CPAPtalk.com

SleepTechulous wrote:

SleepingUgly wrote: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?

When I said doctors, I meant her doctors, and when I said "knowledgeable people here", I didn't necessarily mean medical professionals. There are non-medical professionals here that are knowledgeable and can help her interpret her oximeter results, believe it or not.

thanks s.u.



okay, so this is the big question...

here is a site which sells positional treatment devices....

http://www.sleep-apnea-guide.com/positi ... erapy.html

at the bottom it says.. "good for snorning or mild apnea"

so why is it, that positional treatment cant be considered for severe apnea, or IS IT?

Why send a patient off with a cpap if they have zero apneas in three positons, sides, stomach, and severe apnea on back?

Would not then this patient be the perfect candidate for positional treatment? I dont hear much about positional treatment?
Why is that? Is it because there is no money in it?

I hear about the occassional tennis ball tip for someone who barely registered some mild apneas on thier back, but i dont hear it as a viable
solution to someone with severe positional apnea...

Has anyone been diagnosed with severe apnea and been put on positinal therapy instead of cpap?

I don't know... It would be nice if a sleep tech would chime in here and speak to how often apnea is exclusively positional with NO SDB in any other position (Keeping in mind that sleep techs tend to only see one night, and I worry that it could be strictly positional one night and not so strictly positional another night). Yoo hoo, Muffy...

bumping this, as its one of the last pieces of the puzzle Im trying to solve..

thanks!


Has anyone been diagnosed with severe apnea and been put on positional therapy instead of cpap?

If they were put on positional therapy instead of CPAP, they might not be around here...

maybe a tech has heard of someone?

but youre right! maybe there are a LOT OF THEM, and they arent here!

Sleep position can affect airway size and patency with a decrease in the area of the upper airway, particularly in the lateral dimension, while in the supine position.22 Positional therapy, consisting of a method that keeps the patient in a non-supine position, is an effective secondary therapy or can be a supplement to primary therapies for OSA in patients who have a low AHI in the non-supine versus that in the supine position (Guideline).21 Because not all patients normalize AHI when non-supine, correction of OSA by position should be documented with PSG before initiating this form of treatment as a primary therapy (Consensus). A positioning device (e.g., alarm, pillow, backpack, tennis ball) should be used when initiating positional therapy (Consensus). To establish the efficacy of a positioning device in the home, providers should consider use of an objective position monitor (Consensus). Treatment specific outcome indicators to monitor with therapy include: self-reported compliance, objective position monitoring, side effects, and symptom resolution (Consensus).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699173/

OK, Elena, here is what I recommend:

First, an ABAB design:
For a week you do CPAP=4 on your stomach, while wearing the oximeter. Outfit yourself with something to prevent you from sleeping on your back.
Then for a week you do CPAP=4 on your back, while wearing the oximeter. Outfit yourself with something that will ideally keep you on your back all night so you don't flip onto your stomach for REM. Consider video recording some of the time, especially in the early morning hours to ensure you really are on your back.
Then a week at 4 on your stomach again, with the oximeter.
Then a week at 4 on your back again, with the oximeter.

SOMEONE (you know who you people are!!), help Elena interpret the results of her CPAP and oximeter data from this trial.

IF it really looks like you have NO SDB whatsoever on your stomach, but you do on your back, I would recommend:

Repeat your sleep study on your stomach with your gizmo that prevents you from rolling onto your back. This is necessary to verify that you really do have positional OSA, and that your NO CPAP results are the same as your 4cm results. Afterall, if there are people who use 5 or 6cm of pressure, it's possible that 4 is helping somewhat. If you need it in order to sleep through your sleep study, get an Rx for a sleep aid. You need a complete night of sleep, including REM, not one hour! Wear comfy undies.

Or you could skip the ABAB design and go straight to the sleep study. I really think that you're going to need another sleep study at some point as I don't think your first one is valid. You can decide whether you want to try to get it in this year, or whether it's better that it go toward meeting next year's deductible.

thanks S.U.

youre such a littie googling!

Positional therapy, consisting of a method that keeps the patient in a non-supine position, is an effective secondary therapy or can be a supplement to primary therapies for OSA in patients who have a low AHI in the non-supine versus that in the supine position (Guideline).21

its an effective secondary therapy perhaps if the patient fails at the first therapy?

or a supplement to primary therapy..

how about it BEING the primary therapy, and the ONLY therapy for positional severe osa.. ??? I think I must start a trend here, Im such a weird case anyway!

why the heck would anyone need a cpap if their severe osa was completely positional?

elena88 wrote:

Positional therapy, consisting of a method that keeps the patient in a non-supine position, is an effective secondary therapy or can be a supplement to primary therapies for OSA in patients who have a low AHI in the non-supine versus that in the supine position (Guideline).21

its an effective secondary therapy perhaps if the patient fails at the first therapy?

or a supplement to primary therapy..

how about it BEING the primary therapy, and the ONLY therapy for positional severe osa.. ???

It says:

Because not all patients normalize AHI when non-supine, correction of OSA by position should be documented with PSG before initiating this form of treatment as a primary therapy (Consensus).

