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[Treatment] Is backwards head tilt bad? Are wedge pillows bad?
#1
Is backwards head tilt bad? Are wedge pillows bad?
I normally sleep on my side.

OSCAR shows my apneas occur simultaneously with CPAP mask leaks. 

I speculate that my apneas occur when I roll slightly into a slightly prone (front sleeping) position, which allows my pillow to interfere with my mask. Maybe the apneas occur because I have to fight gravity to lift my torso weight, to breath in by pushing out with my diaphram. An/Or maybe a slightly prone position causes an airway blockage, because of the effect of gravity on my tongue and soft palate. (My ENT says my airway obstruction is probably produced from a large tongue and a loose soft palate.)

I am playing sleeping on my back, to avoid pillow impingement of my CPAP mask, an AirFit F20 full face mask. (And yes, I realize that sleeping at the side of the pillow, or cutting a foam pillow with a hole in it for the mask, or using a cervical collar, might work too - I am experimenting to find the best alternative.)

But, even without a mask, laying on my side means I take the least effort to breath in, because I don't have to lift any body weight. Laying on my back takes slightly more effort to breath, because I am still fighting the weight of the front part of my torso. So: 

Question 1: Should I sleep on my back to avoid mask impingement?

I found something that said that a forwards head tilt (where your chin comes close to your throat) tends to block airways (which is why it is tilted back for CPR), and that an elevated head and upper body position tends to unblock airways.

Sure enough, while my throat is relaxed, if I tilt my head forwards, breathing is harder. And, If I tilt my head back a little, breathing is easier.

And, sure enough, If I elevate my upper body with a wedge pillow, breathing is easier.

I am trying to figure out the best way to achieve both.

The obvious way to way to avoid the forwards head tilt is to support the head less than the body. E.g., to sleep at the back of the pillow, instead of the front, creating a slight backwards head tilt.

Question 2: Is supporting the head less, by sleeping at the back of the pillow, to create a slight backwards head tilt, dangerous, while sleeping? E.g., could it injure the cervical spine, or create acid reflux? 

(Note: I don't think I have acid reflux, now, but don't want it.)

Next is working on achieving an elevated upper body.

I've also been playing with a wedge pillow. (Is that better than using multiple pillows? Or than placing another pillow under my upper back?) I ran into two problems: 

A. Over the course of a few hours, I side down off the wedge. That may be fixable - various places say to counter that by using a foot pillow, too.

B. With an elevated upper body, gravity tends to tilt my head forwards. As above, I could sleep at the back of the wedge pillow, but that isn't the way pictures show using a wedge pillow.

Question 3: When using a wedge pillow, what is the best way to avoid the induced tendency to tilt my head forwards?
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#2
RE: Is backwards head tilt bad? Are wedge pillows bad?
Unfortunately, there are no answers.  We could look to stats and say we predict that sleeping supine, on your back, is not likely to be the answer because so many people develop obstructions that way.  But, the truth is...we are each only an entity of 1.  Each of us must hoe all those stone-filled rows, bending and heaving the big ones out of the way, until we have something useful.  It may mean, in other words, that you will do best on your back, unlike so many others, but maybe with a chin strap or something if you have to use a nasal pillow or mask and not a full-coverage mask.

If anything, holding your head so that it doesn't tilt forward, is going to be better than having it tilted 'back' because of the closure of the airway when your chin is tucked (happens a lot when sleeping on one's back).  If you can sleep comfortably with a pillow that forces your head to tilt backward, and not scream in pain the next morning due to your neck being out of whack.....go for it.

For the first six months, I, a nasal mask user, couldn't sleep on my side.  I'd deflect the mask and have a leak...instant arousal, and not the fun kind.  So, I had to learn to sleep on my back, which is not normally advised.  Then, after several months, I suddenly found myself awakening on my side and having no leakage to speak of.  That was a breakthrough...I had adapted somehow to get rid of small leaks without fully awakening, and I do manage to dream.

