Update - Positional Sleep Apnea Therapy

I could only sleep on my right side before using the machine.

Now I can sleep on my back and left side in comfort. I was always a little short of breath before.

I believe positional has a great deal to do with Apnea's but once that jet air is blowing down you air tube it is like heaven as far as sleep and breathing goes.

I live in the United States so no one can force me to do a sleep study. If anyone threatens you by saying they are going to not provide treatment unless you do exactly what they say just walk out. Make sure you tell the receptionist you are not paying for the visit. MANY people are scammed by sleep studies going as far as the study, getting a machine and using it for years when there was no problem in the first place. I have had doctors push tests that are so far out of left field I declined. A good example was when I have pneumonia, they wanted to test for COPD/Asthma and do a cardio work up. I just had all that done months before so I said no. Amazingly enough to nightmonkey my doctor FAILED and still did the chest X-Ray and gave me the medications I needed to get over it.

I can not count how many times to I told a doctor he is not checking my prostate. I was surfing in Hawaii and did something to my neck, the doctor starts putting on a glove for a prostate check, I said no. He still went on checking my neck and prescribed pain killers and muscle relaxers. Again, my doctor failed me I guess.

All a medical professional can do is recommend treatment options, if they failed they only failed not stressing the point of a sleep study. I was told to get one for a very long time but never did. I explained I did not have the money and once I was diagnosed with OSA I would NEVER get private insurance again. I own my own business and move from state to state a lot and even the doctor AGREED in that instance I just have to take my chances and wait (I cant force a sleep clinic to do it for free). People do have reasons to refuse treatment. Oh yeah, that doctor still helped me with my symptoms, another terrible doctor I guess.

If doctors are going to get into pushing people into expensive tests they should spend some time looking for ways to make it affordable for those that can not afford it. In my case the insurance company dropped me after I was diagnosed with OSA, told me I had to wait one year to be covered despite the fact I was diagnosed with severe OSA. I called the doctor and explained if he wrote a letter to insurance they would cover it, he said NO! It was not worth 5 minutes of his time. So I in the end I had to shell out 7,000 of my own cash and have no access to doctors until next month.

Counselors are not doctors either, most are worse off in life than their patients (my general MDs words).

Cuda wrote: . . . MANY people are scammed by sleep studies going as far as the study, getting a machine and using it for years when there was no problem in the first place. . . .

Interesting opinion.

Any data to back it up?

Just curious.

Thanks in advance.

jnk wrote:

Cuda wrote: . . . MANY people are scammed by sleep studies going as far as the study, getting a machine and using it for years when there was no problem in the first place. . . .

Interesting opinion.

Any data to back it up?

Just curious.

Thanks in advance.

Waste not, want not, my Grandmother told me - so to save me having to think - I quote

Postby jnk on Tue Sep 20, 2011 2:45 pm
Events may appear to be positional during the night of the PSG, but that doesn't prove the problem is always that positional every night. Some factors may increase or decrease the effect of position on breathing and on sleep. (Food, beverage, tiredness, state of nasal passages from allergies, etc.)

and instead of working out my own question (and I am genuinely interested in the answer) I quote JNK again

Interesting opinion.

Any data to back it up?

Just curious.

Thanks in advance

Mars

Oh. I never back MY opinions up with data--that way I'm less likely to convince anyone.

But I am always interested in whether anyone ELSE has data, at least when their opinions interest me.

I keep hearing about these people sent for sleep studies who have nothing wrong with them, but I can't figure out how they get sent if they have no symptoms.

Seems to me that response to therapy is the ultimate measure of the usefulness of PAP, and I can't imagine anyone using it if they don't experience any improvement in anything.

But getting back to my statement, it was about what one night does NOT prove and what MAY affect the position factor. I loves me my weasel words, and we all know the impossibility of proving a negative.

Postby jnk on Tue Sep 20, 2011 2:45 pm
Events may appear to be positional during the night of the PSG, but that doesn't prove the problem is always that positional every night. Some factors may increase or decrease the effect of position on breathing and on sleep. (Food, beverage, tiredness, state of nasal passages from allergies, etc.)

