New CPAP User-Would Chin Strap & Side Sleeping work as well?

[sleepwisher]

Hello,

I'm new to CPAP and this forum. I started CPAP three weeks ago and I'm not getting anymore sleep than before (so far). I'm using a Resmed S9 and started with Respironics Nuance nasal pillows. After my first two weeks of trying to sleep with the nasal pillows the inside of my nostrils became very sore and I had to stop using it for several days. My medical supply company just shipped me a Respironics Wisp nasal mask to try instead. I've tried the Wisp nasal mask for three nights now and it seems to be working out somewhat better than the nasal pillows for me. Just don't like the more elaborate silicone type of headgear across my face and cheeks the nasal mask requires.

My question is would positional therapy (side sleeping) combined with a chin strap potentially work nearly as well as CPAP for someone with moderate obstructive sleep apnea like myself

Thanks so much!

[grayghost4]

That depends on what your sleep study says your AHI was while sleeping on your side.
It is also very hard to stay on your side all night.

Your reaction and questions are very tipical of a new cpap user ... but usually after a few weeks or months ... it will become very natural to put the mask on a go to sleep.

The mask choice and fit is the hardest thing to get right, most of us have tried 5 or 10 different one before getting one that fits and works.

[kteague]

There are strap cushions such as by PadACheek or others that can make the straps more comfortable. As to if side sleeping and a chin strap would work just as well - only if your OSA is strictly positional. Check out your detailed report from your study. Were all your events while supine? Did you spend some side sleeping time in REM? If you answered yes to both questions, you've got a chance. Otherwise, no, side sleeping and a strap will not resolve your OSA.

[49er]

Hello,

I'm new to CPAP and this forum. I started CPAP three weeks ago and I'm not getting anymore sleep than before (so far). I'm using a Resmed S9 and started with Respironics Nuance nasal pillows. After my first two weeks of trying to sleep with the nasal pillows the inside of my nostrils became very sore and I had to stop using it for several days. My medical supply company just shipped me a Respironics Wisp nasal mask to try instead. I've tried the Wisp nasal mask for three nights now and it seems to be working out somewhat better than the nasal pillows for me. Just don't like the more elaborate silicone type of headgear across my face and cheeks the nasal mask requires.

My question is would positional therapy (side sleeping) combined with a chin strap potentially work nearly as well as CPAP for someone with moderate obstructive sleep apnea like myself

Thanks so much!

Hi sleepwisher,

You might want to try the Elan Cloth mask listed in my equipment profile as I have found it very comfortable after struggling with so many other masks previously. Obviously, your mileage will vary but it might be worth a shot.

49er

[Pugsy]

My question is would positional therapy (side sleeping) combined with a chin strap potentially work nearly as well as CPAP for someone with moderate obstructive sleep apnea like myself

Unknown. You need to get your diagnostic sleep study to see just how many events you had on your side and compare those numbers to side sleeping and don't forget REM stage sleep. If you happen to have more events in REM stage sleep it may not matter what position you sleep in. My OSA is much worse in REM sleep and it doesn't matter what position I sleep in.
Also...it isn't always so easy to stay off one's back when sleeping.

Also don't rely totally on the number of "events" which earns you the "moderate" category. There's the length of events that is involved. People can have a "mild" AHI number in terms of category but yet still have massive long events with huge drops in oxygen levels.
You would need another sleep study to know for sure if side sleeping and a chin strap would be enough...there's no other way to know for sure.

If you like the idea of a nasal cushion mask but the Wisp headgear is annoying then maybe look at the ResMed Swift FX Nano nasal cushion mask. The headgear is a lot less annoying and less intrusive.
https://www.cpap.com/productpage/resmed ... dgear.html

[bwexler]

The Wisp comes with 2 choices of headgear silicon and cloth. The cloth is just a soft covering on the silicon and I haven't yet tried the silicon version even though I have one.
If your pressure range stays below 12 cm h2o you might like the SleepWeaver Élan, I know I did before I had to switch to ASV and higher pressure.
As has been suggested the right mask and fit is the most difficult part of this therapy. And we change over time and so do our needs for a mask. I have a dozen different masks, several of which were favorites for a while but no longer work for me today.

[sleepwisher]

That depends on what your sleep study says your AHI was while sleeping on your side.
It is also very hard to stay on your side all night.

