Soft collar: How tight?

[drmaestro]

Hi,

I have been trying the soft collar (Eliminator) for 4 days. The first 2 days it was ok but the last 2 days, I had some really long obstructive events. I've never had 45 sec long events before so I suppose it might be related to the collar. How tight should it be? If it is tight, I can keep my mouth somehow closed but I think it pushes the soft tissues under my chin up, obstructing the passage. I've checked the audio recordings and during the obstructive event I am making some choking sounds, almost as I am struggling to breath (interestingly I didn't get heavily desaturated (dropped from 95 to 91). Also I had very high amounts of mouth leaking in the last 2 days, which is odd, as the collar was supposed to help preventing that. If the collar is too loose, my chin can drop down, effectively negating its effect. I am confused....

[sleepyp]

For me it works best it fits snugly, but with enough room to push fingers between the collar and my neck without any discomfort. You shouldn't feel your pulse. Overly tight is likely to impede the airway. It needs to be tight enough not to allow the jaw to slip down inside the collar.
The big thing is to ensure that the collar is sitting right under my jawbone. Any lower and it's not nearly as effective.

The collar will not stop mouth leaking fully. It does help to reduce it, but not eliminate it. The best way to eliminate mouth leaking is with mouth tape.
Personally, I use both a collar and mouth tape.

[Sleeprider]

This is the aspect of the Eliminator and the similar Dr Dakoka wedges I don't like. A soft cervical collar that has a cradle for the chin applies pressure to the jaw line, while the Eliminator is shaped like a watermelon wedge. If a U-shape recess was in the center of the collar I think it would be more comfortable and effective. We should get together and invent and sell this innovation! Anyway, if you can get to the padding and carve our a space that prevents it from pushing on the soft tissues behind the chin, between the jaw it would resolve the problem. Basically remove material from the back edge and top-center that causes impingement on the tissues that results in the same problem, chin tucking, that we are trying to solve. If not, then a different style of collar is needed.

[holden4th]

SR has hit the nail right on the head. The basic collar I use ($AUS10) from my local pharmacy has a small scoop where my chin goes which allows the whole of the collar to support my chin line. The issue with chin straps is that they force the chin back and looking at an image of the Eliminator it would probably reproduce some of that issue.

[Damiansd]

SR has hit the nail right on the head. The basic collar I use ($AUS10) from my local pharmacy has a small scoop where my chin goes which allows the whole of the collar to support my chin line. The issue with chin straps is that they force the chin back and looking at an image of the Eliminator it would probably reproduce some of that issue.

Agreed. I'm using the $10 special and it works great.

[vrapche031]

Could one of you maybe post a picture of the collar you bought in the pharmacy ?
I havent done too much research on using collars for sleep apnea but I think that I might need to get one. So far I have been using a Resmed chin strap which is apparently not the best because it pushes your jaw back ( although my AHI is maybe 1 or 2 during the night even with it, so not sure if thats a problem ).

I am a bit scared of going to a pharmacy and just asking for a collar since they probably wont understand why I want it. Need to do some proper research about this so that I fully understand how it actually helps.

[Gideon]

Read the Soft Cervical Collar link in my signature.  It has a pic of a standard and non-standard collar.  It also talks about the fit of the collar.

[vrapche031]

thank you

[BillMar]

SleepRider,

Thanks for the article on soft collars on the Wiki page. I don't remember how I ran across it, but I am glad I did. A soft collar has made a MAJOR difference in my AHI readings and mask leaking annoyance. I strongly suggest anyone who has had an unexpected jump  in AHI, or decline in alertness in the morning to consider this option as a first solution, rather than just going for more pressure. It really made a difference for me.

BillMar

[Aludj]

Agree with others, that having place for the chin makes it easier to wear the soft cervical collar. Mine is Coreflex Ultra Cervical Collar, the local pharmacy didn't have any that I liked:

   

It doesn't just hold the chin; as it curves up, it gently holds the lower jaws in place in addition to the chin. Once it passes the jaws, it narrows down, presumably to prevent overheating. I am yet to find this Soft Cervical Collar warm, it is soft,  very comfortable and easy to put on. Taking it off not hard, but the Velcro in the back really holds strong.

Coreflex Ultra is made from medium firm foam and has loosely woven cover:

   

While it looks dirty, it is not; there are small black/gray dots spread around for some reason.

If you select Coreflex, size it properly. I went by my shirt-size (19) and got the medium size that fits perfectly. The actual range for the medium is 18 - 22 shirt-size. I find this metric easier to follow, than measuring the distance between the chin and the chest.

I did try the travel size Eliminator, but couldn't get the non-travel one, and it did not fit my physical size:

   

Good luck...