HELP, Experts & Patients, exactly how positional can OSA be?

[elena88]

To those of you who who test people and those of you who have been tested and know..


Just how positional can OSA be?

Lets say you hit all stages of sleep, and end up on your stomach in REM..

In the test it turns out you have severe apnea on you back, lets say 45 ahi, then you roll over to one side and its 3 ahi,
and you roll on your stomach, and you have none at all.. 0.0 how would that be addressed?

Would you still be diagnosed with OSA, or would they suggest that you just never sleep on your back?

Would you likely be asked to do a titration?

If the titration pressure on your back was 13, and 4 on your stomach, would they send you home with a cpap at 13, or
an apap at 4-13?

And... how often do you sleep specialists see positional apnea where there are absolutely no apneas in one position, and quite a few in another?
Is that common, or is it rare?

[mayondair]

My AHI at sleep study was 59, worse on R side than left, no incidents at all on my back. My tritation did not go well, never fell asleep so sleep lab doc recommended a trial at 8 cm,even though I had events at that pressure. That took my AHI to around 15. Fast forward to new doc and auto pap that I now run 8-15 , my AHI now averages less than 3 , may tweak further, but am feeling good right now. If I had listened to first doc I would still be struggling with ineffective treatment . When I look at my reports, my pressure varies quite a bit over the night, I sleep mostly side and tummy, never back.

[elena88]

My AHI at sleep study was 59, worse on R side than left, no incidents at all on my back. My tritation did not go well, never fell asleep so sleep lab doc recommended a trial at 8 cm,even though I had events at that pressure. That took my AHI to around 15. Fast forward to new doc and auto pap that I now run 8-15 , my AHI now averages less than 3 , may tweak further, but am feeling good right now. If I had listened to first doc I would still be struggling with ineffective treatment . When I look at my reports, my pressure varies quite a bit over the night, I sleep mostly side and tummy, never back.

That is amazing, that you would still be stuck with your treatment not working if you hadnt figured it out..

Facinating that you had no apneas on your back..

I have been reading that sometimes patients wont be givin cpap and given "positional treatment" instead..
I wonder what the criteria is for that?


So, do any of you sleep experts know what happens with the positional apneans? Are they given a choice, cpap, or dont sleep in the position
that causes the apneas?

[mayondair]

It is odd,I understand most have more apneas while on their backs. I think sleep lab doc just wanted to run another tritation in a few months and bill my ins another $1200. You really have to look out for yourself.

[xerort]

OSA can extremly positional.

The relative position of your head and neck is a direct indication of where the lower tissues of your throat might be.

Example: I had an ER doc that HATED snoring. It was like nails on a chalk board. He would call me down to the ED and be like "FIX THAT!" Like I could run in there, flick the guy in the throat and be done. Eventually he taught me how to slowly position peoples heads and necks so that they would stop snoring. Typically by pushing their head back, so that it was more of a direct line through the airways to the lungs.

As far as treatments and such......

I have no idea. I do know that one time an RT at my branch had a patient that had extremly positional OSA on his back, but other positions was ok. He was having a lot of issues with cpap compliance, so she asked him to bring in a pajama top, or whatever he wore to bed. He brought in a white t-shirt.

she took it home, and of all things, sewed a tennis ball onto the back of the shirt. She gave it to him, he took it home and tried it. It kept him off his back, and thus he was not nearly as apenic as he was previously.

Something to think about.

[SleepingUgly]

I am no expert, and I don't know. But there is so much night-to-night variability that I would be nervous to accept the findings of one night in the lab (especially if someone slept only an hour because they were busy ransacking the hospital looking for scissors to cut off their underpants...). But if it proved true that the patient only had OSA on their back, if I were the patient, I would do everything possible to ensure no back-sleeping, and I'd shelve the CPAP. But how would one ever prove that without several good sleep studies?

[elena88]

I am no expert, and I don't know. But there is so much night-to-night variability that I would be nervous to accept the findings of one night in the lab (especially if someone slept only an hour because they were busy ransacking the hospital looking for scissors to cut off their underpants...). But if it proved true that the patient only had OSA on their back, if I were the patient, I would do everything possible to ensure no back-sleeping, and I'd shelve the CPAP. But how would one ever prove that without several good sleep studies?

