After knee surgery, recommended to sleep on back AHI high

[LindaGinCanada]

I am 4 weeks after full knee surgery. During recovery it is recommended to sleep on my back. I use Resmed 10 and F20 full face mask. The issue I'm having is the AHI numbers have skyrocketed since surgery, most likely because I'm sleeping on my back. I recently changed the headgear (use For her small) and the cushion, but it doesn't seem to help. Before surgery my AHI numbers were 1 or under, (was a side sleeper) now the odd day they are between 20 and 30. Are there recommendations for cutting down the AHI numbers, probably due to leakage from back sleeping. As well as the discomfort of knee surgery I keep waking up constantly. Need sleep desperately. My pressure is 11, machine was new September 2022, headgear replaced about a week ago. Thanks ahead of time.

[lazarus]

I am 4 weeks after full knee surgery. During recovery it is recommended to sleep on my back. I use Resmed 10 and F20 full face mask. The issue I'm having is the AHI numbers have skyrocketed since surgery, most likely because I'm sleeping on my back. I recently changed the headgear (use For her small) and the cushion, but it doesn't seem to help. Before surgery my AHI numbers were 1 or under, (was a side sleeper) now the odd day they are between 20 and 30. Are there recommendations for cutting down the AHI numbers, probably due to leakage from back sleeping. As well as the discomfort of knee surgery I keep waking up constantly. Need sleep desperately. My pressure is 11, machine was new September 2022, headgear replaced about a week ago. Thanks ahead of time.

The machine you show selected is an ASV. Is that what you are using? That usually is used to treat something beyond simple obstructive apneas. That is significant because someone with obstruction from relatively pure OSA using straight CPAP may need a bit more pressure when on his or her back to keep the airway open. But if you are using an ASV, that may or may not apply to you and your situation.

You said you 'wake up constantly' because of "the discomfort of knee surgery." That situation alone can cause many pauses in breathing in transitioning from wake to sleep and sleep to wake, for example. That can show up as increased AHI in the numbers from a home machine. And being in pain may be a unique situation for you that will start to sort itself out as you heal. Pain meds can also wreck our sleep, putting us in a bit of a half-asleep/half-awake zone that causes irregular breathing that shows up as high AHI.

Get the sleep whenever you can, even if it is brief periods, day or night. And do what is practical to limit your movement during sleep, if possible. After my recent abdominal surgery, I used a recliner for sleep because that kept me from moving around as much as I would have moved in a bed. I managed to recover without any pain meds that way. I kept the pain meds where I could see them and get to them quickly if I needed them, but I prefer to feel pain that keeps me from injuring surgical incisions that need to heal. Hey, just me.

I wish you a speedy recovery and a return to better sleep!

[LindaGinCanada]

Sorry I originally had 11 (typo) but the machine is here, Resmed Air Sense 10 with humidifier. I see it listed the wrong one in my profile, hopefully I have corrected that.

https://thecpapstore.ca/collections/dea ... ud-version

It was the one sold by my local supplier.

I nap constantly, trying all sorts of things to sleep with the machine, while trying hard to not be worried by the AHI numbers as I know eventually they should go back to my normal range.

[chunkyfrog]

Have faith it will get better.
Healing after surgery is only the first phase.
Next comes rehab--which will require discipline.
You will be rewarded by your effort.

[lazarus]

Sorry I originally had 11 (typo) but the machine is here, Resmed Air Sense 10 with humidifier. I see it listed the wrong one in my profile, hopefully I have corrected that.

https://thecpapstore.ca/collections/dea ... ud-version

It was the one sold by my local supplier.

I nap constantly, trying all sorts of things to sleep with the machine, while trying hard to not be worried by the AHI numbers as I know eventually they should go back to my normal range.

Then posting OSCAR results here may be helpful for experienced ones to help you, or at least sharing your machine settings and results as reported from the screen as to whether the AHI is from closed-airway or open-airway events. Helpful information on downloading and using OSCAR is in the stickies toward the top in the thread list.

Many times as patients we are handed machines with the minimum set at 4cm when we may really need to set our own minimum on our own machine to within one or two cm of what we need to prevent obstructive apneas, in order to keep our AHI down, especially on our back.

It looks like you corrected the listed machine in your profile. As a side note, most of us here choose to show our equipment as text, not pictures, since that makes it easy for others to see at a glance what we are using.

[LindaGinCanada]

Have faith it will get better.
Healing after surgery is only the first phase.
Next comes rehab--which will require discipline.
You will be rewarded by your effort.

My recovery is going well, and gets better daily. I exercise 3 to 5 times a day, can now walk in the house without my cane. Thanks for the encouragement.

[LindaGinCanada]

Sorry I originally had 11 (typo) but the machine is here, Resmed Air Sense 10 with humidifier. I see it listed the wrong one in my profile, hopefully I have corrected that.

https://thecpapstore.ca/collections/dea ... ud-version

It was the one sold by my local supplier.

