Question About BackSleeping and MaskPressure

[DavidCarolina]

Sorry to hit the board with questions, but ive found it really helpful. I had a second sleep study and was raised from pressure level 10 to 13. The sleep study showed a higher than normal AHI level, from average 1.5, to 3.0 that night, not sure why. Im a natural backsleeper, which causes snoring and apneas, and during sleep studies let myself do that, which may explain.

But Im still having the occasional nasty Apneas---maybe a really bad one once a week--- of the type where you jump out of bed gasping for air, and your body stays agitated for at least an hour (Adrenaline?). Fortunately, i have Klonopin to soothe the central nervous system.

To complicate matters, at age 50, I've developed food allergies from an autoimmune disease (turning 50 has been nasty business for me, I was totally healthy all my life previously) that can cause shortness of breath, agitation, and apneas if I eat after 7 pm. Ive also gained weight, but am trying desperately to get down to ideal weight. Doc says I have a narrow airway and slightly larger tongue---snoring......apneas.

Question: ANyone have any experience or advice on this one? I wouldnt ask for more help, but as everyone knows here, this kind of stuff can pretty much ruin your life and ability to work. Not to mention keeping peace in the family on a daily basis. Would it be an extreme measure to ask the doc if I can "TRY" pressure 20 just for the sake of giving in to my natural back sleeping to prevent any more apneas?

By the way, Ive tried every thing I can think of to prevent myself from ending up on my back, and its more complicated than you can imagine, short of calling Nasa in here to devise a really good restraint mechanism. THanks in advance. Love you guys.

[Mary Z]

I don't think it would be extreme at all to explain to your Doc that your present presssure is not always high enough since you sleep on your back and see what the doc says. If you've already tried the usual methods of staying off your back and they just don't work, waking up at night once a week gasping for air sounds like you need better treatment. If you know how to adjust your machine you could try a pressure of 20 for a week and see if it helps.
Good luck. Keep us posted.

[DavidCarolina]

Thanks Mary. So far my sleep doc has been resistant to my "advice" about increasing pressures. The first time, it was going from 9 to 10 simply because it felt like i had to suck air.

I suspect that he thinks im an air junkie-----somebody who thinks the more air the better.

Hopefully, after two sleep tests, he will start actually listening to me, or i'll be forced to getting another doc.

[archangle]

Please fill in the equipment in your profile so we know what equipment you're using.

[Mary Z]

This is why so many of us end up doing our own titrations- docs who won't listen. Since you have an Auto machine you could set your machine to auto with your prescribed pressure as the EPAP and experiment with slightly higher pressures for the IPAP. You may not need to go up to 20, but you could set the IPAP at 20 and watch for the highest pressure that relieves your symptoms. I'm glad you're keeping your doc in the loop, but when they won't listen to us we have to find new docs, or fend for ourselves. Continue to work with sleeping on your stomach or side since that may be the easiest way to deal with your problem.

[Mtnviewer]

I did not have success with higher pressures & found it kept me far more awake than apneas. The other problems that I had with higher pressure is the extreme tightness of the mask which I found hard to get used to & painful. Not only that, but it stretches the headgear so much that it stretches out fast, needing ever more stretching before it is soon ruined. The air noise was also a huge problem for me. All in all, I found higher pressure a horrible experience with more problems than it solved.

Instead, I began to force myself to side sleep. I tried various fanny packs, back packs & types of fill for these. In the end I found that a medium sized but squarish fanny pack that I had for camera gear filled with shaped pieces of blue house construction styrofoam worked very well & still does. I wear the fanny pack fairly high on my chest vs. around my waist.

Next I made my own pillow out of good foam. The pillow is a narrow rectangle & looks nothing like a normal pillow and I can make it as thick as I want to perfectly align my head to my spine when side sleeping. Next, I put a 4" column in the center of the pillow as a divider & mainly a head stop. This column helps stop my head from turning. But the main reason for my own cut foam pillow is that I wanted to add velcro to the pillow, which I couldn't easily do with a "normal" pillow. I use a soft length of female sided velcro around the pillow, & then through my head gear strap I put in a pieice of the male velcro, about 8 inches long. Effectively, this allows me to actually keep my head attached to the pillow & from turning & from turning me to my back, & the head turning is the start of one going from a side position to a back position. Video recording my sleep helped me understand this, as it took ages to otherwise figure out why the body insisted on back sleeping.

Yes attaching one's head to a pillow is a bit weird initially, but it was FAR FAR easier to get used to than a higher pressure. I've used a male piece of velcro on each side of my head strap & yes in the middle of the night I have to unattach my head to roll over, but again, it was easier to get used to than the many problems that I had with high air pressure if I wanted to insist on back sleeping. Now a few months later I don't need to use the velcro but I still use the same pillow & my fanny pack. I use a towel as a pillow case.

