Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Is this clearly positional apnea or something else?
#1
Is this clearly positional apnea or something else?
Hi all,

It's been a while since I've checked in - a couple of pieces of context here:

1. I am most comfortable on my back falling asleep, although I move a lot in my sleep so it's anyone's guess what position I am at any given moment. I believe I spend a significant amount of most nights on my back (I really wish there was a good way to monitor body position, that would be worth a lot to me) so if this is positional apnea, I think it must be something more specific than just "on my back" 

2. I use a full face mask because when I did the fittings, my ears hurt a lot with the nasal pillows. The DME said that would happen less with FFM. I don't have any evidence that I do much mouth breathing *except* if I have a bad cold, flu, sinus infection, etc. That was also quite a while ago and it was literally the first moments that I encountered CPAP - if switching might help I'd be willing to try (I use the Dreamwear FFM, I assume I can just get the nasal pillow cushion and attach it to existing headgear?) I suspect the massive jumps in leaks are related to body position changes and perhaps that might reduce or eliminate that problem?

3. My professional says I'm doing well because my average RDI (we use RDI because I didn't qualify for treatment on AHI alone, but had enough RERAs to qualify under RDI) is well under 5.  Looking at the past 90 days, I would say about 8% of nights exceed 5, most only barely. But, I think I could still do better and I am stuck on what, especially given there are nights that are really good and some that are really quite bad (relatively speaking) and I can't find anything obviously all that different. 

4. I used to get tons of clear/central events (treatment emergent, didn't have them on testing). They have gone way, way down over time, but now I have lots of RERAs instead. I can post trends for anything if requested.

5. Although I tolerate the mask fine and the only time it comes off unintentionally is when I do things like pull the whole machine off the nightstand or pull the tube out at the headgear connector (happening a lot less frequently recently, each thing has happened at least 10 times) anything else I try to do like sleep in a particular position is very temporary. I always wake up in a different position than I fell asleep, including on my front (I absolutely hate sleeping on my front and would never intentionally do it). I move pillows around, kick sheets off, etc - basically if it's in arm or leg length (ironically, testing never saw any of this) it's fair game that I'll push it away or move it around with no memory.  I'm not saying I won't try stuff that would involve positioning or whatnot, but it's not terribly likely to be successful. 

Anyway, here are three charts - one from a good day (which I think is pretty optimal), one from a day that's generally pretty good but had a big cluster of events, and one that was pretty bad (worst day in the past 90 days). I cannot tell you anything specific that was different among these days (other than the one where you see I tried to take a nap later - I don't normally nap but I had a moment and tried, and failed).

Is this clearly positional? My testing did show REM as being much worse (like 4 times worse) than non-REM, so I am also wondering if it is possibly sleep stage related instead?

I've been on fixed pressure for a while and rarely get aerophagia anymore (on variable at the larger swings I got tons) - does my data indicate a variable pressure might be better? Or changing the EPR (currently zero)? I'd need to know why I'm changing something. 

Any other thoughts?  Anything to try? 

Bad night:
   

Obvious cluster:
   

Good night:
   
Post Reply Post Reply
#2
RE: Is this clearly positional apnea or something else?
Definitely positional. The big tell is that you don't have those clusters every night - but you should (in theory) have REM every night. And frankly even the worst REM sleep doesn't result in that many apneas usually. Lucky you!

There are tons of pieces of advice between this board and the wiki on how to keep yourself from sleeping on your back and you can easily find them, so I'll skip that part. I think easiest thing to try first for you might be to try a wedge pillow and a soft cervical collar as it seems the habit is embedded.
Post Reply Post Reply
#3
RE: Is this clearly positional apnea or something else?
Thanks. Problem is though that I don't think the issue is sleeping on my back - I think it's some other position or maybe back plus something else happening. I almost always fall asleep on my back, and that period of time is usually few apneas and low to no leaks, and the clusters don't come until usually hours later - I am pretty sure I change positions 3-4 times per hour, or at least that's what I did in both sleep studies. The clusters all seem aligned to higher levels of leaks, which I think are almost always on my slide (too much pressure on one half of mask which breaks the seal on the other side) or when I unconsciously push my face into the pillow (I wake up somewhat frequently in pain because I am pushing my mask into my face via the pillow - no idea why). I have a CPAP pillow with the cutout for slide sleeping - I can fall asleep with little leak that way if I am very careful but there's no chance of staying in that position long. So yes, I agree but I am trying to figure out what I can do to get better info to figure out exactly what combination of things is the problem. My gut instinct is it is flipping to my front and twisting my neck but I can't find any way to prove or disprove it.
Post Reply Post Reply
#4
RE: Is this clearly positional apnea or something else?
Yep, it's positional.  You would benefit by wearing a properly fitted soft cervical collar, but I would skip the wedge pillow.  Your collar needs to be high enough to keep your chin up.

I sleep on my back every night because of back pain, and my positional apnea is gone.

I suggest that you turn EPR on full-time, set at 3. That will make your breathing more comfortable and, more importantly, lower your flow limits. Flow limits are apneas that are too short to be reported but which disturb one's sleep.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution and F&P Nova Micro

Link to thread about switching from Autoset to Bilevel:
https://www.apneaboard.com/forums/Thread...+a+bilevel

Post Reply Post Reply
#5
RE: Is this clearly positional apnea or something else?
Thanks! I have gone back and forth with EPR several times. Putting it to zero basically eliminated central/clear events but you are right that FL has crept up a lot, I'll give it a try. FYI, I don't feel struggle to exhale although I did back when I first started Maybe now that I've been on treatment a lot longer centrals won't come back.

I just found the Wiki on soft collars - I really dislike the idea of attaching yet another thing to me when I'm sleeping, but I'm willing to give it a try.  If you have any suggestions (type, where to get, etc.) I welcome them.
Post Reply Post Reply
#6
RE: Is this clearly positional apnea or something else?
Lots of folks like the Caldera Releaf collar as it is very comfortable, but for men with a long neck it may not be high enough. The Velpeau collars are also quite popular and they come in more heights.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution and F&P Nova Micro

Link to thread about switching from Autoset to Bilevel:
https://www.apneaboard.com/forums/Thread...+a+bilevel

Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Success for Positional Apnea MrIvanDrago 15 784 01-20-2025, 10:29 PM
Last Post: NewlyDiagnosed
  Positional Hypopneas ? Vike3 2 259 01-05-2025, 12:13 PM
Last Post: Vike3
  Did I find a cheap positional apnea solution?!? jimbobule 2 312 12-28-2024, 12:29 PM
Last Post: G. Szabo
  Self-Treating Sleep Apnea | First Night with CPAP = 0,87 AHI | Central Apnea? Dumdi 27 6,021 12-15-2024, 08:31 AM
Last Post: mugen4u
  [Diagnosis] how to tell if my ca apneas are positional Scimorelli 14 784 11-04-2024, 06:18 PM
Last Post: SarcasticDave94
  REM or Positional? prp1714 13 1,463 10-26-2024, 01:04 PM
Last Post: prp1714
Cool [Treatment] Palatal prolapse mitigated with positional therapy. G. Szabo 4 641 10-26-2024, 07:33 AM
Last Post: SeePak


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.