sleep apnea (untreated AHi = 41) for some months now. I have given various updates on this, but the information has been polluted by the usual hijacking and misinformation, so no matter what is posted after this, at least my personal experience will be clear

So I am repeating past information, plus more history, so that it is all in one post.

You may want to check the credentials of my Sleep Centre, which I think is one of the best in the Southern Hemisphere, but I have no comparative studies to prove that, just my opinion

http://www.southernhealth.org.au/page/S ... laboratory

The recent study I posted on positional sleep apnea is worth noting -

http://www.antisnoreshirt.com/v/vspfile ... graphy.pdf

In particular their conclusion -

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.


and a more consumer oriented overview

http://www.ehow.com/about_5183851_posit ... apnea.html

of which I was particularly interested in this paragraph -

According to the experts at the American College of Chest Physicians in an October 2005 issue of "Chest" magazine, as many as 60% of the people with obstructive sleep apnea experience a lowering of symptoms when they slept on their side as opposed to their back. They estimate that as many as 50% of the people that experience sleep apnea could be successfully treated by using positional therapy.


I have done a lot of travelling in my life, usually by what used to be known as hitch-hiking. So I would normally end up at night in a strange place, and I would sleep out. Given that I never had much money, this became my preferred option when travelling. Although my health is not good, I have not given up on the travelling, and carrying a machine around is not really an option for me.

Reading the threads on this Forum I first came across the Nasopharyngeal Airway

http://en.wikipedia.org/wiki/Nasopharyngeal_airway

https://www.youtube.com/watch?v=fR5jsmGg6e8

and the Oropharyngeal Airway

http://en.wikipedia.org/wiki/Oropharyngeal_airway

https://www.youtube.com/watch?v=sVlRylzLor0

https://www.youtube.com/watch?v=xI9Heh5A ... re=related

Now, next to my favourite Animal Aid Opportunity Shop there is a medical equipment shop. So I ordered a Nasopharyngeal Airway in a couple of sizes. I quickly discovered that, for me, it wasn't going to work. Then I tried the Oropharyngeal Airway in a couple of sizes. Now, someone might be able to make this work, but the gag reflex has to be overcome, and whilst I was about to persist I discovered something else.

I knew from my recliner/napping times that I did not desaturate with my body nearly upright, and my head back; and that I did desaturate if my head was forward, or my body more supine.

I also remembered seeing some Forum posts of the head being moved backwards, so opening the throat. This being cited as a possible help in overcoming obstructive sleep apnea. I also knew about this as I have to do it when I get a laryngospasm. So I bought my first soft cervical collar for $8 from the medical equipment shop, and tried it out.

And that was when my experimenting became testing, as using the collar and sleeping on my side meant no desaturations.

So this is the way it has developed -

The starting point is sleeping on my side - all night. I have also wore an oximeter every night since I started this, and the only time the alarm went off is when I have deliberately turned onto my back and fallen asleep again. I no longer do this.

http://www.the-pillow.com.au/more/side_ ... r_more.php

(I think this also has minimised my plmd, but I will have to wait for the full study results to be sure about that.)

and I still use this most of the time - but possibly no longer need to -

http://www.the-pillow.com.au/more/posit ... w_more.php

and, of course, the soft cervical collar - together with a feather pillow -

http://www.nextag.com/soft-cervical-collar/stores-html

http://www.amazon.com/dp/B002674542/ref ... B002674542

http://www.beddingco.com.au/pillows.htm ... 4god13_p-Q

which also has some interesting pillows.

I will add that I no longer use a cervical collar, but advise all those experimenting to start by using one. When using the soft cervical collar I do not use the cervical neck support pillow, I use a feather pillow.

I now use a cervical neck support pillow

http://www.the-pillow.com.au/more/compl ... s_more.php

which keeps my head upright, ( head in the dip and chin resting against the edge,) and serves the same purpose as the soft cervical collar. The pillow has less resistance than the collar, so I believe it is best to use the collar first until one is used to the head being upright in relation to your body when going to sleep.