Edit was to change "effect" to "affect." I just fired another copy editor.

jnk wrote:
But getting back to my statement, it was about what one night does NOT prove and what MAY effect the position factor. I loves me my weasel words, and we all know the impossibility of proving a negative.

Does that mean I can add your words to -

http://www.bhatt.id.au/blog/watsons-dic ... nt-jargon/

I do hope you are not training to become a politician

cheers

Mars

mars wrote:I do hope you are not training to become a politician

I wouldn't even vote for myself.

Anything that can affect AHI during one part of the night can make it appear that events are positional in a person who tends to sleep in one position during that part of the night. That includes drugs, amount of food in the stomach, and the state of the nasal passages. Any and all of those variables mix in a way that can make a person cross the line into so-called positional apnea on one night but not the next. I believe most positional discussions in research studies mention that--that people meet the criteria one night and then not the next because of the arbitrary nature of the criteria.

What makes it all so difficult to define and follow is that it is mostly people with mild-to-moderate apnea who fall into the positional-apnea category on some nights, and they are also the ones who are most likely to show night-to-night variations in their AHI that would take them across the OSA lines in the sand on some nights and not others as well as the positional lines in the sand. Much of the trouble with categories with OSA is that how you define the categories defines the so-called success in treating the people in those categories.

I think most everyone agrees that patients tend to sleep during away-from-home sleep studies in a way that is often different from how they sleep in their own beds. Many are asked to sleep in a position they do not normally sleep in, or feel they have to sleep in a non-standard position because of the discomfort of the wires. It seems odd to me to take the data from that non-standard night and to then declare something about treatment being a mere matter of position once the person gets home.

No data to back that up--only thought experiments performed slightly faster than the speed of light.

jnk wrote: The point is that oximeters measure O2, not arousals.

A slight correction. Pulse oximeters measure both oxygen saturation and pulse rate. Arousals may not involve a desaturation in oxygen, but they often, if not always, involve a spike in pulse rate...

My sleep study showed that my apnea is positional to a degree, but that I do have it whether on my side or back (back is worse, as it is for most people, I believe).

Debbie

mars wrote:Hi All

There is no doubt that many of us are using cpap machines unnecessarily, because we have positional sleep apnea, but do not know it.

An interesting study has been out for some years -

http://www.medscape.org/viewarticle/514608

and the large print version is below -

Positional Sleep Apnea May Be Common

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

CME Released: 10/17/2005; Valid for credit through 10/17/2006

Oct. 17, 2005 — Positional sleep apnea is common and not usually diagnosed on split-night testing, according to the results of a retrospective chart review published in the October issue of Chest.

"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."

The primary objective of this study was to determine the prevalence of positional OSA, defined as a total apnea-hypopnea index (AHI) greater than 5, with a greater than 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI less than 5) in the nonsupine posture. The secondary objective was to determine if positional sleep apnea could be accurately diagnosed during a split-night study.

The investigators reviewed records of 326 patients, including 57 patients who underwent a split-night study and 242 patients who underwent polysomnography.

Positional sleep apnea was diagnosed in 49 (49.5%) of 99 patients with mild sleep apnea (AHI, 5 - 15/hour), 14 (19.4%) of 72 patients with moderate sleep apnea (AHI, 15 - 30/hour), and 5 (6.5%) of 77 patients with severe sleep apnea (AHI greater than 30/hour). Sleep time did not exceed 15 minutes in both postures in 104 (38.7%) of 269 patients at the VAWNY and in 80 (33.1%) of 242 overnight studies at the Associated Sleep Center nor in 47 (82.5%) of 57 split-night studies. The percentage of studies with insufficient sleep time in both postures was greater for split-night studies ( P < .0001).

"Positional sleep apnea is common particularly in patients with milder disease who have smaller neck circumferences," the authors write. "Positional therapy has the potential to be an effective therapy in a significant proportion of patients with sleep apnea. Rigorous outcome studies evaluating the efficacy of this treatment modality are urgently needed in patients with mild-to-moderate sleep apnea."

