Preventing positional apneas, flat pillow or not?

[Newcpaper]

Hello. I am seeing some conflicting advice on the forum.

Some suggest using a flat pillow, with a cervical collar to keep head from tilting forward and obstructing the neck. However, by keeping the head perpendicular to the neck, I'd imagine you are also increasing the risk of the tongue falling backwards, which is also a source of apnea. 

I cannot sleep on side, but I have a cervical pillow. I'm wondering if keeping my nose facing the ceiling at 90 degrees is actually the right move. 

TIA!

[Deborah K.]

Assuming you sleep on your back, you can do what I do.  I bought a child-size pillow, as they are flatter than regular pillows.  Mine has a raised front and back edge, that causes me to sleep with my head tipped slightly back.  That has completely solved positional apnea for me.  My pillow is no longer made, but some on Amazon look like they would work the same way.  Here's a link in case you are interested:

https://www.amazon.com/MLILY-Adjustable-...r=8-5&th=1

This has never caused a problem with my tongue.  I almost always have a 0.something AHI.

[G. Szabo]

 However, by keeping the head perpendicular to the neck, I'd imagine you are also increasing the risk of the tongue falling backwards, which is also a source of apnea. 

You are right about your tongue falling backwards. This is why mouth taping is suggested. The best position is to sleep on the side, facing a bit downward.

[staceyburke]

mouth taping will NOT help positional apnea.  Positional apnea is also called chin tucking where your chin drops to your sternum cutting off you air way.

[G. Szabo]

mouth taping will NOT help positional apnea.  Positional apnea is also called chin tucking where your chin drops to your sternum cutting off you air way.

Above the position of the tongue was discussed not the chin tucking. 
There are studies about the improvements of different sleep parameters during mouth taping, including reduced AHI, obstructions, and snoring.

See for example: 
The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea: A Preliminary Study, 
Healthcare (Basel) 2022 Sep 13;10(9):1755.  doi: 10.3390/healthcare10091755.
Method: Mouth-breathers with mild OSA who met inclusion criteria and tolerated the sealing of the mouth were enrolled in the study. We used 3M silicone hypoallergenic tape was used to seal the mouths of the participants during sleep. The home sleep test (HST) used in this study was ApneaLink®. Subjects received both a baseline HST and an outcome HST to be used 1 week later while their mouths were taped. The changes between the baseline and the outcome HSTs were compared, and the factors that influenced the differences in the sleep-test parameters after the shift of the breathing route were analyzed. A "responder" was defined as a patient who experienced a reduction from the baseline snoring index of at least 50% under mouth-taping in the HST; otherwise, patients were considered as having a poor response.

Results: A total of 20 patients with mild OSA were included. Following the taping of the mouth, a good response was found in 13 patients (65%). The median apnea/hypopnea index (AHI) decreased significantly, from 8.3 to 4.7 event/h (by 47%, p = 0.0002), especially in supine AHI (9.4 vs. 5.5 event/h, p = 0.0001). The median snoring index (SI) was also improved (by 47%, 303.8 vs. 121.1 event/h, p = 0.0002). Despite no significant difference in the mean saturation, improvements in the oxygen desaturation index (8.7 vs. 5.8, p = 0.0003) and the lowest saturation (82.5% vs. 87%, p = 0.049) were noted. The change in AHI was associated with baseline AHI (r = -0.52, p = 0.02), oxygen desaturation index (ODI) (r = -0.54, p = 0.01), and SI (r = -0.47, p = 0.04). The change in SI was strongly associated with baseline SI (r = -0.77, p = 0.001).
Conclusions: Mouth-taping during sleep improved snoring and the severity of sleep apnea in mouth-breathers with mild OSA, with AHI and SI being reduced by about half. The higher the level of baseline AHI and SI, the greater the improvement was shown after mouth-taping. Mouth-taping could be an alternative treatment in patients with mild OSA before turning to CPAP therapy or surgical intervention.
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[staceyburke]

There is a process called "tongue suck method", which I use to stop mouth breathing.  You suck your tongue to the top of the mouth and train your tongue to stay there.  It takes several weeks of practicing keeping there while doing ever day tasks.  Finally your tongue will stay on the roof of the mouth stopping mouth breathing.

BUT that is not positional apnea.  Again, positional apnea is also called chin tucking.  If we use the same terminology it helps everyone know what we are talking about.

[Deborah K.]

The point of this thread is overcoming positional apnea.

[quiescence at last]

yeah, the point is trying to defeat the positional apnea. I have not done that, myself. However, my initial problem was breathing through my nose, even though my body has always wanted to breathe through my nose while sleeping. what helped me get over that is if I pointed face up, then turn my head to my left by about 15 to 30 degrees, both nostrils became free flowing.
I never felt like I could sleep unless I had 2 or three pillows under my neck. It is so inverse of what positional is all about. Well I still do it, but have a neck donut that keeps my chin from getting close to my chest.
I did find I could sleep on my left side, and it kind of resolves (to some extent) each conflicting issue, enough that I feel I'm doing well.
My AHI is well above 0, RERA is big killer, it vaults me to RDI of (3 to 8) disruptions per hour, though I rarely notice that.
Please don't sleep without the air stent that APAP provides.

Greeting to you all,

QAL