Update - Positional Sleep Apnea Therapy

[jess]

Twice last year, just as I was falling to sleep on my back, I felt my throat close ---- it was unnerving. I rolled to my side and was fine. That's why I went to the sleep doctor. I have always slept fine and had no idea that I had apnea. I do have Bruxism and at times restless leg. I also think I've had this for many years -- maybe always --- because of the extreme BP drop from normal to low normal within two weeks of using the machine. Has anyone else felt their throat close just as you are falling to sleep?

[mars]

Twice last year, just as I was falling to sleep on my back, I felt my throat close ---- it was unnerving. I rolled to my side and was fine. That's why I went to the sleep doctor. I have always slept fine and had no idea that I had apnea. I do have Bruxism and at times restless leg. I also think I've had this for many years -- maybe always --- because of the extreme BP drop from normal to low normal within two weeks of using the machine. Has anyone else felt their throat close just as you are falling to sleep?

Hi Jess

First of all - you are not on your own -

http://www.faqsleepapnea.com/apnea-moni ... -its-apnea

This used to happen to me a lot, mainly starting naps, in a sitting up position. Then I started having laryngospasms any time night or day, and the falling asleep choking stopped. I would also wake up, conscious, but unable to move, unable to breathe, trying to mentally wake myself up properly so that I could breathe. Very frightening

This might be useful -

http://heartburn.about.com/od/gastrictr ... is_LPR.htm

and this might be interesting -

http://www.mombu.com/medicine/heart/t-c ... 74207.html

My suggestion - do an online search with different search words, and see what you come up with. Also get checked out for reflux.

cheers

Mars

[ozij]

Reality - cpap therapy does not work for most who try it.

Please show us some peer reviewed studies of this issue, from last 5 years, that support your statement.

Please refer us to peer reviewed studies that have shown the success of any therapy specifically targetted at changing sleep position as a solution for positional sleep apnea.

So lets not be closed minded about this .

Right.

O.

[mars]

Reality - cpap therapy does not work for most who try it.

Please show us some peer reviewed studies of this issue, from last 5 years, that support your statement.

Please refer us to peer reviewed studies that have shown the success of any therapy specifically targetted at changing sleep position as a solution for positional sleep apnea.

So lets not be closed minded about this .

Right.

O.

Maybe I should have said

mars wrote:Reality - cpap therapy does not work for many who are prescribed it

It is still a lot of OSA sufferers.

I am just trying to be helpful. But thank you - I have changed the original statement

But hey, why don't you produce the studies which prove I am wrong.

cheers

Mars

[jess]

Mars --- those articles were very interesting. It does sound kind of like what I have ----- however, since I've started on my CPAP I can sleep on my back with no problem. I'll do more reading about this because also last year I choked on some water or something and coughed so hard that my throat closed. Again, really scary. That happened once before when I was only 21 years old.

[ozij]

Reality - cpap therapy does not work for most who try it.

Please show us some peer reviewed studies of this issue, from last 5 years, that support your statement.

Please refer us to peer reviewed studies that have shown the success of any therapy specifically targetted at changing sleep position as a solution for positional sleep apnea.

So lets not be closed minded about this .

Right.

O.

Maybe I should have said

mars wrote:Reality - cpap therapy does not work for many who are prescribed it

It is still a lot of OSA sufferers.

I am just trying to be helpful. But thank you - I have changed the original statement

But hey, why don't you produce the studies which prove I am wrong.

cheers

Mars

I did not say you were wrong and have no need to prove you are.
I am open minded - which means I am alway very interested in data.
Please produce relevant studies to support your statements - or hints - about non-cpap therapy for postional sleep apnea.

[mars]

Reality - cpap therapy does not work for most who try it.

Please show us some peer reviewed studies of this issue, from last 5 years, that support your statement.

Please refer us to peer reviewed studies that have shown the success of any therapy specifically targetted at changing sleep position as a solution for positional sleep apnea.

So lets not be closed minded about this .

Right.

O.

Maybe I should have said

mars wrote:Reality - cpap therapy does not work for many who are prescribed it

It is still a lot of OSA sufferers.