I am still experimenting with the two inserts, but it works with and without the inserts.

Then, of course, I have my two trusty oximeters - CMS50E and CMC60D.

I was due for this sleep study months ago, and have had to postpone it 4 times due to ill-health. But at last, on Sunday night just past, I had another full diagnostic sleep study at Monash Sleep Centre, using only a cervical collar and thigh wedge support and back wedge.

I do not get to see the Sleep Doctor until the 1st December, but he sent me a message to continue using positional therapy, that I did not need to use the cpap machine.

So there it is. The prescription of cpap machine is easy, it works if successfully applied, and a whole manufacturing and retail industry is supported by it. And I have no argument with that. But for those it does not suit - for whatever reason - taking the steps to find out if positional therapy is for them - may be a step well worth taking

cheers

Mars

[Pugsy]

Tennis balls hurt. Pain causes awakenings. For the tennis ball thing to work it has to wake us up to make us turn off our backs. Seems like not the most optimal of solution, for me anyway, though some people have done it.
I have enough pain to wake me up without adding to it.
You might find some of this discussion helpful.
viewtopic.php?f=1&t=78699&p=716493#p716493
There are of course lots of other ways to try to stay on one's side. Since I am lazy and don't like pain...this is the way I have chosen to go.
Jury is still out on what my final decision will be but I am leaning towards a small body pillow made with buckwheat hulls unless I can add enough hulls to my Regensis pillow to keep it from sliding out from under me.
So I am still experimenting.
A large man..might need something larger than my Regensis pillow...measures 14" X 18" X 2". It looks like I also need something larger but hoping making the Regensis a bit heavier and a little taller and firmer will do the trick.

Larger king size buckwheat pillow would work great but it is a bed hog and not conducive to having a spouse in bed with you.

The buckwheat pillow is extremely comfortable...just have to figure out some way to have it not hog the bed.

Oh, BTW...I had a friend who tried the tennis ball thing because she also has much, much worse OSA on her back.
She filled a backpack with tennis balls. Woke up the next morning...on her back...and her reports pointed to a long time on her back. It's amazing what the body will do sometimes.

[raffles97]

[quote="Pugsy"]Tennis balls hurt. Pain causes awakenings. For the tennis ball thing to work it has to wake us up to make us turn off our backs. Seems like not the most optimal of solution, for me anyway, though some people have done it.
I have enough pain to wake me up without adding to it.
I
All good advice although I'm not yet totally convinced it will work for me if the elbow in the back hasn't managed the trick. No comment on the lack of slow wave deep sleep? I know we need less of this when in 60's but 'none'?

[jnk]

It is normal and proper for a doc to point out when it appears that there may be a positional factor to a patient's sleep-breathing problems. However, unless the doc does several weeks of sleep testing to prove efficacy of sleep-position therapy as an effective approach for that patient every night, it is unlikely that a trained sleep doc of any worth would in good conscience prescribe posititional therapy for someone with serious sleep-breathing troubles unless the patient refuses PAP therapy (the first-line treatment) or is unable to use PAP therapy for some reason. Then many second-best approaches may be explored. And that overall order of approach isn't because prescibing PAP is easy; it is because, according to present science and widely-accepted standards of practice, PAP is the treatment that is most effective for most people with sleep-breathing troubles. On the other hand, body position is only one factor of several for measuring the nature of one's sleep at any given moment. For example, one would have to measure every position in every sleep stage at every moment of the night for several nights in varying circumstances of tiredness, health, substance use, and food consumption for positional therapy to be verified as a reasonably practical approach for any person who could be using a therapy as effective as PAP.

A person in a sleep study may not get as much N3 as that same person in his or her own bed, as I understand it--especially in comparison to what that person may get once his or her breathing gets stabilized over several nights by the effective application of PAP. Amounts of SWS can vary night-to-night.

