Chest/Lung Restriction - Impact on CPAP use?

[cathyf]

What is comfortable for me is that it keeps my chin up, which means it needs to be tight enough that my chin doesn't just slip down behind it. AND I don't want the back foam part to overlap -- just the velcro flap goes over the velcro target. In my case out of the box the two sides were overlapping by 5 inches, so I knew that's how much I wanted to take out.

[2SleepBetta]

I was slow to adopt but fast to adapt the cervical collar once I tried one as recommended here. Can't recommend it enough. You may have to try a couple, but do get the first one. All brands will vary as necks and jaw and chin lines do.

I had been using one, my narrower one, and saw I would still get some obstructive apneas  and too many flow limitations when supine. I found a way to prevent supine sleep and continued wearing the 3.5" until I got my 4" collar. Only lately, after a year with the 4" and the supine block, I decided to quit the supine block for an experiment. Guess what? Numbers and my fewer flow limitations changed little, if any, and I have become free to turn and sleep comfortably in most positions --back issues and a chiropractor broke me of prone sleep years ago.  

Didn't care for the 4" for a while--seemed too high (it just felt different somehow)--then I tried it again and switched to it. The cushion is 21 inches and I must overlap it about an inch--the overlap is no bother as a side and supine sleeper (on a small, thin sponge or buckwheat pillow). Inverted and lying on a flat surface the down curve for the jaw rises about 3/4 inch.

There's quite a variety of collars. I just searched and saw many. This link  shows one most like mine, in being somewhat serpentine. If I needed another, I'd get their 4X20. I don't know what density mine is, but it is firm enough but not rigid. If I stand heels, butt, shoulders and ball of head against the wall, I, like the woman in the pic, see that the bottom of my nose and the main "bore" of my ear are very close to level, and my eyes would look level into our skipper's eyes (same height).  No effort or comfort issues there, just a bit of effort to stand at attention that way again.

Tightness? No. I can easily slip all four fingers in, up to my large kunckles at the palm, between chin and jut of the jaw. In the pic you can see a gap, upward from the collar bone, along the bottom of the collar. That is much as I have, yet all work together to support the head and jaw, keeping airway straight comfortably. 

Letting the jaw go slack (as when awake, of course) I can totally relax and my jaw is held up, but still with some resilience if I open my mouth fairly wide. Forcing my mouth opening widest, my head tilts back slightly. 

To wrap this up, I suggest you find some small container, I just now chose a pressurize shaving cream cylinder 2 x 5 in, and used it as a gauge to measure what my key fitting distance was for my effective fit  without pain. Plastic cover of can to bottom of chin, bottom of can resting firmly on the two bone-knobs where collar bones end with a drop between them straight below my chin. The 5 incher was right on. So for my body a collar 80% as high my 5 inch gauged distance is perfect.

[pkersey]

I really appreciate all the help I'm getting. I'm committed to making the cpap work this time. I know I can't leave severe sleep apnea untreated.

So, I've been trying to use the CPAP during the day. I've tried different hoses, different settings, different masks. The only thing I haven't tried is using it with a neck collar on (I managed to make the neck collar for now work with a t-shirt tucked in the top, but I'm ordering one I hope will fit better.)

I always feel off after using the CPAP, even if it's only for 30 mins at a pressure of 5. I was having trouble figuring out how to describe the symptoms. I thought maybe aerophagia because my stomach feels funny afterwards. But I'm not swallowing any air. AHI = 0 also.

When the pressure is up at 9 I can feel my ears have popped when I stop using it.

Well, I decided it's nausea. I feel a bit queasy and I also have a sensation in my fingertips that's hard to describe. Maybe like the beginning of tingling.

Okay, so I have a half-mask respirator that I wore in Left/Uber early during the pandemic. That thing makes me nauseated too!

Could I be hyperventilating?

Or is it a medical problem? I have appts scheduled with an ENT, a neurologist and I'm working on a pulmonologist.

I think I mentioned above that I've had silent reflux for a long time that I should have dealt with sooner. When I get it, it causes a strong pain in my right ear. I wonder if the CPAP is doing something to my inner ear, thus causing the nausea? But why would it happen with the Half Mask Respirator too.

I know you all aren't doctors, but let me know if you have any thoughts on things I should bring up with the docs. Thx!

[pkersey]

Hi Cathy, I'm ordering a new Corflex collar now. Hoping it will work.

After doing a bunch of research and fooling around with the two collars I already have, I now understand better what you were explaining.

I'm thinking that in order to get enough height, I have to turn a 4.5" collar upside down, which makes it about 5"

[pkersey]

I'm ordering a new Corflex collar now. This was EXTREMELY helpful in figuring out what I needed. Thanks!

[pkersey]

Post your OSCAR charts, we need to see what's going on.

Hi Gideon,

So I finally managed to go to sleep with the nasal pillows mask on. I tried a FFM 2-3 years ago and gave up. In retrospect, I don't think it sealed as well as these nasal pillows.

You can see on the chart that I only made it about an hour and fifteen minutes before I took the mask off. My sleep was scary. I would half wake up and realize I wasn't breathing, then fall back asleep. I took the mask off because I was scared and because I wasn't sure it was safe to keep trying.

Last sleep study was 2018 and I believe centrals were not an issue at that time. I'll try to post it.

What's going on? Could I just have been panicking? Could I be unable to breathe out against the pressure?

[Sleeprider]

Did the 2018 sleep study evaluate your therapy under CPAP pressure (titration)? Central apnea can appear in sleep studies or as treatment emergent. We can see the flow rate line in your graph has periodic breathing typical of individuals with hypcapnea related centrals. This tends to be a feedback loop as the individual swings from hyper ventilation to hypoventilation depending on the CO2 levels in the bloodstream. This can often be reduced by turning EPR off or to a low setting to reduce respiratory ventilation. You need to try to get more hours on the CPAP, probably without EPR to determine if this is a trend. If the CA events continue, you will require a titration that evaluates CPAP and bilevel ASV to find what works.

[pkersey]

Hi Sleeprider,

I appreciate your help with this.

I've attached 3 pages from my December 2018 Sleep Study.

My anxiety was completely off the charts that night. When I finally fell asleep with Benadryl my body was still totally rigid ... I don't know if that would affect the results.

[pkersey]

Here is my July 2017 in home sleep study. I was more relaxed for this one.

[Sleeprider]

Regardless of the use of Benadryl, your AHI with CPAP was dominated by central events with a strong correlation of events with increased pressure, and interesting that an inverse relationship between SpO2 and event rate and pressure as well as AASM desaturation. So the better ventilated you were during this test, the more apnea you had, but the better your oxygen saturation was. It goes without saying that EPR or bilevel pressure would likely increase central events. This is clearly a treatment onset central apnea pattern! It simply could not be more obvious with 100% of events under CPAP therapy being central, and increasing with increased pressure, and certainly pressure support.