Old user, had neck surgery, struggling with collar

[Chinkapin]

Hi! I just signed up. I've been using CPAP very successfully since 2010. Three weeks ago I had anterior cervical discectomy and fusion surgery to join my C4 and C5 vertebrae together; many years earlier (before CPAP) I had C5-7 fused together so this extends the fused region.

The trouble: combining a hard cervical collar with a full face CPAP mask, jammed together actually, is turning out to be so overwhelming that I can't sleep. Last night I only made it 25 minutes. From the middle of my sternum to the bridge of my nose, I am rigid plastic, and there are tight straps around my head and rigid plastic behind my neck and shoulders. I just can't manage it, like I'm getting claustrophobic or something. I need the full face mask and tight straps because my pressures run high.

I have to wear the hard cervical collar, which is a tall and rigid affair, because my neck is unstable and fragile. I've worn it 3 weeks now and need to wear it 3 more weeks.

I originally adapted to CPAP pretty well, and for the past 13 years I have used CPAP all night every night. When the power goes out, I have to stay up all night.

I have pretty severe apnea, with an AHI of 74.4.

For the surgery, I have been taking prescription muscle relaxer 3X daily. In addition to one of the muscle relaxers at bedtime, I've also been taking a Tylenol PM. But it's either not putting me to sleep, or if it does it's only keeping me asleep about 2 hours. Normally I don't use any kind of sleep aid, and I don't drink or use any narcotics (other than occasional codeine cough syrup for chronic bronchitis). For the first week or so after surgery I was also taking prescribed gabapentin, which induces sleep, and even with that I wasn't sleeping all that well.

I sleep on my front, turned a bit to one side or the other, with pillows wedged to hold my neck properly with respect to my shoulders.

I'm looking for any advice or suggestions anybody can give. I really want to get back to successful CPAP. If I have to tough it out 3 more weeks, I guess I can, but it's pretty awful.

I hope I gave enough information. Thank you!

[Sleeprider]

Wow, that sounds miserable. Any chance your physician can help you make an adjustment on the hard cervical collar that would make it more tolerable? Have you tried inclined sleeping on a wedge pillow. It seems being on your back or side-back would be better than prone. A hybrid style mask might be easier with the collar. This is a mask that covers the mouth and maintains nasal pressure with nasal pillows. The Resmed Airfit F30 is a full-face mask but minimalist and would not be on the bridge of your nose. You could get setup from your DME or an onlline supplier pretty quickly if it looks like that might help. There are two styles. The F30 has the tube attaching to the front of the mask, probably like your current gear, and the P30i has the hose connected to flattened air-tubes at the top of your head. I suspect if you are a prone sleeper the F30 would be better.

That's all I can think of right not. I don't envy your situation.

[Chinkapin]

Thank you for all your thoughts!

I discussed the problem with the surgeon, who stressed that my neck is fragile and vulnerable and my collar is adjusted properly. He said he doesn't know what to tell me. Of course, he's not an apnea or CPAP doctor.

My neck has mostly lost its lordosis (the normal curvature) and if I am on my back I can't tolerate any pillow at all, though I only lie on my back occasionally for something other than sleep. 

I could look at different masks. I arrived at the Mirage Quattro after trying several others which couldn't be made tight enough. What I remember about my pressure in years past was that it was limited at 20 and would often automatically rise that high, though when I look at the current 12 month average I see 10.8. How are the ResMed AirFit masks at handling this pressure?

I like the idea of the tubes on the top of my head. My current mask has the tube projecting out over my mouth and immediately going through a swivel elbow; I cemented the elbow so that it always points "up" (over my forehead I mean) to make it easier to manage the hose between mattress and headboard.

Other than the current problem, I guess CPAP is working well. I see I have an AHI of 3.0 with the machine over a 12 month average, though for the most recent measurements it's 12.0. I love the humidity; in fact I got my 3rd machine not long ago and its humidification was set at "auto", which seemed a bit dry, but just now I found how to set that manually and set it to 6 (on a scale of 10) so possibly that will be some help. Though it doesn't seem exactly on point.

[car54]

I also have had 2 cervical fusion serguries. The second one was both anterior and posterior and I also had a hard collar. I ended up sleeping in an upright position for the duration of the hard collar. It was the only way that I could get comfortable. I  was not on cpap then but it might be worth a try.

[Sleeprider]

Chinkapin, if you could download and install OSCAR software (free) and post a chart I could help much more. Your comment that your pressure seeks the maximum in your range tells me it would be helpful if I could see your settings, and especially, I want to see you using EPR full-time at 3 to minimize flow limitations and increase comfort.

The Resmed masks can handle any pressure you throw at them as long as they fit. The Quattro Pro mask is an old very heavy design and while it is very stable on your head it's a huge, uncomfortable mask for most. I hope you try some alternatives. Supplier #1 lets you buy a mask insurance for a minimal cost, and if it doesn't work out, you can return or exchange.

[Chinkapin]

That's very kind, Sleeprider! I just installed OSCAR and will get data into it soon, and post a chart. Thank you!

[Sleeprider]

That will be a big help to let us help you.

[Chinkapin]

   

I am looking at all my data in OSCAR. I think I got the chart I'm supposed to post according to "OSCAR Chart Organization", is this right?

I understand what I'm looking at indicates my pressures aren't maxing out at 20. I think this is a memory of quite a few years ago, not current. I think I've put us off the scent with this old memory because I didn't have more current impression of my pressures.

Last night was better, though still less sleep than I'd have liked. I've been struggling with dry airways and yesterday increased the humidifier setting to 6; what woke me up was enough condensation in the hose to make a gurgling noise. I think tonight I'll try increasing the hose temperature by 5 degrees. Any thoughts on this?

I also took not 1 but 2 of the Tylenol PM, in addition to the prescribed muscle relaxer. But I'm pretty nervous about building some sleep med dependence. Normally I wouldn't take any sleep aids.

I am VERY encouraged to see all this information and the controls I have access to, which I'd never paid that much attention to before!