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CPAP, Surgery, Dental Device or.... "Positional Therapy"?

Even if you don't think you know what positional therapy is, you actually do. It's the push or shove to your side you get from your spouse when you snore; it's the fancy $150 pillow at Brookstone which is promoted as a cure for snoring; and it's the old-fashioned snoring remedy of pinning tennis balls to the back of your nightshirt. Nevertheless, the term was an entirely new one to me, and one I still have never heard spoken by my sleep physician, or any other doctor for that matter. The reason, you might guess, is that positional therapy isn't an effective treatment for Sleep Apnea. But an ever expanding body of scientific research shows that certain forms of it can be.

Remember that pesky sleep study you had the pleasure to undergo when sleep technicians strapped you with enough scary looking equipment and leads to have you doing a double-take as to whether in a former life you were a suicide bomber? One of the things it measured was the position you were in when your apnea and hypopnea events occurred. A fair portion of the Sleep Apnea population, by some estimates a third to a half of all those with Sleep Apnea, experience events that can be "cured" by staying off one's back at night, and instead sleeping on one's side.

Scientists at Temple University have released a study (results of which attached below) that indicates that their new device, the ZZoma, pictured above, is as effective as is CPAP in normalizing the AHI of individuals suffering from positional obstructive sleep apnea.

So why don't we hear much about positional devices such as the ZZoma as an option from our doctors? It's a good question that each of us should ask our doctors. Putting their silence on this subject in the best light, positional remedies aren't appropriate for a vast number of Sleep Apnea patients, particularly those who have central or mixed apnea, or who have apnea/hypopnea events in all sleeping positions. More important, sending patients who have a chronic, life threatening disease away with a prescription to sleep on their sides, even if they have positional sleep apnea, is not as optimal a solution as prescribing a CPAP, which can give ongoing data about usage and effectiveness in a way that the ZZoma, Brookstone pillow and tennis ball cannot.

That said, we know that doctors, DMEs and patients don't always follow up on and scrutinize CPAP data. In fact, the CPAP machines often prescribed first do not even record data. We at SleepGuide believe that if doctors and DMEs are to justify the additional costs of a high caliber piece of technology such as a CPAP machine for their patients, that they must do a better job of monitoring compliance, including allowing patients to have as much access to their compliance data as possible. If they don't, maybe their patients would be just as well off as with a tennis ball pinned to their shirts.

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Comment by Melba Cooper on March 19, 2009 at 9:57pm
The role of position is a question that I noted with a check up appointment with my Doc yesterday. I noted that when I take off my mask, I often have a strong urge to stretch out and sleep on my stomach. I like a small down filled pillow that I can easily shape into different positions. I also sleep very flat, rather than propped up on it. I often sleep a couple of hours on my stomach...wake up put my mask back on and finish off the night. My doc said that the stomach position relieves the apnea/ I guess gravity is helpful in this position.???? I know that my sleep apnea is much worse on my back...and I have never liked to sleep on my back. I think it is much less on my side. I continue to do my yoga neck exercises even more diligently as I want to keep my neck flexible enough to sleep on my stomach.
Comment by Anne Pf on March 16, 2009 at 11:05pm
I found it interesting that the sleep tech told me I never slept on my back the entire night of the first study -- he asked me to try, and i did, but i never slept that way.
The second study, for titration, was while wearing a CPAP mask. I slept THE ENTIRE NIGHT on my back. He asked me to turn on my side, and I did for a short time, then once I fell asleep I went back onto my back again.
Sleeping on my back is my preferred position, but i could never breath that way. With CPAP, I can.
The sleep study showed more apneas while on my back.,
Comment by Steven Y. Park, MD on January 1, 2009 at 10:43pm
Great point, mike. It's important to look at the sleep data to analyze the severity of apneas in different sleep positions. Unfortunately, not all labs and especially the home studies don't analyze sleep position, or there isn't enough time in all positions to make any useful recommendations. But sometimes, when you see positional sleep apnea, it can be a very dramatic difference.

Some of my patients do very well with positional therapy alone, but there are may that are not able to gain any benefit, no matter how hard they try.
Comment by Mike on December 11, 2008 at 2:38pm

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