What to do while I cannot use CPAP

[ncgncg]

A little earlier, I posted about how I managed to get a CPAP prescription from Stanford Sleep Clinic without waiting for the first available appointment with the doctor in August. Unfortunately, I won't be able to start CPAP for another 6 weeks anyway because it would interfere with the recovery from some surgery I had done. I'll explain the gory details below for those who are interested, but meanwhile...

Is there anything else I can do in the meantime to manage my apnea as best as possible while I'm not allowed to start CPAP?

Oh, and now for the details of what happened. In case you care. In December, I visited a dentist, for the first time in years, to complain about a toothache, and she determined that I needed to have my wisdom teeth out since they were causing periodontic problems with the adjacent molars. An orthodontist that I also saw on the dentist's advice referred to the impaction as "a bear" and declared that if it were his mouth, he'd leave them where they were if at all possible. Unfortunately, it wasn't, and the OMS took out all four. It was weeks before I could do anything beyond curling up in a foetal position without the aid of Vicodin, but in the end, it all healed. The only problem was that at some point, while squeezing water from the plastic syringe they gave me into the upper wisdom tooth socket, I managed to get the water to come out my nose. Back at the surgeon's office, I was told that I had been explicitly instructed not to "irrigate" the upper sockets, and only the lower sockets. I don't remember any such instruction, but I'm willing to grant that it is quite possible I may have misremembered instructions conveyed to me while waking up from the "IV sedation" used for the surgery (fentanyl and diazepam, if I recall.) Not much later, I developed a very foul taste in my mouth, which later turned out to be coming clearly from postnasal drip. In hindsight, that was the start of sinusitis that is still not entirely over. In fact, I have had sinusitis for going on 4 months and 3 courses of antibiotics, the last one seasoned with liberal amounts of prednisone. The ENT that I saw after my primary care doctor gave up and referred me determined that the "communication" between the mouth and the sinus was the cause of the sinusitis and indeed the lab found a type of bacteria in the mucus he sent in that is not normally found in the sinuses and can only really come from the mouth. He basically set an ultimatum of three weeks on a cocktail of antibiotics and prednisone, after which point he would do FESS (functional endoscopic sinus surgery) if things hadn't gotten better. Fortunately, they did get better—not completely, but enough to ward off surgery for now. What was not immediately clear, though, was that the hole that caused it all was still there. I only found that out when I was attempting to clean beneath my gums, since I'm also having some periodontal problems (the original reason for having my wisdom teeth out), and the hygienist instructed me to clean very thoroughly. I used a Waterpik on the site of the tooth with the hole and the water came out my nose, just like it had months before. The ENT confirmed that this meant the opening was still there and would almost definitely cause more sinusitis in the future. I ended up at the original OMS (oral surgeon) to have the opening closed this Thursday. Instructions are not to do anything (sneezing, nose-blowing, spitting, sucking, nasal irrigation, or CPAP) that would cause a pressure differential between the mouth and sinus for 6 weeks.

[patrick_a]

Damn, what a nightmare. Sorry, don't have any advice, but hope you heal ad quickly as possible.

[Todzo]

A little earlier, I posted about how I managed to get a CPAP prescription from Stanford Sleep Clinic without waiting for the first available appointment with the doctor in August. Unfortunately, I won't be able to start CPAP for another 6 weeks anyway because it would interfere with the recovery from some surgery I had done. I'll explain the gory details below for those who are interested, but meanwhile...

Is there anything else I can do in the meantime to manage my apnea as best as possible while I'm not allowed to start CPAP?

Oh, and now for the details of what happened. In case you care. In December, I visited a dentist, for the first time in years, to complain about a toothache, and she determined that I needed to have my wisdom teeth out since they were causing periodontic problems with the adjacent molars. An orthodontist that I also saw on the dentist's advice referred to the impaction as "a bear" and declared that if it were his mouth, he'd leave them where they were if at all possible. Unfortunately, it wasn't, and the OMS took out all four. It was weeks before I could do anything beyond curling up in a foetal position without the aid of Vicodin, but in the end, it all healed. The only problem was that at some point, while squeezing water from the plastic syringe they gave me into the upper wisdom tooth socket, I managed to get the water to come out my nose. Back at the surgeon's office, I was told that I had been explicitly instructed not to "irrigate" the upper sockets, and only the lower sockets. I don't remember any such instruction, but I'm willing to grant that it is quite possible I may have misremembered instructions conveyed to me while waking up from the "IV sedation" used for the surgery (fentanyl and diazepam, if I recall.) Not much later, I developed a very foul taste in my mouth, which later turned out to be coming clearly from postnasal drip. In hindsight, that was the start of sinusitis that is still not entirely over. In fact, I have had sinusitis for going on 4 months and 3 courses of antibiotics, the last one seasoned with liberal amounts of prednisone. The ENT that I saw after my primary care doctor gave up and referred me determined that the "communication" between the mouth and the sinus was the cause of the sinusitis and indeed the lab found a type of bacteria in the mucus he sent in that is not normally found in the sinuses and can only really come from the mouth. He basically set an ultimatum of three weeks on a cocktail of antibiotics and prednisone, after which point he would do FESS (functional endoscopic sinus surgery) if things hadn't gotten better. Fortunately, they did get better—not completely, but enough to ward off surgery for now. What was not immediately clear, though, was that the hole that caused it all was still there. I only found that out when I was attempting to clean beneath my gums, since I'm also having some periodontal problems (the original reason for having my wisdom teeth out), and the hygienist instructed me to clean very thoroughly. I used a Waterpik on the site of the tooth with the hole and the water came out my nose, just like it had months before. The ENT confirmed that this meant the opening was still there and would almost definitely cause more sinusitis in the future. I ended up at the original OMS (oral surgeon) to have the opening closed this Thursday. Instructions are not to do anything (sneezing, nose-blowing, spitting, sucking, nasal irrigation, or CPAP) that would cause a pressure differential between the mouth and sinus for 6 weeks.

