experiment with surprising results

[Catnapper]

In preparation for abdominal surgery later this week, I have been experimenting with different masks to take to the hospital to use in the recovery room. I wasn’t sure how a nurse or RT would deal with my favorite, the decapitated Aura/Headrest mask and 2 legs from fishnet tights! So I was looking for a substitute that would make it easy for them to put on me.

Also, as a tummy/side sleeper, I never sleep on my back, but assume that I will need to do so, at least for a few days after abdominal surgery. I am lucky to be one of the people who does not mouth-breathe, but I wasn’t sure what would happen if I slept on my back.

I decided to experiment with sleeping on my back, but I had to take Ambien CR even to get to sleep in that position. For about an hour, I struggled restlessly, feeling like I was constantly waking up with puffy cheeks. I finally gave up, turned to my side and went to sleep as usual.

Next morning, I checked the data on my machine, expecting to find leaks indicating mouth breathing. Much to my surprise, the leak rate was in the normal range for my mask at my pressure. No obvious mouth leaks. What did surprise me was that during that hour, I had 18 apneas and 3 hypopneas! That is with my very successfully titrated bi-pap pressures! (I generally have 0AHI several times a week, and the rest of the time only a 0.1 to 0.3 range AHI.) The rest of that night, there was NOT one single apnea, hypopnea, flow limitation or even a snore! No wonder I never sleep on my back.

I am asking for suggestions about how to handle this. What comes to mind is to set my machine back to auto, and leave the EPAP as is at 9, and set the IPAP to up to 15 or so instead of the usual 12. In my last titration, when the pressure went up to 13 it woke me up so the doc suggested I go to straight bi-pap at 9 and 12. I am not sure my mask would hold at pressures much higher.

As to masks, I own a bunch of them, and am considering the Soyala nasal, the Swift II, and the Optilife, as well as taking the Ultra Mirage Full Face Mask. If anyone has experience with these masks in the recovery room and would care to share, I would be happy to listen. I would also be happy to hear any other ideas.

Thanks as always to the wonderful helpful hoseheads of cpaptalk.

[kteague]

Catnapper,

Am I understanding correctly that this night you're speaking of you were still using the Headrest/TwilightNP/Aura? Do you think your apneas were so high more due to position or having mouth leaks in that position?
To cover both bases, I would want my pressure to be able address any positional apneas, considering with pain medications you may experience even more apneas. And I think I would choose the mask and accessories that would be minimally uncomfortable and address the potential for mouth leaks on your back. (I generally only mouth leak on my back.)

You are fortunate to have options on machine adjustments and masks. With your diligent advance planning you'll certainly be one of the most thoroughly prepared post-op patients. May your surgery be successful and your recovery swift - couldn't happen for a nicer person.

Kathy

[Catnapper]

Kathy,

I am pretty sure there were no mouth leaks as there were no spikes or changes in the leak data, and certainly no black marks. It looked the same as the rest of the line, and right where it should be. I think they were all from the position. I was wearing the Aura, which is fairly stable for not leaking due to those pretty straps I have.

My sense that it was puffy cheeks was just that something woke me up, so it might have been the apnea events choking me, or the air having trouble getting past the apneas,

Thanks for your kind wishes.

Joanie - Catnapper

[RosemaryB]

Hi Joanie,

One thing you could do is to look at your sleep study and see if there is a big difference when you are on your back. If so, that would give more evidence to your hypothesis that it is back sleeping causing the apneas. If you need to sleep on your back, perhaps you could experiment with different head/neck positions. I think some tend to close the airway more than others.

Also, you should try to find out if you will be able to sleep on your side after surgery. Don't they like you to change positions some? You could tell them why, too.

Wishing you the best possible surgery and a speedy recovery!

[magpie]

I had abdominal surgery a few years ago. It was before Cpap so i could not sleep on my back at all because I couldn't breathe. I was better in a half sitting position with a pillow under my knees to take the pressure off my spine. But they did let me sleep on my side the second day. It was not painful. Also make sure they give you a pillow to hold into your stomach when you need to cough or sneeze and make sure your knees are bent. This takes alot of the pressure off the abdomin. I cannot take most pain meds so I was on motrin only but was up walking and doing well by day three. By day six I was ready to go home. So I would talk to your doctor and see if side sleep is OK. It might be if it doesn't interfere with your drains.

[Bytor]

I eagerly wake up every day to look at the data on my M-series smartcard. One night I had to take anti-anxiety medication (1mg ativan), and the next morning, looking at the data, my AHI went up a *a lot*, and the amount of pressure the APAP had to use went up too. For obvious reasons (body more relaxed & slowed down, etc). It seems possible that your Ambien could have done the same thing.