no more c-pap

[judysunlakes]

I want to make other sleep apnea patients' aware of my recent visit to my Sleep Specialist. After 2 years of fighting with masks, nasal units etc. I was about to discuss other options. Long story short, I asked how many apneas occurred when I slept on my side-NONE! all the apneas, 10 in 30 min. were on my back. I NEVER sleep on my back, don't like it never did. He told me to try without the unit and keep track of headaches, restfulness, etc. I have felt fine and have not used it in 4 months.
I only bring this up, because as you know when they do sleep studies ( I had 2 at 2 different centers) they generally have you on your back. Maybe a few min. on you side. Something to check into if you are an exclusive side sleeper as I am.

[Linda3032]

So are you saying that your sleep study was bogus and that you never had sleep apnea?

[Goofproof]

Sounds like a swim in De-Nile, from here. Why did you have the sleep study before. Jim

[OSAGuy]

I don't agree with you about having to sleep on one's back during a sleep study. When I had mine done they said nothing about sleeping on my back. The only thing they said is to slepp (try to) as I normally would.

[Handgunner45]

While they didn't tell me to sleep on my back they said that they were glad that I did spend a portion of the night on my back. My study showed most, but not all of my apneas occurred while I was on my back and my desats were <80% during supine sleep. The apneas that occurred while I was on my side were not severe enough for them to put me on CPAP. After a month on CPAP I noticed that all my remaining apneas seemed to be grouped during the night. I suspected that these were occurring while sleeping supine. I verified this by video taping for a week and corelating the video to the smartcard data. I have taken steps to ensure that I spend the majority of my time on my side and this has reduced my AHI to <1 but it is not going to lead me believe that I don't need CPAP. I still do occasionally roll to my back and my AHI will jump to as much as 2.4.

[There]

A good study would have asked you to sleep on all sides. And there's no guarantee that even if you are mostly a side sleeper, you won't move to your back some nights. After all, you are unconscious! I'd be hesitant to stop without a bit more quantitative data considering the risks. Not that I wouldn't LOVE not to have to use the CPAP any longer myself!

Tina

[MandoJohnny]

My sleep study did not ask for different positions, but I guess it was because they didn't have to. Apprarently, I gave them good samples of both side and back positions spontaneously. They did keep track of apneas by postion though and in my case, my apnea is about the same in both, even though my wife maintains that I used to snore a lot less on my side. In any case, I am probably on CPAP to stay until they invent something better.

[Guest]

Judy,

Most of us would trade an eye tooth to find we really didn't need treatment, that our original assessment was too aggressive for our particular situation. Now I am curious about what proportion of my own apneas were while back sleeping.

There have been other posts on here about having to sleep on their back at their study (I didn't). One even commented how hard it was to sleep because they aren't a back sleeper. Guess some places do go with that worst case scenario.

I am curious - did you used to be a back sleeper? Did you lose weight? I'm just wondering what caused you to be symptomatic enough for them to order a sleep study in the first place. Did you have results of both studies saying all your episodes were on your back? I ask that because I'm one of those of the school of thought that one night in a clinic can not be representative of every night's sleep. If you develop symptoms that make you wonder, a 2 week trial on an autopap might be a good spotcheck.

Judy, I sincerely hope you are a free woman forever. My jealousy will not keep me from wishing you well.

Kathy

[rested gal]

Not sleeping on one's back can help matters, but equally important is controlling apneas and hypopneas when in REM sleep, when the apneas and hypopneas are most apt to hit, no matter what the sleep position.

REM is something we can't control the way we might be able to control what sleep position we use. It's normal to have at least three or four episodes of REM during a night, each one increasingly longer in duration as morning approaches. I'd want to be sure that the events were prevented during REM. REM's good for us...I wouldn't want to be knocked out of REM repeatedly during the night even if I were sleeping on my side.

judysunlakes, did your sleep specialist mention how many apneas and hypopneas (those can be just as disruptive to sleep as full blown apneas) there were, specifically during REM?

[oldgearhead]

Judy,
Your story sounds a bit like mine. In 2000 a PSA uncovered severe OSA.
At that time I always slept on my back. About 9 months later, I slept a couple of nights without the CPAP. I discovered the symptoms went away, if I slept on my side. So, with a lot of effort, I learned to sleep on my side and put away the CPAP machine.

Fast forward to December 2005, I'm sleeping 3-4 hours, waking up, and unable to lay back down (breathing problems). In 2004 and 2005 I was in the hospital 5 times for uncontrolled A-Fib, and had to be shock treated 4 times. Well I finally put two and two together, and realized, IT'S BACK.

......

[GoofyUT]

After 4 months or so of xPAP treatment, I'd begun to get weary and skeptical of it as well. I was diagnosed after a HORRIBLE split night study on my last night of a 5 day stay in the CCU following my first (and ONLY, I hope) heart atack. I barely qualified for xPAP during that study with an AHI of 23, though I KNOW that I had frank, undiagnosed, untreated apnea a couple of years ago, when I had put on some weight.

Anyhow, since my PSG, such as it was, I've struggled as most newbies do, obsessed as most newbies do, fretted as most newbies do, tried masks as most newbies do, switched from CPAP to APAP as most newbies do, and finally settled into a routine.

