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Could physical therapy exercises for neck muscles worsen AHI?
#11
RE: Could physical therapy exercises for neck muscles worsen AHI?
"I have never had a positional apnea issue in any of my recent sleep studies"

looks like you now understand that the positional apnea the sleep study and docs identify is different than the positional apnea referred to on this site. to be clear, the docs' are referring to body position (left right supine stomach), as opposed to the kind you read about here whose shorthand is often 'chin tucking'. essentially anything that causes a 'kink' or otherwise restricted airway. these are not passive which means pressure can't overcome them unlike the typical relaxed floppy tissue that is often the source of obstructive apnea.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#12
RE: Could physical therapy exercises for neck muscles worsen AHI?
I'm not very good at reading obstructive charts myself, but it wouldn't necessarily need to be much of a difference (like switching from side to back or vice versa), but simply your chin shifting (usually towards your chest) and it may just be a little, depending on how easy it is for your airway to "kink" in a way that causes obstruction. But I can't think of any way that neck PT could cause you to struggle to breathe just from having stronger muscles, otherwise, we'd expect rampant apnea problems in people who are fitter and very muscular. I'm not a doctor though, so maybe there's something I'm not thinking about.

You're saying these changes haven't happened gradually over the course of the PT and persisted, right? It's that you do PT on your neck, then have a higher AHI that night, and then when you aren't doing the PT, it goes back to normal?

If so, then I don't think strength is the issue - strength doesn't improve significantly after a single episode of PT, and certainly not immediately afterwards when the muscles are tired. It takes some time for the muscles to improve their tone and strength in response to more regular demands. So if it were down to strength, then you would expect to see your AHI increasing gradually since you started the PT, even on the "off" days.

I notice you said you're getting more arousals too, from the increased pressure. That in itself can produce "junk" OAs, but again, I'm not as good at reading those from op close data, but that's also a possibility, too.

Hopefully someone better at the close up data can give you a better idea.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#13
RE: Could physical therapy exercises for neck muscles worsen AHI?
(06-01-2021, 01:13 PM)sheepless Wrote: "I have never had a positional apnea issue in any of my recent sleep studies"

looks like you now understand that the positional apnea the sleep study and docs identify is different than the positional apnea referred to on this site. to be clear, the docs' are referring to body position (left right supine stomach), as opposed to the kind you read about here whose shorthand is often 'chin tucking'. essentially anything that causes a 'kink' or otherwise restricted airway. these are not passive which means pressure can't overcome them unlike the typical relaxed floppy tissue that is often the source of obstructive apnea.

(1) It had been my understanding that chin-tucking positional apnea was far more common in left/right-side versus supine. That is why I mentioned my sleeping position.

(2) Machine pressure DOES overcome my OAs. So are you saying that that means my OAs are not positional?
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#14
RE: Could physical therapy exercises for neck muscles worsen AHI?
(06-01-2021, 01:17 PM)Ratchick Wrote:  But I can't think of any way that neck PT could cause you to struggle to breathe just from having stronger muscles, otherwise, we'd expect rampant apnea problems in people who are fitter and very muscular. I'm not a doctor though, so maybe there's something I'm not thinking about.

But I'm neither "fitter" nor very muscular.  I have significant stenosis and spondylitis---so neck structures are not necessarily in the positions one would expect in a younger and fitter person. 

I would be surprised if raised muscle tone from cervical PT can put significant pressure on airway structures but I also realize that a neck with spinal configuration problems (and an almost missing disc) is not shaped like what finds in a typical anatomy book. Important tissues and infrastructure are not in their normal position.
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#15
RE: Could physical therapy exercises for neck muscles worsen AHI?
(06-01-2021, 01:17 PM)Ratchick Wrote: You're saying these changes haven't happened gradually over the course of the PT and persisted, right? It's that you do PT on your neck, then have a higher AHI that night, and then when you aren't doing the PT, it goes back to normal?

If so, then I don't think strength is the issue - strength doesn't improve significantly after a single episode of PT, and certainly not immediately afterwards when the muscles are tired. It takes some time for the muscles to improve their tone and strength in response to more regular demands. So if it were down to strength, then you would expect to see your AHI increasing gradually since you started the PT, even on the "off" days.

(1) I find it takes about two or three days of PT for the AHI to increase. After two or three days without PT, my AHI settles back to normal levels.

(2) No, I've never considered muscle strength to be the issue.  If there is a true correlation (rather than just a coincidence), I would assume it is related to muscle TONE and the ways in which that tone slightly repositions neck structures and perhaps displaces soft tissues by a very small but aerodynamically meaningful amount.

