New CPAP, new thread

[Geer1]

So this was back to normal setup with wedge, nasal mask etc. Only difference that you tried tape?

The portion you posted is decent, if you look at 2:30 to 3:30 will see it is all restricted.

Biggest issue is the positional apnea that is occurring. If I had to guess most of your restriction is positional, the trick is finding a way to resolve it.

[midwestguy]

So this was back to normal setup with wedge, nasal mask etc. Only difference that you tried tape?

The portion you posted is decent, if you look at 2:30 to 3:30 will see it is all restricted.

Biggest issue is the positional apnea that is occurring. If I had to guess most of your restriction is positional, the trick is finding a way to resolve it.

There is some research that points to side-sleeping as a fix for 
positional apnea. Will continue looking at this.

Other than the collar, are there other possible solutions?

[Geer1]

There are two kinds of positional apnea.

There is positional apnea related to sleep position (supine, side etc). This is what modern medicine (doctors) would consider positional apnea.

The other positional apnea is the one we have been discussing and is related to position of airway. To my knowledge this terminology is used almost exclusively on forums like this one and I don't know who decided to call this positional apnea. If you went and told doctor you had positional apnea they probably wouldn't know this is what you meant.

Stuff like side sleeping would primarily affect the first kind but potentially could influence the second kind as well. Cervical collar is the go to and it seems to work for most patients but can take fiddling trying different sizes of collars and getting the fit right. Using a single thin pillow is the next most common recommendation, a lot of patients that show this type of apnea often are sleeping on a couple pillows or really thick ones. I don't know of any other recommendations other than to play with collars and pillows to adjust your airway position until you find what works.

[midwestguy]

Something about this doesn’t seem right.

We’re talking about ways the airway gets 
restricted and how to open it up. Okay.

If I’m on my back, on a wedge, isn’t that already
tipping my head forward and narrowing my airway? 
What does a thin pillow under my head do but tip it 
forward more?

The collar I use seems to restrict bending my 
head forward. But it’s soft, so maybe it’s not
doing the job.

The tape stops mouth breathing until it works
loose.

I am very confused. And very tired.

[Geer1]

A wedge pillow only affects your upper airway position if you are sleeping at the base of the wedge. If you are sleeping far enough up the wedge then your upper airway is effectively sleeping on a flat surface. Perhaps this image showing the different neck positions will make this clearer.

   

A cervical collar does two things. One it helps keep your neck in a straight position. The other is that it holds chin position up and forward. Both of these actions prevent chin tucking and airway restriction. 

Pillows are primarily used to support spine and provide comfort. I assumed you used some sort of pillow on top of your wedge pillow but perhaps not. You are correct that using a pillow can cause your head to tilt forward especially if you sleep low on the pillow (like wedge pillow example), the pillow is too thick, or you use multiple pillows. 

If you currently do not use a pillow (other than wedge pillow) then it might be worth trying one to see if it has any effect. You could try a thin pillow or something like a folded towel and see if it adds any comfort or has effects on your data.

[midwestguy]

Here's last night. Mouth taped, no pillow on the wedge,
head as far up on the wedge as possible.

I think the collar is too soft.

The night starts out fine. After the one bathroom break,
my head tilts, and the collar doesn't keep it from happening.

Will look for a stiffer collar.

   

[midwestguy]

Hey geer1,

There are hard plastic rigid collars. They might be very hot in the summer, but they’d 
sure keep my neck straight. 

Haven’t looked on the forum yet to see if anyone’s used one. 

Do you know?

Thanks,

Harv

[Crimson Nape]

As far as I know, we strongly advise against them.  Only use the soft collars.  We are using them to help in preventing chin tucking and not for therapeutic use.

[midwestguy]

As far as I know, we strongly advise against them.  Only use the soft collars.  We are using them to help in preventing chin tucking and not for therapeutic use.

Hi Red,

You misunderstand. If a soft collar allows my chin to move toward my chest, it’s too soft. A rigid collar would seem to work better. 

This is therapeutic only in the sense that it’s preventing positional apnea. 

Best,

Harv

[Geer1]

I personally have used one but because I fractured my neck last fall. I was able to notice a difference in my data even though I don't have significant positional issues. That said it was not comfortable and the support could cause issues by reducing muscle tone (which I am now in physio to regain).

You mentioned head rolling. That could the problem and using pillows or towels etc to support and hold head/neck in position might help. If sleeping with head on top of pillow raises it up too much you can try tucking a little pillow on each side so back of neck rests on wedge pillow and side pillows just keep head from rotating. That is pretty much how I slept when I had to wear the hard collar as sleeping with it on top of a regular pillow was uncomfortable.