Sleeping on side... Why is it helpful?

Do most people with OSA do better on their side? Does anyone know why that is.
I start out fine going from one side to another and somewhere in the early morning I go to my back. Then I notice that I am awakened by swallowing air?
I have ordered a chinstrap so I hope that will help but what do you do to keep from rolling on your back?

vdol52 wrote:Do most people with OSA do better on their side? Does anyone know why that is.
I start out fine going from one side to another and somewhere in the early morning I go to my back. Then I notice that I am awakened by swallowing air?
I have ordered a chinstrat so I hope that will help but what do you do to keep from rolling on your back?

I have read that about 40% of people with sleep apnea have "positional sleep apnea". This means their sleep apnea is less severe when side sleeping as compared to back sleeping. On your back, gravity is working directly on your tongue and soft palate to cause an obstruction. On your side the effect of gravity is less.

As an example of positional sleep apnea, I need a pressure of 19 cm to prevent apneas when sleeping on my back. On my side a pressure of 8.5 cm is sufficient to prevent apneas.

By nature I am a back sleeper so I wear a small backpack containing an empty 20-ounce water bottle at night. This forces me to stay off my back and allows me to use a pressure of 8.5 cm.

You need to figure out whether your sleep apnea is positional. Then you can develop some tactics to take advantage of this.

Regards.

That makes alot of sense. I am usually to sleepy to get up and look at my pressure though but I can tell it is high when I am on my back.

vdol52 wrote:That makes alot of sense. I am usually to sleepy to get up and look at my pressure though but I can tell it is high when I am on my back.

What settings are you using?

vdol52 wrote:Do most people with OSA do better on their side?

Basically because when you are sleeping on your side, gravity does not assist the the other factors which cause airways to close!

Cheers,

Bill

In addition to what has already been mentioned (tongue flopping back), lung volume is also likely to play a role in the increased incidence of OSA while on the back. The upper airway is more collapsible at a lower lung volume. Lung volume is significantly smaller when sleeping on your back compared to when sleeping on your side.

Edit: Corrected last sentence.

split_city wrote:.......... The upper airway is more collapsible at a lower lung volume. Lung volume is significantly smaller when sleeping on your side compared to when sleeping on your back.

Huh, Split City? My brain can't get around that one. Seems counterintuitive to the previous discussion.

it is my opinion that:

When you go to a sleep lab they may test you in the various sleep positions but they will always titrate you while on your back. Why? because that will be the worst possible conditions for you to have an apnea. So if they titrate you in that worst possible position, pressure should be high enough to handle your disorder should you switch and sleep on your side.

From the pictures, cartoons, videos I have ever seen on this disorder, obstructive sleep apnea is mainly made up of your tongue getting lodged into the back of the throat during inhale. While there may be other obstructions and ways the airway can become blocked such as VCD, for most of us it is the simple fact the tongue gets sucked into the back of the throat. This is why after UPPP surgery that patients still have OSA. The reason that surgery fails so often is the fact it cannot prevent the tongue from becoming lodged into the back of the throat.

The tongue is attached to the back side of your chin, not the back of the throat. So when it blocks your airway it is in a relaxed state. Can be many reasons for that to happen, age, loss of muscle tone etc., etc. But what plays into that when you are in the supine position is gravity. So now you are inhaling which creates a low pressure area in the esophagus on one side and atmospheric pressure of 14.7 PSI on the other side of the potential obstruction. Should that airspace narrow or close up further during inhale it may suddenly slam shut in a frank apnea just like putting your hand over a vacuum hose. Gravity aids in that taking place. Sleep on your side gravity pulls the tongue to the side.

Look at a dental advancement device like Tap, it moves your mandible forward, that also moves the tongue forward extending the airspace at the back of the throat.

Look at the MMA surgery procedure, in that procedure they cut the mandible and extend it forward also extending the airspace at the back of the throat.

There are some companies working on the tongue tether to prevent the tongue from lodging into the back of the throat.

Then there are other suggestions that if you mouth breathe the tongue can become enlarged, the actual cause of the tongue getting larger is unknown to my knowledge.

But you can be assured gravity plays a big role in the OSA process. Watch the videos, observe what the tongue does and where it is attached. Unfortunately the tongue muscle is a very complex organ, not much they can do with it in the way of surgery, but if they could only make it shorter.

I bet Gene Simmons really has a problem with it.

Snoredog wrote:.........Unfortunately the tongue muscle is a very complex organ, not much they can do with it in the way of surgery, but if they could only make it shorter.

......

Some organs we want shorter, some .......

Snoredog wrote:Look at a dental advancement device like Tap, it moves your mandible forward, that also moves the tongue forward extending the airspace at the back of the throat.

Look at the MMA surgery procedure, in that procedure they cut the mandible and extend it forward also extending the airspace at the back of the throat.

