Why doesn't everyone use a cervical collar?

I have worn a cervical collar for years while sleeping with CPAP. My AHI has been 3.6 for the last six months.

Sunday afternoon I decided to take a nap with CPAP and had a stupid attack and did not put on my soft cervical collar:



What a disaster! AHI = 40 and a pressure of 18 did nothing to prevent apneas.

If I get such dramatic results, why aren't cervical collars recommended for everyone who has OSA? At least on trial basis to see if it makes a difference?

Well, they would have to catch me first ...

Years ago, I wore one of those suckers for six months, day and night, while recovering from a slipped cervical disk. I swear I never slept comfortably with it. When I first got my CPAP gear and had to pep-talk myself nightly to mask up, I would say to myself: "Well, at least it's not a cervical collar."

But I am intrigued by your story. Why do you think the collar produces such obvious benefits for you in tandem with CPAP? Were you wearing it for some other reason when you started CPAP or was it prescribed for you as part of your apnea treatment?

No way will anyone get me to wear one of those voluntarily. I hate my seatbelt pressing up against my neck, hated wearing skivvies as a child, and any scarf I wear has to be loosely drapped.

I have been using a soft cervical collar for the past eight months. Even wearing it loosely, it controls the jaw drop and seems to position my PAP with less resistance. My pressure has dropped a full point as well as my AHI is so low (July I had 13 zeros) that I wondered if just wearing the collar without PAP would have be sufficient. Of course, I will continue PAP as my baseline study was AHI 49.6, desat 65, so bad they called the doctor to start PAP. I am underweight, maybe like Sheffey, so I can wear a collar easily. Plus as a back sleeper, the collar doesn't cut me off like when I try to sleep on my side. Since my husband has a thick neck and is a side sleeper, a collar probably will not work with his PAP.

It is too hot. I tried it during the winter and it wasn't bad but in the summer there is no way I could wear that.

mgaggie wrote:No way will anyone get me to wear one of those voluntarily. I hate my seatbelt pressing up against my neck, hated wearing skivvies as a child, and any scarf I wear has to be loosely drapped.

Same here. I have a strong gag reflex with anything touching the front of my neck. Also, my ahi is usually less than 1.5 with my apap of 11-17. Untreated was 79. I am quite happy with my current therapy.

I am in a similar situation to Sheffey. If I wear one, I can run a pressure at around 8 with a great AHI. Unfortunately, I never can stay asleep on the machine for more than 2-3 hours and when I wake up, I can't get it off fast enough. And my body rebels big time when I try to put it back on.

I am looking to find a comfortable full face mask I can wear at higher pressures that doesn't leak to see if I can shed it. The ones I currently have all leak at high pressures. Asked Resmed to send me the fitting template that isn't available online for the ultra mirage.

49er

Kitatonic wrote:I have been using a soft cervical collar for the past eight months. Even wearing it loosely, it controls the jaw drop and seems to position my PAP with less resistance. My pressure has dropped a full point as well as my AHI is so low (July I had 13 zeros) that I wondered if just wearing the collar without PAP would have be sufficient. Of course, I will continue PAP as my baseline study was AHI 49.6, desat 65, so bad they called the doctor to start PAP. I am underweight, maybe like Sheffey, so I can wear a collar easily. Plus as a back sleeper, the collar doesn't cut me off like when I try to sleep on my side. Since my husband has a thick neck and is a side sleeper, a collar probably will not work with his PAP.

Kitatonic, Good to hear you have success with the collar. As you note, it can be worn loosely and still be effective. I hope everyone understands these are the soft, cotton mesh fabric-wrapped foam collars. There is no need to snug it up around the neck. I would say the lady in the photo is wearing it too tight for CPAPers.

It seems to me it works by keeping your head in an upright position and not allowing your head to bend so that the chin moves closer to the chest. This puts the soft palate in a position where the CPAP pressure can more easily create an air splint between the soft palate and tongue. I believe when your chin drops toward your chest the tissues of the soft palate and tongue are more "bunched up" and thus require more air pressure to splint open. (All speculation on my part.)

Whatever the case, I think it would take 20 cm or more to control my condition without the collar.

Yes Kitatonic, I am toward the slim side also. BTW, I can sidesleep with the collar but then I get aerophagia. So I try to stay on my back.

The collar, by stabilizing the head, seems to also help avoid unwanted mask leaks.

As far as why I started wearing a collar, I was desperate to find a way to lower my pressure. It was quite a few years ago and I read that some CPAPers were using them, so I gave it a try and it immediately made a large difference.

