Why Can't We Sleep on our Backs?

[SleepyT]

Perhaps my question is too simplistic...but humor me. My technician told me after I woke up from the sleep study that I didn't have too many events until I flipped over onto my back to sleep...she said, "you really went to town then!" I had one event that lasted over 50 seconds.

I am assuming they determine your CPAP pressure during one of those type events, yes?

So...if my pressure was set to correct an apnea in that position..why isn't that pressure now enough to hold my airway open when I flip over onto my back? Why do they discourage back sleeping?

[GumbyCT]

Why do they discourage back sleeping?

In a word - gravity!

[SleepyT]

gumby,
i appreciate a response from one of the 'elders'...but that still doesn't 'splain it for me. of course, i don't need to know everything...and i actually do preferside sleeping...but sometimes my hips just won't allow it.

sleepyt

[DannyP]

During my Sleep Study I was tested on my Back and given a Pressure of 13. I have always been a back sleeper and continue to do so ( three years now ) with Cpap and I have been really successful with my Therapy so Far, I feel Rested and Refreshed when I get up most Mornings and I have been sleeping an average of Nine Hrs a night. I have had a few bad nights but thanks to the Melatonin I get through them and still sleep well.

[Raj]

When lying supine, the tongue falls backwards as do various soft tissues within the mouth and throat. Also inhalation becomes slightly more difficult with the extra abdominal weight on the diaphragm.

[rested gal]

I am assuming they determine your CPAP pressure during one of those type events, yes?

Yes. That's exactly what they try to do during a sleep study CPAP titration -- find a pressure that will keep the airway open even during worst case scenario, which for most people is sleeping on their back ("supine") AND in REM sleep.

So...if my pressure was set to correct an apnea in that position..why isn't that pressure now enough to hold my airway open when I flip over onto my back?

It should be.

Why do they discourage back sleeping?

It shouldn't matter what position you sleep in if the pressure is set right for "worst case scenario." Who are "they?"

[JimIllinois]

It is strange that your sleep study setting doesn't work for you now, but you should expect to change over time. It gives the sleep centers a reason to retest you occasionally, and generate more income...

But, yes, gravity hauls your tongue and other tissue back, making it easier to stop up the works. Sleeping on your side helps reduce that.

I'm the same as you. My study said I needed a setting of 17, but since I mostly sleep on my side, the data shows that my auto cpap spends 95% of the night much lower than that. The graph rarely gets above 15, and usually sits around 11.5.

[SleepyT]

rested,
'they' would be my sleep doctor...and a lot of the folks on this forum seem to feel like back sleeping is to be discouraged. it's just a curiosity to me, that's all. not trying to buck conventional wisdom...and i DO try to stay off my back...I was just wondering. sometimes the three year old in me wants to know "why?"

thanks to all for the answers. see ya on the flip side!

[rested gal]

Well, sleeping on your back if you're not using a CPAP machine (like waiting to get one after being diagnosed with OSA in a sleep study) is definitely to be discouraged.

But if you've had a sleep study that found a pressure which prevented apneas and hypopneas while in REM and on your back...both situations at the same time...and you have a CPAP machine set to that pressure or an autopap machine with the minimum pressure set up pretty close to that prescribed single pressure... then I'd say sleep any which way you like. While using your CPAP, of course!

But that's just my opinion, and I'm sure not a doctor.

[Goofproof]

You sleep on you side instead of your back, because side sleeping requires less pressure to correct your sleep apnea. A properly (?) set APAP can give you the correct pressure for either position, but some people are bothered by having to use the added pressure or the pressure changing. So it makes sense to get your treatment at the lowest pressure you can, that's why we try to sleep on our sides. Me, I'm all over the place, side, back and face down, I run my pressure to the highest level to control sleeping on my back, but then again I don't have a problem with the pressure, I work well under pressure. (15 CM) Jim

[DreamStalker]

I am assuming they determine your CPAP pressure during one of those type events, yes?

Yes. That's exactly what they try to do during a sleep study CPAP titration -- find a pressure that will keep the airway open even during worst case scenario, which for most people is sleeping on their back ("supine") AND in REM sleep.