I am just trying to be helpful. But thank you - I have changed the original statement

But hey, why don't you produce the studies which prove I am wrong.

cheers

Mars

I did not say you were wrong and have no need to prove you are.
I am open minded - which means I am alway very interested in data.
Please produce relevant studies to support your statements - or hints - about non-cpap therapy for postional sleep apnea.

Hi Ozij

If I ignored the sarcasm of your first post it was because I was trying to keep this friendly. But I guess I failed

In response to your first post I changed what I wrote, and told you I had done this. I notice you have completely ignored this, and quoted the old post and the correcting post, but ignored the change.

This statement may not be correct -

Reality - cpap therapy does not work for most who try it.


So please consider it replaced by - cpap therapy does not work for many who are prescribed it
(with thanks to Ozij for bringing this to my attention )

and I acknowledged this by saying -

Maybe I should have said

mars wrote:Reality - cpap therapy does not work for many who are prescribed it

Ignoring this tells us that your supposed concern is dishonest, and you are, in fact, hassling me.

How is your demand for studies in any way helpful to this Forum. If you read my posts you will find links to this subject. Are you incapable of taking what value there is in them, without demanding a study.

And why are you demanding a study from me, and not everybody else who shares their experience, information gathering, and who consequently draws conclusions and posts them.

I will always be grateful for the help you gave when I first joined the Forum, but this isn't the first time you have run a "spoiler" on one of my posts.

It started after SAG and Banned had called me an asshole, and I challenged various members about still supporting them. Everybody else who was involved with that disagreement has got over it and moved on. I know I have .

It's time you did !

Mars

[jnk]

I apologize for this long response to your good points, Mars. I think this is a great discussion, myself. I'll leave the subject alone after these drawn-out statements of my opinionated 2 cents.

. . . for some, it may be better than nothing. . . .

True.

But for some (many? most? the vast majority? who knows?) it may be worse than nothing, if "positional therapy" is made to sound like a widely accepted approach to moderate-to-severe OSA, and patients decide to abandon their efforts to give PAP therapy their full effort before moving on to the experiemental. I consider that a very real danger, so I attempt to clarify the limitations and the status of those approaches in comparison to the mainstream gold-standard treatment whenever I see the opportunity.

. . . aren't you assuming that correcting desats is all that is going on ? A sleep study would be needed for that. . . .

I only assume that it is dangerous to make treatment-approach decisions based on assumptions whenever data could be obtained for dealing with a potentially life-threatening condition.

. . . We are told that most of those to whom cpap is recommended do not use it, or try and fail to keep on using it. . . .

Perhaps that was another statement to "correct"? I don't know. Your choice.

. . . Why do we continually forget them, or blame them for not using cpap. . . .

No. I remember them by posting statements in threads where theoretical approaches that are vastly inferior to PAP therapy are discussed without what I see as needed clarification that those methods are not yet considered viable first-choice approaches for those with moderate-to-severe OSA.

Some who don't like the sound of PAP come to this forum because they are grasping at straws to keep from facing the reality of their medical situation. That is why I make posts in threads such as this one to clarify the point that the things being discussed here are not considered even one of the top four or five choices for the majority of those who are said to have "failed" PAP therapy.

I would like to repeat my point that unless you film yourself sleeping every night all night, you have no way of knowing whether you sleep in a certain position, or avoid a certain position, all night. That is true even if you strap a bowling ball to your back. You also have no way of dealing with situations that may increase your AHI, such as eating late, drinking alcohol, getting a cold, having allergies, etc. That is serious business for someone with significant OSA, and it CAN be dealt with, very easily, by positively pressured air.

Modern PAP therapy is a comfortable and easy way to keep the airway open for patients who get the help they need to make it work. It would be a shame if someone said "I can't get help from my DME to make PAP work, so I'll just try not to sleep on my back and then I can simply forget the entire diagnosis." Those people are the ones I don't want to forget, even if it makes my posts irritating to those who cannot, or will not, use PAP for some valid medical reason. Sorry about that.

. . . How many of those who failed with cpap were then tested to see if they had positional OSA, and then know how to alleviate some or all of their symptoms. . . .