My anatomical intuitions still lead me to doubt a cause-and-effect relationship between PT and AHI----but systematic falsification can be a valuable tool in scientific inquiry. So, until I have an alternative explanation, I'm exploring even the most unlikely factors.  (By the way, I've never been able to find any discussions of causal link in the NCBI literature.)
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#16
RE: Could physical therapy exercises for neck muscles worsen AHI?
"(2) Machine pressure DOES overcome my OAs. So are you saying that that means my OAs are not positional?"


pressure as high as about 23 cmw has not resolved the clusters of obstructive apnea shown in a screenshot in post #7

http://www.apneaboard.com/forums/attachm...nail=32588

my understanding is that clusters are mostly due to some form of 'chin tucking' which can occur in any position. it's also my understanding that it's more common supine but I don't have evidence to support that.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#17
RE: Could physical therapy exercises for neck muscles worsen AHI?
(06-01-2021, 04:55 PM)sheepless Wrote: pressure as high as about 23 cmw has not resolved the clusters of obstructive apnea shown in a screenshot in post #7

http://www.apneaboard.com/forums/attachm...nail=32588

It sounds like we are using the word "resolved" differently.   My meaning was that my machine responded to the OAs by raising the pressure to 23 and the OAs stopped. (To me, that means the machine did its job. It resolved the problem.) And gradually the pressure headed downwards in the hours which followed.

How are you defining "resolved"?

Thanks for your help.
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#18
RE: Could physical therapy exercises for neck muscles worsen AHI?
no way to know how many oa were resolved (as in treated out by pressure) but in that screenshot you had 6.78 unresolved oa/hr even as high as 23 cmw pressure, so it doesn't seem accurate to me when you say your oa is resolved with pressure. one need only look at the number and proximity of the blue lines to know these are chin tucking clusters (although I suppose it's possible you could have other physical conditions that might look similar; I just haven't seen them in my years here).

on second read, I understand you're saying that the oa stopped after each cluster. maybe due to pressure but equally possible and maybe more likely the pressure eased when you stopped obstructing.

it really doesn't matter. the point is that you can avoid those clusters and substantially reduce your ahi by avoiding kinking the airway using fewer flatter pillow(s) and a soft cervical collar.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#19
RE: Could physical therapy exercises for neck muscles worsen AHI?
(06-01-2021, 07:02 PM)sheepless Wrote: no way to know how many oa were resolved (as in treated out by pressure) but in that screenshot you had 6.78 unresolved oa/hr even as high as 23 cmw pressure, so it doesn't seem accurate to me when you say your oa is resolved with pressure.  one need only look at the number and proximity of the blue lines to know these are chin tucking clusters (although I suppose it's possible you could have other physical conditions that might look similar; I just haven't seen them in my years here).

on second read, I understand you're saying that the oa stopped after each cluster. maybe due to pressure but equally possible and maybe more likely the pressure eased when you stopped obstructing.

it really doesn't matter. the point is that you can avoid those clusters and substantially reduce your ahi by avoiding kinking the airway using fewer flatter pillow(s) and a soft cervical collar.



My present pillow is quite flat/thin.  A few months ago I even experimented with no pillow just to see what would happen and my AHI increased significantly. However, some of my other variables have changed considerably since then so I am definitely game to revisit that issue.  (My biggest change is I started using a green-light therapy lamp to the left of my computer monitor every morning and that has done so much to adjust my melatonin cycle. My sleep is now far less segmented and both my total sleep time and my AHI improved considerable within days of adopting the 500 nanometer lamp. ) 

When I've talked with various of my specialists about going with a cervical collar or even no pillow, they told me that both run the risk of disrupting the "natural line of the spine." (The specialists were my neurosurgeon, the pain management physician, the pulmonologist, and the DPT, i.e., Doctor of Physical Therapy.) NEVERTHELESS, I'm very open to what you are saying.  Over the years I've on multiple occasions been reminded of the somonology-related limitations of these specializations in the USA.  (For example, my pulmonologist, who is considered the resident sleep expert at my regional clinic, not so long ago told me that my central apneas were "as low as you can expect with the BIPAP technology available at present"---and yet when I raised my machine's trigger setting to its highest level, I suddenly started having nights of just one or even zero CAs.  When I explained my success to him, he was appreciative but definitely surprised. It was clear that he had never heard of such a solution.

I do have a standard cervical collar.    Some specialist (can't remember which) once recommended to me that I try just a bath towel rolled up to fit the curvature of my neck. He seemed to think that was a better sleep option than a cervical collar.

I am going to reread the two recommended articles and perhaps try another experiment tonight.
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#20
RE: Could physical therapy exercises for neck muscles worsen AHI?
Most in the medical field are not going to recommend a soft cervical collar to combat positional Apnea. They'll tell you it'll damage your neck or spine or the neck muscles. So I'm not surprised they want to tell you all the risks which just aren't relevant with the type of collar and the fit that we're suggesting. So many of these Dr. McQuack types don't want you to be able to solve medical problems without them. They've been trained how to take boat payments, who can't care less if you are healthy or not. If you dare not listen to doc McQuack's advice, you're certain to be told it's a serious health risk... Fear mongering at its best.
Dave

OSCAR
Standard OSCAR Chart Order
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Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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