That's how this patient understands it, anyway.

This gentleman sounds like he may know what he is talking about as far as SWS: https://www.youtube.com/watch?v=o7kNaJEFIA4

And here is his take on positional therapy using a tennis ball, which I don't agree with him on quite so much : https://www.youtube.com/watch?list=ULBP ... P5YIcQW948

[Pugsy]

No comment on the lack of slow wave deep sleep? I know we need less of this when in 60's but 'none'?

OSA means sleep disturbances and unbalanced (when compared to normal) % of time in whatever sleep stage...or lack of sleep stage just goes along with the territory. Fragmented sleep messes with the overall sleep architecture. All stages get whacko.
If you had presented entirely normal % of time in the sleep stages...now that would have been unusual.
We expect to see abnormal % on the sleep studies...the whole idea behind the therapy is to fix them.

Hence my no comment. Prior to cpap therapy I got minimal to none REM sleep and likely the stage right before it because every time I would get to REM sleep I would have a truckload of events (53 per hour they said) and with the arousal..we get to start all over with the sleep cycles..so not much time spent in deeper sleep which is where most of the restorative powers of sleep are and why we feel like crap.

Hopefully with optimal sleep therapy your % of time in each sleep stage will become more "normal" and normal does have a wide range it seems when we get older. I am sure you need it. The fact that you didn't get it was because of the OSA and not because you are abnormal. Now how much your "normal" is? That could vary.

[raffles97]

Very thoughtful comments perhaps I think so because it reinforces my own feeling that it's going to take more than sleeping on my side to obtain refreshing sleep pattern.

Yes this Dr. has 'smarts' and suspect will work with me to get things on the road to improvement, haven't see that many initials after a name for a long time 'MB Bch, DPM & N, DPM, FIBA, CRPC(C), MRC (Psych), FRCP (C) as will as diplomas from American Boards of Forensic Mendicine, Forensic Examiners and Psychiatry and Neurology. Pretty sure I'd fall into one of the above categories! I've not spoken to him yet but just reviewing the report he gave to My GP along with the sleep clinc data and graphs.

[sylvie]

Here's something for you to look at from a member who has not been posting in a while (and you'll see why)...

Hi Everybody,
As most of you know, I have been experimenting with myself, and using positional sleep apnea therapy for my obstructive sleep apnea (untreated AHi = 41) for some months now. I have given various updates on this, but the information has been polluted by the usual hijacking and misinformation, so no matter what is posted after this, at least my personal experience will be clear

So I am repeating past information, plus more history, so that it is all in one post.
Mars

I found this information to be invaluable. Thank you so much for reposting this.

[lazer]

Tennis balls hurt. Pain causes awakenings. For the tennis ball thing to work it has to wake us up to make us turn off our backs. Seems like not the most optimal of solution, for me anyway, though some people have done it.
I have enough pain to wake me up without adding to it....

+1 This was my doctor's first course of recommended therapy to me and it didn't last but one night. I had the worst sleepless night ever trying this and it is very painful.

[n0hardmask]

No comment on the lack of slow wave deep sleep? I know we need less of this when in 60's but 'none'?

OSA means sleep disturbances and unbalanced (when compared to normal) % of time in whatever sleep stage...or lack of sleep stage just goes along with the territory. Fragmented sleep messes with the overall sleep architecture. All stages get whacko.
If you had presented entirely normal % of time in the sleep stages...now that would have been unusual.
We expect to see abnormal % on the sleep studies...the whole idea behind the therapy is to fix them.

Hence my no comment. Prior to cpap therapy I got minimal to none REM sleep and likely the stage right before it because every time I would get to REM sleep I would have a truckload of events (53 per hour they said) and with the arousal..we get to start all over with the sleep cycles..so not much time spent in deeper sleep which is where most of the restorative powers of sleep are and why we feel like crap.