In other words, you would need a sleep study that documents that your AHI normalizes when you're not on your back. Hence my recommendation that you do another sleep study.

If $ were no object, you could use two sleep studies: A real one in which you sleep all night, instead of one hour, in a variety of positions, including your back. If that suggests positional OSA, as you suspect, you need a second study where you sleep exclusively off your back and demonstrate that your AHI and other stats normalize completely when you're off your back.

I don't think anything will substitute for a sleep study. Still, a sleep study is one night in time, so the ABAB design would provide indirect support for your hypothesis. Still, 4cm is not NOTHING...

I can share my experience. My sleep study showed an AHI of 60-70 on my back and an AHI below 5 on my side. The sleep doc thought the CPAP showed promise. And I now use the CPAP set at a pressure of "4" cm. "4" seems silly to me but what do I know? Anything higher and the AHI's climb into the 20-30 range (hyponias and centrals). I make and effort to sleep on my side but don't use anything to prevent my from rolling side to side so I do end up on my back sometimes.
I have been 100% compliant but I cannot say I feel much better. Maybe a little better. I'm trying to be patient. I did seek a second opinion. I am going to try something called loranepam. So I am here searching the board for information on this medication. I'm sure that I am going to end up strung out on the drug, selling my body on the street corner to feed my habit the day after I take this stuff. But I feel like I'm loosing the fight so I have to try something.
But back to your question. I think I would be a good candidate for secondary therapy. I also agree with what someone else said. That one night is not a good measure. With all the new technology out there hopefully the next generation of apnea patients will run the tests at home over a period of weeks not hours.
For people with position related OSA maybe it makes more sense to just use an oximeter and forget the CPAP. But I would not want to put anyone in harms way. Oxygen is pretty important and an oximeter is not going to help you breath.

My goodness Underdog, that is quite a big difference it AHI on your back vs side!
wow..

So you have a pressure of four cm too? That is what I had been using when I couldnt take the high pressures anymore, which turned
out to be dead wrong..

How do you feel about the doctor prescribing a medication for you? What have you found out about it?
I have heard of drug with a similar name, only with a "z" in it..
So were you tired before cpap?

I of course was not, and since my pressure is now four, Im drifting away from wanting to deal with it at all.

I havent worn my apap for a week, but have been wearing my oximeter.

I only have a few tiny dips once or twice a night that go down to about eighty, but they only last from two to five seconds..

Now what IM trying to figure it out how many seconds do I have to stop breathing to get it that low..

A couple times I think I ended up on my back, but not sure, so I will have to investigatet this further..

If I can stay hovering around the high nineties all night long if Im on my tummy, Im hoping I can hang up the apap..

If I have to wear it, Ill go back to wearing it half the night on and half the night off, so I can recover from wearing it.

I know one thing, I simply cant wear it all night long and function at all the next day, even at four cm, with no leaks, and 0.0 ahi..

I think you mean Lorazepam do you? It is a sedating drug ( a Benzodiazepam - I think is the drug class) used for anxiety I think.

I take 1.5 mg of Lorazepam every morning with breakfast for "a-typical migraine" (never get - never got -the migraine headaches just the leadup symptoms). I was diagnosed with a- typical migraine in 1982 and started on 3 mg of Lorazepam in the am and 3 mg in the evening.

I never felt a need to "feed my habit" or craved more, although I understand it can be very addictive. In fact, over the years I have weaned down to 1.5 mg per day and that dose now deals with the issue. As I said, I always take it in the morning with breakfast. I do well on cpap (AHI always below 2 and leak rate fine). That small a dose may well be out of my system by bedtime.

I developed this a-typical migraine thing way before I was diagnosed with sleep apnea, which was in 2002. I do not take Lorazepam for sleep apnea. Is a doctor suggesting it for that?

If you are being prescribed it for helping you with sleep apnea, I think there are probably less addictive drugs available. I don't know what they are but someone else may.

Yes it is "Lorazepam" sorry my mistake (.5 mg).
And Elena88 I am not looking forward to taking it.
I don't want to steal the thread. As for giving the CPAP the slip, I think about it every night.
Each time I go in to my sleep Dr. I meet with the RN first and we go over the sleep numbers that I print out from the prior month. 3 out of the last 6 times I have done this the RN says, "you know, I don't think you should be on this machine, I don't think this is your problem" and then she goes to her computer and pulls up my original sleep study and says " oh, no you need CPAP, your numbers were terrible."

So like you Elena88 the seed of doubt has been planted in my mind.
You are smart to be monitoring your oxygen levels.
Are you under the assumption that during the titration study you responded more favorably to the pressure but then later reacted differently? Or did the original sleep study identify this issue?

my sleep study was 18 years ago, started cpap Feb 23 '93
my original study:
AHI supine - 100 (yes, one hundred per hour)
AHI non-supine - Zero, nil, zilch, NOT one apnea or hypopnea while on my sides
90% pressure - 6 cm
100% pressure - 7 cm
doctor prescribed 8

This is why I HAVE to use APAP.

I have clear recollections of sleeping on friends' sofa's when I was young, and feeling fantastic the next day. Too bad I hadn't figured out back then that it was because I spent the whole night on my side.