AHI tweaking help needed

[Melman]

I did a little research. Soft cervical collars are generally used by people with whiplash or other neck injuries or have had spinal surgery. They are worn to immobilize the neck which requires they be tight and in contact with the entire circumference of the neck. They are worn 24 hours a day. Prolonged use results in muscle atrophy and tendon and nerve damage resulting from prolonged immobilization of the neck.

For our purposes it is worn fairly loosely, just tight enough to keep the chin from tucking. I just tried a tight fit and my usual loose fit and found that the loose fit for chin tucking allows quite a bit more neck motion than the tight fit. Also, since the collar is not worn during the day, when our heads and necks are much more in motion than when sleeping, I think risks of muscle atrophy and injuries due to immobilization are negated. That, of course, is my opinion based on what I have read and long term experience.  If you are still concerned I suggest you consult your doctor regarding the risks. He will probably never have heard of this use so you will need to explain that it will be worn loosely and only at night.

I will add that as we age, neck range of motion exercises are recommended by physical therapists. I’ve done them several times a week for a number of years and haven’t noticed any decrease flexibility or strength since using the collar nightly.

[rlchau]

Merci... I will buy the collar today and I will keep you posted on progress. I, again, got a cluster of apneas/hypopneas last night (see attached)

[rlchau]

Melman, thanks a big bunch for this last post/research on collar (as posted earlier, I'll buy my collar today) ... duly noted regarding neck range of motion... I'll do as you do/did 

[rlchau]

I did a little research. Soft cervical collars are generally used by people with whiplash or other neck injuries or have had spinal surgery. They are worn to immobilize the neck which requires they be tight and in contact with the entire circumference of the neck. They are worn 24 hours a day. Prolonged use results in muscle atrophy and tendon and nerve damage resulting from prolonged immobilization of the neck.

For our purposes it is worn fairly loosely, just tight enough to keep the chin from tucking. I just tried a tight fit and my usual loose fit and found that the loose fit for chin tucking allows quite a bit more neck motion than the tight fit. Also, since the collar is not worn during the day, when our heads and necks are much more in motion than when sleeping, I think risks of muscle atrophy and injuries due to immobilization are negated. That, of course, is my opinion based on what I have read and long term experience.  If you are still concerned I suggest you consult your doctor regarding the risks. He will probably never have heard of this use so you will need to explain that it will be worn loosely and only at night.

I will add that as we age, neck range of motion exercises are recommended by physical therapists. I’ve done them several times a week for a number of years and haven’t noticed any decrease flexibility or strength since using the collar nightly.

Hi, my observations after two days with a soft cervical collar;
-      No comfort issues wearing the collar
-      Still having clusters of events
-      AHI slightly on the rise: 7.1 and 8.5
-      Median cmw down by 2
-      Wednesday Aug 28th: 2 clusters (see pic Aug 28 all night)
   o  1st cluster in “LIGHT” sleep
   o  2nd cluster in “REM” sleep (see pic aug 28th 2nd cluster)
-      Thursday Aug, 29th: 1 cluster (see pic Aug 29 all night)
   o  cluster in “REM” sleep (see pic Aug 29 cluster in REM)
-      There are less ‘flow limitations’ situations when not in apnea/hypopnea
-      My breaths/min have gone down by 3-4 (that is to 15 and 14 respectively)
-      Still not well rested in the morning; I sleep less hours per night lately; mainly due to upper back pain waking me up. No issues regarding those during the day; must be due to the fact that I sleep more on the sides lately; I’ve always been a supine sleeper
I’ll keep wearing the collar for now… only been 2 days after all. I may need to adjust my EPAP soon as suggested by Sheepless.

[Melman]

I'm surprised that you're still getting the clusters. Are you sure the collar is tight enough? By that I don't mean snug around the neck but enough so that your chin can't tuck behind it. With mine properly adjusted I can easily get a finger down the side between my neck and the collar with a little room to spare and without stretching the collar. I'll leave advice on your pressure settings to those more knowledgeable like Sleeprider.

[rlchau]

I'm surprised that you're still getting the clusters. Are you sure the collar is tight enough? By that I don't mean snug around the neck but enough so that your chin can't tuck behind it. With mine properly adjusted I can easily get a finger down the side between my neck and the collar with a little room to spare and without stretching the collar. I'll leave advice on your pressure settings to those more knowledgeable like Sleeprider.

I make sure, yes, when adjusting the collar that my chin doesn't tuck behind it. I'll pay even more attention to this tonight and on... THX Melman

[rlchau]

Soft cervical collar usage update (8 days of usage):
·       Using a soft cervical collar did not inhibit clusters of events from happening and I observed minor negative impact on my AHI (median of 7.0 versus 6.7 for the       previous 8 days)
·       I however observed improvement in my respiratory rate (15 breaths/min versus 17 for the previous 8 days) and my median cm of water (19.9 versus 21 for the   previous 8 days)
Based on my observations, I’m concluding that, in my particular situation, using a soft cervical collar did not inhibit clusters of events from happening and had no positive impacts on my AHI.  Since many seem to have reported that the usage of a soft cervical collar inhibits the appearance of clusters of events and significantly reduces their AHI, I would -- at least for now based on 8 days of usage -- attribute the cause of no change in my case on my high median cm of water (median cm of water of 20.3 over 51 days, using a BPAP). Is anyone experiencing similar no results?
PS: I can show snapshots of my data for those 8 days if of any interest

[Sleeprider]

Like many solutions, it seems results vary with the soft collar. It is successful with enough people that we will continue to recommend trying it, but if it's not working for you, by all means get as comfortable as possible, and look for alternative means to accomplish the same objective...avoid chin tucking. Be aware of pillow height and shapes, sleep positions and other factors that may cause your neck to bend or obstruct the airway. Your pressure is already at high levels and I don't think there is much more we can do with positive air pressure other than possibly increasing EPAP min or PS. You can try PS 5 and see if it helps suppress flow limitations and hypopnea. I'm not sure it will resolve the OA clusters that seem to make up much of your AHI, but it may be worth a try.

[rlchau]

Thanks Sleeprider, your quick response and expertise is highly appreciated.  I will probably keep using the soft cervical collar anyway since it seems to show other advantages (improved respiratory rates and lower median pressure results) and its usage is not really bothering me.
As per your recommendation, I will increase PS to 5 for a while and see how it goes.  As a note, in case it may be of interest to you, I’ll post my last day (sept 5th, without the collar) and the previous 8 days (Aug 28th to sep. 4th with the collar). - NOTE: due to limitations, I'll post my first 5 snapshots followed by the rest in an other reply
Thanks again... I’ll keep you posted!

---

.. rest of snapshots

[sheepless]

the usual advice for collars is to keep them loose-ish for comfort. I suspect that works for most. others like me have to tighten the collar much more, in my case because of a short neck and weak chin. 2 fingers is way too loose for me. if the collar is insufficiently snug, it'll allow the chin to slip under. I can't say tight is comfortable but I'm used to it so it's not uncomfortable either. no worse than the mask.