Pending Back Surgery and CPAP

I have performed a search on the board and did not locate what I am looking for so I am posting in the hopes that someone can offer their personal experience.

I have spine surgery scheduled, which involves a bone graft, plates, and screws. After speaking with the spine surgeon yesterday (he is highly regarded) he had some concerns about the severity of my sleep apnea but nothing that we could not work through.
With the assistance of the Airsense 10 Autoset and the Dreamwear my AHI has gone from 112 to less than 5 on a consistent basis. I have actually achieved below 1 twice this week alone! Absolutely incredible!

However; on to my question(s): I have been instructed to bring my equipment with me to the hospital. I will be spending a minimum of three days in the hospital with a possible maximum of seven days (depending upon my recovery period).
How exactly does this work? I will be highly medicated the first two days and possibly beyond. Obviously there will be on-going pain management for some amount of time but not as severe as the initial days.

I will not be out of bed for the first day following surgery at all. Because of the high doses of pain medication, I am assuming that I will be in-and-out of consciousness frequently.

Will I be wearing the Dreamwear non-stop during this period? What about during surgery; will I actually be using the CPAP during surgery?

Any information as to what to anticipate would be greatly appreciated. And as always, thank you to those of you who always seem to come through with thoughtful and considerate responses.

During surgery you will be under the supervision of an anesthesiologist who will administer anesthesia and oxygen. Your oxygn level will be monitored in surgery and in recovery. You might ask about using CPAP in recovery. While in the hospital you can use your CPAP at night. It may need to be inspected by the respatory department. Your anesthesiologist should consult with you before surgery...ask your questions at that time.

I am assuming general anesthesia?? If so you will be intubated and no need for cpap during that time frame.

Of more concern will be the post op sleepy times...in the recovery room...I don't know what they will do as it depends on general protocol. Ideally the nurses will put cpap on you in the recovery room but that doesn't always happen. You will have a pulse ox on your finger during this time and if the oxygen levels drop to warning levels the nurses should come around to likely wake you or move you or something.
This is something to talk to your surgeon and anesthesiologist about....what is done in the recovery room.
It's usually only a couple of hours though and your O2 levels are closely monitored during that time.

In your room...use your cpap machine at all times when you are sleepy. You will still likely have a pulse ox on your finger but nurses aren't so quick about those alarms. If you have a family member there with you they can make sure that you wear the mask when asleep.
If you are alone...and fall asleep without the mask and your O2 drops...the alarm may be enough to wake you. I have heard that alarm...it would wake me for sure.

While I know that there's more to OSA than just the O2 levels...it's the O2 levels that are going to be available for monitoring and while having some apnea events slip past the defenses isn't ideal..it's likely going to happen but as long as the O2 levels don't drop to dangerous levels the short time you the risk is minimal.
It won't be a perfect situation for sure but it is manageable.

You won't need it for surgery - 02 will be constant and the anesthetist will be there.

However... you need to meet with the nurses and/or docs in charge of the Recovery Rm ahead of time (find out who's scheduled) and explain to them how you set things up... and that you want Cpap in the RR, not just after you get back to your room. And talk to whoever's in charge on your floor, or get the doctor to do it (far more effective, tho' not as likely to happen) and show them how to set up the machine. The problem is that even if who you speak to at first 'gets it', chances of the next shift of nurses getting the right info and actually carrying anything out can be pretty iffy, however efficiently things are otherwise run there, which is why it would be great if you get the doctor to write specific orders for all shifts to learn the protocol properly... but that would be an ideal situation and every hospital's different - some are incredibly clueless and the hospital may not even admit to having equipment of its own, let alone wanting to take time to learn yours. You might talk to the hospital patient liaison if one exists there and tell them your concerns if you are not confident of things being done well. Beyond that, it's difficult to say more or predict how carefully they'll follow through.

I would ask to meet with someone in the Anesthesiology department prior to surgery even though they will encourage you to wait until the day of the surgery. That way, you're in a better position to ask the necessary questions vs. the day of surgery when your nerves are shot from anxiety about the surgery and your body is screaming from hunger and dehydration.

I would ask about plans to provide local anesthetics as I have read that many times, that can reduce the need for pain medications.

And don't hesitate to raise any other concerns you have as now is the time to get everything out on the table.

Ask your surgeon to write orders for the machine to be used in the recovery room and on the floor. Otherwise, it might not be available to you as quickly as it should be.

These are all great responses, thank you. Have any of you actually experienced CPAP during a hospital stay and if so how did it work out for you?

It was the spine surgeon who told me to bring my equipment with me and I have a meeting with him the day before surgery. So, you have all provided some great questions to ask at that time.

Thanks!

n2it wrote:These are all great responses, thank you. Have any of you actually experienced CPAP during a hospital stay and if so how did it work out for you?

It was the spine surgeon who told me to bring my equipment with me and I have a meeting with him the day before surgery. So, you have all provided some great questions to ask at that time.

Thanks!

I had a septoplasty in March and was wrongly told I had to use the hospital's machines. Anyway, a machine was ready for me in the recovery room that wasn't needed since I woke up very quickly.

Unfortunately, due to a 5 hour delay in getting a room, a machine was not ready immediately which I raised a fuss about. If I had had my machine available, this would not have been an issue. Live and learn.

One question you might want to ask is what happens to your machine when you go into surgery. If it gets locked up, how far in advance will it be set up in the recovery room.

