I can't figure out my positional apnea

[mellocello]

I can't seem to figure out my positional sleep apnea.  It doesn't seem like cervical collars is making a huge difference, and they're uncomfortable.  I've also tried a device to move my jaw forward (https://www.amazon.com/gp/product/B07BTL...UTF8&psc=1) to see if that helps, and it doesn't seem to.  I've also tried different pillow heights (should I go flatter or thicker?).  I noticed that my I wonder if I should just get a sleep study and have them specifically study positional OSA for me.

Attached is a really good night, despite there being leak rate issues (I remember having super vivid dreams) and a crap night.

I've also noticed that when I went to a hotel, for some reason, my AHI was at least 1 lower on average, and I can't figure out what changed.

[CorruptAlligator]

I get positional apnea as well, and I use a cheap flatter pillow. The problem is, my body likes to naturally side-sleep part of the time, and flatter pillow is bad for ergonomics. I don't believe what kind of pillow really matters when I sleep on the side (in terms of apneas). Because I've had a sleep test done, and all my apneas are mainly in supine position. When I'm on my left side, I have nights it's 0 or close to 0 apneas in the left side position. The issue is, I sleep supine 60-90% of the night.

I've recently tried out MyPillow, and Medium fill worked best since I have positional apnea. Firm is too high that probably causes chin-tuck. Also, it works better for side-sleeping with the mask than the cheap flatter pillow. Still doesn't perfectly rid of my mask leaks.

For some reason, OSCAR data doesn't show signs of positional apnea if I use nasal mask, N20. I get positional apnea with F20, likely in supine. Oddly, I get positional apnea with nasal pillow, P10 (which makes no sense).

[mellocello]

Because I've had a sleep test done, and all my apneas are mainly in supine position

It seems like this kind of information would be really useful for me to know.

---

Also because I have mainly positional sleep apnea and pressure doesn't seem to really help, maybe I should cap out the pressure like you do?

[Gideon]

There are two kinds of positional apnea, what the doctors talk about is supine (back) vs non-supine which is usually side sleeping.
What we mostly talk about here, and in general doctors are blissfully unaware of it is cervical alignment with the chin tucking down and causing major havoc by kinking the pipe that is your airway.

[CorruptAlligator]

It's well known that OSA is caused by collapsing of the airway during supine sleeping position. Which is why it's widely recommended to sleep on the side if you snore and/or have sleep apnea. Left side is recommended over right for alleviating acid reflux. My sleep study results reflects this.

I did a take home sleep study, and the sleep monitoring device figures out the orientation of your body based on the accelerometer's orientation. So, even a take home test can tell you this.

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.

[mellocello]

I generally do sleep on my left side .  I think collapsing of my airway during side-sleeping is probably the only possible cause, but I've found only minimal improvement with a cervical collar.

---

> Oddly, I get positional apnea with nasal pillow, P10 (which makes no sense).

I'm going to try tonight with my old Nasal Pillow mask and not use the P10.  I'm also suspicious it's not great for me.  This all feels like black magic.

[Sleeprider]

I use a medium fill down pillow that I can pull between my jaw and shoulder while side-sleeping. This prevents the airway from being compressed by chin-tucking and maintains very good alignment and comfort. Maybe it will work for you?

[gettingbetter]

It took me awhile to figure out my positional apnea, and it seems a little odd.  I can sleep on my back when using the N20 mask, but have to sleep on my side when using a full face mask, otherwise I get a very high AHI.  Doesn't really make sense to me.

[Gideon]

Likely the very high apnea is from kinking your neck. The difference is in the straps?

[gettingbetter]

Gideon:  In my case, I think you are correct.  I've tried a cervical collar while sleeping supine and it didn't help.  So it has to be the lower FFM straps retracting the lower jaw, reducing airway patency.   It's hard to side sleep with a FFM.