Cervical collar success story - can I turn pressure down?

[JamesD0079]

Hi there,

Thanks to this apnea forum, I came across the suggestion to try a soft cervical collar with CPAP to potentially help with positional apneas. I can say that it has made a massive difference. I was going from massively disrupted sleep, while my AHI was only around 3.0, I was constantly waking up, having both CAs and OAs or Hs and just feeling terrible most mornings. With the collar i have gone down to about 1.2AHI, and having few OAs or Hs and just a couple of CAs, and starting to feel somwhat human. 

Please give a cervical collar a go if you haven't already, especially if you are like me and know that your soft palate collapses really easily.

Having said that, I am being woken up by pressure/leaks once or twice a night - could someone please look at my data and let me know if I can bring down my pressure, or make any changes that might avoid this?

Thanks so much

   
   
   

[staceyburke]

Your pressure is not very high. Are you using EPR?  If not you could try EPR 2 FULL TIME.  T would set the exhale to 4.

[Melman]

I agree, your pressures are not very high and your charts indicate that you should not turn them down. I suggest you change EPR from 2 to 3. It won't solve your leak problem but it should improve your comfort and therapy. If you have not already, read the mask primer (link below) for suggestions for controlling leaks.

[SevereApnea]

I totally agree, it sounds like you are doing well. You are in the well treated zone and are now looking for comfort.

Sounds like the leaks are your main problem.

From these charts it appears your Flow Limitations are driving up your pressures which lead to leaks. You need better control of the FLs.

If the leaks are waking you, you have a few options.

a) wait and see if you get used them.
b) optimize your mask management, find a better mask etc.
c) increase your minimum pressure. This alone will help reduce the FLs and reduce the pressure fluctuations.  Your current EPR of 2 will only kick in once your pressures get high enough. Currently your Min EPAP is too low. Your Med EPAP is only around 5 or less. Therefore, if you increase your starting pressure to get you closer to your Med or 95% pressures you should have less FLs and less pressure fluctuations. I would start by upping the Min to 7 for a week and see how you go.
d) EPR of 3 can also improve FLs but it appears your pressures are low enough to not need that at the moment.

Of course, your neck position while you sleep can independently cause FLs, but your current settings and collar are already taking care of that.

(Is your ramp on, do you think you still need that?)

[StevesSp]

I tried a collar for the first time last night. It was an abysmal failure. The collar is too tight and too firm. I wasn't able to mouth breathe easily and developed a headache from neck strain. I also struggled to control my mask, resulting in leaks. On the plus side, it has confirmed that I do tuck my chin in, though I wasn't aware of doing so, hence the discomfort in my neck. I'll try again tonight but I think I need to try a different supplier and get a version that is softer and fits better.

If at first you don't succeed, take the darn thing off and take painkillers ...

[Gideon]

Looking pretty good, but try this
Min press=7
Max Pressure= 11
EPR=3, fulltime, up from your 2
Ramp off, just try it, your ramp is short and your pressures are low.

See if this suits you better than EPR=2, I think it will.

[JamesD0079]

Thanks all for these suggestions. I upped my min pressure to 7.0 for the later part of my sleep this morning and I think it helped, but forgot to put SD card in so don't have OSCAR data! While my AHI was 3.0 (a reasonable increase), I feel more rested. From what little data I have, it seemed to be 95% CAs again.

I'm just curious however, as I seem to have quite a few CAs, wouldn't upping my EPR any higher than it is (currently on 2), possibly cause more CAs? Likewise with upping max pressure?

I'm so confused about these CAs... are they actually CAs; are they sighs and normal; are they caused by EPR being too high; could it be from soft palate collapse (my main problem which was never picked up in sleep study); how do I tell?

Are there any links to really good tutorials to interpret the OSCAR data, especially CA analysis?

Early days, but there does seem to be a link between CAs and using the collar...??

Steve, sorry about your experience with collar, I have found that if it's too tight it can affect airflow negatively also, so it's a balancing act for sure.  I just got mine from local chemist, but wouldn't have a clue what brand, I'll look next time I'm in.

Thanks again to all of you for your advice re. this, I'm most grateful!

[Gideon]

Post your chart.
We don't know if increasing EPR will cause increased CA events for you or if the increase is significant. That is one of the many factors we try to evaluate.
Increasing EPR can, not does, increase CA events, at the same time Obstructive events will decrease. It can literally be a balancing act. Looking at your charts is a large part of seeing where that magic point is for you.

There is no correlation that I am aware of between the collar and CA events but often a large one between the collar and obstructive events.

Max pressure has absolutely nothing to do with it, it increases in actual pressure that not can but might. Frequently we will raise the max pressure just to see what your device will try to do. It is always better to remove the cause of the increase in pressure than to artificially limit it.

Your soft palate collapse is physical and as such obstructive, not central.

How to read central depends on the cause. CO2 induced central build and subside gradually waxing and waning. Awake breathing tends to be rather irregular, and obstructive apneas often have a large recovery breathe following the event.

[JamesD0079]

Thanks Gideon - I really appreciate your detailed response. I found that I was getting a lot of CAs with EPR on 3, and they seemed to decrease when I went to 2. So might stick with 2 for now and see how I go with min pressure at 7. 

Trying to understand in more detail around flow limitation. Can you advise what the measures are to look for re this if you are having flow limitation issues?

Thanks again!

[Gideon]

On the basis of raw numbers, 95% being 0.10 or less you are fine, though this number is arbitrary but seems to work for most people.
On the basis that flow limits are driving pressures up you need more control. As this is what is driving your pressures up. The best fix is to in trade your EPR. The third measure is that of comfort which is entirely subjective on your part.ant

Assuming that higher EPR causes increased CA events you actually want to see some CA events so your apneic threshold will shift as your body adjusts to your breathing with a CPAP. This takes months.