SA surgery related questions and newbie introduction

Hi All, I"m putting questions before intoduction since I've been far too verbose. I apologize. If you could get through the questions and have any advice to give, I would really appreciate it. Thank you, Cynthia. Questions: As a pre op patient with pretty severe SA, who is just now getting on a CPAP machine, what can I do to reduce surgery risks besides wearing the CPAP? Are there things I should know to do after surgery to help prevent complications because of the SA? What are the increased surgery risks because of SA? Are sleep apnea patients more likely to have surgery complications than other patients even if they have been using a CPAP machine for at least a month and are on it during surgery? I think someone mentioned that SA patients are likely to have low oxygen levels after surgey and have to stay in hospital longer or possibley in ICU. Is this the case for patients who are on a CPAP? If a patient does have low oxygen levels after surgery, does this prevent walking right after surgery? I'm having a duodenal switch, and because it includes more "cut-and-pasting," walking to prevent blood clots is even more critical. I don't really understand the significance of raising oxygen levels before and after surgery as compared to wearing the CPAP during surgery so you keep breathing. It seems to me that if you are wearing a CPAP then your oxygen levels shouldn't be low, but I still don't understand the implications of oxygen levels. Recently, I've not only been waking up because I've stopped breathing and/or my heart is fluttering, but also because I am choking on bile. Does anyone know if this is SA related? I have had GERDS to some degree or another that varies with my weight, but I've never woken up choking on bile in my windpipes. Is it typical for SA patients too have more episodes when falling asleep than when sleeping? Is it typical to experience heart paplitations when falling asleep, and sometimes in middle of the night? Introduction: I've just found this forum and have read some posts here. It's been enlightening. I am scheduled for a sleep apnea test December 7th, but I have little dout that I have it - probably a serious case. The first time I noticed something wrong was in by twenties, about twenty years ago. I had gained about twenty-five pounds while in college, and I started waking up in middle of the night having to tell myself, "breath"! I never went to a doctor or heard of sleep apnea. Then I lost weight and it rarely happened. About fifteen years ago, after gaining about 75 lbs, I went through a period when it was happening again, along with heart flutters and sharp chest pains that brought me to the ER several times. I never put the heart issue together with the having to say "breath" in middle of the night, and the doctors never talked to me about it. I always had normal EKGs, so they would send me home. I did learn that I probably had something called sleep apnea about that time because I talked to a surgeon about obesity surgery, and he told me it was a comorbidity that would qualify me for the surgery. I lost some weight again, without surgery, and again the SA didn't happen much anymore. About five years ago, I gained weight the 75+ lbs again, and the SA has started happening worse than ever. It's worst when I'm falling asleep. I've been going through about three episodes every night before I fall asleep, and sometimes it feels like my heart is freaking out. About a month ago, after an hour on a cross-trainer and ab machine, I thought I might be having a heart attack - chest pain, shortness of breath, etc. I had a slightly abnormal EKG at first, but all the other EKGs and a catscan came up normal. Finally, they decided it was GERD and anxiety from thinking I was having a heart attack. I do have GERD, but it hasn't ever felt like that. Anyway, one of the ER doctors started asking me questions about sleep apnea and practically begged me to go get a sleep study. In the mean time, partly as a result of the last hospital episode, I decided to go ahead with a duodenal switch surgery after several years of considering it. When I was talking to the nurse about scheduling, she said I would need to have a sleep study before surgery and would probably need to wait a month or so after getting a CPAP before having surgery and that I would need to wear it during surgery. That sounded fine to me since I was already planning to get a sleep study, but recently I think I've gradually begun to understand that my surgery risks are quite a bit higher because of the sleep apnea. I had thought I was pretty safe with a BMI of about 41, but now I don't feel too safe. If you actually got this far, thank you so much for your patience and support. Cynthia

Hi cynthia, I didnt have a sleep study before surgery, and i never knew i had sleep apnea. my surgeon never required this test . anyway, i had surgery and when they woke me up, i stopped breathing. i was intubated and put on a vent for about 6 days, it was awful . when the breathing tube came out, they put me on a bi pap, which helped me a lot. when i was discharged i was put on 24 hour oxygen and also sent home with a bipap machine. i was never tested yet and didnt know why i needed that machine so i didnt use it. about a month later, i woke up and had a very bad asthma attack. i was rushed to the e.r. by ambulance not breathing again. i was again on a vent for a week and when i went home was only on oxygen when i slept. after that i had a sleep study, which showed that i stopped breathing 195 times in 5 hours....i was so in denial that i had it, but i am relieved to know what is wrong with me. it took a while to get used to it, but now i couldnt sleep without it. i am so rested and have lots more energy. good luck with your test, i hope you get the rest you need soon. Linda

Hi Cynthia, I don't know if I can answer alll your questions, but I can give it a stab. I had to have a sleep study before surgery because my surgery team wanted to know as much as possible about my state of health so they could handle any emergency that might come up. The surgery is very serious. The anesthesiologist knew I had apnea, so they watched my oxygen levels closely during surgery and intubated me with oxygen. When I came out of surgery, they raised the head of my bed up to help me breathe and when I went to sleep, they made me use my CPAP. Just having the surgery team know that you have apnea can reduce your surgical risks a lot. When you have sleep apnea, your blood oxygen level goes way down and causes your heart to work extra hard to pump oxygen to your brain and vital organs. If the heart has to work very hard for a long time, you could develope some heart problems ( they should also test your heart before surgery) and high blood pressure. If enough oxygen does not get to where it needs to go, your body cannot repair itself and metabolize( use, burn for fuel) your food. You do not get enough of deep REM sleep because you keep waking up trying to breathe. You might wake up with headaches, fatigue and it is difficult to lose weight. You may be irritable or have problems concentrating or working. You might feel "dull". You might actually nod off at inappropriate or dangerous times. You may have a lot of aches and pains. I am a singer, and I noticed a difference in my breathing. I had to breathe more often to sing a long line or hit high notes. Oygen is required for so many of the body's chemical processes. A huge lack of oxygen can cause brain damage and death. God Bless the doctor who begged you to get a sleep study done! If you find you indeed have sleep apnea, the machine they want you to use will improve your health, reduce your surgical risks, make it easier to heal from surgery, make it easier to lose weight and maybe even save your life. When you have lost a significant amount of weight, you can be re-evaluated and perhaps you will not need to sleep with the machine forever. I am happy that my doctors sent me for a sleep study and I am happy they had me get my CPAP machine! I felt better the first week I used it and I promptly lost 6 pounds (before weight loss surgery!). Hope this helps. Good Luck! Alice