Lastly, for those who open their mouths and let the pressurized air escape, and who don't want to tape, or who just have to sleep on their backs and get the resultant obstructions due to their heads and chins falling forward, we recommend a foam cervical collar.  They help a lot.  They're warm...so not ideal, but they'll allow you to sleep better without leaks or increased obstructions.
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#3
RE: Is backwards head tilt bad? Are wedge pillows bad?
Because of aches and pains, at times and only part of the night, I do sleep on my back. This not only increases my apneas because of my chin is closer to my chest which restricts my airway but it also causes more leaks. I find that if I purposely tip my head back it helps with both of the above problems not unlike a wedge. At least for me it is still best to sleep on my side. You also learn the sweet spots in your pillow so that leaks are minimized.

car54
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#4
RE: Is backwards head tilt bad? Are wedge pillows bad?
Thanks so very much for your reply!

I didn't know a cervical collar might push the mouth closed. Interesting idea.

The Airfit F20 mask fits me in such a way that it slightly pulls my upper lip. down and my lower lip up, so tends to keep my mouth closed. It works for me somewhat better than a chin strap.

Perhaps I should try a contour pillow - that might be safer than sleeping at the back of a pillow.

However, I love the idea of going a low tech route, with minimal equipment. If it turns out I can manage with nothing but a simple pillow, and perhaps a chin strap, without CPAP, and without a collar, that would be great. Partly because I like backpacking, where bulk and weight matter. (There are even compact lightweight inflatable pillows, including wedge and contour pillows.)  


That said, I am taking the high tech route, using a CPAP machine, and a pulse oximeter, with OSCAR, to help figure out what works. 

(My sleep studies were useless. It was too uncomfortable and too noisy for me to get much sleep. I also think I was mildly allergic to the detergents they put in their sheets, which didn't help. On top of that, the technician insisted I use a particular nasal mask, despite my being a mouth breather, especially when forced onto my back by all the tubes and wires. The mask fit my nose so poorly it leaked even when my mouth was closed, and it literally hurt to wear. On the plus side, I remembered dreaming, which I never do. Perhaps the pain woke me directly out of REM sleep, so I didn't forget my dreams...)

Though, if it turns out a simple pillow is enough, I will have wasted a lot of people's time, and a lot of my insurance company's money.
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#5
RE: Is backwards head tilt bad? Are wedge pillows bad?
too many or too large pillows will crook the neck too much. many wedges can be too much angle too, plus the tendency to slip down them. putting chocks (like a short piece of 2x6) under bed legs at the head might be better.

I have a foam contour pillow that's rounded low at the long front edge and rounded higher at the long back edge with a much lower area between them. it might work well if back sleeping but I try to side sleep so no good for me as the mask is easily bumped. best for me is a buckwheat pillow that is very firm but easily conformable to ins and outs of head, face, mask and mask assembly.

it took me 6 months to get around to trying the cervical collar for event clusters and runaway lip leaks. intuitively I could understand how the collar would keep jaw from dropping but was skeptical it would prevent lip leaks, which is more my problem than jaw drop. now I can attest to the fact that while there's nothing comfortable about it, the collar is very effective for all above: event clusters, jaw drop and lip leaks. I can't pap without one mostly because of leaks.
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#6
RE: Is backwards head tilt bad? Are wedge pillows bad?
Not liking to be the bubble buster, but unless your AHI was tested as very low like 5 or thereabouts, I'm skeptical a simple pillow or collar eliminates CPAP. IMO it's more likely part of your sleep apnea arsenal to fight apnea. You're likely to need, along with the CPAP and proper mask, any or all of these things: some sort of pillow, collar, hose management, maybe bed adjustment, white noise generator, and/or whatever else you need. Special apnea fighting pj's and coffee app for your humidifier not being required.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
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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#7
RE: Is backwards head tilt bad? Are wedge pillows bad?
(06-24-2019, 02:41 PM)SarcasticDave94 Wrote: Not liking to be the bubble buster, but unless your AHI was tested as very low like 5 or thereabouts, I'm skeptical a simple pillow or collar eliminates CPAP. IMO it's more likely part of your sleep apnea arsenal to fight apnea. You're likely to need, along with the CPAP and proper mask, any or all of these things: some sort of pillow, collar, hose management, maybe bed adjustment, white noise generator, and/or whatever else you need. Special apnea fighting pj's and coffee app for your humidifier not being required.
Thanks for all that info. My AHI is that low, or lower, except for false events that occur while I'm awake. But I have a lot of near events, where my breathing isn't quite get shallow enough for long enough to register - this occur during certain parts of the night at about 1 minute intervals. 