I nap constantly, trying all sorts of things to sleep with the machine, while trying hard to not be worried by the AHI numbers as I know eventually they should go back to my normal range.

Then posting OSCAR results here may be helpful for experienced ones to help you, or at least sharing your machine settings and results as reported from the screen as to whether the AHI is from closed-airway or open-airway events. Helpful information on downloading and using OSCAR is in the stickies toward the top in the thread list.

Many times as patients we are handed machines with the minimum set at 4cm when we may really need to set our own minimum on our own machine to within one or two cm of what we need to prevent obstructive apneas, in order to keep our AHI down, especially on our back.

It looks like you corrected the listed machine in your profile. As a side note, most of us here choose to show our equipment as text, not pictures, since that makes it easy for others to see at a glance what we are using.

Thanks for the advice about picture vs text. I use Sleepyhead on Macbook Air so will look into how to post that info.

[lazarus]

My recovery is going well, and gets better daily. I exercise 3 to 5 times a day, can now walk in the house without my cane.

Excellent!

Now let's see how folks here can suggest things for getting that sleep a little better once they see your charts and specific numbers. A few here are particularly gifted with a good eye for that.

[Janknitz]

I've been sleeping on my back a lot more lately, because of knee and hip pain. But my AHI is still good. So it's hard to say that it's all positional in your case. Consider that pain, pain meds, and simply recovering from anesthesia may play a role, regardless of your sleeping position.

Play around with your pillow configuration. Remember CPR training? To open the airway, we tilt the head back. When we sleep on our backs, gravity tends to pull the head forward, which can mechanically obstruct the airway too much for the CPAP to overcome. So play around with your pillows to find a supported position that doesn't allow your head to fall forward. I have one of those buckwheat filled U-shaped pillows. I took most of the buckwheat out, so it's very soft and moldable. I sometimes use that as a chin support around the front of my neck. It keeps my head from falling forward and supports my chin. A soft cervical collar may accomplish the same thing. Readjust your mask straps, if necessary, too, to compensate for the different sleeping position.

Glad your recovery is going well. I'm a retired occupational therapist, and my patients who had total knee and total hip replacements told me that the pain from surgery was not so bad considering the pain they were in from bone on bone weight bearing before surgery. Most people make a full recovery and are able to resume an active lifestyle after the recovery period. And I read recently that joint replacements are now lasting around 30 years or more. so hopefully you won't ever have to do it again. In the "old days" they wore out more quickly and people had to undergo revisions.

[LindaGinCanada]

Trying a screen shot from Sleepyhead, Macbook Air

The top part of the image is the AHI with up and down numbers from Nov 17 to Dec 19

[lazarus]

You selected an APAP in your profile. Is it being run in APAP mode or CPAP mode?

Many of us are comfortable taking control of our own therapy and choosing APAP mode and tweaking the minimum treatment pressure, if there is no reason we shouldn't. And we leave maximum at 20 to allow the machine to raise pressure when it needs to in order to keep our airway open.

You still may want to consider using OSCAR and following the forum instructions in the stickie threads on which charts to post and how. That added detail may help the experts in this forum give specific advice.

Sleep is worth it.

[LindaGinCanada]

You selected an APAP in your profile. Is it being run in APAP mode or CPAP mode?

Many of us are comfortable taking control of our own therapy and choosing APAP mode and tweaking the minimum treatment pressure, if there is no reason we shouldn't. And we leave maximum at 20 to allow the machine to raise pressure when it needs to in order to keep our airway open.

You still may want to consider using OSCAR and following the forum instructions in the stickie threads on which charts to post and how. That added detail may help the experts in this forum give specific advice.

Sleep is worth it.

Thank you, I'm in the process of downloading Oscar and adding the details. I'll check which files would be best uploaded. The machine was originally set in APAP mode while pressure was determined. Once my supplier determined 11 seemed best it was set that way. Would it be advisable to set it back to variable APAP, I think I remember how to do that. I really appreciate the help.

[lazarus]

Without seeing details, and if it were my therapy, my stab in the dark would be maybe to put it in APAP mode and to set the minimum pressure to 9 or so, depending on comfort, and the maximum to 20. Then I would see how that went to tweak from there.

But if you are able to post some nights of OSCAR following the instructions on what the experienced eyes like to see, I am sure you will get better observations and suggestions than that.

You'd probably want to stick to this thread to do that, and once properly-formatted OSCAR info is linked to, then adjust the thread title to mention OSCAR to make sure it doesn't get overlooked by the talented ones.

I think you are gonna be fine, Linda. Glad you are putting the work in to get there with your sleep. I hope you feel the joy in that!

-Jeff

[ChicagoGranny]

I'll check which files would be best uploaded.

Complete instructions on which image to post and how to format it are in my signature.

[lazarus]

Thanks, Granny.