DanEm [Therapy Thread]

[OpalRose]

Are you still using the cervical collar?  Thinner pillow?  
Are you "aware" of how you sleep?  Whatever position you are sleeping in, you are somehow allowing your head to drop forward and causing the clusters of apnea.  

Keeping your maximum pressure that high isn't going to help, as stated many times, the Flow Limitations are going to drive the pressure to whatever max you have set.  

Maybe we can get some other ideas on a different type collar to use.  The one you're using isn't working that well for you.

[DanEm]

It is my first time ever trying a cervical collar.

I know how I sleep. 
Most of the time I am on my right side with a pillow on my back to try and not get on my back because I get a very dry mouth that way.

I will turn down the max pressure setting.
Would 16 be good?

As for trying another type of collar, maybe I should wait a little, it was just one night with that one.
But in any case, the one I got is:
UniForU Neck Brace Foam Cervical Collar Soft Adjustable Neck Support Brace for Neck Pain.

See picture

What other type of collar would you suggest?

[Gideon]

Does your chin slip under the collar? We don't want it too tight, but was it tight enough?
Theoretically tilting to the side could also cause this. As a side sleeper is your pillow firm enough.

Is there someone else in the house that could see if your head is tilting either to the side or forward?

[DanEm]

Gideon :
Nope, my chin cannot slip under the collar and I am comfortable with it. It does not feel too tight.

I think my pillow is firm enough, I will try a firmer one.

I will ask my wife to check on my head position, but the collar does not allow my head much motion.
It is not possible for my head to tilt forward.

[Gideon]

Please roll into multiple positions (r side, L side, back, mostly face down or 3/4) and see if movement is seen by your wife.
You are there and I/we are not so we rely on your info along with the data.

[DanEm]

Gideon :
I small correction of what I wrote, I mostly sleep on my LEFT side.
I don't think it makes a difference in my condition but I wanted to be precise.

Further more to be as thorough as I can with my description, when I sleep, my left arm is extended under the pillow so my head is on the side above my arm (shoulder).
My pillow is a king size and I pull part of it close to my chest with my right arm above it.
My head is kind of hold in place between my arms (shoulders).

I don't know if those details are useful but I thought I might as well be as precise as can be.

The multiple position test requires I sleep for each.
It will be a couple of nights before I go through all of them.
I will give the results as I go along.

[DanEm]

Last night, I forgot to reduce the pressure as OpalRose suggested.
Unless I am told otherwise, I will set the pressures to max 16 and min 7 for my next sleep.

I went to sleep for the first and second session on the right side and the third on the left.

I woke on my back at the end of the second and third session.

My head did not tilt and my chin did not go under the collar.

This morning, I feel as good as I am used too.

What happened to get my AHI to peak at 65 around 1:00 AM?

I am still wondering if it is not unusual to get that kind of result now and then or if it is the sign of a problem.

[Gideon]

Your flow limits are on one of those flights to outer space, extremely high. Your collar is not doing the job, that is what that clustering is saying. NO amount of pressure can rectify that.

The only other thing that I can think of that can do that is a growth in your throat. Did you ever get a Teflon injection in your vocal cord like my wife did. She developed a growth, a granuloma that restricted her breathing to 10% all the time until she got a trach and subsequent surgery to remove the growth. I know you don't have that as she was an unknown 3rd living person in the world to be afflicted with this.

Ask an ENT to scope you to eliminate anything similar to the above. I very much doubt he will find anything.

A trach would work, bypassing the entire upper airway. I certainly don't recommend it.

Try different collar, see if you can get a higher under the chin collar

[DanEm]

Flow limits: I can't say I know much about those.

When you say my flow limits are extremely high, do you refer to the amplitude or the frequency (number of events) of the flow limits graph?
Are there figures for those I could watch for?

Comparing with other days graphs, the flow limits seem all the same. See attached file.

As for consulting a specialized physician for any kind of investigation, it is a bit of a problem where I live.
Distance and pandemic are not helping.
The way the system works, I have to go through my family doctor (some delay there) who after is own investigation will decide if he refers me to a specialist (big delay there). The same goes for a trach.

I will check what kind of collar I can get.  It would help if you could recommend one you think would do the job.

I am starting to think my situation is either hopeless or I am looking for perfection which, of course, does not exist.
Maybe I should be content with the way it is and just monitor improvements, if any, of my sleeps.

[Gideon]

The size of the FL in the flow limit chart, gt 0 in med FL stats, gt 0.1 in 95% FL stats.
Think of FL as small Apneas.

See the wave form in the OSCAR logo, my avatar, that is a "perfect wave form, flow rate". And we want to see near that, but accept some differences. Most things other than that rounded top are flow limited. Flat tops, M shaped tops represent FL look in the guide, I know examples are there. Think of a continuum, Apneas, then Hypopneas, then flow limits in order of severity. All of the above mean resistance which means your body must work harder to breathe