sleep study found apnea, but only when on my back

[eyeball]

Hi all,

I had a sleep study a few weeks ago and a follow up today.

I never sleep on my back when at home, but the doc and tech insisted I do so during the sleep study. So the result was that I had a super hard time falling asleep and between 10 and 5 AM got about 1.5 hours on my back before rolling over onto my usual right side position where I slept another 2 hours before it was time to go.

Went over the study results with a PA today and the AHI was 34 per hour, lowest oxygen 79%, longest apnea 39 seconds.

The thing is, all of this happened during the 1.5 hours on my back. During the two hours I was on my side I had zero events.

The PA wants me to start on a cpap right away (it will be a day or two before I can get in to be fit with one). Even though I said I don't really sleep on my back ever so I feel like this was kind of a manufactured result. With my medical history (obese, stroke at age 34 (I'm 36 now)) she felt strongly that I should try it anyway.

I'm curious to hear opinions on this. I really don't like the idea of having to sleep with something on my face all night and depending on a machine, that said, I do have symptoms/risk factors such as the stroke history (which the neurologist wasn't able to find a cause for), obesity (45 BMI) , snoring, tired/groggy thinking during the day frequently. I've been blaming the tired/groggy on just being overweight and out of shape, but part of me wonders if I could be rolling over onto my back and having apneas. I always fall asleep and wake up on my side, and the times I do share a bed with someone (not married) I haven't been observed to be sleeping on my back.

[Pugsy]

We don't often always stay in our preferred sleeping position. The body does some odd things once we go to sleep.
If you are having symptoms you very well could be ending up on your back and not realize it for part of the night.
With your significant oxygen level drop when supine...I not sure I would want to risk it but if you could rig up something to make absolutely sure you never went on to your back...maybe see if it helps your symptoms.

I prefer side sleeping because of back issues but I can't stay off my back...it hurts my back to stay in one position and it hurts my back to be on my back...damned if I do and damned if I don't.
But then my OSA isn't particularly worse supine...mine's worse in REM stage sleep and I can't do anything about controlling REM.

How long were you at with oxygen levels below 90%?

[kteague]

Did your side sleeping and apnea-free two hours include time in REM? Since it is so common for apnea to be worse during REM, you'll want to know for sure that this scenario was captured during the study. Do you snore on your side? For some, snoring is disruptive to sleep. Just scrutinize every detail of your report before accepting that no events on your side is all you need to know. If it turns out that you have no need for CPAP when on your side, I'd take steps to assure you can't roll onto your back and be glad. Just don't make a premature decision. You may want to ask your doctor to order an overnight oxygen monitoring with you definitely only on your side just as a backup to any decision to forego CPAP.

[ChicagoGranny]

Did your side sleeping and apnea-free two hours include time in REM? Since it is so common for apnea to be worse during REM, you'll want to know for sure that this scenario was captured during the study. Do you snore on your side? For some, snoring is disruptive to sleep. Just scrutinize every detail of your report before accepting that no events on your side is all you need to know. If it turns out that you have no need for CPAP when on your side, I'd take steps to assure you can't roll onto your back and be glad. Just don't make a premature decision. You may want to ask your doctor to order an overnight oxygen monitoring with you definitely only on your side just as a backup to any decision to forego CPAP.

+1. Perfect response kteague.

[Pugsy]

The overnight pulse ox idea is great but I would go further because I wouldn't want to limit it to a one night deal from a DME....I would buy my own pulse ox so I could check oxygen levels multiple nights to confirm no drop while trying to stay on my side.
Not horribly expensive and easy to use.
http://www.pulseoxstore.com/Downloadable-Pulse-Ox.html
This is where I got mine. Just make sure you get one that records overnight.
I opted for the cheaper CMS 50 D Plus because I knew I wasn't going to be doing night to night stuff.
There are other sources available but Kevin at the pulse ox store is real good to help if someone runs into software trouble getting the reports.
It was worth it to me to have that backup available and the cost wasn't all that much more than EBay and slow boat from China pulse ox.

[Christine L]

check oxygen levels multiple nights

My DME did one for my father for four nights and did not charge anything. He did have a doctor's order which was emailed to the DME by the doctor's office.

[eyeball]

How long were you at with oxygen levels below 90%?

I'm not sure. Here's the study printouts:





As you can see, not a good night of sleep. It was especially bad because there was a "special" patient a room over who talked to the TV loudly much of the night. I guess it was one hour on my back and about 2.7 hours total sleep. All in all it was nothing like my typical night of sleep at home which makes me wonder how good it can be for diagnosis. The PA insists it doesn't need to be good sleep or even like your home sleep for this.