(especially if someone slept only an hour because they were busy ransacking the hospital looking for scissors to cut off their underpants...).

You know that sounds rather odd out of context S.U.!


I agree whole heartedly, I think my sleep study was screwed by the pooch from the get go!

I have a bucket of tennis balls, and I could find room for that apap on the shelf, or on my husbands night stand... lucky him!

My deductable is eight grand, so far I have spent seven.... do I really want to spend another grand so I can do another sleep study?
One thing is for sure, I will NEVER sleep if Im paying for it! do you know how friggen that much is an hour? OMG!

I pulled a 0.0 at four cm last week... I felt like faxing THAT to my doctor... does anyone have a titration pressure of four? I mean really?

They use four to start because you cant safely vent out below that......

Im so feeling like I got misdiagnosed, and its been a slurpy comedy of errors from the beginning to the end..

[SleepingUgly]

What do the doctors and knowledgeable people here think of your oximeter results? I don't know how to interpret those, but that would be pretty telling. Also, what about your flow limitations or any other signs of SDB? Does your sleep look normal on 4cm? That is the question.

I think you should try 4cm on your back, although how you'll get to sleep on your back is another story.

[elena88]

What do the doctors and knowledgeable people here think of your oximeter results? I don't know how to interpret those, but that would be pretty telling. Also, what about your flow limitations or any other signs of SDB? Does your sleep look normal on 4cm? That is the question.

I think you should try 4cm on your back, although how you'll get to sleep on your back is another story.

My flow limitations are all over the place apap wide open, straight, or no cpap they look like an earthquake..


but my oximeter readings.. I did last night.. without the apap are always the same.. above ninety all night with one tiny few second dip
to eighty one or eighty two, and thats it.. it always happens about five am.. I see a pattern, but two seconds big deal.. who cares..

I have plans to try four cm on my back, but I already trained myself to sleep on my tummy!

I have a feeling the experiment on my back wont be pretty! ewww..

[SleepingUgly]

I don't know the stats on how many people who have positional apnea EXCLUSIVELY have it ALL the time, OVER TIME. In other words, if you concluded that you only have OSA on your back, I would think you would have to keep reestablishing this over time to make sure you haven't succumbed to any OSA in other positions. And I just don't know how many people have NO SDB WHATSOEVER in other positions.

See Opinion #6, item #1 in this link:

http://www.talkaboutsleep.com/sleep-dis ... ract31.htm

[elena88]

I don't know the stats on how many people who have positional apnea EXCLUSIVELY have it ALL the time, OVER TIME. In other words, if you concluded that you only have OSA on your back, I would think you would have to keep reestablishing this over time to make sure you haven't succumbed to any OSA in other positions. And I just don't know how many people have NO SDB WHATSOEVER in other positions.

See Opinion #6, item #1 in this link:

http://www.talkaboutsleep.com/sleep-dis ... ract31.htm

I agree, it would have to be monitored, but one can do that with a trusty apap and oximeter
sort of!!!

item six, no problem, Im the princess and the pea, a grain of sand in the bed will wake me up!

I do not know why my apnea is so so so positional, other than I have a tiny mouth, and a ginormous tongue.. but I am not related to gene simmons..
Im Indian/english/french , and I think he is polish..

[SleepTechulous]

What do the doctors and knowledgeable people here think of your oximeter results?

Doctors? Knowledgeable people? Here? Have you noticed all of the medical professionals being attacked and run off?

[xerort]

What do the doctors and knowledgeable people here think of your oximeter results?

Doctors? Knowledgeable people? Here? Have you noticed all of the medical professionals being attacked and run off?

I know insurance regs in NY state you have to be below 88% for a total of at least six minutes to be considered for o2, so that is moot.

[elena88]

What do the doctors and knowledgeable people here think of your oximeter results?

Doctors? Knowledgeable people? Here? Have you noticed all of the medical professionals being attacked and run off?

I know insurance regs in NY state you have to be below 88% for a total of at least six minutes to be considered for o2, so that is moot.

Well, that is interesting, six minutes eh? Thanks for that, I appreciate the information.

[SleepingUgly]

I know insurance regs in NY state you have to be below 88% for a total of at least six minutes to be considered for o2, so that is moot.

Well, that is interesting, six minutes eh? Thanks for that, I appreciate the information.

I thought he was saying supplemental oxygen...