Cervical Collar Experience

[Geer1]

As the community has noted soft cervical collars appear to be helpful in many obstructive apnea cases that has been dubbed positional apnea. 

The main concept behind this is believed to be their assistance in keeping an airway straight and open. There is also some thought that it helps keep chin/mouth closed and there may be truth in both of these. 

At one point I was diagnosed with apnea via a home sleep study but since then I have had two PSG's claiming I do not have either apnea or UARS (UARS would be the only possibility but imo isn't the issue) although I do have poor sleep quality (spontaneous arousals). I continue to use my CPAP machine off label because I do find that I sleep better with it and I believe the humidity it provides is a reason for that. Anyways I am including this paragraph as a statement that I do not have known apnea let alone positional apnea and supposedly have near normal sleep breathing.

2.5 weeks ago I was involved in a work accident in which I fractured my c6 neck vertebrae in two different ways and since then I have been wearing an Aspen Vista hard cervical collar and will continue to do so for a minimum of 6 weeks. This collar holds my neck straight and it also holds my head in position relative to my neck.

Interestingly I have noticed a minor change in my OSCAR data and thought it worth sharing. 

Here is a view of 6 nights of flow rate data before my accident. There are some user flags and the odd apnea (most post arousal but the very odd real one) but you can see some areas that it looks like flow rate was declining and potentially ending up in a RERA as well as a couple periods of what appears to be high expiration effort. Nothing crazy just the flow data from someone with mediocre sleep quality tossing and turning and hitting different body and neck positions while sleeping.

   

Here is a view of 6 nights with the collar. My apnea and flow limitations is perhaps down very slightly (not statistically relevant) and the user flags is down somewhat noticeably but the main thing that caught my eye was how consistent the breathing is and how there are next to no obvious periods of restrictions, RERAs or high exhalation effort etc. 

   

This agrees with some of my previous sleep video recordings in which I noticed that many times when I have an obvious restriction/RERA it is because I have slid down on pillow and my neck is kinked into a strange position. 

Anyways I just figured some people might be interested in seeing that people even with near normal sleep breathing can see a difference in their breathing by controlling airway positioning using a cervical collar or other methods (pillows etc) to keep neck and airway inline and open. I definitely wouldn't recommend everyone try a hard collar out as they are far from comfortable but I guess it could be tried in cases where people have obvious positional apnea and can't seem to get a soft collar or anything else to work. If I had to wear a hard cervical collar in order to get good quality sleep I am pretty sure I could figure out a way to get used to it.

[Sleeprider]

Interesting comparison and it appears you do have more even breathing with the collar. How much difference do you see in the smoothness of the tidal volume chart?

Off-topic, I wonder if you would be interested in joining the wiki editors. Always looking for some help to keep things updated and add new ideas. How to become a wiki editor: http://www.apneaboard.com/wiki/index.php...iki_Editor

[Geer1]

TV before collar.

   

TV with collar.

   

A bit smoother, with fewer declining periods but not hugely different.

[Sleeprider]

Agree that it is not very significant but this is a pretty good measure of potential sleep disruption, I can't quantify it, but the difference is noticeable.

[cathyf]

One thing I've been thinking for awhile is that we downplay as "sleep-wake junk" when we see movement followed by apneas. What I think I'm seeing is movement which is getting me in some bad position, followed by disordered breathing, which is ended by movement that gets me out of the bad position. The apneas cause desaturations, the movements represent arousals that kick me out of deep sleep or REM sleep.

I also have a sleep study with an AHI of 2 that got me a "you don't have apnea" diagnosis. And then 5 months later a sleep study with an AHI of 18. And I've got a wicked spell of positional apnea where in 46 minutes I had 47 OAs and 3 hypopneas and spent 20 minutes in apnea with multiple desats below 90% -- and had the mother of all headaches the next day.

The "you weren't asleep so it's not sleep apnea" is true in a pedantic way. But when it's the sleep deprivation that's wrecking your life the "you weren't asleep" part is the whole point of your problem!

[DaveL]

Geer1 I wish you a speedy recovery. I hope that work has corrected the circumstances and that will prevent others from being hurt.

Be careful out there! (and at home. I fell at home and broke my left shoulder a few years ago. Healed well.)

Dave

[mper6794]

Hi, Geer1

_ that is so interesting observations! Many thanks!
_ that, indeed, has called my attention: I am going to experiment tight up my soft collar and see (go for something harder? :  . I might have experiencing such strange kinks during REM atony;
_ it looks to me you should be sleeping better with the harder collar (as per flow rate and TV's aspects); except, maybe because not get used to it yet;
_ since long ago I  completely worked " official" flow limitations/RERA's, etc, however still have significant RERA's during REM stages (either truncated them before fininishing or not allowing them run smooth without arousal/awake/wake ups). Essentially, my remaining drawbacks of my therapy on RLS and UARS, being 90% treated/solved with the bilevel and 0.4 mg of Clonazepam;



all the best and good luck

[Geer1]

I still have poor sleep quality but it isn't breathing related.

If I had to wager a guess I would say the discomfort and limited available sleep positions has very slightly negatively impacted my sleep quality. If I had untreated positional apnea that may be a different story.