Foam Collar vs Chinstrap

I started using a chin strap about a month ago because my mouth kept dropping open below the mask. I don't cinch it up tight, but just tight enough so my mouth can open slightly. I'm a mouth breather, so it needs to be open some.

Since different muscles open and close the jaw/mouth, maybe the mechanics of keeping a baby's mouth shut
work with the muscles developed by suckling, while with adults, the muscles keeping the mouth open
provide considerably more resistance. (plenty of exercise talking-- )

Nate, I'm also a soft cervical collar wearer after the chin strap, PapCap and taping (over and under the month). Do you think there is any circulation downside to wearing the neck collar?

Interesting point Nate.

But i dont have my chin straps any tigher than my mask straps anyway.

Kitatonic wrote:Nate, I'm also a soft cervical collar wearer after the chin strap, PapCap and taping (over and under the month). Do you think there is any circulation downside to wearing the neck collar?

Kit, while I don't think of myself as an expert on anatomy, my instincts suggest that it is much less likely for the soft cushion neck collar to restrict circulation pressing upward under the chin than the chinstrap pressing downward on the head; but, even if it did, I would think the possible complications are likely to be much less serious. Just my hunch, of course.

Of course, you wouldn't want to make the collar too tight around the neck to the extent that it would restrict breathing, but from a blood circulation standpoint my hunch is there is no problem.

Regards, Nate

Nate do you have the old or new papCap ? I definately find the newer one more comfortable i.e less pressure than the old one.

Old one on the left, newer larger one on the right.



Old fixed tension strap on the bottom, newer flexible (stretchable) strap on the top

Uncle_Bob wrote:Nate do you have the old or new papCap ? I definately find the newer one more comfortable i.e less pressure than the old one.

Old one on the left, newer larger one on the right.



Old fixed tension strap on the bottom, newer flexible (stretchable) strap on the top

Thanks, Uncle_Bob, I do have the new one on the right.

There were only two sizes available, I think one called S-M and one called L-XL and I was right on the borderline measurement-wise so I got the S-M. It seemed to be the right size when it came, but if I put it on so that the top comes in full contact with my head, it slips down over my eyes. If I slide it backward a bit, then there is an unfilled air space at the rear of the top of my head. When I attach the chinstrap, I tighten the back strap to try to keep it from sliding forward over my eyes. It seems to then stay in place for the night, but then my head hurts the day afterward. ***Just to clarify, I think the head pain comes from the pressure of the whole cap itself, pulled down by the chinstrap and back by the back strap, not just from the backstrap.

Now, with two days wearing the foam neck collar and nothing on my head, I have no head pains. The only thing I missed was the little velcro ring around my hose that kept the hose from pulling my Aloha nasal pillows away from my nostrils as I changed positions from time to time during the night. Without it, the hose kept pulling and setting off my leak alarm. By 5AM, it finally dawned on me to slip the hose between the first two buttons of my PJ top, and that stopped the problem with the pulling. From 5AM on, my leak chart stayed nicely down under the red line.

Regards, Nate

Sheffey wrote:

PreemieNrsTiffy wrote: CPAP hats or chin straps are not implicated in any long term effects.

I doubt there have ever been any studies. Do some studies of adult CPAPers with chinstraps cinched tight and you might be surprised.

I agree that are probably no long-term studies on the effect of chin straps. There is a lot of study comparing outcomes of infants treated with non-invansive CPAP versus intubated positive pressure ventilation and in general the infants have better outcomes though this usually refers to respiratory disease sequelae not brain effects. I will post a couple of studies that list that there are no increased neurodevelopmental complications in CPAP infants vs. intubation (the previous standard).

The OP had also asked how I get the top of the PapCap to fold up and the answer was in his question. I do keep the cap cinched pretty tight, but this does not bother me in particular. I suffer from migraines so I know about headaches but they have not been triggered by the Papcap. I do sympathize because I am very sensitive to some sensory input such as tags on clothing and have been known to sneak into a bathroom and just about rip a seam apart getting that blasted tag out. But I am not sensitive to the tight cap.

