Sleep Apnea Surgery
A yuletide log of surgery, recovery, and hope
Hello Again
Been a while. Hope you’re well.
Since last time, I’ve still been continuing to live a regular life, getting to activities that were beyond my reach pre-CPAP.
Put aside a lot of the deep emotional processing so that I could get this project over the finish line, so probably gonna resume that in the new year.
Today, I’ll recount the tale of a boy with a simple dream, to breathe, and the pound of flesh he exchanged for a chance at inner peace.
Reactions and Discussion
A few things have stood out from people’s reactions when I talked about the surgery. Including frequently asked questions, with answers below (as conversations permitted).
Surprise. Learning that sleep apnea could be treated surgically.
Deep concern that I had an operation at all. “Oh my god, you had surgery?! Are you okay?!” A few clutched at their chests or put their hands on my shoulder. Yes, and yes. I was most surprised by this reaction, which I suspect is related to a CPTSD-esque self-abandonment thing. Kind of expected a neutral but curious attitude of “Oh, you tried out that new restaurant? How was it?” Instead, everyone, including acquaintances and people I just met, were gravely concerned and feared for my wellbeing. That was nice, and I should probably think long and hard about why I expected nobody to care.
“What kind of surgery?”
Five procedures: three in the nose, two in the throat.
Septoplasty to straighten my deviated septum. Estimated 30% obstruction in my right nasal passage.
Bilateral Turbinate Reduction Rhinoplasty to reduce the size of the turbinates in both sides of the nose; not sure which ones. See diagram below. Humidify, heat, and filter air coming into the nose. When they’re too big, they block air from coming in as easily. Improves pressure in upper nasal passage. Reduces mouth breathing. Improves sleep quality and reduces daytime fatigue (!!!) 💀
Columellar Rhinoplasty to increase size of nostrils. Tightens up the columella (skin separating nostrils). Also done cosmetically to address “hanging/drooping nose.”
Uvula-Preserving Palatopharyngoplasty (UPPPP) to move the flaps in the back of my throat out towards my molars to open up airway. Like opening curtains in a theatre. Not to be confused with uvulopalatopharybgoplasty (UPPP), where the uvula was not preserved.
Tonsillectomy to remove tonsils and open up airway.
Sombre grief.
“Wow, after everything you went through in childhood, you also struggled to breathe at night?”
Yes.
“If you can’t breathe or sleep well, what’s the point of going on?
I don’t know.
“How did you make it this far?”
I don’t know.
My apnea score was only moderate. I’ve met a few people with severe sleep apnea, with quadruple my AHI score.
On the Epworth sleepiness scale, I rarely fell asleep randomly unless I was in bed, e.g., after work. Never reached narcoleptic levels.
From those who also have OSA or who share beds with people with it: “Tell me everything.”
“Do you have a CPAP?”
Yes, and a mouth guard.
Since I have to clean both daily, I don’t always use them every night. When I do, I still sometimes wake up and find both on my nightstand with no memory of removing them.
“What made you decide to get the surgery?”
To improve my sleep duration and quality, whether or not I use my CPAP and/or mouth guard.
Who knows? Maybe after I recover completely, I won’t need either.
“What was your sleep score?”
AHI score was 16 events/hour, just within the moderate range.
“How long was the surgery?”
Maybe around two hours?
My ENT performed surgery on four patients that day. I was third, and the fourth was scheduled 2.5 hours after mine. *shrug*
“Was it painful?”
Yes, the first three weeks were torture. All three painkillers combined weren’t strong enough.
I had to space them out carefully because they all had Tylenol. They maxed out my liver’s ability to process acetaminophen/paracetamol. Death by painkiller overdose can be a result of too much Tylenol.
“Can I get in with your ENT?”
Alberta Health Services (AHS) and your insurance provider would probably prefer a doctor’s referral (preferral).
My family doctor referred me. It was a yearlong wait for my appointment.
“Did it cost you anything?”
Universal healthcare, baby.
Minor loss of income from taking time off work.
Buying special food for recovery, like tofu and chocolate.
That’s the gist of it. For those interested in the gory details, read on.
Editor’s note: I would normally cut out a lot of the following details in a regular post, but I’m going to keep it lengthier for those who might consider taking the plunge themselves. There are plenty more details I could get into, but mostly keeping whatever stood out to me. Apologies in advance for the absence of brevity.
Pre-Surgery
Back in June, surgeon asked when I wanted to schedule the operation. And though I would book it and also possessed a few diagnoses and pieces of equipment to improve my catnaps, I couldn’t exactly be passive about it all in the intervening months. I was still experimenting with the CPAP machine, eye mask, medications, timings, wind-down routines because the specific variables and results would come front and centre immediately after the operation. Surely I could have taken the waiting period lying down, but that seemed…irresponsible.
I tried not to research anything about the procedures. I don’t generally enjoy looking at medical images, least of which the before, during, and after photos. Plus, frankly, I was busy, still enjoying my enhanced productive capacity powered by the CPAP+mouth guard combo.
A month before the procedure, I received an email about a new questionnaire in my MyAHS portal asking for medical history, prescriptions, lifestyle, family history, etc. Shout out to my favourite aunt who helped me with the extended family details.