So...if my pressure was set to correct an apnea in that position..why isn't that pressure now enough to hold my airway open when I flip over onto my back?

It should be.

Why do they discourage back sleeping?

It shouldn't matter what position you sleep in if the pressure is set right for "worst case scenario." Who are "they?"

What RG says is assuming there are no leaks. SleepyT uses a Swift LT ... pressure of 17 or even 15 on auto mode very likely make the lips go a flappin ... then back sleeping is bad ("worst case scenario").

[BlackSpinner]

When I sleep on my back my mask doesn't fit. My jaw drops back and down and I have a 1 cm gap between me and the bottom of my mask.

[SleepyT]

Yep...I see what you all mean. I forgot about the tongue and the jaw causing trouble when we sleep on our backs. I guess I am satisfied now. Knew there had to be a good reason why. Thanks to all!

[Snorebert]

I happened to see this posted from Saturday, November 17, 2007 in a blog by "the sleep doctor", Michael Rack, MD.
http://sleepdoctor.blogspot.com/search? ... results=20

I am not endorsing this doctor, especially given his comments at the end that APAPs would reduce his boat payments. I just thought it interesting that he made one case for APAP.

Auto-CPAP in the new portable testing world
To paraphrase a reader question, what role will auto-CPAP play in the future?

Auto-CPAP is basically CPAP that is self-adjusting based on the patient's pressure needs (various manufacturers have different alogorithms to monitor airlow). There are 3 main ways to use auto-CPAP:

1. Some patients who undergoe an in-lab regular CPAP titration are found to have large pressure difference needs between different body positions or sleep stages. In these cases, the patient can be prescribed auto-CPAP within a preset pressure range. For example, if someone needs a pressure of 6 during stage 2 sleep and 10 during REM, he might be prescribed an auto-CPAP machine that was set to automatically adjust between 6 and 10.

2. A patient could just skip the in-lab titration and be sent home with an auto-cpap machine for permanent use. The pressure range might initially be set at 4-20 and then gradually narrowed based on the data generated by the auto-cpap machine.

3. Instead of an in-lab titration, a patient could be loaned an auto-cpap machine for a few days to use at home. Based on the data generated by the machine, the patient could be prescribed a regular fixed pressure cpap machine.

Most sleep specialists, including myself, do option 1 at times. Some sleep specialists will do options 2 and 3 occasionally, but this requires close patient follow up and in my opinion is not appropriate for widespread use, nor for use by non-specialists. If options 2 and 3 become more widespread it would reduce the number of titration studies done by sleep labs and have a negative financial impact on the sleep testing industry.

[Hawthorne]

I have slept on my back for almost 15 years now. Since I was diagnosed with Rheumatoid Arthritis, it is the only pain free position.

I was diagnosed with sleep apnea just about 7 years ago. I have continued to sleep on my back, with my cpap, for all of those almost 7 years. I was diagnosed and titrated on my back.

As Rested Gal said, diagnosis and titration while sleeping on your back is preferred since you may be like me and find back sleeping to be the only pain free position. It's either sleep on my back or don't sleep at all because of pain. There are many people who sleep on their back for various reasons.

My titrated pressure was 10 cm, 7 years ago. A 5 night in home auto test, almost 2 years ago, said my pressure should be 11 cm. I am now using an auto set at 10.5 cm minimum and 13 cm maximum. I spend the largest part of my night at 11 cm and a very small part of my night at 12 cm. On a very few nights, I will reach the 13 cm mark. My AHI is almost always below 1. It has not been over 3 in the 17 months I have been monitoring my own therapy. This morning the AHI was 0.3 and that about average for me. I have 0.0 AHI a few times a month as well. My leak rate is right on pretty much.

I guess most people have fewer events on their back. I have hardly any events on my back and doubt I would have fewer events on my side. I suppose I MIGHT be able to use a lower pressure if I could sleep on my side but I will never find out probably and it doesn't matter one bit to me. I'm getting optimal therapy just the way things are!