I've also started an aggressive fitness program since my MI. I began in cardiac rehab as soon as I got out of the hospital, did that for 8 weeks, and then joined a gym. I now exercise 5 days/ week and do AT LEAST 45 minutes on the treadmill at 6% inclination each time. I've changed my diet completely and I've lost a bunch of weight.

So, I've been harboring doubts about whether I really need xPAP anymore. I also was on 2L/min. supplemental oxygen. So, I got a Nellcor N-395 pulse oximeter to see what effect my xPAP and supplemental O2 was having on my sats., which is really ALL that matters. A couple of nights ago, I slept without the damn oxygen concentrator rumbling away all night, and loe and behold, I slept better and my sats throughout the night were fine (SpO2>89%). So, emboldened, I tried to sleep withhout my S8 last night hopeful that once again, my sats would be fine, and that I would be able to take this data, throw it in my sleep doc's face, and then kiss my Australian-hip ResMed S8AutoSet GOOD-BYE!!!

Well folks, listen to the wisdom of those who know and who posted on this thread: About 90 minutes after I fell asleep, I was awakened by the alarm on the Nellcor blaring away, as my SpO2 had plunged to 82%. That was enough for me. On went the Swift and I slept the rest of the night through with a smile on my face.

So, I've lost weight, I've achieved a fair degree of cardio-vascular fitness, I have low blood pressure, VERY LOW cholesterol, don't smoke, don't drink, sleep on my side consistently, and I HAVE OBSTRUCTIVE SLEEP APNEA and I NEED xPAP. Period.

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, swift, CPAP, AHI, APAP

[Ric]

At my SS I was told to "sleep in any position I would normally sleep". Seemed like good advice, and a scientifically valid method to "sample" my sleep pattern. What that really came down to was "sleep in any position I would normally sleep with 83 wires, tubes, microphones, straps, cameras, sensors, transmitters, and other scientific-looking hootchamadooties poking in every direction". That said, I slept mostly on my back, and a little on my side. I was genuinely fearful that if I so much as rolled over I would morph into a cocoon and wake up (if at all) in a dustbin somewhere. Or a museum.

They were clever enough to record sleep position, which in fact DID correlate most apnea events with back-sleeping. But with only a total of a few hours sleep that night I didn't think that was a very scientifically meaningful. And they didn't make anything of it. What the data also showed is that after they bumped the pressure from 6 to 7, I spent most of the rest of the study on my side. This may have led to an artificially LOW titration. I was titrated at 7.

Were it not for having an AUTO, a straight pressure of 7 would have proved almost completely useless. I have subsequently been a consistent 9 or 10, occasionally an 11 (according to the titration data from MyEncore). There is probably some good validity to the notion that back-sleeping is a major contributor to apnea events for SOME individuals.

Judy, if you are convinced that your apnea occurs only while sleeping on your back, and that you don't actually SLEEP on your back, you may be justified in tossing the CPAP. The technique of sewing tennis balls into the back of your jammies has been suggested as a "poor person's" CPAP device. I personally reject that method, after all there is a transitional state when you roll from side-to-side and that would be a rude and needless awakening. I don't imagine anyone tolerating that for more than about 10 minutes. It would be an interesting way to prove one is NOT a back sleeper. Or even an back-roller-overer. My main point is that before you actually DO toss the machine, make sure you really don't need it. Maybe rent an APAP for a few weeks and get a longer baseline and see what is operative in your case.

That is also my main complaint about sleep studies in general, they represent a very small data sample under abnormal conditions. It is useful for learning that some individuals have apnea under some conditions. The titration numbers that emerge should only be considered "ball-park". And they don't even BEGIN to estimate variability in pressure requirements. For that you would need a multi-night study with few wires or none at all, and a reasonably long baseline under reasonably natural conditions. The traditional sleep study fails that test.

Sadly, the tennis-ball technique usually surfaces in the context of el-cheapo insurance plans or sleep docs who are too deeply invested in their HMO to bring themselves to write a script for the proper equipment. But it might be an interesting experiment. (I'm not actually recommending this )

-Ric

[ghmerrill]

I am interested to see Ric's posting concerning his original titration level and subsequent experience with a rather constant higher level on APAP. It mirrors my experience exactly and is the reason I recently decided to spring for an APAP out of pocket. Like him I was titrated at 7 but see that most of my time on the APAP is spent at 9 (lower bound is now set to 8.5) with episodic periods as high as 12, but generally not higher (upper bound is now set to 15). I knew (after a year of use) that 7 obviously wasn't doing the trick for me, but couldn't get any decent results through Apria to change things and didn't want to go back for another sleep study that might well have yielded the same results.

A rather constant criticism in clinical/epidemiological literature seems to be that sleep studies are not done under genuinely realistic conditions (for a set of variables that include things like level of fatigue, recent alcohol ingestion, recent food ingestion, etc.) and that consequently the titration determined can be undependable.

In terms of the issue of sleeping on one's back, I can only report that over decades (prior to being diagnosed with sleep apnea) my wife has trained me not to sleep on my back. This has involved a certain stimulous/response approach that has been rather effective, though perhaps not entirely legal in some jurisdictions .

So even on my side I have apneas and hypopneas. And I can snore in any position (perhaps this is a skill?), contrary to those folks who believe that you need to be on your back to snore. I think (though I haven't actually tried it) that I could probably snore while hanging upside down. I know that my wife believes this.