Soft Cervical Collar- What went wrong? Help!

[JadeThreads]

So, I got a soft cervical collar as my flow limit wasn't great and was getting positional apnea clusters. Night one was brilliant- my AHI dropped, no clusters, no arousals, I thought I had cracked it. Night two... not so great. My flow limit was the worst it's ever been, woke up feeling like I had been hit by several trucks, groggy, dizzy, AHI not super high but lots of arousals. Side by side OSCAR comparison below. What could have gone wrong? It was the same collar both nights. Is anyone able to offer insight or a fix? I have read the full wiki article. 

   

[G. Szabo]

Your flow limits are significantly higher in the second case.
Possible causes: You turned to your back or opened your mouth, and your tongue slid backward.

Look for tools on Amazon which can prevent sleeping on your back,  and try taping your mouth. 
Also, ensure that you tighten the collar to the same degree. Not too tight or loose. The tight can cause obstruction, the lose is useless.

[JadeThreads]

Hi 

Thank you. I was very tired last night (two nights previous up with unwell cat so only got about 4 or 5 hours Vs my usual 9). So maybe I didn't fit the collar right. 

Can I ask why breathing through my mouth is bad? I have a full face mask (not sure why Oscar says nasal, the machine is set to full).

[G. Szabo]

Can I ask why breathing through my mouth is bad? 

When you inhale with an open mouth while asleep, your tongue slides back and can cause inspiration obstruction. It is even worse when you are on your back.  

Some more details: When you need high pressure to combat obstruction, mouth taping cannot prevent leaks when you use a nasal mask. In this case, you need a full face mask (together with taping); hence, there will be no pressure difference at the tape. It will function better and can keep your mouth shut.

[JadeThreads]

I see. I will add in mouth taping in a few nights. The rapid adjust ment to a CPAP with full mask, then a collar has been a bit rough, adding a third thing I am not used to might be a bit much but will try it in a couple of nights time. Thank you!

[PeaceLoveAndPizza]

G.Szabo made some good comments on your one wonky night. Hopefully just a one-off.

Breathing through your mouth is not bad with a full-face mask. Breathing through your nose is better for a variety of reasons, but mouth breathing is not a no-no.

My opinion on taping is nasal mask/pillows and mouth tape? Absolutely. Full-face mask and mouth tape, not required. I do not suggest mouth-taping with a full-face mask, it is not necessary and may prove to be quite disturbing. Even with a FFM you should try to nose breath, but don’t dwell on mouth breathing as needed. A soft cervical collar with a FFM is sometimes needed for chin-tucking and/or mouth drops that cause leaks by dropping under the mask.

Do you need to continue using ramp? If not, turn it off.

Another thing to ponder is for the moment ignoring the flow limitations and shooting for a better nights rest. If you are open to some experimenting, try the following:

Mode CPAP
Pressure 15
EPR 3 full-time
No ramp (unless you must have it)

We will ignore the FL’s for now and focus on the sleep quality. Over a few nights slowly creep up your pressure by 0.2 or 0.4 per night or every other night. If you hit a spot where things go totally off the rails or you have a cracking good night, then stop. I would stop around 18 anyway as this is a test. If it does not feel comfortable then go back to the current settings.

There is a finite amount we can do with your machine with pressure and pressure support. If you have not tried it you can set your response to “soft”, which may or may not make a difference. Easy enough to try. 

Think also about sleep hygiene. Flatter pillow, relaxation before heading to bed, no TV or electronics an hour before, etc. Here is a link to some good suggestions: https://www.sleepfoundation.org/sleep-hygiene

[BigWing]

As already mentioned, getting the tightness of the SCC just right can be very tricky. I got the same terrible results as you one night, and decided my SCC had been too tight and was basically strangling me (pressing on the soft tissue at the back of the lower jaw).

[HalfAsleep]

I created all kinds of flow limits by wearing the cervical collar too tight. Yep, just about strangled myself, kinked my neck down by my shoulders, and cut off my air flow. What I found is that I have to have it loose enough just to keep my chin from dropping below the edge of the collar and a little support just at the jaw. This adjustment is very different than if you were using the collar to actually reinforce your neck for medical reasons.

Personally, I won't consider mouth taping, since I sometimes cough in the night and frequently need water.

[SevereApnea]

I mouth tape, I cough at night, I get up to drink water through a straw...

Cannot tolerate full mouth taping...