Hopefully with optimal sleep therapy your % of time in each sleep stage will become more "normal" and normal does have a wide range it seems when we get older. I am sure you need it. The fact that you didn't get it was because of the OSA and not because you are abnormal. Now how much your "normal" is? That could vary.

Curt,
I'm going through this same pain of limited REM, negligible Deep Sleep, and loads of awakenings. I started Zeo a month ago, and am still looking for an indication of what is causing my frequent wake-ups. As Pugsy mentioned, about when I should go into deep sleep, I have some kind of wake-up and miss out on the restive part of the sleep cycle. I suppose the forum could support a (new?) separate thread on the subject of improving sleep quality. We can't be terribly unique having this struggle. earl

[kteague]

Few thoughts on this...

Wondering if the time on your side had enough REM time to definitively say your AHI is that low when on your side?

Although I spend most of my time on my side, I do turn over now and then on my back. What I'm not clear on is when have we technically left our side? I tend to be comfortable somewhere in between, leaned slightly back at an angle. Does that mean my AHI is somewhere in between? I just wouldn't say yet that your test means you don't need treatment as long as you can stay on your side until these questions are resolved.

Have your wife keep an eye on your limb movements. Not sure if they are respiratory related or a separate sleep disorder that could also affect sleep. If you do go on CPAP it would be interesting to note if the limb movements resolve or not. If you have PLMD, then I wouldn't place a lot of value on your test results being a complete picture of your needs. Won't go into a lot of detail on that right now, as it may be totally unnecessary. One bridge at a time.

[SleepTechTN]

<removed>

[raffles97]

Few thoughts on this...

Wondering if the time on your side had enough REM time to definitively say your AHI is that low when on your side?

REM (what there was of it) was all while on side and perhaps oddly not associated with much in way of leg movement arousal or as much other apnea events which as study reported was positional related as occurring while on my back.

Although I spend most of my time on my side, I do turn over now and then on my back. What I'm not clear on is when have we technically left our side? I tend to be comfortable somewhere in between, leaned slightly back at an angle. Does that mean my AHI is somewhere in between? I just wouldn't say yet that your test means you don't need treatment as long as you can stay on your side until these questions are resolved.

Have your wife keep an eye on your limb movements. Not sure if they are respiratory related or a separate sleep disorder that could also affect sleep. If you do go on CPAP it would be interesting to note if the limb movements resolve or not. If you have PLMD, then I wouldn't place a lot of value on your test results being a complete picture of your needs. Won't go into a lot of detail on that right now, as it may be totally unnecessary. One bridge at a time.

Oh yes my wife keeps eye on everything, even showed me how I'd worn hole in sheet on my side of the bed, over time of course. 10 years ago I had a sleep study and that was zero'd in on so I do have some medication which helps calm down that leg. Hate taking any medication so only take this when wife starts objecting to my twitchy leg.

By the way, I'm ever so appreciative of all the thoughtful comments received. Does indeed help me prepare for meeting with specialist.

[kteague]

My many studies showed my PLMD is usually calm during REM which I think that is expected just due to the nature of REM and not moving. I can see how you could wear out some sheets since the movements are repetitive - that's a lot of wear and tear. And I understand about the meds - I've used several of them. Were the movements on this study breakthrough movements while on medication or were you not on the med at the time of the study? I now use a TENS Unit to control my legs, and have had more consistent and prolonged success than with any of the 4 meds I've used. Since your limb movements are being treated seems like a bit more discussion is not premature...

When both OSA and limb movements from PLMD are present, there is a chance that either could mask the severity of the other in a study. Each can cause arousals and cause difficulty reaching deep sleep or REM sleep. It may be that the limb movements preempt what would have been more apnea events had the movements been been absent. On the flip side, the apnea events may preempt more limb movements that would have manifested had the apneas not happened. What I'm saying is based on playing this cat and mouse game since the late 90's. Can't say it applies to everyone, but I doubt I'm very unique.

Best wishes as you go forward.