Get this...differences with my AutoPaps after tonsillectomy

[SuddenlyWornOut45]

As Ive mentioned on here before, I had a tonsillectomy a year ago. The surgery itself went great and stopped cold the repeating respiratory infections I had been experiencing, which i now have to assume was basically, tonsillitis. The bad thing was, after the tonsils were taken out, I can no longer tolerate much sustained pressure like I could before the tonsillectomy.

Ive used my Resmed S9 Autoset APAP mostly since, with a little on the Resmed S9 auto VPAP run in auto Bilevel mode.

I own two other auto machines, a Resmed S8 II APAP, my old standby. I bought the current S8 II I have myself. And I have a Phillips Respironics system one APAP with A-Flex that I got via my insurance in 2011. I never really used the P & R system One much, I kind of use it as a travel machine so I dont have to take apart my S9 APAP.

But, once in a while I will try the Phillips and Respironics System One APAP and also my Resmed S8 II APAP after the tonsillectomy and the results are disconcerting to me.

Basically, it comes down to this after the tonsillectomy: The two older machines skyrocket in the pressures. Im talking they will stay maxed out nearly or all night. Its like the "auto" mode went away after the tonsillectomy. Before the tonsillectomy, the Phillips Respironics sytem one APAP gave me basically the same pressure and the 90th percentile was almost identical to my 95th percentile on the Resmed S9 APAP. The S8 APAP has a more conservative algorhythm, which I now believe is actually a good thing after what Ive experienced. It only zaps apneas up to 10, after that it only zaps hypopneas and flow limitations, basically and was good at preventing the thing from spiraling out of control with regards to pressure.

Now, after the tonsillectomy, BOTH of these older style APAPs just spiral out of control when I use them. I used my P & R system one the other night. It ramped up so high it woke me up in the middle of the night, the thing was blowing 16!!!! I had to set the top back to 14 in the middle of the night and when I woke up, my 90th percentile said "14." The thing ramps up, stays that way all night long!!!

Ditto for my Resmed S8 II APAP.

Neither machine is broken. Its me, its the tonsillectomy. Evidently it must be true if you have soft tissue surgery in the throat, auto machines no longer work that well on you. The Resmed S9 auto algorythyms work more normal and are the only ones that dont just rocket, they actually came down in pressure needs after the tonsillectomy.

Still though, I have been wondering if the Resmed S9's autoPap algorhythm works AS GOOD as it did before the tonsillectomy. Like, is it speeding up too fast or too slow or is poorly titrating inaccurately while Im asleep? It certainly feels nothing at all like an APAP felt before the tonsillectomy.

Glad I did NOT have the UPPP!!!

Word to the wise, if you depend on these auto-titrating CPAP devices, DONT let a doctor talk you into soft tissue CPAP surgery like UPPP. The tonsillectomy I had, I believe I had to have that because that was done because of infection reasons and I was sick as a dog all the time, but in a different way than I am complaining about now. But soft tissue throat OSA surgeries, to hell with those. I think the only one I'd look into now would be the jaw break surgery and tracheostomy and surgery to correct deviated nasal septums and sinus surgery (Nasal Airway Resistance).

I also believe that Resmed S9 has the best algorhythm out there, after what Ive experienced. although it probably would not work if I had had a UPPP instead of a tonsillectomy.

Eric

[wut]

SuddenlyWO45 -

I'm very sorry to hear about the post tonsillectomy PAP "challenges". As if the tonsillectomy wasn't painful enough...

In 2008, I had tonsillectomy w/a pharyngoplasty (but not the evil UPPP). A year later, I had an MMA and septoplasty. I used an auto BiPAP (MSeries 21/17 in both non &-auto mode) for the year prior to the tonsillectomy and for a few months prior to the MMA/post tonsillectomy. I restarted PAP in January 2013 using an FP Icon Auto APAP (7-11). About a month ago, I switched machines to a PR760 Auto BiPAP (18/10 PS 5). I've been fortunate not to have experienced the runaway ramp you described post tonsillectomy using the F&P and PR machines. It would be interesting to try an S9 and see if I respond the same as you did.

While most people seem to respond quite well to most machines, the challenges you describe support the theory that not all auto algorithms are created equally...


As part of the tonsillectomy, did they trim the soft palette or remove other "excess" tissue?
Have you had a sleep study and/or titration since the tonsillectomy? (removing tonsils can be a pretty big airway remodel/expansion)