Preventing events while sleeping on back

[dcuste]

I'm a newbie to this forum so my apologies in advance if this post is inappropriate. I realize that most of you are not medical professionals and I will take any and all comments without bias. Thanks in advance for any of you that take the time to comment.

I’ve used a CPAP for over 20 years now. Up until now, I considered all good if my Total AHI stayed below 5/hr and never thought to look any closer to what was going on.

Last week with hopes of improving my immunity through better sleep, I started using OSCAR with an AirSense 10 and even purchased a CMS50F for recording my pulse and SpO2 data. I noticed that every night, a few hours after I fall asleep, my SpO2 dropping into the low 80s with multiply occurrences of Obstructive Apnea, and Hypopnea. At the same time my mask pressure rises up and tilde volume swings rapidly from 0 to 1000 multiple times.

I sent the OSCAR report to my primary HMO doctor and she forwarded it to the Sleep Clinic people. The tech called and we talked for 40 minutes about the report and other things. She concluded I was suffering from anxiety by having too much information about my sleep. She is convinced that as long as my total AHI is less than 5/hr there is no problem. She did raise my minimum pressure from 12 to 14, but I think she did that just to make me think she was not totally ignoring me.

So last night I put a time lapse camera on while I slept and found out that as soon as I roll onto my back, my SpO2 dropped and over the next 20 minutes while I was on my back, I had 6 Hypopnea events, 5 Obstructive events and one RERA. The rest of the night, while I’m on my side, all is pretty good. I ended up with a total AHI of 2.81 for the night. Most all from that time I was on my back.

I would ask the Sleep Clinic tech’s opinion, but I doubt she would be helpful, so I’m wondering if any of you have any thoughts. The only thing I came up with is to set an alarm so when my SpO2 drops, I’ll awaken and know to roll over. Any of you have a better idea?

Thanks again for any help.

[becker44a]

I sent the OSCAR report to my primary HMO doctor and she forwarded it to the Sleep Clinic people. The tech called and we talked for 40 minutes about the report and other things. She concluded I was suffering from anxiety by having too much information about my sleep. She is convinced that as long as my total AHI is less than 5/hr there is no problem.
. . .
I would ask the Sleep Clinic tech’s opinion, but I doubt she would be helpful, so I’m wondering if any of you have any thoughts. The only thing I came up with is to set an alarm so when my SpO2 drops, I’ll awaken and know to roll over. Any of you have a better idea?

Hi dcuste,
I'm not surprised at what this tech told you - spend some time reading here, and you will find out that they can say the most outrageous things, probably because that is how they have been indoctrinated.  However, many here have discovered that AHI < 5 is far from the final test for getting good rest.  Also, SpO2 desatuations such as you are describing are NOT to be ignored: anything below 88% is regarded as problematic.

I was diagnosed and started therapy early in 2014.  I didn't know to get a full copy of my Sleep study, and can't now because Kaiser is no longer operating here in NE Ohio.  In that study, my AHI was measured at almost 60 while supine, about 3 otherwise:  VERY positional.  I didn't know this at first, so I tried a number of means to lower my AHI - nothing worked.  I was typically in the 10 to 15 range, sometimes higher.  One Respiratory tech mentioned that some people have more issues when sleeping on their back.  So I started reading here, and tried a number of the popular techniques for avoiding back sleeping - large pillows wedged behind me, socks with tennis balls attached to a tee-shirt, several things.  Some did better than others, but nothing was reliably effective.  So I went to what was then the go-to suggestion: I loaded a school backpack with light lumpy items, and strapped it on to force side-sleeping.  That worked, and continues to work now.  My AHI is usually less than 0.5, almost never as high as 1. 

More recently on this board, clusters of events like I was experiencing are attributed to chin-tucking, and the wearing of a Soft Cervical Collar is suggested.  I tried that, going without the backpack, and it failed for me.  I continued with both the backpack and the SCC, but I don't seem to tolerate the SCC too well. 

I don't know if any of these measures will work for you, but this issue has some solutions.  Experiment and continue to monitor, and you'll find the right solution. 
By the way, the open-source software OSCAR provides much more information than MyAir, and is available for Windows, Mac, and Linux.  See the links at the top of any forum page for the download page for OSCAR.

Good luck on your journey.

[dcuste]

A. Becker,

Thank you so much for the great reply. Last night, probably for the first time ever, I had no AHI events. The OSCAR pie chart doesn't even show up, just a big 0.0! instead. And I'm feeling well rested this morning too. It would have never occurred to me to wear a backpack. Thanks. This forum is the best.

[Sleeprider]

decuste, it's great that staying off your back seems to have resolved your problem. A backpack seems to have helped. I'm going to point you to a couple of our wiki articles:
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar http://www.apneaboard.com/wiki/index.php...cal_Collar

I don't know if these solutions will be more effective for you, but they should be less obtrusive if they do. As soon as I read your first post I know you were probably suffering from the typical clusters of apnea of positional apnea. Is it asking too much for professionals to recognize this pattern? We see it often and it's easy to fix.