After wearing it for a few weeks, I got to the point where I don't even notice it. On the muggiest, hottest nights I may turn the A/C down two degrees below where my wife prefers it. But she can put on bed clothes - I can't do without my collar.

If you can learn to tolerate a CPAP mask, then tolerating a soft foam spinal collar should be easy.

I would do anything for sleep; but I won't do that!

chunkyfrog wrote:I would do anything for sleep; but I won't do that!

I am surprised that people (and frogs) have that reaction. The collar is comfortable compared to a CPAP mask.

But then I was conditioned because I lived in the old days when we wore ties cinched around our necks all day long even here in the muggy South.

I have one but never tried it.
Thanks for the reminder, I'll try it tonight.

Sheffey wrote:If I get such dramatic results, why aren't cervical collars recommended for everyone who has OSA?

Those are dramatic results!

Sheffey wrote:

chunkyfrog wrote:I would do anything for sleep; but I won't do that!

I am surprised that people (and frogs) have that reaction. The collar is comfortable compared to a CPAP mask.

But then I was conditioned because I lived in the old days when we wore ties cinched around our necks all day long even here in the muggy South.

Some of us really have a bad gag reflex. I cannot wear turtleneck sweaters, scarves, etc. It isn't about tightness, just the touching gets me feeling crazy. Even a t-shirt has too small a hole for the neck, I will tug at it all day, assuming I don't switch shirts within a few minutes. Years ago, I was required to wear a now tie at work. I had that thing at the loosest setting, and stiffened in a way to keep it from touching my neck. I had my blouse, open at the collar and away from my neck.

I also have trouble with seatbelts at my neck, and I constantly tug it away from neck. I even have a problem with weight on the back of my neck. My work aprons have a strap around the neck. As soon as you put stuff in the pockets, it puts weight on the back of the neck. I can't stand it. I take the straps from 2 different aprons and customize one apron so that it has two long straps that criss cross behind my back and tie around my waist. That moves the weight to my shoulders. I have done this for years. I will not wear the aprons the way they come.

I also cannot wear dangle earrings as they touch the sides of my neck. I don't know why these things bother me, but they have bothered me since I was a child. Just like some foods make me gag due to texture or smell.

A mask on my nose and mouth does not touch an area that bothers me. I do have the Oracle as well, and I do have to work hard to calm down the gag reflex when I first put it on. I am not used to having something like a pacifier in my mouth. Oh, years ago, I had a retainer. I gagged on that too. And the dentists struggle to do xrays with me as I gag on those. They also have to use the child size on the back teeth. And no tongue depressors at the doctor's office. If they insist, I request a barf bag. I used it once at the ER when the guy insisted on using the tongue depressor 3 times. I warned him.

Everybody has different things that bother them. My nephew is scared of spiders. Even as an adult, if he sees a spider, he has to get somebody else to get rid of it. As long as the spider isn't on me, no problem. My nephew drives a semi truck. Has for several years now. I am about to turn 41, and I am just now getting my first driver's license (hopefully on Thursday). Driving has scared me for years. What is easy for one person, even fun, could be terrifying to somebody else.

49er wrote:I am in a similar situation to Sheffey. If I wear one, I can run a pressure at around 8 with a great AHI. Unfortunately, I never can stay asleep on the machine for more than 2-3 hours and when I wake up, I can't get it off fast enough. And my body rebels big time when I try to put it back on.

I am looking to find a comfortable full face mask I can wear at higher pressures that doesn't leak to see if I can shed it. The ones I currently have all leak at high pressures. Asked Resmed to send me the fitting template that isn't available online for the ultra mirage.

49er

What pressure do you need without the collar? Which masks have you tried so far?

I use the Quauttro FX with 11-17. I do tend to wake up when I get into the 15-17 range which isn't very often. But I think it is more because I am on my back, and my jaw opens wider. Since I am on my back, my pressure needs go up, and with the mouth open wider, my cheeks flap. I wake up, restart the machine, and roll over. Back to sleep. Now, most of the time, I just don't roll onto my back. Or if the pressure starts creeping up, I tend to roll back over before it gets bad. I only remember it happening once or twice a week now.

I do get the occasional leak, but it is usually associated with drooling, excessive sweating (temp is up, and I didn't adjust the remp/humidity). Or I rolled onto my left side, and for some odd reason, my mask doesn't do well on my left side. I think I must smoosh my head into the pillow differently on that side.

But most nights, I don't have any leak problems. My leak line is pretty much zero. My pressure is usually in the 11-14 range. I believe my 95% number is 13 something.

So, I am not sure how it would do at consistently higher pressures.