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"Positional" apnea - desaturator - 01-17-2022
Hi all
I've read on this forum that it's possible to suffer from sleep-related obstructive apneas that depend on sleeping position. I've also read -- and been surprised to read -- that CPAP machines won't fix this kind of apnea.
Is this "positional apnea" something that affects only people who are also candidates for OSA? Or can it affect anybody? It seems a pretty poor design strategy, to put the airways where they can be completely obstructed by sleeping in a particular position. Why won't CPAP pressure fix this, when it will fix other types of obstruction?
Best wishes, DS
RE: "Positional" apnea - Ratchick - 01-17-2022
I mean... I guess if you turned the pressure up REALLY high it might work - if it had enough pressure to force your chin away from your chest! But CPAPs don't have that must pressure. Think about if you kink a hosepipe and then stand on it with your foot. It's going to be almost impossible to get a good flow of water out, no matter how far you turn on the tap. The main reason why CPAP helps OSA is that it's splinting the airway open so it won't collapse in on itself... and that takes far less pressure than it would take to lift someone's chin enough to end the kinked airway.
"It seems a pretty poor design strategy"
Yep, and the human body is full of things that look like poor design strategies. A side effect of evolution having no designs. Consider the path of the recurrent laryngeal nerve, for example.
When doctors talk about "positional" apnea, they mean which position you are lying in. When we here generally talk about positional apnea, we're referring to anything that pinches the airway partly shut, usually chin tucking to the chest, which can happen in any position that you lie in, depending on if you're curled up on your side into a ball or you have higher pillows that encourage your chin towards your chest.
Generally speaking, no, it's not going to cause central apnea to worsen. It could potentially trigger some obstructive events in a cluster for an otherwise central apnea patient, but it's one of those things that doesn't seem to affect everyone - whether because of how they sleep, or the size of their nasopharynx, their neck size, weight or whatever. But a person with central sleep apnea won't get more central apneas from chin tucking.
RE: "Positional" apnea - desaturator - 01-17-2022
(01-17-2022, 11:14 AM)Ratchick Wrote: Yep, and the human body is full of things that look like poor design strategies. A side effect of evolution having no designs. Consider the path of the recurrent laryngeal nerve, for example.Fair enough. And the fact that the retina is backwards. And, in fact, that we breath and swallow through the same hole. I supposed evolution has "designed" us for a forty-year lifespan, so a bit of apea probably isn't a big deal in the grand scheme of things.
Still -- I've frequently seen the word "positional" in reference to my own OSCAR data. I do tend to have hypopneas in bunches. I think I might need some sort of camera to record my sleeping position. Is this something that can be done using a smartphone? Sorry -- there are probably other threads on this.
BW, DS
RE: "Positional" apnea - Ratchick - 01-17-2022
Not sure about JUST with a phone. For about £30 or so, you can get a Wyze v2 or similar camera with IR that will record all night onto a microSD card and most of them come with an app that lets you monitor it, configure it, go through the videos on your phone using the app. The Wyze will alert on movements or sounds, record in colour or night vision. No real complaints other than if you want to save all of the data (rather than record a small section of it) you have to remove the card and read it on your computer or whatnot, but other than that, it's been fine.
Otherwise, I've used OBS and my webcam too.
RE: "Positional" apnea - staceyburke - 01-17-2022
Yes grouped O and H events show positional apnea. The best way to help them is with a collar. I have a link to collars at the bottom of the post.
You can see people without using a collar and the same people with collars. It makes a HUGE difference.
RE: "Positional" apnea - Sleeprider - 01-17-2022
Take a look at the Positional Apnea wiki section of Optimizing Your Therapy http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea An exercise to simulate the flow limitation or obstruction is discussed there. We understand the problem to range from light snoring and flow limits in some people to full obstructive apnea in others. It is also far more common in those that sleep inclined or sitting. Surprisingly, it seems worse in those using "ergonomic" pillows with a neck roll.
RE: "Positional" apnea - desaturator - 01-17-2022
(01-17-2022, 12:18 PM)Ratchick Wrote: Otherwise, I've used OBS and my webcam too.
Aha! It never occurred to me that I could use a webcam for this. Thanks.
I think a cervical collar and a ventilator might be too much for my poor wife. The mask gives her nasty flash-backs on its own. But I'll have to try it if it turns out there is a position aspect to my respiratory weirdness.
BW, DS
RE: "Positional" apnea - cathyf - 01-17-2022
To repeat what Ratchick said -- when we talk about positional apnea we are referring to the physical arrangement of your head and body in 3 dimensions plus worrying about gravity. To sleep doctors, it's 4 possibilities of rotation on just one axis -- front/back/left/right, with your body horizontal on a flat bed.
It occurs to me that it's one reason that the condescending idiots at the sleep center think I'm the idiot when I talk about cervical collars and positional apnea. They believe that there is some voodoo magic relationship between supine sleep and apnea, as opposed to the reality which is that sleeping on your back makes certain neck angles almost inevitable and so it's an indirect cause.
Whether it's propped on the couch in front of the TV with the couch arm forcing your head forward to your chest, tucked into a fetal position on your right side, tucked into a fetal position on your left side, on your back in bed deeply sunk into a gigantic pillow pile forcing you into that same position as asleep-lying-on-the-couch-in-front-of-the-TV, sitting up in the car (hopefully as a passenger!) with your face down in a painful slumped over angle -- ALL of those are the same "position" when it comes to positional apnea!
RE: "Positional" apnea - SarcasticDave94 - 01-17-2022
If the position you sleep in causes the airway to kink like a garden hose, you need to stop letting the airway kink. The correct collar diminishes the airway kinks.
Our position on positional Apnea is different than the doctors position. With the batting average of this sleep doctor group, I'm thinking it's a pretty good chance they got this wrong too. And since sleep medicine is a supplemental boat payment for most of these doctors, I have a hard time believing that many are willing to put an effort in learning more about Apnea.
RE: "Positional" apnea - desaturator - 01-18-2022
(01-17-2022, 03:34 PM)cathyf Wrote: Whether it's propped on the couch in front of the TV with the couch arm forcing your head forward to your chest, [...] ALL of those are the same "position" when it comes to positional apnea!
That's interesting. Do you think this positional effect could be operative even when you're awake? I note that my oxygen saturation falls in certain postures even when I'm awake, but I don't actually notice anything untoward.
I have a measure of intracardiac shunting which seems to be posture-dependent, so that might also explain the desaturation. I'm still trying to work out whether to have the cardiac defect fixed; if one can have "positional apnea" when awake, that makes the case for fixing it less compelling.
Best wishes, DS