In harmony with ozij's excellent point, until there are studies to verify the usefulness of that approach on a large scale (which I think is what she was asking for), few docs/clinics/payers would see any reason to waste their resources on testing something with so little scientific backing on any regular basis. As far as the industry is concerned, a doc's noting the positional nature of the apneas and telling a patient about it is fine, but it doesn't take the place of an actual treatment for moderate-to-severe OSA. Docs are in the business of offering actual treatments that have been proven to work, unless they are the experimental-research kind of doc where the people they deal with understand that.

I personally believe that too many primary-care docs already tell their patients, "Eh, don't bother with a sleep study. Just lose a few pounds, avoid sleeping on your back, and then everything should be fine. You don't want to have to sleep with a machine every night do ya?" How many of those patients die in car accidents as they drive away from the doc's office?

Sleep medicine is a real field with real tests and real treatments for real sufferers whose lives are in real danger. Most severe patients can't afford to play around with sleep position. They need some effective sleep.

. . . We should think of ourselves more as OSA sufferer's, rather than cpap users. This then allows us to include in our concerns all those who do not (for whatever reason) use cpap, but do have OSA. I think by continually minimising the potential of positional sleep apnea we are doing a grave disservice to those I think we are supposed to be helping ie OSA sufferer's. . . .

I respect your position in principle, although I disagree with its application in this instance.

I think that when we discuss experimental treatment approaches (a good thing to discuss very often here, IMO) we should try to keep in mind the importance of constantly minimizing those approaches in comparison to PAP in order not to mislead the casual readers. There is a big difference between posting "I have decided to use an unproven experimental approach" and posting "Hey, look at all the scientific evidence proving that my approach is correct and that more should be doing exactly what I'm doing." One kind of post informs; the other kind has the potential to mislead, IMO.

. . . I know this is a cpap forum, but Johhny and Caroline have never hesitated to mention others forms of treatment (bravo ). . .

I am always happy to see a thread that discusses future potential approaches that are not yet standard. They are some of my favorite threads to read and to participate in. But I will trollingly attempt to interject information pointing out the limitations of those approaches in MY attempt to remember those readers having difficulty with PAP, if I feel that the experimental nature of what is being discussed may be lost on the casual reader.

I appreciate your tolerance of my posting what I consider to be counter-balancing info into those threads for that reason. And I apologize again if my tone seems to over-balance in the other direction.

[mars]

I apologize for this long response to your good points, Mars. I think this is a great discussion, myself. I'll leave the subject alone after these drawn-out statements of my opinionated 2 cents.

. . . for some, it may be better than nothing. . . .

True.

But for some (many? most? the vast majority? who knows?) it may be worse than nothing, if "positional therapy" is made to sound like a widely accepted approach to moderate-to-severe OSA, and patients decide to abandon their efforts to give PAP therapy their full effort before moving on to the experiemental. I consider that a very real danger, so I attempt to clarify the limitations and the status of those approaches in comparison to the mainstream gold-standard treatment whenever I see the opportunity.

. . . aren't you assuming that correcting desats is all that is going on ? A sleep study would be needed for that. . . .

I only assume that it is dangerous to make treatment-approach decisions based on assumptions whenever data could be obtained for dealing with a potentially life-threatening condition.

. . . We are told that most of those to whom cpap is recommended do not use it, or try and fail to keep on using it. . . .

Perhaps that was another statement to "correct"? I don't know. Your choice.

. . . Why do we continually forget them, or blame them for not using cpap. . . .

No. I remember them by posting statements in threads where theoretical approaches that are vastly inferior to PAP therapy are discussed without what I see as needed clarification that those methods are not yet considered viable first-choice approaches for those with moderate-to-severe OSA.

Some who don't like the sound of PAP come to this forum because they are grasping at straws to keep from facing the reality of their medical situation. That is why I make posts in threads such as this one to clarify the point that the things being discussed here are not considered even one of the top four or five choices for the majority of those who are said to have "failed" PAP therapy.

I would like to repeat my point that unless you film yourself sleeping every night all night, you have no way of knowing whether you sleep in a certain position, or avoid a certain position, all night. That is true even if you strap a bowling ball to your back. You also have no way of dealing with situations that may increase your AHI, such as eating late, drinking alcohol, getting a cold, having allergies, etc. That is serious business for someone with significant OSA, and it CAN be dealt with, very easily, by positively pressured air.