Did your side sleeping and apnea-free two hours include time in REM? Since it is so common for apnea to be worse during REM, you'll want to know for sure that this scenario was captured during the study. Do you snore on your side? For some, snoring is disruptive to sleep. Just scrutinize every detail of your report before accepting that no events on your side is all you need to know. If it turns out that you have no need for CPAP when on your side, I'd take steps to assure you can't roll onto your back and be glad. Just don't make a premature decision. You may want to ask your doctor to order an overnight oxygen monitoring with you definitely only on your side just as a backup to any decision to forego CPAP.

I do snore while sleeping on my side (I record it with an iphone sleep tracking app). I think the side sleep did include time in REM looking at this. And the table above says the lowest oxygen was 93% while in REM:




Thanks all for the feedback all. It helps to get some informed thoughts. I know what the dr. and his PA want, but it would be really nice if I could find a reasonable argument to not be depending on a machine. It seems like they're being extra cautious because of the past stroke. The sleep DR. before we ordered the study seemed like he wanted to give me a machine right then and there after talking and listening to the recording of the snoring.

I like the idea of checking out oxygen myself a few nights at home as a check before trying to argue with them that I'll just sleep on my side.

[chunkyfrog]

" . . . it would be really nice if I could find a reasonable argument to not be depending on a machine. It seems like they're being extra cautious because of the past stroke."

---YOU HAD A STROKE!!!?
--and you are looking for reasons not to use cpap?
I'm sorry, but I cannot think of any.

[Pugsy]

It doesn't look like you spend an awful lot of time below 90% in terms of O2. Kinda hard to see at this angle but you can look at the SPO2 graph and eyeball where those dips are.

You have a history of stroke? Man...that makes it extra tough. I know that wearing a mask on your face isn't at the top of your "to do" list but that prior risk factor makes for a real sticky situation.
It wasn't on mine either but my O2 went to 73% and while I don't remember how long I was there...that scared the crap out of me and that was when I wasn't even in REM sleep (where my OSA is 5 times worse than in non REM).

Not my job to tell you what to do with your life but I can offer ideas and my thoughts and you can do with them what you wish.

I would suggest at least try cpap...of course I would...you came to a cpap use forum to ask for help...guess what kind of ideas you are going to get.

But if you are bound and determined to go against your doctor's wishes...be prepared with an armful of pulse ox reports and explanation of how you know for sure you can always be on your side....and even then I don't know if you can sway them.

[Pugsy]

check oxygen levels multiple nights

My DME did one for my father for four nights and did not charge anything. He did have a doctor's order which was emailed to the DME by the doctor's office.

Tis true...they will often do it for free but not always...as I had my DME do it for me early on in therapy but they had to get the doctor's order and wouldn't tell me a damn thing about it and all the doctor would tell me was "everything is fine" and that irritated me...and as you know..I like to have my hands on my own reports and don't like having to mess with doing the official records requesting thing....and getting that run around.
It was worth it for me to just buy my own pulse ox and bypass the hassle and I only wanted ability to do occasional spot checks.
In this situation with the OP in this thread....unless buying the pulse ox took food off the table I would want to be able to do check the overnight O2 anytime I wanted and have that data available immediately and easily without the hassle.

[RicaLynn]

Your report does not say that you had 0 events while not supine (at least not on these pictures); what I see is "Supine AHI: 85 REM AHI: 0" and then your overall AHI: 34. As Pugsy mentioned we rarely stay in our preferred position for the entire night, and ANY apnea/desaturation is bad for your body. It's NOT normal for a 34yo to have a stroke, and I would be willing to wager a large sum that your apnea was a significant factor. Your sleep doctor was ready to send you home with a machine because he could hear that you needed it, even without the benefit of the study. Without treatment, your OSA could lead to another stroke and you might not be so lucky this time.

[bv1800]

My sleep study had similar results. At the same time, I've found that I sleep on my back more than I thought that I did. Based on reports from my wife, the time spent on my back has increased greatly, since starting treatment. She says that it's unnerving that I sleep so peacefully and quietly in that position (in 26 yrs of marriage, I tended to snore heavily when sleeping on my back, particularly when my weight was above 240 lb).

[Greg Riddle]

There may be a time when your forced to sleep on your back

I'm in that positron now. My back has been hurting very bad lately. I have found that sleeping on my back stops it. Problem is I hate it. I never sleep on my back and would not do it if not for the pain when sleeping on my side.

[kteague]

Ok, somebody help me out here, but isn't that a disproportionate number of centrals?

[Pugsy]

Ok, somebody help me out here, but isn't that a disproportionate number of centrals?

It appears to be disproportionate but I can't tell when they were flagged...we know it wasn't in REM but beyond that I can't tell if maybe they were sleep onset or whatever or if may awake/semi awake when they would be numerically counted but not a factor in the diagnosis ( even if they were counted and not a factor). In other words a central that gets tossed out the window or not in terms importance as in coming up with a diagnosis.
I can't see well enough to get an idea or if they were associated with any desats.

Maybe Sludge could offer in put on this question if he's around. I can't see things very well and even if I could I am not sure what I am looking at. Don't know when those centrals occurred other than not in REM.