What To Do When Soft Cervical Collars Fail

[mawaw1992]

Last month something happened overnight where I went from averaging 1.0 AHI over the last year to now where my AHI's consistently run between 4 to 7 with a high of 9. When I post charts showing some of my nights with these higher numbers everyone points out that it is due to positional apneas. Well I know that. I have been wearing a soft cervical collar for the last 3 years because of that and have been able to keep my OA's to a very few and averaging 1.0 AHI UNTIL last month. It is like flipping a light switch to how quickly this problem started. Nothing has changed as far as my pillow, bed or anything else. Everything is exactly the same as before when this problem started. So I thought maybe the foam in my collar has broken down over the last 3 years so I decided to order 4 different brands including a brand new one of the one I have been wearing. After trying them all out I ended keeping the one that is like the one I have been wearing which is the Coreflex Ultra. Even with the new collar my AHI is still high. I am normally having between 30 and 40 OA's  each night feeling very fatigued every day. I have tried wearing it tight around my neck as well as lose and nothing helps. I even reduced the height of my pillow to see if that would help but it hasn't. If the soft cervical collar is the cure all for positional apneas then where am I going wrong. Am I missing something. I know a lot of people on here have to wear the collars like I do and am wondering if someone else has run into this problem also.  I am at my whits end with this problem. Does anyone have any suggestions. I will try anything that will help.

Thanks,
Mark

[Jay51]

Thank you for posting that.  You have OSCAR, correct?  Are your new OA's clustered or not?  If clustered that would lean towards positional apnea.  If not, not sure what to do.  Maybe try raise pressure if they are not clustered.  

You are sure nothing has changed?  No covid, illnesses, etc. correct?

[mawaw1992]

Nothing has changed. I have not been sick or had any health problems. Before the problem started, most of my OA's were spread apart at different times through the night. Now most of my OA's are positional clustered OA's. But like I mentioned, nothing has changed. I could understand if I had maybe I had changed something such as, a taller pillow, sleep style, etc... My sleep is the same where I always start out sleeping on my side but do end up on my back at times during the night. I faithfully wear my collar every night. And the new one I am wearing now is a lot stiffer than the old one so I do not see how I could be chin tucking with it on. It is almost impossible to drop my chin down to my chest even when I purposefully try to do so. The only thing that did change was back in August I had to ship my Aircurve 10 to a repair center to have the blower motor replaced. The week leading up to me shipping it off my AHI averaged 1.0 and the night before I shipped it off my AHI was 0.5. So the next night I had to use my Dreamstation 2 which I had just received as a replacement from Respironics. The nights I had to use the DS2 my AHI was 6.02, 4.85, 5.65, 3.97, 4.96, 5.54, 3.64, 9.12, 9.44 which is a very big increase over the average with my Aircurve 10. I thought it was just that the Dreamstation is not as good as the Resmed. That week I purchased a Resmed Airsense 10 while on sale to use as my backup. The nights I used it my AHI was 2.31, 1.46, 3.62. Then I received my Aircurve 10 and the following nights in August was 3.53, 6.78, 1.05, 3.26, 5.82, and then this past Monday it was 5.92. Tuesday night I switched back to the Autosense 10 and my AHI was 4.75 and then last night was 3.96. At first I thought there still could be a mechanical problem with my Aircurve 10 but I still have a high AHI with the Autosense 10. But as far as the positional apneas I just don't see how I could that many a night wearing a brand new very stiff cervical collar. Every time I post charts everyone says I am having positional apneas and I need to start wearing a collar and also attach articles about it. I know that I have them and have been wearing a collar for 3 years. That is why my subject on this thread was "What To Do When Cervical Collars Fail". The main problem I had before this started was trying to fix my leaks. Now I have them fixed and now I have this problem to deal with.  I have posted my most recent charts.

[Sleeprider]

Mark, how would you feel about increasing the pressure support to 3 or 4? Your flow limits have climbed and maybe we can reduce those and perhaps reduce the clusters of OA.

[mawaw1992]

I will try anything if it helps me. I used the Autosense 10 the last two nights but will switch back to the Aircurve tonight. I'll start with PS 3 for a few nights and then on 4 to see the difference in the two and let you know. Like I had mentioned, for so long every time I posted charts everyone would tell me I needed to fix the leaks. Now that I have fixed that problem, I just need help in figuring this problem out and then maybe I will finally start feeling better.

Thanks,
Mark

[Sleeprider]

With the majority of events being obstructive, you should not lower EPAP minimum pressure, so be sure to increase the maximum pressure enough to accommodate the higher PS. I'm going to suggest a maximum of 18.

[mawaw1992]

Thanks Sleeprider, I will definitely try that. I was going to ask you, Is there anyway to tell on the flow rate graph whether an apnea or a pressure increase is waking me up. I average waking up 2 times each night. I know I have read on here that some people are very sensitive to pressure changes and it wakes them up. If it is a pressure increase is waking me up, then maybe I could raise the Epap Minimum up closer to the Maximum.  Anything to keep me from waking up. I always have a hard time getting back to sleep each time I wake up and in most cases have to take an Ambien to get back to sleep. Just wondering.

Thanks,
Mark

[Sleeprider]

Look for the spike in flow rate suggesting arousal, and take a close view of the flow wave ahead of it. If flow restriction is present, that suggests a respiratory issue we can address. If the arousal looks spontaneous, there isn't much we can do with it. Post a few and I'll try to clarify.

[fotjon]

I'm sleeping on a hard cervical collar, the Aspen Vista because of my cervical instability, maybe it helps to keep the airways better opened because of the jaw support.

[Sleeprider]

fotjon, thanks for your input. Jaw support is far more preferable than chin support in my opinion, but finding a comfortable collar that accomplishes that is no easy task.