I can't figure out my positional apnea

[CorruptAlligator]

@gettingbetter. I'm exactly the same way. I use N20 mask in supine as well. But with F20 I have to sleep on the side to reduce AHI. My issue is with something going on during supine with F20. I think it has to do with strap as well.

I recently tried out the Resperonics Wisp nasal mask, I get absolutely no leaks sleeping on the side. The mask seal is designed well. I get leaks with N20 when sleeping on the side.

[gettingbetter]

@corruptalligator:  I know seems crazy, but it seems like you have about the same issue as me.  I've tried a few different FFMs, even the hybrid, and still have the same issue.  I also have a Mandibular Advancement Device.  I've tried wearing it with the FFM, hoping it would hold the lower jaw forward enough to tolerate the FFM while supine...but no such luck.  I guess the lower straps retract the lower jaw and alter the airway enough in some of us, enough to cause problems with sleeping supine with a FFM.  I've also tried bumping up the pressure and that doesn't help either.

[ICEMAN]

You can just try sleeping on your side to see if it reduces your AHI.  If you sleep mainly on the side, that would likely help a lot.

It was also interesting that my CA was the lowest for side sleeping.  CA occurred mainly during supine.

 Hi mellocello my thoughts,  May or may Not  as ease as just Sleeping on Side, but is few knowledge / awareness for success of such as Side sleep "Fetal position" may also contribute to bringing on Positional Apnea's ? 
 
I sleep both Supine and Side, but in effort to reduce Positional ,I started consciously positioning my Body on side Laying my Head properly placed, positioned on Pillow, so as "Head / Neck Straight" in align with Body/Neck Spine that did not have Chin ticked in from laying in as fetal position. I continually consciously practicing that position, once placed in that position, mostly Body head weight would hold that position on pillow. Initially I did use in conjunction using Collar, while I trained myself for that position. Now I feel quite unconsciously controlled automatic, that positioning.  I and have since given away the collar, do keep monitor Events/OSCAR but  I am keeping position's under control. Now still not completely strict as at times if very restless, then All Rules are Off, I will sleep in any position Supine / Side, or what will ever get me to Nod off to good sleep? but that is exception not a rule, and confident I now have little if any positional issues any more? (touch wood my AHI is presently under control averaging around the 3 AHI ? mostly CA) Also need awareness that daytime sleep/fatigue often considered as 1st off Cab as Sleep Apnea, also don't tunnel vision so as blind to other issues, very similar, side effects from Medicines and or other Medical conditions?  the list as Fatigue, Hair loss, Blurry vision just few, that often is over looked? So especially if have AHI under control ? also have a "Look" (Outside the Box)?

[CorruptAlligator]

@gettingbetter

I've seen a tmj and sleep specialist recently who specializes in mouth devices, and I was told that he generally recommends nasal masks since the FFM straps can cause jaw to retract. In my experience, I think FFM aggrevates teeth clinching which maybe result of higher incidence of apnea, not sure. Since bruxism is understood to be a reaction from air obstruction. I personally wear a mouthguard for tmj, and I've noticed FFM with cervical collar causes clinching more so than nasal.

I don't know how much of an effect the strap has in regards to sidesleeping. I've noticed my apnea episodes reduce (I've had incidences of little to no AHI) when side sleeping with FFM and cervical collar.

Several threads at *paptalk about FFM and jaw retraction.

[gettingbetter]

@corruptalligator:

I can certainly empathize with the perils of TMD.  I have TMD due to bruxism, as well.  I have the standard mouthguard for bruxism and also a mandibular advancement device.  I agree that the lower straps on a FFM can aggravate TMD.  I normally wear a nasal mask but during allergy season I've found that I need to use a FFM due to nasal congestion.  I'm a newbie with CPAP, so I'm hoping the bruxism will settle down once my body is used to CPAP.

[CorruptAlligator]

It would be ideal if jaw retraction info about FFM was standard knowledge for CPAP equipment providers. So that they ask if the person has bruxism when helping the person pick out a mask.

Who knows, it maybe possible for person that doesn't suffer from bruxism to develop the issue from wearing the FFM over a period of time.

Stuff like this are worth doing research on. Position apneas should be an area well researched.

[gettingbetter]

I agree.  How this stuff affects people is a very individual thing.  Most people don't have trouble with FFM causing increased AHI.

[CorruptAlligator]

When I saw the chinstrap they sell for keeping people's mouth closed, I immediately knew it would mess up my jaw. I think it can possibly cause jaw issues from long term usage. I never suspected FFM to cause jaw issues. Which wasn't so obvious.

I think the masks that's worth trying is the ones that does not have a piece that adheres to the lower jaw, and pulls it back with a strap (which pulls the lower jaw back since the pressure point that pulls is right under the lip), which the FFM does.

Looking online the least intrusive for our usage are nasal masks, and pillows and cradles seems to be least intrusive. N20 and wisp has the side brackets requiring two sets of straps for stability I don't like.

[cathyf]

My perspective is that every mask is just too damn big on me, and some of the implications of that are kind of subtle.

Basically, the problem is that the whole mask/headgear assembly needs to fit in 3 dimensions, and when I finish tightening straps it can end up with strange puckers and running at odd angles. But I really must get it right, or end up with the cushions bending or collapsing. Yes, I get kinks in my mask cushions if I'm not careful! The traditional problem is leaks, but I've managed to get myself into the position where my nasal pillows were turned and firing the air at the wrong angle so it wasn't actually going up my nose!

...and more to the point, I recently figured out that during my going-on-7-years on cpap there have been more than a few nights where I was desperately trying to fit myself into the mask and keep it in position on my face and I was getting myself into severe positional apnea in order to do it.

Sleep doctors have this stupid model of supine sleep causing your throat to relax. It's all about the contortions you are putting your neck through -- it's about inches not millimeters!

[SarcasticDave94]

I think this discussion has me wanting to ask a few questions, how tight do you wear any mask that the headgear straps pull your jaw backward? Is the issue one of very tight straps to vainly try to control leaks? That is what I'm hearing out of this discussion, very tight straps. This means wrong mask model, type, size, etc. if your attempt to control leaks means torque the straps so much it pulls your jaw backward.

just my thoughts