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verysincere - Therapy Thread
#1
verysincere - Therapy Thread
I started wearing a cervical collar a few nights ago and my AHIs dropped another point or two.  However, seeing how the collar may have solved some sort of positional apnea situation---I never had any evidence of chin tucking but the collar has somehow helped and I'm glad for that---I still have one or two OA clusters per night. I've attached an example. This one led to full arousal and so I got up and drank water, etc.  

Seeing how these last three OAs (of a series of five) had durations of 52, 52, and 84 seconds respectively, do you have any ideas as to what is going on?

I thank you all for your ongoing help.


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#2
RE: Any ideas on this Obstructive Apnea cluster of very long OAs?
I think this is positional apnea. 

Clusters Usually shows positional apnea. Sleeping on your back - too high of pillows.  I don’t think this is bad enough to use a collar but you need to see why you are getting into a position where you are cutting off your own airway.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Any ideas on this Obstructive Apnea cluster of very long OAs?
(06-06-2021, 09:42 AM)staceyburke Wrote: I think this is positional apnea.

Clusters Usually shows positional apnea. Sleeping on your back - too high of pillows.  I don’t think this is bad enough to use a collar but you need to see why you are getting into a position where you are cutting off your own airway.

Thank you for your response.

I realize that positional apnea is the usual explanation.  But I use a very flat pillow and a cervical collar. And because this cluster woke me, I was able to know my position at that time: I was sleeping on my back (as usual) and the cervical collar was keeping my chin up.  This is my usual position as observed by my video camera monitoring system. 

Accordingly, I have assumed that this sort of cluster is some sort of sagging of soft tissues in the airway---which is the typical physician's interpretation---but I've learned from this forum that pulmonary physicians are not necessarily well informed about such topics.
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#4
RE: Any ideas on this Obstructive Apnea cluster of very long OAs?
Addressing chin-tuck is good, but when you're sleeping on your back, your tongue may be sliding back/down and obstructing your airway. The pressures generated by a PAP machine are not able to move your tongue out of the way. Do you find side-sleeping fairly comfortable? If so, you may want to train yourself to do more of it.
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#5
RE: Any ideas on this Obstructive Apnea cluster of very long OAs?
I agree with Dormeo.  If we can all be reasonably assured that the collar is doing its job, and that your pillow isn't of the kind that forces your chin toward your chest when you are sleeping supine, then what's left is either CA's or obstructions, and the CA's are not indicated.  That leaves obstruction, and the only other candidate that I am aware of would be your tongue.
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#6
RE: Any ideas on this Obstructive Apnea cluster of very long OAs?
(06-06-2021, 01:22 PM)Dormeo Wrote: Addressing chin-tuck is good, but when you're sleeping on your back, your tongue may be sliding back/down and obstructing your airway.  The pressures generated by a PAP machine are not able to move your tongue out of the way.  Do you find side-sleeping fairly comfortable?  If so, you may want to train yourself to do more of it.

I slept on my side until about age 45 but had to give it up. It was definitely my preference---and I would love to side-sleep if I could. I have significant neurological problems in my arms which turn even more painful if I try to sleep on them. 

A few years ago I did try to find a product that would help with the tongue issue but I found nothing satisfactory.  Perhaps there are new products which would help, so I'm still open to suggestions.

I'm very happy that these clusters haven't been occurring all that often lately.  Indeed, I have often wondered why tongue-blocking doesn't occur more often than it does. I am always on my back so I would think it would be far more ubiquitous.
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#7
RE: Any ideas on this Obstructive Apnea cluster of very long OAs?
(06-06-2021, 01:49 PM)mesenteria Wrote:   That leaves obstruction, and the only other candidate that I am aware of would be your tongue.

The medical literature considers the tongue just one of the possibilities for obstruction but the technical journals aren't always specific about identifying those other soft tissues.  There are pharyngeal exercises for apnea sufferers which claim to address them.  (And I basically do the same sort of "therapy" by means of the singing I do, which I began to realize was utilizing the same tissues as those targeted in those therapies.) 

Of course, a lot of the standard references just say things like, "With age the soft tissues of the airway begin to sag more and more as the smooth muscles tissues lose their tone."   So I have always assumed that the tongue is just one of the possibilities. But I've not researched it in several years so I'm not at all sure about any of this.

Thanks for your help. Much appreciated.
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#8
Any ideas on why my AHI has recently deteriorated?
After adding a cervical collar to my regimen of AHI-lowering efforts, I experienced a significant drop in AHI in the first half of June.  My average AHI dropped from about 4.5 to 1.8. Unfortunately, in the last week my AHI gradually increased to around 4.  My BIPAP pressures have increased accordingly and I'm experiencing more arousals and mouth dryness. 

In my experience (which goes back through some 20 years of CPAP/BIPAP therapy), if my AHI rises above 4 or so, I experience abdominal pain. That has always been my main apnea symptom. (And in the days before my apnea diagnosis when my untreated apnea was severe, the abdominal pain was excruciating.) So even though most physicians merely say "An AHI<5 is normal", my quality of life is poor if I'm not AHI<4.

I have posted a screen shot from a typical night early in the month (when my AHI was going as low as 0.16!) and a screen shot from last night.  I would appreciate any suggestions on what I might do in hopes of returning to the relative bliss of early June.


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#9
RE: Any ideas on why my AHI has recently deteriorated?
It looks like positional apnea. Your collar is not working. Maybe it has degraded and the foam is too soft now or you don’t have it tight enough. 

You can see positional apnea by grouped OA or H (or both) and that is what I am looking at.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#10
RE: Any ideas on why my AHI has recently deteriorated?
(06-21-2021, 09:13 AM)staceyburke Wrote: It looks like positional apnea. Your collar is not working. Maybe it has degraded and the foam is too soft now or you don’t have it tight enough. 

You can see positional apnea by grouped OA or H (or both) and that is what I am looking at.


I bought the cervical collar in late May and started wearing it the night of June 1.   I'm wearing it these nights the same way I wore it that first week (when I had such vast improvements in my AHI.)  I wear it semi-snug because I don't want to make it tight enough that it pushes the body tissues under my jaw into my airway.  (So I have made no changes in how tight the collar is worn.)  Would you recommend I try making it tighter?  

FYI:   Due to neurological problems in both arms, I had to give up side-sleep long ago.  So I'm a very consistent back-sleeper. (I do understand the disadvantages of that but I have no choice.)

FYI:   I consistently use a very flat pillow and my physician has emphasized I should stay with that pillow for proper spinal support. 

I'm racking my brain trying to figure out what might have recently changed. 

By the way, my cervical collar is a 3".    I recently bought a 4" collar and only tried it for two nights because my AHI seemed to respond with a significant tick upward---but perhaps that was unrelated? Perhaps I should give it another try? (Does the brain during sleep need several nights to get used to that feeling of "restraint" around the neck which would come with a larger collar?)

It is amazing how consistently I have daytime fatigue when my AHI drifts above 4 or so. 

I really appreciate your analysis of these OSCAR graphs.
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