Chest. 2005;128:2130-2137

Extremely important is the statement that

Positional sleep apnea was diagnosed in 49 (49.5%) of 99 patients with mild sleep apnea (AHI, 5 - 15/hour), 14 (19.4%) of 72 patients with moderate sleep apnea (AHI, 15 - 30/hour), and 5 (6.5%) of 77 patients with severe sleep apnea (AHI greater than 30/hour).

Experimentation with an oximeter and different sleep positions is the way to find out, and then get confirmation by a sleep study. Sleeping on your side, with no back sleeping, is probably the the most likely position to avoid sleep apnea for those who do have positional sleep apnea, but it always needs individual experimentation.

The fact that this study, and other information about positional sleep apnea, tends to be ignored by the mainstream sleep disorder professionals, and also by many who have OSA, , only reinforces the truism that we have to be self-affirmative in getting the best treatment for ourselves, and sometimes have to go against current majority opinion.

My own positional sleep study is now set for the 6th October 2011, having been delayed because of other serious health problems. I use a back wedge and a thigh wedge to keep me on my side.

cheers

Mars

Thanks for the correction, HoseCrusher.

I agree that many methods can be used to infer (read: guess at the possibility of) arousals to get an overall index, but the fact remains that . . .

"Type 3 devices cannot detect arousals from sleep because they cannot monitor electroencephalography (EEG)."
http://www.uptodate.com/contents/portab ... -in-adults

Said another way, . . .

"Without EEG, portable monitors do not assess arousals directly but surrogate indicators, either changes in heart rate, arterial tone, or flow rate give good approximations for arousal index." (underlining mine)
http://medind.nic.in/iby/t10/i2/ibyt10i2p217.pdf

Please note that my earlier statements were given in the context of statements by others about using O2 measurements, solely, to assess success of PAP therapy.

My point was that it is possible to be very successful at reducing sustained saturations while at the same time failing miserably at stabilizing the airway sufficiently for optimizing sleep consolidation.

And that is why techs don't stop the titration the moment sustained O2 is normalized in the sleeping patient.

Thanks again for the opportunity to restate that point. The clickety-clack of the keys on my netbook seem to take on a sort of musical character this time of night.

-Jeff

jnk wrote:

My point was that it is possible to be very successful at reducing sustained saturations while at the same time failing miserably at stabilizing the airway sufficiently for optimizing sleep consolidation.

-Jeff

There you are Jeff You can talk in a language that even I can understand. And what you say is important.

That is why I am talking about a journey towards the best treatment for an individual, and possibly a second best solution for those who cannot tolerate cpap.

Lets face it, no desaturations but disturbed sleep still present is better than desaturations and other events also causing disturbed sleep. It is desaturations that cause the organ damage, and sometimes, my friend, in your emphasis on other possible disturbances, that tends to get missed.

cheers

Mars

Postby mars on Sun Sep 25, 2011 11:49 pm
Hi All

So trying to get back to basics, this is what I am talking about -

What causes simple snoring and obstructive sleep apnoea?

There are a number of different causes and aggravating factors for narrowing of the throat which worsens during sleep to cause snoring or obstructive sleep apnoea. Mild throat narrowing will result in snoring, more severe narrowing will lead to obstructive sleep apnoea.

For myself, and thousands upon thousands of others, my throat narrows when sleeping on my back, and, conversely, when I have a laryngospasm when awake, or wake up having one, what I have to do is to try to breathe as slowly as possible (not easy when you are choking to death), stretch my head upwards as far as it will go, and exert maximum pressure with finger and thumb on the upper back extension of my jawbone pressing forward. So far this has worked, although the horrible noise I make trying to breathe has brought neighbours running to help me (which they can't).

Now if you want to know what a laryngospasm is, or what an apnea looks like, go to -

https://www.youtube.com/watch?v=nPtdkqOLLP4

This guy does not tell you how to deal with it, but he does realistically show it happening (imagine the wheezing as loud as Black Sabbath) - frightening.