I have slept in a recliner - well - power outage - one night. It did help.

Raising the head of your bed several inches may help.

Keeping off of your back may help (google such as sleep apnea shirt and side sleeping and all).

I find it helpful to go to sleep "looking up". I mean as if you were standing up. The motion tends to make you drop your jaw out and down a bit and then I move my tongue between my teeth a bit. I think it makes the most room in there.

Eating anti-inflammatory foods may help.

[cngcng]

How exactly do the anti-inflammatory foods help? In general, it seems the lists of alleged anti-inflammatory foods I can find are pretty compatible with what I understand to be healthy food. I am just wondering what they have to do with sleep apnea specifically.

[purple]

Sleep sitting up, but not on ones back as one might do in a recliner. This works for OSA. Your Apnea might be more complex and have other aspects. I am not aware that there is any case where sleeping sitting up (not on ones back) makes anything worse.

[Guest]

Thanks for the sitting up suggestion. I rigged up some pillows and part of a tabletop and I'll give it a try tonight. As for the details of the sleep study report, I'll post the whole thing separately so you guys can pick it apart, if you'd like.

[ncgncg]

I tried sitting up last night, or at any rate about 45°. I wrapped a foam mattress cover from the folding guest bed around the two folding leaves from my expanding-top dining table and rested the whole thing against the headboard. That and two memory foam pillows seems to provide a comfortable setup if you arrange the pillows just so; I was surprised I got it on the first try and frankly had imagined having to experiment with other household objects as supports to prop me up. The rough surface of the foam mattress pad actually prevents the pillows from sliding out of position.

Surprisingly, I had no trouble falling asleep. Subjectively, it seemed like I was more rested and less agitated than normal when I woke up in the morning, but that can also be the Vicodin talking. (I'm taking it short term for post-op pain, in case anyone was going to accuse me of inappropriate recreational psychopharmacology.)

I think I'll try again tonight.

[cherylann]

After two years, CPAP still does not work for me. At best I an manage three hours a night and even during that time I am struggling to breathe.

I've tried sleeping in a recliner, but that doesn't help either.

But, one thing that has helped some is a mattress genie. It elevates the mattress up to 24 inches.

[JENNIFER_SUSAN]

I tried sitting up last night, or at any rate about 45°. I wrapped a foam mattress cover from the folding guest bed around the two folding leaves from my expanding-top dining table and rested the whole thing against the headboard. That and two memory foam pillows seems to provide a comfortable setup if you arrange the pillows just so; I was surprised I got it on the first try and frankly had imagined having to experiment with other household objects as supports to prop me up. The rough surface of the foam mattress pad actually prevents the pillows from sliding out of position.

Surprisingly, I had no trouble falling asleep. Subjectively, it seemed like I was more rested and less agitated than normal when I woke up in the morning, but that can also be the Vicodin talking. (I'm taking it short term for post-op pain, in case anyone was going to accuse me of inappropriate recreational psychopharmacology.)

I think I'll try again tonight.

No, i'm not going to accuse you for inappropriate recreational psychopharmacology as it happen some time to me also. I think it is natural, no need to get worried.

[Stormynights]

After two years, CPAP still does not work for me. At best I an manage three hours a night and even during that time I am struggling to breathe.

I've tried sleeping in a recliner, but that doesn't help either.

But, one thing that has helped some is a mattress genie. It elevates the mattress up to 24 inches.

They had a Matress Genie at the sleep lab where I had my sleep study. I loved it.

Maybe you can get help here using your cpap. Start a new topic and explain your problems equipment and pressure.

[ncgncg]

Wow, I just checked out that Mattress Genie thing and it sure looks a lot more convenient than what I rigged up. I have a yellow foam rubber mattress pad wrapped around the "drop leaf" insert from an expandable dining table... Then again, my setup works fine for now. But I might consider something like the Mattress Genie or the other wedge type systems if I have to stick with this long term.