Modern PAP therapy is a comfortable and easy way to keep the airway open for patients who get the help they need to make it work. It would be a shame if someone said "I can't get help from my DME to make PAP work, so I'll just try not to sleep on my back and then I can simply forget the entire diagnosis." Those people are the ones I don't want to forget, even if it makes my posts irritating to those who cannot, or will not, use PAP for some valid medical reason. Sorry about that.

. . . How many of those who failed with cpap were then tested to see if they had positional OSA, and then know how to alleviate some or all of their symptoms. . . .

In harmony with ozij's excellent point, until there are studies to verify the usefulness of that approach on a large scale (which I think is what she was asking for), few docs/clinics/payers would see any reason to waste their resources on testing something with so little scientific backing on any regular basis. As far as the industry is concerned, a doc's noting the positional nature of the apneas and telling a patient about it is fine, but it doesn't take the place of an actual treatment for moderate-to-severe OSA. Docs are in the business of offering actual treatments that have been proven to work, unless they are the experimental-research kind of doc where the people they deal with understand that.

I personally believe that too many primary-care docs already tell their patients, "Eh, don't bother with a sleep study. Just lose a few pounds, avoid sleeping on your back, and then everything should be fine. You don't want to have to sleep with a machine every night do ya?" How many of those patients die in car accidents as they drive away from the doc's office?

Sleep medicine is a real field with real tests and real treatments for real sufferers whose lives are in real danger. Most severe patients can't afford to play around with sleep position. They need some effective sleep.

. . . We should think of ourselves more as OSA sufferer's, rather than cpap users. This then allows us to include in our concerns all those who do not (for whatever reason) use cpap, but do have OSA. I think by continually minimising the potential of positional sleep apnea we are doing a grave disservice to those I think we are supposed to be helping ie OSA sufferer's. . . .

I respect your position in principle, although I disagree with its application in this instance.

I think that when we discuss experimental treatment approaches (a good thing to discuss very often here, IMO) we should try to keep in mind the importance of constantly minimizing those approaches in comparison to PAP in order not to mislead the casual readers. There is a big difference between posting "I have decided to use an unproven experimental approach" and posting "Hey, look at all the scientific evidence proving that my approach is correct and that more should be doing exactly what I'm doing." One kind of post informs; the other kind has the potential to mislead, IMO.

. . . I know this is a cpap forum, but Johhny and Caroline have never hesitated to mention others forms of treatment (bravo ). . .

I am always happy to see a thread that discusses future potential approaches that are not yet standard. They are some of my favorite threads to read and to participate in. But I will trollingly attempt to interject information pointing out the limitations of those approaches in MY attempt to remember those readers having difficulty with PAP, if I feel that the experimental nature of what is being discussed may be lost on the casual reader.

I appreciate your tolerance of my posting what I consider to be counter-balancing info into those threads for that reason. And I apologize again if my tone seems to over-balance in the other direction.

Watch this space

Still watching ?

You can go to the next post now

Mars

[Elvin]

Before I was diagnosed with apnea, I was told my "insomnia" was purely psychological. Took various meds, saw therapists to complain about everything wrong in my life, and still no change. The only change I did notice was that when I slept on my couch (passing out watching TV at night), I woke up remarkably refreshed. I also had a sore back, but felt better in spite of it. My couch is such that it forces a person to sleep on their side with pillows forming a steep incline to the armrest, and the back of the couch keeps you in that side-sleeping position all night. So of course this was interpreted that I had a fear of my bedroom from some traumatic episode and that's why I couldn't sleep in my bed.

Anyway, finally got the apnea diagnosis, am no longer afraid of my bed (well, I never was), and after much practice, I can pile up pillows to sleep on my side. Caused back pains at first, but they went away. Can I stay that way all night? Alas, no. Can I just sleep on my couch every night? I've tried, but on a regular basis, I find that I wind up close to being on my back (how the sleeping body will adapt!).

