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[Diagnosis] Severe supine AHI but low on side...?
Severe supine AHI but low on side...?
I've been diagnosed with severe apnea with AHI of 30+ and prescribed with APAP therapy.

In my sleep study report, all the high numbers are when on my back, but only 1.5 when on my side. Before, during, and after the study I explained that I normally sleep on my side, but I was instructed to stay on my back as much as possible, so that's what I did, mostly 'successfully.'

My concern is that my diagnosis only applies to a non real-world scenario. When I expressed concerns about the apparent disconnect, my doctor essentially dismissed them, saying that the test is supposed to exacerbate the situation, as they do with cardio stress tests on a treadmill. 

Anyone have some insights about a back vs. side study and diagnosis? On the surface, it sure seems like it's a ploy. Thanks in advance for any inputs.
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RE: Severe supine AHI but low on side...?
I cannot explain the why involving PSGs where this is likely to be the prevailing protocol as I understand it. I encountered the same circumstances/request during all my own PSGs. I do think they are attempting to reveal in part the worst case results to at least open a door to investigate apnea existence and/or the need to be treated in some fashion. Other than that again I cannot explain the doctors thought process. Coffee

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

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RE: Severe supine AHI but low on side...?
ScoobyDoo, I'm a little concerned that you may choose to refrain from using your PAP device since it's clear you don't need it.  You don't say why you were Dx'd a sleep study yet it seems there must have been some condition that suggested the need.  Nevertheless, without going into that, I feel confident that my urging you to use the AS10 Auto is valid: even if you slept on your side all night, in the unlikely event you spent more than a couple of minutes on your back, you likely would experience significant effects from the apneas you would be certain to have.  Maybe you've learned that such events quickly develop harmful conditions that slowly dissipate.

Please use wisdom in managing your condition!
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RE: Severe supine AHI but low on side...?
@ShaunBlake thanks for your concern. I've been diligently maintaining APAP therapy for 3 months already, albeit with some difficulty. I've received some great feedback on this forum in my main therapy thread. 

I'm simply looking for any facts or details about this specific aspect, because if I have the same AHI with and without APAP on my side (I'm actually averaging notably higher than 1.5 with the therapy), I'd sure like to feel like it's worth the efforts.
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RE: Severe supine AHI but low on side...?
ScoobyDoo, I had much the same experience as you when I was tested back in 2003, and I rejected a machine. Fast forward about six or seven years and I'm falling asleep at work in the afternoon, so I took early retirement (with a financial hit). I'd forgotten all about the earlier sleep test. It was another five years before a sharp new resident took my tiredness seriously and sent me for a sleep study again. By then I had moderate to severe apnea and I was fast-tracked for titration and an Auto CPAP. Today I feel much better without the sleepiness and mental fog that made me retire early.

You've got the machine - make the most of it and prevent the future problems.
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RE: Severe supine AHI but low on side...?
Most people are not able to control sleep position (despite their intentions/beliefs) so testing/titration is usually for supine position since it is usually worse.
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RE: Severe supine AHI but low on side...?
I may be the only one to have this opinion but I  don't see the benefits of using a machine if you don't need it.
ScoobyDoo posts in another thread:
"My study was in an overnight sleep clinic and diagnosis is severe sleep apnea with up to 45 AHI. I was initially prescribed 4-10 cmH20 with 3 cmH20 EPR. AHI is now reduced and OSA is essentially zero. However, AHI still hovers around 4, and routinely exceeds 5 and even higher, almost all flagged as central apneas. I don’t seem to be sleeping better overall, but maybe a slight incremental increase in daytime energy."

If a person sleeps on their side with an AHI of 1.5, and their AHI with APAP is 4 to 5, how is it a benefit if they don't seem to be sleeping better?
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RE: Severe supine AHI but low on side...?
When I read the title my immediate thought was 'chin droop'. We usually sleep with a pillow which elevates our head. If we are on our side this results in a slight sideways bend in the neck. If we sleep supine then this bend tends to push our chin towards our chest. Anyone who has knowledge of CPR knows that when you breathe into the patient you push up on the chin to open up the airway. If the chin is down then the airway is seriously compromised. Chin droop reduces the airway.

Having said that, many people sleep on their back and don't have apnea issues but according the the sleep study you do and Pholynyk's post may hold a lot of truth in that there is an issue with apnea in your case.

I have a question - do you use a soft cervical collar? This is the best way to prevent chin droop and could positively impact on your current therapy. While you think that you sleep on your side, you don't really know because you are asleep.

The collar is very effective as I found out a couple of months ago. I went to a golf weekend and took my spare machine and it's bits and pieces. However, due to circumstances, I didn't take the little connector that went from my hose to my mask making my machine unusable. I was quite upset about this but thought that I would still use the cervical collar. While my sleep was far from perfect, I didn't feel anywhere near as bad as if I'd simply used nothing at all proving the efficacy of using the collar.
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RE: Severe supine AHI but low on side...?
You are using an Autoset machine that will reduce pressures when you don't need them...what have you been averaging, and what is your 95% pressure? A sleep study is a nice snapshot of your untreated AHI, but you have to look deeper to see what happens in non-supine sleep to draw good conclusions. You might have flow limitations or your study may not have adequately characterized side-sleeping in all sleep stages. It is completely possible you have normal AHI in non-supine sleep, but your moderate AHI over 30 in supine sleep certainly merits concerns. Higher AHI in supine sleep is the norm, and that is the way most sleep studies are designed, although we have some members that actually have higher AHI on their side.

I think it's likely you are benefiting from the therapy and this is something that is likely to increase as time goes on. You are fortunate that you can get by without CPAP if for some reason you experience a malfunction, power failure or find yourself without your machine and need to nap or sleep. I wish I had that luxury.
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RE: Severe supine AHI but low on side...?
You could try the rematee bumper belt. It's designed to keep you from sleeping on your back. Or try the neck cushions like described above. It doesn't seem like sleep doctors are trained to fix apneas in any way other than prescribing xpap machines.
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