There are some companies working on the tongue tether to prevent the tongue from lodging into the back of the throat.

These all sound masochistic

I didn't realize the tongue had that much control, just that it is in the way sometimes, thought it was more the muscles in the throat. Guess it's all connected. I knew gravity played a roll. I am very positional and my apnea is almost non-existant on my side. I was glad I slept on my back the whole time at my titration study and so was the tech. At 12cm H2O I have not had more than 3 AHI now at night. Now if I can take care of the leaks I get when I go on my left side, it would be good.

Everything I've read agrees with what I'm reading on this post. But I have my sleep study in front of me and it really confuses me.

In the S Position, I have Total Dur (minutes) of 158.7 total, 90.1% sleep, and Events Index of 0.4.

In the R Position, I have Total Dur (minutes) of 186.3 total, 87.8% sleep, and Events Index of 17.6.

The other two positions, L and P, are left blank.

Doesn't this mean that I was much worse on my right side than on my back? Am I a rare case, or are there others out there like me?

I'm a newbie and have been using the CPAP for less than a week. This forum is terrific and has been a big help to me in dealing with my questions.

Do you have enough detail to see which sleep stages you were in when you were on your side and on your back? If you had a lot of REM sleep on your side and none on your back, the difference in events could be due to the stage of sleep instead of the position. But this is just speculation on my part at this point.

rooster wrote:

split_city wrote:.......... The upper airway is more collapsible at a lower lung volume. Lung volume is significantly smaller when sleeping on your side compared to when sleeping on your back.

Huh, Split City? My brain can't get around that one. Seems counterintuitive to the previous discussion.

Yes, my mistake...I have edited my posted. I should have said lung volume is smaller when on your BACK not your side.

Was typing late at night so my brain had switched off (that's my excuse anyway ).

Snoredog wrote: it is my opinion that:

From the pictures, cartoons, videos I have ever seen on this disorder, obstructive sleep apnea is mainly made up of your tongue getting lodged into the back of the throat during inhale. While there may be other obstructions and ways the airway can become blocked such as VCD, for most of us it is the simple fact the tongue gets sucked into the back of the throat.

Snoredog: Can you please provide me with some links of videos of the UA (not cartoons) showing airway collapse? It would be great if the same video(s) showed respiratory flow as well.

The reason why I ask is that I think a lot of people simply assume that the tongue flops back during inhalation. One would intuitively predict (including me) that this would be the case....negative pressure sucks the floppy tongue towards the back of the throat. However, I would argue against this based on my current work. I would say in pretty much a majority of cases (and i'm talking about 99% of cases here), of the collapsed events in my OSA patients have occurred towards the end of expiration. While the negative pressure during inhalation keeps the airway closed (due to lose of tongue tone), the actual collapsed event occurs without the generation of negative pressure. This is referred to as passive airway collapse.

Snoredog wrote:The tongue is attached to the back side of your chin, not the back of the throat. So when it blocks your airway it is in a relaxed state. Can be many reasons for that to happen, age, loss of muscle tone etc., etc. But what plays into that when you are in the supine position is gravity. So now you are inhaling which creates a low pressure area in the esophagus on one side and atmospheric pressure of 14.7 PSI on the other side of the potential obstruction. Should that airspace narrow or close up further during inhale it may suddenly slam shut in a frank apnea just like putting your hand over a vacuum hose. Gravity aids in that taking place. Sleep on your side gravity pulls the tongue to the side.

So if gravity is such a key variable, why/how can the airway close when sleeping on your stomach?

Snoredog wrote: Look at a dental advancement device like Tap, it moves your mandible forward, that also moves the tongue forward extending the airspace at the back of the throat.

Just like UA surgery, the success rate of these devices can be relatively low.

Snoredog wrote:Then there are other suggestions that if you mouth breathe the tongue can become enlarged, the actual cause of the tongue getting larger is unknown to my knowledge.

Mouth breathing also drops the jaw, further compressing the airway.

Snoredog wrote:But you can be assured gravity plays a big role in the OSA process. Watch the videos, observe what the tongue does and where it is attached. Unfortunately the tongue muscle is a very complex organ, not much they can do with it in the way of surgery, but if they could only make it shorter.

While helpful, these cartoon videos aren't very accurate. I have seen cartoon videos which go through the process of weight loss and how this helps prevent collapse. You only have to read these boards to know how pissed people become when their doctors simply say, "lose weight." If only it were that simple!

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, video

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, video

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, video

For me it can lower my pressure five to six cm, so I try to spend at least 75% of sleep time on my right or left side and that is were I get my best AHI readings. I try to hit REM on my left side. I usually average 0 to .5 OA during that time. Does make a difference, at least in my case it does.

Dan