BTW - Sleeping at the back of the pillow got rid of most of my events, but my neck was a bit sore. The wedge pillow, plus a somewhat contoured pillow, did not get rid of my events. Sad (However, using a pillow below my feet did fix the tendency to slide down the wedge.)

I'm working on it. I adapt slowly to sleeping arrangement changes, so it is going to take a while.

I should figure out a way to video myself while asleep, and see if these events are positional. If it is, it may be fixable. Either with a cervical collar, or I may try to sculpt the shape of my head and neck into a foam pillow (with extra space in front of the mouth and nose, for the mask or to breath), with a scissors, to lock my head into position. The latter sounds like a cool idea to try, and also a way to make a pillow comfortable, and to deal with mask/pillow interactions. 

As for hose management - definitely. 

My white noise generator is a fan. I haven't decided if it really helps me get to sleep.
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#8
RE: Is backwards head tilt bad? Are wedge pillows bad?
Sounds good camper2. Best wishes for your success. Keep us up to date on how you’re doing.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
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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#9
RE: Is backwards head tilt bad? Are wedge pillows bad?
I have had similar issues. I tried sleeping on my back with no pillow for my head and one under my knees. There was a dramatic increase in my AHI.

I have been sleeping on my side. I now use a cervical collar and a "Contor CPAP Pillow 2.0". I think it helps. My neck feels better. It might help reduce leakage and inprove AHI.
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#10
RE: Is backwards head tilt bad? Are wedge pillows bad?
Progress has been slow.

I sculpted a pillow to fit my head and neck and shoulder. Very problematical - it and my arm (I fall asleep most easily on my right side, in foetal position, with my right arm under my head, with a blanket and fan) interferes with the mask.

But a small 4" thick foam block under my ear (to bring it to the height of my shoulder), combined with the wedge pillow, works, if I sleep near the left edge of the wedge pillow. My right arm rests on the bed, and doesn't touch the mask. I made an extension to that block, at right angles to it, under the back of my head. I sleep at a slight right diagonal across the pillow, so gravity makes my head pitch slightly up, so I maybe don't need a cervical collar. (However, my back is slightly twisted, and my head slightly twists to the right. I could sleep every other night on my left side? A knee pillow between my knees would help too - my next purchase.)

In that position, if I relax everything as much as I consciously can, I breath quite freely, and cannot make a snoring sound unless I work at it, by not relaxing certain parts of my throat.

The foot pillow works - I don't slide down the wedge.

My phone app says I don't snore, but the CPAP hose makes a lot of noise sliding against the bed. 

But my CPAP machine still saw several apnea events last night. (An acceptable rate, I guess. Instead of 12 hours, I felt fairly refreshed after about 4.) Before each apnea, my breathing rate increases. REM sleep? The apnea events and near apnea events occur for about a minute, so if so, I get very little REM sleep. I could increase CPAP pressure, but let's control one variable at a time.

To detect REM sleep, I bought a used ZEO sleep manager, and am working out how to use it.

(If pillows alone are enough, and I use inflatable wedge and foot pillows, the little foam block is light and would easily fit into a backpack. But it will work as well without the CPAP? But one test at a time. I'll seek an app to detect breathing using a smartphone strapped to my diaphram.)
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