Just a long story that sleep position does matter for some of us, which I think gets discussed here a lot. But I should underline that sleeping on my side, couch or anywhere else, didn't eliminate my apnea, just reduced it--it remained a big problem.

PS. There have been other recent posts about weight causing apnea. Someone at work was obese, got their stomach stapled, lost 100 lbs, and no longer has apnea. I, however, started apnea as a skinny 20-year-old at 6 feet tall and weighing 120 pounds. I do have a narrow throat, which seems a contributing factor.

so what u try did u ever visit any physical therapist for for this hm???

[mars]

I apologize for this long response to your good points, Mars. I think this is a great discussion, myself. I'll leave the subject alone after these drawn-out statements of my opinionated 2 cents.

. . . for some, it may be better than nothing. . . .

True.

But for some (many? most? the vast majority? who knows?) it may be worse than nothing, if "positional therapy" is made to sound like a widely accepted approach to moderate-to-severe OSA, and patients decide to abandon their efforts to give PAP therapy their full effort before moving on to the experimental. I consider that a very real danger, so I attempt to clarify the limitations and the status of those approaches in comparison to the mainstream gold-standard treatment whenever I see the opportunity.

. . . aren't you assuming that correcting desats is all that is going on ? A sleep study would be needed for that. . . .

I only assume that it is dangerous to make treatment-approach decisions based on assumptions whenever data could be obtained for dealing with a potentially life-threatening condition.

. . . We are told that most of those to whom cpap is recommended do not use it, or try and fail to keep on using it. . . .

Perhaps that was another statement to "correct"? I don't know. Your choice.

. . . Why do we continually forget them, or blame them for not using cpap. . . .

No. I remember them by posting statements in threads where theoretical approaches that are vastly inferior to PAP therapy are discussed without what I see as needed clarification that those methods are not yet considered viable first-choice approaches for those with moderate-to-severe OSA.

Some who don't like the sound of PAP come to this forum because they are grasping at straws to keep from facing the reality of their medical situation. That is why I make posts in threads such as this one to clarify the point that the things being discussed here are not considered even one of the top four or five choices for the majority of those who are said to have "failed" PAP therapy.

I would like to repeat my point that unless you film yourself sleeping every night all night, you have no way of knowing whether you sleep in a certain position, or avoid a certain position, all night. That is true even if you strap a bowling ball to your back. You also have no way of dealing with situations that may increase your AHI, such as eating late, drinking alcohol, getting a cold, having allergies, etc. That is serious business for someone with significant OSA, and it CAN be dealt with, very easily, by positively pressured air.

Modern PAP therapy is a comfortable and easy way to keep the airway open for patients who get the help they need to make it work. It would be a shame if someone said "I can't get help from my DME to make PAP work, so I'll just try not to sleep on my back and then I can simply forget the entire diagnosis." Those people are the ones I don't want to forget, even if it makes my posts irritating to those who cannot, or will not, use PAP for some valid medical reason. Sorry about that.

. . . How many of those who failed with cpap were then tested to see if they had positional OSA, and then know how to alleviate some or all of their symptoms. . . .

In harmony with ozij's excellent point, until there are studies to verify the usefulness of that approach on a large scale (which I think is what she was asking for), few docs/clinics/payers would see any reason to waste their resources on testing something with so little scientific backing on any regular basis. As far as the industry is concerned, a doc's noting the positional nature of the apneas and telling a patient about it is fine, but it doesn't take the place of an actual treatment for moderate-to-severe OSA. Docs are in the business of offering actual treatments that have been proven to work, unless they are the experimental-research kind of doc where the people they deal with understand that.

I personally believe that too many primary-care docs already tell their patients, "Eh, don't bother with a sleep study. Just lose a few pounds, avoid sleeping on your back, and then everything should be fine. You don't want to have to sleep with a machine every night do ya?" How many of those patients die in car accidents as they drive away from the doc's office?

Sleep medicine is a real field with real tests and real treatments for real sufferers whose lives are in real danger. Most severe patients can't afford to play around with sleep position. They need some effective sleep.

. . . We should think of ourselves more as OSA sufferer's, rather than cpap users. This then allows us to include in our concerns all those who do not (for whatever reason) use cpap, but do have OSA. I think by continually minimising the potential of positional sleep apnea we are doing a grave disservice to those I think we are supposed to be helping ie OSA sufferer's. . . .