Your reaction and questions are very tipical of a new cpap user ... but usually after a few weeks or months ... it will become very natural to put the mask on a go to sleep.

The mask choice and fit is the hardest thing to get right, most of us have tried 5 or 10 different one before getting one that fits and works.

Yes, "grayghost4" it is hard to stay on your side all night long. In the past I've tried using a long body pillow to help keep me propped up on my side and I've read that some folks use a tennis ball sewn to the back of their pajama top.

Here's some of my sleep study stats:
My AHI listed on my home sleep study shows: AHI in Position: 26.1 (Supine) and 24.7 (Prone)
Respiratory Events:
Central Apneas: 2.5 (#/hour) / 13 Total Events / 14.6 sec. (mean duration) / 25.0 sec. (Max duration)
Obstructive Apneas: 17.6 (#/hour) / 88 Total Events / 27.0 sec. (mean duration) / 74 sec. (Max duration)
Hypopneas: 5.2 (#/hour) / 26 Total # Events / 33.8 sec. (mean duration) / 75.0 (Max duration)
Apneas + Hypopneas: 25.4 (#/per hour) / 127 (total # events) / 27.1 sec. (mean duration) / 75.0 sec. (max duration)

Not sure if this makes me a good candidate or not for just using a chin strap and side sleeping?

Thanks for your reply !

[sleepwisher]

There are strap cushions such as by PadACheek or others that can make the straps more comfortable. As to if side sleeping and a chin strap would work just as well - only if your OSA is strictly positional. Check out your detailed report from your study. Were all your events while supine? Did you spend some side sleeping time in REM? If you answered yes to both questions, you've got a chance. Otherwise, no, side sleeping and a strap will not resolve your OSA.

Thanks "kteague" for the strap cushion recommendations. My AHI listed on my home sleep study test result shows: AHI in Position: 26.1 (Supine) and 24.7 (Prone)
I disconnected the device from my chest and laid it next to me in bed because I couldn't stand feeling it sitting on my chest, so this probably totally skewed these positional numbers. I wasn't aware that the device was recording my sleeping position at the time. oops...

Here's some of my sleep study stats:
Respiratory Events:
Central Apneas: 2.5 (#/hour) / 13 Total Events / 14.6 sec. (mean duration) / 25.0 sec. (Max duration)
Obstructive Apneas: 17.6 (#/hour) / 88 Total Events / 27.0 sec. (mean duration) / 74 sec. (Max duration)
Hypopneas: 5.2 (#/hour) / 26 Total # Events / 33.8 sec. (mean duration) / 75.0 (Max duration)
Apneas + Hypopneas: 25.4 (#/per hour) / 127 (total # events) / 27.1 sec. (mean duration) / 75.0 sec. (max duration)

Thanks for your reply!

[sleepwisher]

Hi sleepwisher,
You might want to try the Elan Cloth mask listed in my equipment profile as I have found it very comfortable after struggling with so many other masks previously. Obviously, your mileage will vary but it might be worth a shot.

49er

Thanks for the Elan Cloth suggestion "49er". I'll check it out. I appreciate it!

[sleepwisher]

My question is would positional therapy (side sleeping) combined with a chin strap potentially work nearly as well as CPAP for someone with moderate obstructive sleep apnea like myself

Unknown. You need to get your diagnostic sleep study to see just how many events you had on your side and compare those numbers to side sleeping and don't forget REM stage sleep. If you happen to have more events in REM stage sleep it may not matter what position you sleep in. My OSA is much worse in REM sleep and it doesn't matter what position I sleep in.
Also...it isn't always so easy to stay off one's back when sleeping.

Also don't rely totally on the number of "events" which earns you the "moderate" category. There's the length of events that is involved. People can have a "mild" AHI number in terms of category but yet still have massive long events with huge drops in oxygen levels.
You would need another sleep study to know for sure if side sleeping and a chin strap would be enough...there's no other way to know for sure.

If you like the idea of a nasal cushion mask but the Wisp headgear is annoying then maybe look at the ResMed Swift FX Nano nasal cushion mask. The headgear is a lot less annoying and less intrusive.
https://www.cpap.com/productpage/resmed ... dgear.html

Hello "Pugsy",
My home sleep study did not include an EEG so I don't know how much time I spent in REM. Due to having a very high deductible insurance and struggling with anxiety and panic disorder going to an expensive sleep lab just wasn't an option for me.

