Soft cervical collar for flow limitation?

[Michaely6]

Does a soft cervical collar help with flow limitation or is that more of a help for obstructive sleep apnea due to positional apnea?

[Walla Walla]

Yes if the flow limitation is due to position such as tucking your chin. It might be closing the airway enough to cause flow limitation but not enough to count as an event.

[Michaely6]

Thanks Walla! I have the Dr. Dakota neck pillow specifically designed for sleeping and preventing snoring due to chin tucking. Do you think that this neck pillow works just as good as a cervical collar?

[Walla Walla]

Couldn't say. I've never tried the Dr Dakota. The cervical collar worked for me when I used it.

[Michaely6]

I have both but I use the snore pillow a a majority of the time but also tried the collar recently.

[Sleeprider]

We are working on understanding the mechanism of obstruction and flow limitation associated with chin tuck, and are leaning towards the idea that obstruction is from the upward compression of the tissues at the back of the jaw and front of the throat causing obstruction in the posterior soft palate. Put simply, this can be avoided by any collar or wedge that does not impinge on the neck and prevents the chin from tucking. The Dr. Dakota Snorting Stop seems like a very effective approach if you are comfortable with it.

[Michaely6]

Thanks Sleep rider!

[picante]

We are working on understanding the mechanism of obstruction and flow limitation associated with chin tuck, and are leaning towards the idea that obstruction is from the upward compression of the tissues at the back of the jaw and front of the throat causing obstruction in the posterior soft palate.  Put simply, this can be avoided by any collar or wedge that does not impinge on the neck and prevents the chin from tucking. The Dr. Dakota Snorting Stop seems like a very effective approach if you are comfortable with it.

I'm shopping for a cervical collar now, and am wondering whether this snore pillow would work for me.

As you know, Sleeprider, I've got reflux going all the way up into my sinuses. Stephen Park, MD explains exactly what I'm experiencing in Common Throat Problems That Sleep Apnea Sufferers Face. I was amazed to find this.

"However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle."

The first vacuum effect is from the apnea, pulling stomach contents upward (upstream effect). This sinus inflammation and constriction creates the downstream effect.

My tongue gets glued to my soft palate just in front of the uvula. When people talk about putting your tongue on the hard palate, that tongue trick doesn't work for me because my tongue inevitably slides and seals off further back. Part of this is the chin-tucking problem, no doubt.

In your opinion, does that steer me in any particular direction on choosing a cervical collar? And how do I get one that's sized right for a long, skinny neck? Thanks, SR, and anyone else who cares to answer.

[Sleeprider]

I am admittedly not a big fan of Steven Park who is a big advocate of surgical solutions. His cult-like following is like trying to counter Dr. Oz. It's hard to not agree a lot of his suggestions regarding eating and alcohol make sense for people with GERD, but for CPAP patients, there is pressure threshold that makes the problem worse. Avoiding that threshold may increase apnea and require counter-measures. You have mostly a positional obstructive apnea problem, and at higher CPAP pressure experience a lot of central apnea which has nothing to do with this "vacuum effect". We are trying to find tools like a soft cervical collar to deal with your occasional obstructive clusters tha may aggravate GERD, and to keep pressures lower so that aerophagia is not a huge problem. You chronically hypoventilate as a result of central apnea, and need supplemental oxygen. We can kill two birds with low CPAP pressure and supplemental oxygen, but we can't solve your obstructive apnea with high CPAP pressure, nor resolve central apnea without high IPAP pressure (ASV), which would increase aerophagia. Low CPAP pressure with a cervical collar will solve most obstructive apnea and avoid most central apnea. For the events we can't treat due to the aerophagia / GERD, we are suggesting supplemental oxygen. This should be mostly restful and minimally disruptive, and will keep your oxygen levels at a healthy level. It is not a perfect solution because given the complexity here, a perfect solution may not be available. That's the best I know of. If that does not solve the problem then surgery to reinforce the lower esophageal sphincter may be an option. https://www.healthline.com/health/gerd/surgery Obviously this is a last resort if other approaches have failed.

[picante]

I am admittedly not a big fan of Steven Park who is a big advocate of surgical solutions.  His cult-like following is like trying to counter Dr. Oz.  It's hard to not agree a lot of his suggestions regarding eating and alcohol make sense for people with GERD,  but for CPAP patients, there is pressure threshold that makes the problem worse. Avoiding that threshold may increase apnea and require counter-measures. You have mostly a positional obstructive apnea problem, and at higher CPAP pressure experience a lot of central apnea which has nothing to do with this "vacuum effect". 

Well, that's really good to know! I'm NOT a fan of surgery, either. I was just wowed by his explanation of the sinus inflammation I experience.
It's also good to know the positional problem is not a vacuum effect problem. I don't do cults. I'm a question-authority patient, and some docs appreciate that, some don't.

You & Bonjour have mentioned the cervical collar, and that's why I'm shopping for one. For a neck that's just under 12", but 4" from top of clavical bump to jawbone. Perhaps I'm a giraffe.

Shall we return to the other thread, Possibly dubious things my sleep doctor said, for the oxygen discussion? It fits better there, and I've replied to your comment there.