I've also worn a soft cervical collar to keep my chin up and again with a foam pillow that I can cut & shape (with a bread knife or electric knife (better)) allowed for a space for this. There are various grades of foam at the foam store. I started with an inexpensive softer foam to tweak the pillow & then took that to the foam store & they were able to copy that to a higher quality foam that should last forever. The denser foam is a bit harder & a was a bit harder to get used to, but now I like it. I was going to add a layer of softer tempurpedic type foam, but haven't needed to yet.

Experiement with the 2 options, higher pressure & back sleeping & coached side sleeping & see what works best? For me, the learned & forced side sleeping was a HUGE help. My pressure is nearly always between 8 & 9, nearly always an AHI reading of under 1.0, very ofen 0, with very few apneas events and next to no clusters, just the odd event. While it's tough when we're tired, use your imagination & you can come up with a personal solution. Personally, higher pressure was not a good solution at all.

[louspeachy]

Found this:

http://www.preventsnoring.biz/

[DavidCarolina]

Thanks all. We all learn from trial and error, and i feel pretty awful when i end up rolling over onto my back.

On the other hand, if I successfully stay on my side, i feel 90 percent better in the morning.

Its probably 20 percent snoring, and 80 percent sleep incidents. Im already at 13 titration, and it might
be hard to keep the mask on at 20.

[Shellie_p]

you might not need to go all the way to 20.

I know your not *supossed* to sleep on your back but for me I can't do side sleeping AT ALL due to back issues, my perscribed pressure is 15-20 on a Bi-Pap but I tightened it up a bit to 17-21 and that did the trick for me. My AHI Is almost always under a 1.. at the most since i've tightened it was a 1.8..my Primary doc was cool with such a tiny change.

But once thing they asked me at the sleep center when i had my test was to sleep like I NORMALLY did at home. That was important to get the right readings.

I got scolded for putting the head of the bed up lol.

[Muse-Inc]

...Would it be an extreme measure to ask the doc if I can "TRY" pressure 20 just for the sake of giving in to my natural back sleeping to prevent any more apneas?

YES, extreme!!! Higher pressure often causes centrals, the type of apnea where your brain forget to tell you to breathe...not good! What you might ask for is a trial with an APAP machine, one that changes pressure as needed throughout the night. When I injured both shoulders at the same time, I had to sleep on my back...ugly business, tripled-quardrupled my AHI, had apneas (yikes, something new), sleep was already lousy from pain & pain meds. But, my APAP faithfully increased pressure to compensate as best as it could, so no telling how horrible my numbers might have been without my machine's ability to increase pressure as needed.

...By the way, Ive tried every thing I can think of to prevent myself from ending up on my back, and its more complicated than you can imagine, short of calling Nasa in here to devise a really good restraint mechanism...

This tip is from Ro(o)ster who had a really hard time not sleeping on his back: get a backpack, shove something bulky into it, strap it on -- pretty much guarantees you won't roll over and try to sleep on your back.

[DavidCarolina]

RESULTS:

spot on advice from everybody, THANKS guys.

****I have a backpack but it tends to slip to the side and i can somehow roll onto my back anyway. Im experimenting now with a beltloop through the pack that holds the contraption in place.

**Stomach sleeping doesnt work for me, i HATE it , and it hurts my back.

** i might try a 17 pressure, but im worried about centrals. Thanks for the heads up, i need to research that more.

[robysue]

Sorry to hit the board with questions, but ive found it really helpful.

No need to apologize. The whole point of the board is for newbies (and not-so-newbies) to ask LOTS of questions so that they can get this crazy therapy to work for them!

[DoriC]

If you're worried about centrals why not try increasing 1cm at a time for a few nights? Sometimes a small increase even 0.5cm makes a difference.

[Hawthorne]

I am a back sleeper of necessity. I have Rheumatoid Arthritis and any sleep position except on my back ends up in a night awake with pain.

I wouldn't jump up to 20 cm from 13 cm all at once. Getting used to such a high pressure could keep you awake and may cause some centrals. It would be best to raise it gradually - .5 cm or 1 cm at first as has been suggested. You should leave it at the new pressure for at least 3 or 4 nights before raising it again.

I find I do better, given my situation, with my machine set in auto mode with a narrow pressure range so that it can go up some if it needs to. My range is in my profile. I have the A-Flex set at 1. My AHI is below 2 always and often below 1. If you try an auto range, maybe 11 cm to 14 cm might be a good place to start for you. If, after 3 -4 days you still have trouble, raise the minimum by .5 cm and then by 1 cm and so on. You may end up raising the maximum pressure too but I would not do that unless the minimum gets to within 1 cm of it - then raise the maximum pressure just as gradually as you did the minimum.

I also use a memory foam contour pillow so that my neck is supported and it keeps my chin tipped up while sleeping on my back. This helps keep my airway more open.