I respect your position in principle, although I disagree with its application in this instance.

I think that when we discuss experimental treatment approaches (a good thing to discuss very often here, IMO) we should try to keep in mind the importance of constantly minimizing those approaches in comparison to PAP in order not to mislead the casual readers. There is a big difference between posting "I have decided to use an unproven experimental approach" and posting "Hey, look at all the scientific evidence proving that my approach is correct and that more should be doing exactly what I'm doing." One kind of post informs; the other kind has the potential to mislead, IMO.

. . . I know this is a cpap forum, but Johhny and Caroline have never hesitated to mention others forms of treatment (bravo ). . .

I am always happy to see a thread that discusses future potential approaches that are not yet standard. They are some of my favorite threads to read and to participate in. But I will trollingly attempt to interject information pointing out the limitations of those approaches in MY attempt to remember those readers having difficulty with PAP, if I feel that the experimental nature of what is being discussed may be lost on the casual reader.

I appreciate your tolerance of my posting what I consider to be counter-balancing info into those threads for that reason. And I apologize again if my tone seems to over-balance in the other direction.

and

Rats!

So what's a guy hafta do to make the current-trolls list?

I mean: I hijack. I provoke. I contradict. I like attention. I'm spoiled rotten. I'm opinionated.

Can't I at least get honorable mention?

Don't I at least deserve a trollus emeritus?

Hi JNK

Well, today is your lucky day. With the above post maliciously maligning and disparaging my efforts to pass on what I am learning, you have achieved your goal of the Trolls "A" team. I know you tried hard before when you were pretending to be different members of the Forum, and deceiving many Forum members with your extra names, so it must have been a disappointment to you when most of those made to look foolish by you went and forgave you.

Still, you have obviously been honing your skills as a weasely wordsmith, and we can see how well you have mastered the art of mis-representation, dishonesty, mis-direction, making assumptions then presenting them as facts, burying the good of my posts in a mess of weasely JNK verbal bullshit.

So you have my congratulations . Being a personable guy will not prevent you getting your coveted prize of Troll of the Year, with a distinction for getting away with it before, which no one else has ever done.

There are some who disagreed with me about giving you this award, but when I pointed out the amount of misinformation in your post, and how you obviously were not doing this for your stated reasons, but just to bury me, there was agreement, or embarrassed silence by some.

Just to show everyone what a brilliant job you did, I have underlined all of your lies, misinformation, misdirections, flippant disparagements, assumptions, and the weasely sanctimonious crap that you are so good at etc.

I think you deserve a distinction with your prize for how you pretend this is a friendly post. Thinking no one can see through your mealy-mouthed pretensions should perhaps have lost you marks. But they were so laughable, and obvious, that it really wasn't worth bothering about.

Just about every statement you make has an element of dishonesty in it, sometimes mixed with a supposed desire to help, but actually preventing information being given so people can make up their own mind.These truths and half-truths you then distort to disparage positional sleep therapy, Which incidentally is not an experimental therapy, and which, according to the first study on this thread,

"Body position during sleep influences the frequency of apneas and hypopneas in 50 to 60% of individuals with obstructive sleep apnea (OSA)," write M. Jeffery Mador, MD, from the State University of New York at Buffalo and the Veterans Affairs Western New York Healthcare System (VAWNY), and colleagues. "Various estimates indicate that positional therapy alone could be used to treat approximately 30 to 50% of all patients with OSA."

Your sanctimonious apology at the end really deserves a special commendation. Slimey is the word that comes to mind, and not many Trolls achieve "slimey" status. And being personable and slimey, is a great combination, but will still only fool some of the people some of the time.

We both know you have a hidden agenda, and your post is not to enlighten, but to bury the truth. Which you just about do on a casual reading. Well done JNK - I think we might even put you up for that Trollus Emeritus award you want. You deserve it

But as I have been saying for a long time - The truth will set you free - but first it will piss you off

Mars

[jnk]

Thanks, Mars.

Points taken.

I wish you all the best with your various treatments for various conditions.

-Jeff