[2SleepBetta]

I started using OSCAR with an AirSense 10 and even purchased a CMS50F for recording my pulse and SpO2 data....[E]very night, a few hours after I fall asleep...multiply occurrences of Obstructive Apnea, and Hypopnea....  ]M]y mask pressure rises up and tilde volume swings rapidly from 0 to 1000 multiple times.

She is convinced that as long as my total AHI is less than 5/hr there is no problem.  

[A]s spon as I roll onto my back...I had 6 Hypopnea events, 5 Obstructive events and one RERA. The rest of the night, while I’m on my side, all is pretty good. I ended up with a total AHI of 2.81 for the night. Most all from that time I was on my back.

The only thing I came up with is to set an alarm so when my SpO2 drops, I’ll awaken and know to roll over. Any of you have a better idea?

.

I would ask the Sleep Clinic tech’s opinion, but I doubt she would be helpful, so I’m wondering if any of you have any thoughts. The only thing I came up with is to set an alarm so when my SpO2 drops, I’ll awaken and know to roll over. Any of you have a better idea?

Hi dcuste,
I'm not surprised at what this tech told you - spend some time reading here, and you will find out that they can say the most outrageous things....  However, many here have discovered that AHI < 5 is far from the final test for getting good rest.  Also, SpO2 desatuations such as you are describing are NOT to be ignored: anything below 88% is regarded as problematic.

In that study, my AHI was measured at almost 60 while supine, about 3 otherwise:  VERY positional.  I didn't know this at first, so I tried a number of means to lower my AHI - nothing worked.  I was typically in the 10 to 15 range, sometimes higher.  One Respiratory tech mentioned that some people have more issues when sleeping on their back.  So I started reading here, and tried a number of the popular techniques for avoiding back sleeping - large pillows wedged behind me, socks with tennis balls attached to a tee-shirt, several things.  Some did better than others, but nothing was reliably effective.  So I went to what was then the go-to suggestion: I loaded a school backpack with light lumpy items, and strapped it on to force side-sleeping.  That worked, and continues to work now.  My AHI is usually less than 0.5, almost never as high as 1. 

More recently on this board, clusters of events like I was experiencing are attributed to chin-tucking, and the wearing of a Soft Cervical Collar is suggested.  I tried that, going without the backpack, and it failed for me.  I continued with both the backpack and the SCC....l. 

I don't know if any of these measures will work for you, but this issue has some solutions.  Experiment and continue to monitor, and you'll find the right solution. 
By the way, the open-source software OSCAR provides much more information than MyAir, and is available for Windows, Mac, and Linux.  See the links at the top of any forum page for the download page for OSCAR.

Good luck on your journey.

**********************

The only thing I came up with is to set an alarm so when my SpO2 drops, I’ll awaken and know to roll over. Any of you have a better idea?

becker44a

  
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Hello becker44a and dcuste,

I'll go into a lot of detail here because my and some other persons' experience and positional apnea matters are squarely on your points. Also, it's been my experience that people like me do discover AB in their google searches for help on a specific sleep problem, idea or device.  Furthermore, through AB and digging using google, I have found THE most restful, comfortable and consistent solution for my SA. Also, interested people here and in my other CPAP connections frequently want more detail, pictures and drawings of people's ideas that have worked well. 

My experience has been  much the same as in the above fragments, which I copied from both of you. I'll mention where I might differ much from those. 

It took accelerometer data and graphics   (Gulf Data Concepts manufacturer of the X16) to convince me that supine sleep was my lingering OSA problem and that it would still be without measures I take and occasionally try skipping, all the while wearing the very helpful SCC.

I long struggled with sleep disturbing (non-therapeutical large FFM leaks), mouth breathing, and supine sleep's OSA effects. More than 90% of clustered sleep disturbances were from sleeping on my back. My 3-night home sleep test was taken while supine in a recliner tilted back about 70 degrees. RDIs were near 60 and there were long desats below 70%.

Like your 60F dcuste, I got the Contec CMS50I at about my first 3-month mark. Results were long erratic until I began using a 2-inch medical tape to secure the boot to my finger. SpO2 graphics were not all that bad. Along with 50I I made progress after finding AB, but it was slow. Yes, applying the SCC idea at AB helped a lot along the way. Beyond the blessing of prescribing the Autoset, my MD's were little help--none at all after getting AHI down to mostly 5.0 and being "treated". 

Dissatisfied, I found someone, (was he here at AB?) "BasementDwellingGeek", had posted accelerometer findings and graphics on his site; those were persuasive on their merits. BDG showed documentation of his rotational position during sleep. I got the GCDC X16 ( I think he ID'd it). At first I wore it next to the headband on the bill of a cap, doing that until I got the vest below and could carry the X16  nearly flat against the small of my back. I could measure more accurately how much more of my body mass was turning or moving, not just how my head swiveled.


It was clear in graphics. All anti-roll-rollover measures, other than the vest pictured below, were ineffective including the vest's predecessor, a large, well and hard stuffed fanny pack  worn backwards and tight. The SCC (as in the AB Wiki) was insufficient for this side sleeper who always uses a minimal pillow.  