I asked that question regarding the hospital machine and was told that the Respiratory Department would be notified 15 minutes prior to the ending of my surgery that the machine needed to be set up. So you might want to ask how notifications are handled regarding your machine setup.

49er

I had spinal surgery (lamanectomy) in July. I was instructed to bring my bipap with me. They put it on me after I got to my room. I had surgery late in the day, so I did not get to my room until very late (10:00 pm). I did not use the bipap while in the recovery room. The hospital had distilled water to use in the machine. The first two hours after I got out of the recovery room, my obstructive occurrences was very high (total of 48). I think was a residual effect of the anesthetic. Once I got home, I began having problems with my medication (severe nausea), and did not use my bipap for two weeks, until I got off the medication. With the nausea, I could not stand the mask being on my face.

49er wrote:

n2it wrote:These are all great responses, thank you. Have any of you actually experienced CPAP during a hospital stay and if so how did it work out for you?

It was the spine surgeon who told me to bring my equipment with me and I have a meeting with him the day before surgery. So, you have all provided some great questions to ask at that time.

Thanks!

I had a septoplasty in March and was wrongly told I had to use the hospital's machines. Anyway, a machine was ready for me in the recovery room that wasn't needed since I woke up very quickly.

Unfortunately, due to a 5 hour delay in getting a room, a machine was not ready immediately which I raised a fuss about. If I had had my machine available, this would not have been an issue. Live and learn.

One question you might want to ask is what happens to your machine when you go into surgery. If it gets locked up, how far in advance will it be set up in the recovery room.

I asked that question regarding the hospital machine and was told that the Respiratory Department would be notified 15 minutes prior to the ending of my surgery that the machine needed to be set up. So you might want to ask how notifications are handled regarding your machine setup.

49er

Excellent questions; thank you!

Okie bipap wrote:I had spinal surgery (lamanectomy) in July. I was instructed to bring my bipap with me. They put it on me after I got to my room. I had surgery late in the day, so I did not get to my room until very late (10:00 pm). I did not use the bipap while in the recovery room. The hospital had distilled water to use in the machine. The first two hours after I got out of the recovery room, my obstructive occurrences was very high (total of 48). I think was a residual effect of the anesthetic. Once I got home, I began having problems with my medication (severe nausea), and did not use my bipap for two weeks, until I got off the medication. With the nausea, I could not stand the mask being on my face.

Okay, that is definitely something to think about as well. Did you try anything for the nausea? Honestly, I can't see me going more than a night without my CPAP anymore. My success with it has been unbelievable.

Thank you for the reply!

Ask your surgeon to write orders for the machine to be used in the recovery room and on the floor. Otherwise, it might not be available to you as quickly as it should be.

Really good advice!

Ask your doctor to write out the orders on your pre-op visit and then MAKE SURE they are in your chart when you arrive the morning of your surgery. Your doctor should order something like "patient may use CPAP machine and mask from home at _____ (setting) for sleep and ad lib while resting.'

I didn't look to see what mask you are using but if the mask doesn't have an O2 port (most full face masks do) they will need to add an adapter to put oxygen on through your CPAP. You might talk to a DME or the respiratory therapist at the hospital about that before your surgery, too.

I didn't look to see what mask you are using but if the mask doesn't have an O2 port (most full face masks do) they will need to add an adapter to put oxygen on through your CPAP. You might talk to a DME or the respiratory therapist at the hospital about that before your surgery, too.

I had similar thoughts...I had the cervical disk surgery in 1990 before any of my apnea issues. However, I did develop some lung congestion and breathing issues afterwards. I'd smoked up until 1986 so I'm sure my lungs had not recovered. In any event, I had the oxygen "in the nose" which was quite pleasant and had to do some breathing treatments for a day or so before going home. I was curious how oxygen might be used in addition to the CPAP.

highstick wrote:

I didn't look to see what mask you are using but if the mask doesn't have an O2 port (most full face masks do) they will need to add an adapter to put oxygen on through your CPAP. You might talk to a DME or the respiratory therapist at the hospital about that before your surgery, too.

I had similar thoughts...I had the cervical disk surgery in 1990 before any of my apnea issues. However, I did develop some lung congestion and breathing issues afterwards. I'd smoked up until 1986 so I'm sure my lungs had not recovered. In any event, I had the oxygen "in the nose" which was quite pleasant and had to do some breathing treatments for a day or so before going home. I was curious how oxygen might be used in addition to the CPAP.

Okay, both yourself and Janknitz have brought up something that I completely overlooked. I will have breathing exercises both the day of the surgery and the day after. That language was contained in the information booklet that I received.

However; I never thought about having oxygen administered after surgery. I don't know how that would happen with the Dreamwear mask. You've given me much food for thought.

Thank you both!

Adding O2 to a nasal mask that doesn't have an O2 port is easy..
Just a little adapter. Works with any mask and you can use it at the humidifier end (won't work so great with heated hose so would need a non heated hose) or at the mask end and it wouldn't matter if a heated hose or not.
https://www.cpap.com/productpage/oxygen ... apter.html

Pugsy wrote:Adding O2 to a nasal mask that doesn't have an O2 port is easy..
Just a little adapter. Works with any mask and you can use it at the humidifier end (won't work so great with heated hose so would need a non heated hose) or at the mask end and it wouldn't matter if a heated hose or not.
https://www.cpap.com/productpage/oxygen ... apter.html

So just to be certain; I could place this adapter between my heated hose and the mask? I don't use a short hose, I just connect my heated hose directly to the Dreamwear.

Thanks much!