One suggestion I might have is that this last week as I was ironing the cap. I apparently cannot follow instructions and washed it in the washing machine causing it to turn into a small scrunched ball of fabric. I noticed the fold over the eyebrows was still present and just ironed that down to help it stay that way. Maybe this could help?


Early Bubble CPAP and Outcomes in ELBW Preterm Infants in the Journal of Perinatology:

http://www.nature.com/jp/journal/v23/n3 ... 0904a.html

Nasal CPAP or Intubation at Birth for Very Preterm Infants in the New England Journal of Medicine:

http://www.nejm.org/doi/full/10.1056/nejmoa072788

The blood vessels feeding the brain run deep inside the neck, enter the skull at the bottom away from the skin, and run inside the skull. You're not going to affect them with a chinstrap.

I agree that the cervical neck collar works better than a chinstrap. I've been drawing a washrag up thru the middle of the collar and kind of bunching it up a bit at the top to provide a suitable chin rest. In other words, the neck collar isn't high enough to my liking, plus now I have a chin rest.

I was still curious about the question as to whether or not the use of cpap chinstraps on infants is relevant to my concerns about the potential effects of tightness of chinstraps sufficient to keep the adult mouth closed.

Here's what I found regarding infant chinstraps at: http://www.neotechproducts.com/product- ... /chinstrap

The use of the Neotech ChinStrap is not to restrain the mouth from opening, it is to simply provide support to the patient to help maintain the pressure of CPAP. The ChinStrap should not be placed tightly, the infant should still be able to use a pacifier and if needed, cry, open their mouth, and if emesis occurs it will be expelled through the mouth.

I suggest that this supports my more tentative first impression, to-wit: that these are not comparable applications, since the purpose of an adult cpap chinstrap is in fact to keep the mouth closed in order to prevent the adult patient from breathing through the mouth.

Respectfully,

Nate

Loreena wrote:In other words, the neck collar isn't high enough to my liking.

They do make the cervical collars in different heights - but, I am sure you already knew that.

I would not even try to convince someone otherwise who has some concerns with using a chinstrap.

I personally do not have such concerns.

But, the chinstrap is just uncomfortable & I also am considering trying out a cervical collar because of that.

Have any of you who do not use a chinstrap because you think it may be unsafe thought about what pressure a cervical collar may exert on the carotid arteries in your neck?

StuUnderPressure wrote:I would not even try to convince someone otherwise who has some concerns with using a chinstrap.

I personally do not have such concerns.

But, the chinstrap is just uncomfortable & I also am considering trying out a cervical collar because of that.

Have any of you who do not use a chinstrap because you think it may be unsafe thought about what pressure a cervical collar may exert on the carotid arteries in your neck?

As far as I have been able to tell, the collar does not squeeze or press on my neck, even at its closest setting. Sitting, my chin rests on the collar and lying down, it pushes my chin upward. I have no sensation of any pressure on my neck. It only encloses my neck.

Of course, neck sizes vary, and I assume it would be possible for someone to have a neck with a large enough circumference that a neck collar might squeeze it, but that would be immediately uncomfortable and I assume that person would reject wearing that neck collar, even while standing or sitting.

Regards, Nate

It appears that the collars come in the neck sizes which apply to shirts. See, for example the pulldown menu marked OPTION at:

http://www.parentgiving.com/shop/deluxe ... ar-4487/p/

so that, if a person is familiar with the neck size of the dress shirts they normally wear comfortably, they would be okay wearing a neck collar in the same size range.

Lying down does not appear to add any further compression to how the collar encircles the neck while sitting or standing, as far as I can tell. In fact, it seems to loosen the front a bit more, as one's weight against the mattress or pillow pushes the collar a bit forward.

Regards, Nate