Now, sleep in the vest is great except for my bad habit of staying up late. Frequently, there are 0.0 nights for AHI and, less frequently, 0 for leaks; the past 12 months AHI--the weekly average almost always-- has been 0.2. No more of those frequent OSA's throughout the 60  to 155 second range (two were virtually one in my first week: 107+48=155 seconds). No more of those clusters with my anti-supine vest on. 

The vest is made of light canvas with  enough body and edge reinforcement to free stand as pictured and weighs one pound. The two nested boxes for inside the knapsack weigh 1.5 lb and measure 13 X 10 X 5 inches. It is heavily reinforced along edges where heavy duty metal snaps are. Clearly it was "a gift from above" when I saw and wondered what that red thing was on the rack of a hospice's   thrift store I rarely visit for books. I was only there that day to find a heavy used Levi denim jacket, with metal buttons,  like cowboys and farmers wear so I could make a jacket or vest with a large pocket for boxes. The vest is a perfect fit, a bit larger than being snug; it will displace side to side a little with my shifting so I can get within about 40 degrees off supine. I sleep mainly in the 60-75 degree range and don't turn over (that takes real effort) except after getting up to drain.

I've tried to discover where those vests are used/sold so I could point someone to sources. Unsuccessful, it seems likely it was special made and used by someone involved in mountain or rugged road surveying or timber cruising. It had lots of pockets I removed from outside and inside. It's likely a small pouch and the large one below it were for phone or walkie talkie, rolls of plans, theodolite, etc.  

I credit AB and their SCC, BDG and the accelerometer, the vest below (comfortably keeping me at least 40 degrees off supine), the P10 (my favorite, though normally a mouth breather who fails to learn the tongue-seal method), the Silipos Gel-E-Roll (in lieu of mouth tape for this mouth breather), the Autoset and, for a year now, the Vauto to keep FL well down. Note that the wrap around my mouth and neck was made from Velcro and a piece from the top end of an elastic compression stocking. The wrap holds an otherwise loose (and at first instant clammy) piece of the clinging mineral gel bandage (Silipos Gel-E-Roll) against my face. That material is like an Ace bandage with, say, about a 1/16 inch thickness of gel on one site, stretchy only parallel to the lips, but unstretched. One piece of a roll lasts for months, can be washed with soap and beats all else I've tried..

It's likely the bad OSA place I started from heightened my motivation and tolerance of measures most might see as too intrusive, but they work without fail or any discomfort. The only downsides are the few additional moments it takes to turn in for the night and, thankfully, being deprived of and missing the vest when briefly hospitalized and forced to sleep supine  as happened a couple of times.

dcuste, becker44a closed (in blue colored font above) with good encouragement and advice I second. The vest approach described may be waaaay out there to you, but it is one way to address your need if other measures fall short. Had I not found that vest I would have made/had-made something similar from a heavy denim jacket. Personally, the 60F will help know your need, but I think the way to go is to make sure you do not sleep near the supine position for a time. That done, if SpO2 confirms benefits from side sleep, good. Otherwise, continue your quest. Maybe the SpO2 alarm is the only answer.


2SB 

   

   

   

[dcuste]

Thanks Sleeprider and 2SB. That is a lot of information to digest. Not being familiar with the acronyms, it's going to take time to sort this out. 

Using an accelerometer is very clever. I found the time lapse camera recording was a very efficient way for me to figure my movements out. The WYZE $20 security camera I already owned, has a time stamp so I could easily sync the video to the OSCAR chart. I recorded at a frame every 3 seconds so that the whole night was about 6 minutes. It showed that I hardly move other than my legs moving just ever so slightly. I rolled over about once an hour. The only real problem occurred when I was on my back and even then I hardly moved, but I knew from OSCAR that my breathing was very restricted.

Once again, I had a very good night last night using the backpack method to keep me from going onto my back. I also bought a very nice collar at CVS. It has ways to adjust height so i tried it late last night while watching TV in my recliner. I had never made the connection to why falling asleep in a chair was such a problem for me until I read the info that Sleeprider had linked. Now it all makes sense but I need to work on the adjustments to get it fine tuned.

My HMO "sleep expert" has scheduled a followup consultation in a week. I'm debating if I should bother trying to educate her. I find it very annoying that she didn't even suggest that this could have been my issue and instead diagnosed me as just being overly anxious. It is disconcerting to me that there are OSA sufferers out there not getting proper care.

[Sleeprider]

Most "sleep experts" are unaware of the use of a soft cervical collar, and some are even alarmed that it might be harmful. This is not a pattern they are taught in training or school, however we have consistently seen it in as many as 30% of the people that come here, adn the solution is nearly 100% effective. We find people easily and cheaply eliminate very high obstructive apnea and snoring problems, and require less pressure in ongoing therapy. Someday, it might become mainstream, but as it stands today, therapists would rather sell you expensive oropharyngeal surgery and mandibular advancement dental devices than a simple collar for less than $20.