And he does not tell you, but laryngospasms can kill you.

From this I learned that my throat was most likely to stay open, or become open, when my head was upright or leaning back. From my sleep study, and later personal experience with my oximeter and my recliner, I learned that I was guaranteed apneas lying on my back, but not if I was nearly upright and my head was also positioned upright.

This led me to the soft cervical collar -

http://www.healthhype.com/trapezitis-sy ... tment.html

to keep my chin up,

http://the-pillow.com.au/more/complete_ ... l_more.php

and then found I could discard the cervical collar, and just use the cervical neck support pillow -

To stay on my side I use this --

http://the-pillow.com.au/more/side_sleeprrr_more.php

In a couple of weeks I will be be having a full blown sleep test at the finest sleep lab in the Southern Hemisphere, and I promise you that when I get the data, which may take a few weeks longer, I will post it in full. Incidentally, my original sleep test gave me an AHi of 40.

So I got to where I am now by simple steps forced on me by my experience. Others will no doubt have their own variations if they have positional sleep apnea, or, if they experiment, will find out they do not have positional sleep apnea. My experience so far is that I do, and am part of the statistics in the paper on my original post -

Positional sleep apnea was diagnosed in 49 (49.5%) of 99 patients with mild sleep apnea (AHI, 5 - 15/hour), 14 (19.4%) of 72 patients with moderate sleep apnea (AHI, 15 - 30/hour), and 5 (6.5%) of 77 patients with severe sleep apnea (AHI greater than 30/hour).

But things may be happening to me that I am not aware of, which is why a sleep test is necessary. But if I wanted go camping or travel I would not hesitate to just take my collar, knowing that I would not be having desaturations.

As they say - more will be revealed

cheers

Mars

Cuda wrote: Amazingly enough to nightmonkey my doctor FAILED and still did the chest X-Ray and gave me the medications I needed to get over it.

So Cuda, you have left the discussion we were having and are now creating imaginary positions for me that you can criticize? Thank you, but I will create my own positions.

Cuda wrote: I was surfing in Hawaii and did something to my neck, the doctor starts putting on a glove for a prostate check,

Was that Dr. K. at Wahiawa General Hospital? When I saw him, midway through the long, rough exam, I noticed there was a hand on each of my shoulders.

mars wrote:. . . It is desaturations that cause the organ damage . . .

Actually, sleep deprivation is considered to be damaging to organs too.

Especially the brain.

And when a person is sleepy, he is more likely to die from loss of all organ functionality in accidental death--perhaps the biggest risk to life and health of all that is associated with SDB. Simply put, bad sleep kills.

As one study put it so well:

"The consequences of EDS [excessive daytime sleepiness] are significant deterioration of the psychosocial and cognitive functions of individuals with OSA. In addition to its impact on quality of life, EDS increases the risk for industrial and motor vehicle accidents, decreases work capacity, and frequently leads to adverse psychosocial consequences. . . . Apnea/hypopnea-related EDS is usually reversible with appropriate nasal continuous positive airway pressure treatment." -- http://chestjournal.chestpubs.org/conte ... l.pdf+html

One book that addresses these facts well is Dement's book The promise of sleep: A pioneer in sleep medicine explores the vital connection between health, happiness, and a good night's sleep.

As one abstract about the book explains:

"Healthful sleep has been empirically proven to be the single most important factor in predicting longevity, more influential than diet, exercise, or heredity. . . . The author reveals the price we have paid for ignoring sleep: an epidemic of heart disease, 33% of traffic-fatigue-related accidents, and immeasurable mental and psychological disadvantages. He offers . . . the latest research on how sleep affects the immune system." -- http://psycnet.apa.org/psycinfo/2000-07284-000

I would not settle for merely correcting desats.

Sleep it too important to give up on it.

jnk wrote:

I would not settle for merely correcting desats.

Sleep it too important to give up on it.

I agree.

But for some, it may be better than nothing.

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

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

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

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 )

So lets not be closed minded about this .

cheers

Mars