Bilevel and anesthesia

[AAF]

Hello,

I may have an upcoming endoscopy relatively soon due to some swallowing issues. Now, I am scared about the sedation/anesthesia with my sleep apnea. I've searched and I see a lot of people mention doing well but they commonly mention CPAP. I'm looking for people with experience using bilevel/BiPAP who underwent procedures.

A little background: I've been diagnosed with sleep apnea since 2020. I first used a Phillips DreamStation, then a DreamStation II after recall. In 2021 the Dr wanted a new sleep study and I was changed to a bilevel/BiPAP machine. I do not recall how many events occurred in the lab but I know it wasn't enough for my insurance to authorize the use of mask for the first night. I think I was off the necessary amount by a small handful or so.

I don't have Oscar, unfortunately, since my machine does not support it (if I had known a year ago what I know now about the machine I would've asked for a Resmed). However, my 2023 average stats are as followed:

Apnea Hypopnea Index: 5.0
Apnea Index: 4.0
Hypopnea Index: 1.0
Central Apnea Index: 3.6

[ChicagoGranny]

I've searched and I see a lot of people mention doing well but they commonly mention CPAP.

As far as anesthesiology, there is no difference. Bilevel machines are just CPAP machines which allow a wider pressure differential between inhalation and exhalation. Your anesthesiologist will know how to keep you breathing. They have done endoscopy on many CPAP/bilevel patients.

Take your machine, but you probably won't need it. Let your medical team know you are a CPAP user.

[AAF]

I've searched and I see a lot of people mention doing well but they commonly mention CPAP.

As far as anesthesiology, there is no difference. Bilevel machines are just CPAP machines which allow a wider pressure differential between inhalation and exhalation. Your anesthesiologist will know how to keep you breathing. They have done endoscopy on many CPAP/bilevel patients.

Take your machine, but you probably won't need it. Let your medical team know you are a CPAP user.

I think another thing I'm worried about is in regards to things I've experienced at home when I'm falling asleep. If I don't have my mask on and doze off, sometimes I can wake up feeling stuck and have to jolt myself up. I also tried out a regular pulseox last night dozing off without my mask and it woke me up showing an Sp02 of 92% and my heart rate around upper 50s. Don't know if it's just my anxiety adding to all this as well.

[ChicagoGranny]

my heart rate around upper 50s.

That's low. You must be in good aerobic shape.

[Okie bipap]

I have had two major surgeries (hip replacement and back surgery) since being on a bi-level machine. I had no problems either time.

[chunkyfrog]

Over the years, I have had general anesthesia numerous times.
The science is continually evolving--my first was probably a nurse-anesthetist.
More recently, a physician, specializing in the practice.
At this point, you will be in very good hands.
You should have a face to face meeting with the anesthesiologist before surgery.
If not, you should request a meeting.

[AAF]

my heart rate around upper 50s.

That's low. You must be in good aerobic shape.

Not really. I normally run between mid-60s through mid-70s. Sometimes 80s if I'm stressed. That's why I'm kinda freaked when I saw that heartrate while falling asleep without my mask.

Over the years, I have had general anesthesia numerous times.
The science is continually evolving--my first was probably a nurse-anesthetist.
More recently, a physician, specializing in the practice.
At this point, you will be in very good hands.
You should have a face to face meeting with the anesthesiologist before surgery.
If not, you should request a meeting.

I have had two major surgeries (hip replacement and back surgery) since being on a bi-level machine. I had no problems either time.

I guess I shouldn't be so worried because general is a bit more intense than Endoscopy sedation. They told me when I decide to schedule they'll be using Propofol and that it allows you to maintain your airway. But if I'm in-between sleep and awake how can I maintain my airway if dozing off in my room gives me unpleasant side effects on its own?

[chunkyfrog]

The professionals in charge will take care of everything.
You are allowing your anxiety to be in control.
Please do not do that.

[Miss Emerita]

They will be watching you like hawks, and they will swoop in if they see any sign of a respiratory problem. Their monitors will help them in their vigilance.

I had an endoscopy after starting with PAP, and I had some of your same worries. I told the people in the procedure room that I have apnea, and they were very reassuring — with reason!

All in all, this is about as safe as respiration can get.

[ozij]

Sleeping without your Continuous Positive Air Pressure machine i- be it bilevel or not - s a great way of freaking yourself out.
Telling you medical team ahead of time, like now that you need a bilevel PAP when you sleep is a great way of ensuring you'll get the necessary breath support during the procedure.

I know a person who is not a user of any PAP machine whose breathing was so bad during an endoscopy that they stopped the procedure and had her come back to do it with an anesthetist present.

[ChicagoGranny]

I've had three surgeries under general anesthesia and about four endoscopies with propofol. I always brought my CPAP but never had to use it. They took good care to make sure I was breathing. The anesthesiologist for my last colonoscopy told me he is also a CPAPer and would make sure I kept breathing.

[AAF]

The professionals in charge will take care of everything.
You are allowing your anxiety to be in control.
Please do not do that.

You're right. I'm a very anxious person. I'm just scared is all.

[chunkyfrog]

Everybody is anxious before surgery.
The more I think about it, the worse I feel.
Concentrate on other things--puzzles, crafts, a really exciting novel.
Challenge your mind, so it can't torture you.

[icipher]

The professionals in charge will take care of everything.
You are allowing your anxiety to be in control.
Please do not do that.

You're right. I'm a very anxious person. I'm just scared is all.

I can understand why you'd be scared. Keep in mind, anesthesiologists work on people who have sleep apnea ALLLLLL the time. Many of people don't even know they have sleep apnea. The anesthesiologist is going to be well aware of the fact that sleep disordered breathing is a reality for many patients. You'll be fine.

[chunkyfrog]

You are quite right!
Anesthesiologists are often the first professionals to observe apnea.
"Your surgery went well; but now you need a sleep study."