Here's a some SpO2 data from my overnight home sleep study:
Oximetry Summary:
Dur. (min) % TIB
<95 % 195.2 65.1
<90 % 18.8 6.3
<85 % 2.7 0.9
Total Dur (min) < 88 8.4
Average (%) 93
Total # of Desats 100
Desat Index (#/hour) 20.2
Desat Max (%) 14
Desat Max dur (sec) 89.5
Lowest SpO2 % during sleep 79
Duration of Min SpO2 (sec) 4

The sleep physician that analyzed my test results wrote the following:
"FINDINGS"
The duration of the recording was 299.9 minutes. During that time, the patient had 164 snoring episodes.
There were 127 apneas and hypopneas which were mostly obstructive in type with an average of 25.4 per hour (AHI 25.4).
These events ranged in duration from 10 to 75.0 seconds with a mean duration of 27.1 seconds.
There were a total of 100 desaturation events with the lowest SpO2 at 79% compared to an average value of 93% and with a desaturation index of 20.2. Patient spent 8 minutes with SpO2 below 88%. The mean heart rate was 68.9, and the highest heart rate was 103.
Impression:
Obstructive sleep apnea/hypopnea syndrome of a moderate degree.
Recommendations
1. Auto PAP 7-15 cmH2O.

Thank you very much for your helpful reply! I appreciate it!

[sleepwisher]

The Wisp comes with 2 choices of headgear silicon and cloth. The cloth is just a soft covering on the silicon and I haven't yet tried the silicon version even though I have one.
If your pressure range stays below 12 cm h2o you might like the SleepWeaver Élan, I know I did before I had to switch to ASV and higher pressure.
As has been suggested the right mask and fit is the most difficult part of this therapy. And we change over time and so do our needs for a mask. I have a dozen different masks, several of which were favorites for a while but no longer work for me today.

Hi "bwexler",
I wasn't aware that the Wisp mask offers the cloth covering over the silicon headgear. I'll also check into that.

Regarding the "SleepWeaver Elan" the sleep physician that analyzed my test results recommended my auto CPAP pressure be set to 7-15 cmH2O. It seems like my CPAP machine is staying well under the 15 max pressure setting whenever I check it during the night, but I'm not totally sure.

The sleep physician that analyzed my test results wrote the following:
"FINDINGS"
The duration of the recording was 299.9 minutes. During that time, the patient had 164 snoring episodes.
There were 127 apneas and hypopneas which were mostly obstructive in type with an average of 25.4 per hour (AHI 25.4).
These events ranged in duration from 10 to 75.0 seconds with a mean duration of 27.1 seconds.
There were a total of 100 desaturation events with the lowest SpO2 at 79% compared to an average value of 93% and with a desaturation index of 20.2. Patient spent 8 minutes with SpO2 below 88%. The mean heart rate was 68.9, and the highest heart rate was 103.
Impression:
Obstructive sleep apnea/hypopnea syndrome of a moderate degree.
Recommendations
1. Auto PAP 7-15 cmH2O.

Thank you for your input!

[FredToo]

Interesting comment about you're not getting any more sleep than you were before. I may be some "blow back" on this, but I don't think the intent of CPAP is to help with insomnia. The kind of waking that CPAP cures is a "semi" waking that we are not even aware of .

In other words, if you know you are awake, then it is not Apnea.

But as others have pointed out, in time the CPAP equipment will become second nature and should not bother your getting to sleep...however, I don't think it will assist you in getting to sleep either, because that is an Insomnia problem and not Sleep Apnea (but I'm not a doctor, so this is just an uneducated opinion). If you discuss it with a doctor, I recommend you make it quite clear that you were consciously awake BEFORE CPAP, otherwise the Dr. will certainly blame the CPAP for it.

As for the nasal pillows...I loved them at first (hated the first and second masks I had) but eventually they cause soreness in the nostrils. The Opti Life headgear I had also allowed me to use the Cushions instead of the pillows. The Cushion presses against your nostrils without any insertion. Total comfort, but difficult to adjust for no-leak. The air pressure actually helps press the cushion against your nostrils, so you don't need really tight straps.

If your headgear can take this option, I recommend you give it a try. If you can't solve the leak problem, I might be able to help with a trick.

Good luck,
FredToo