Chin Tucking as cause of apnea

[Crimson Nape]

Keep all your posts that deal with your therapy in one thread. We can always rename it.

- Red

[Jay51]

ejbpesca, I am sorry to hear about the metal plate used for C2, C3, C4.  I now understand why you need the Dr. Dakota or Eliminator.  I have a little bit of degeneration in C3, C4, and C5; and found the Eliminator very comfortable (because it has nothing but a thin strap on the back of it where it contacts your neck).  

Since they are out of stock (and they may not make them anymore), ebay is your best shot (from my experience finding some of them).  What you can do if you feel confident enough also, is cut out the back portion of the collar with a sissors.  Then get some velcro and super glue (or use some t-rex duct tape - multiple times stronger than regular duct tape) to try to replicate the design of the Dr. Dakota or Eliminator collars.  If you feel any pain or have any problems though, scrap it.

[PamVT41]

I think chin tucking is a big factor in hypopneas that escape just about all treatment.  I am experimenting with small pillows, cervical collars, soft  dog toys etc to keep my chin up and forward.  the sleep doctor thinks a chin strap is the solution but it is not. You need to get that chin out of your neck or chest. I'm even using an ASV and still get a bunch of hypopneas and periodic breathing and flow limits.

[Old Mike]

If you did a laboratory sleep study, then it would have been filmed, and positional apnea noted (perhaps very high supine?). Even now, you could buy a cheap infra-red camera and film yourself sleeping to see whether or not you appear to be "chin-tucking" and, if so, whether it coincides with apnea clusters. I think there is an over-emphasis on chin-tucking and cervical collars on this forum, even when clustering is barely noticeable. And, as far as I know, there is no medical evidence to support the chin tucking theory. If, there are some relevant studies out there, I would love to see some references. Until then, I remain skeptical.

[ancheero]

As a personal anecdote, I've been using a cervical collar, and it's helping me with issues with slack jaw and chin tucking, but I don't really notice more or less apneas. But I tend to have issues with my tongue falling back, so perhaps it varies.

[ejbpesca]

The left side of this report may be an example of what chin tucking can do.  I fell asleep with ffmask/tape/collar in place but failed to remove my stack of pillows for sitting up.  Maybe the collar was not tight enough.  The right side of the report is after I woke, removed 3 pillows, and returned to sleep on my side with one thin pillow.

   

[eok361]

if you're experiencing a sore neck, then your collar is probably too tight.

i went through a few before getting the caldera releaf (readily available) on amazon. it's soft enough that it doesn't create neck strain (for me). it also folds down a little at the bottom to keep it in place.

you definitely don't want to wear them too tight. i had a few bad experiences doing that. and an awful one with one that was too tall.

good luck.

[UnicornRider]

The left side of this report may be an example of what chin tucking can do.  I fell asleep with ffmask/tape/collar in place but failed to remove my stack of pillows for sitting up.  Maybe the collar was not tight enough.  The right side of the report is after I woke, removed 3 pillows, and returned to sleep on my side with one thin pillow.

You are correct in your observation of what excessive pillows can do.

Looking at your charts, you may benefit from tightening up your therapy pressure spread.

    Mode:   APAP
    Press Min:  15 cmH2O
    Press Max:  20 cmH2O
     EPR :   Full Time
     EPR: 3
  
  The additional EPR will help reduce the Flow Limits, therefore reduce the pressure increase, possibly reducing the leaks you experience, and provide a more comfortable therapy session.

I recently purchased a "Velpeau Enhanced" neck brace (SCC) from Amazon, If you chose to try the Velpeau, be sure to measure your neck and use the size chart for the model of Velpeau you have selected. They have three different models of Velpeau on the same listing. You have to look closely and read carefully to discover the difference.

On the Enhanced model of Velpeau the velcro strap behind the neck is just that, a wide velcro strap, probably a little more than twice a wide as "The Eliminator". Therefore no bulk behind the neck.The Enhanced model also carries the wide (not  thick) soft foam around the sides further than The Eliminator, thus giving additional support to the back of the jaw. For me this prevents the jaw from sliding backwards, which increases my obstructions.

I use a Checkme O2 Max pulse/Oximeter/Motion recording monitor, Bluetoothed to an Iphone for live remote monitoring and secondary alarming, the wrist strap finger ring also has audible as well as vibratory alarm. I also us an Apple watch for additional monitor/recording functions.. My major concern with my therapy is SpO2 drops like a rock with obstructions.

 I was surprised the recorded SpO2  Max, Min and Average each increase a minimum of 1%. Min actually increased better than 2%, Just by replacing my old "Caldera Releaf".

Now I will admit the Caldera served me well  and was aged, worn and probably did not provide the same support as when it was new. The Caldera also did not provide the support at the back of my jaw to keep it from sliding backwards as the Velpeau Enhanced does.

I also would recommend ordering from Amazon for their free shipping and liberal return policy if the fit or size is wrong for your personal needs.

[ejbpesca]

 Mode:   APAP
    Press Min:  15 cmH2O
    Press Max:  20 cmH2O
     EPR :   Full Time
     EPR: 3

Those are some very interesting settings.  My first prescribed setting was constant 8 then 8 min 20 max once I had a machine that would auto adjust.  That was 15 years ago.

The doctor who writes my CPAP prescription and my DME have no idea how to set up a CPAP machine nor much knowledge of CPAP therapy.  No, zero knowledge.

Thanks for the advice.  I will try the settings.

The Valpeau looks like a collar that may be more comfortable than the Corflex.  I do not have enough chin for a collar to hold up unless I choke myself with it.  If a collar is comfortable, my chin will still drop down.      

[ejbpesca]

PamVT41 wrote:

"I am experimenting with small pillows, cervical collars, soft dog toys, etc to keep my chin up and forward.  the sleep doctor thinks a chin strap is the solution but it is not. You need to get that chin out of your neck or chest. I'm even using an ASV and still get a bunch of hypopneas and periodic breathing and flow limits."

What is ASV?

Chin straps do not work on me.  It would take one of inflexible material strapped to me with great force to keep my chin up and jaw closed.

Collars are not working out so far.  I wake and pull them off finding them so uncomfortable and a source of pain.

If I could find a way to not roll to my back I think I would improve.  That's when things get bad.  My wall of pillows to my back when side sleeping does not stop my rolling to my back during sleep.  Maybe no pillow at all would make back sleeping not produce chin tucking.

Thank you for the reply.  I have no advice/help except forums.  My doctor/dme have no idea how CPAPs work nor how or why to adjust them.  My doctor is not a sleep doctor.  Here, after a sleep test, they turn you over to a pulmonologist with zero knowledge of CPAP therapy.