The hospital also scheduled a call two weeks before the big day to go over all my submitted responses.
“You used to smoke? How many packs a day? Oh, it was actually an e-cigarette. When did you quit?”
“Bring your CPAP machine so that you can sleep after the operation. Label it with your name.”
“Stop taking any vitamins and supplements seven days before your surgery. Night before and day of, take your prescription medications as normal.”
On the eve of the surgery (surgeryve), I was supposed to call the hospital to get my time slot. I, uh, forgot, but they kindly called and left a voicemail.
9 AM surgery time. Show up at 6 AM. Don’t eat or drink anything after midnight.
Probably quite costly when people are booked for surgery and don’t show up. I went bouldering because I wasn’t looking forward to being bed-bound and losing all my gains. I also stayed up late to get some chores done since I wouldn’t be able to for who-knows-how-long. Took my Intuniv as instructed.
Surgery Day
I slept about 3 hours. Popped a Vyvanse. Anticipated the discomfort of taking an upper before going under and trying to go down for a nap after getting cut up.
Parked and found the way through the maze of the Peter Lougheed Hospital with my home nurse. Updated my address with the information desk. Got a personalized wristband. QR code enabled entry into one of the most exclusive parties at the club.
Second floor, Day Surgery unit.
Big whiteboard with all of the operations grouped by surgeon, sorted by time. I was the third of four patients. First two were only 40 minutes apart, with 2.5 hours between mine and the fourth. When did the first two have to arrive this morning?
Beds arranged like a zipper along a large U-shaped room. Thought of how people in Gaza would respond if Albertans said our hospitals were overcrowded.
Found my bed. Little pile of folded cloths waiting for me. Hung up my jacket. Put my CPAP, chargers, and other belongings into the little nightstand drawers. Slipped on my gown, booties, and hairnet. Hung tight while staff, patients, and family buzzed about. Day Surgery nurse took all my medical information. Chilled for three hours while different members of the surgical team came by to visit. Surgeon. One anesthesiologist. Surgical nurse. Two anesthesiologists.
Asked about mixing the stimulant and sleep potion. “If your Vyvanse has a power level of 1, then the anesthetic would have a power level of 1000.”
Despite already digitally providing all manner of medical history, I would continue to verbally recite the same answers about five more times before hitting the operating room. They probably do this so that the anesthesiologists get all of the possible information to prevent any undesired drug interactions. “Think of us as priests. You wanna tell us everything,” said one. I can be honest to a fault, but I suspect that they’ve had important data slip out after the sixth or so questioning from those that wanted to hide something. Felt like a lie detector test. Maybe answers tend to escape based on how different people with different personalities phrase the questions, or maybe it’s a form of spy movie interrogation, but altogether, it seemed vitally important to answer truthfully every time; with consistent confidence, at that.
Surgeon said I was lucky to be having my surgery before the nurse’s strike. I support labour rights. If it were called, non-essential surgeries like mine would be delayed in favour of minor operations for trifles like cancer. Mine was some 3.5 years in the making, so trying to plan for contingencies like a strike was simply a matter of luck. Who could blame 16,000+ healthcare workers for wanting better pay after COVID, increased responsibilities, and the recent explosion in living costs? A deal with retrospective pay increases was ratified shortly after.
Home nurse went home to nap because it was still ungodly early. No reason for both of us to feel like shit all day.
Wheeled to the operating room by a nurse who seemed dead-set on telling me about her children, who were both in competitive sports programs at their schools and playing abroad. Got out of my bed, walked to a new one in the OR. The whole team was there except the ENT. They were strapping this thing to me and putting a blanket here and moving my arm thisaway.
“All ready to go?”
Actually, one last request. The senior of the anesthesiologists seemed caught midway into injecting me with something.
“Oh, sure! What’s up?”
Too embarrassed to share what I requested, but they graciously agreed. The syringe plunger went all the way down.
*fade to black*
Post-Surgery
Woke up to the din of a large, busy room. Couldn’t open my eyes, didn’t want to.
Inhaled nasally. Thought to myself, “Wait, have all of you been able to breathe like this the whole time? What the fuck.”
Parked next to a nurse seated at a computer station. Breathed deep, felt wet resistance in lungs. Coughed hoarsely. Productive and painful.
Nurse asked “Did that hurt?”
Yes.
“Do you need a painkiller?”
Yes.
*Morphine*
Pain remained but felt different. This experience would become a central theme for the next three weeks. Dizzy now too.
Swallowing hurt like knives. Also a central theme for four to five weeks.
Nostrils didn’t ache terribly unless poked. Outside edges were inflamed, like when catching a seasonal bug. Columella was tender.
Eventually realized I was sporting a Moustache Dressing, taped under my nose. Like Einstein’s but soaked in warm, wet blood.
Wheeled back to my original area in Day Surgery. Would lay in bed, moaning and partially conscious, for another 6 hours. Home nurse was already there waiting.
Groggy af. Apparently, my liver had been sleeping on the job since I stopped drinking in 2024. Hadn’t had much to do by way of detoxifying poison from my blood. Took its time to clear anesthesia compared to patients who drank regularly, so said the surgeon. Clear evidence that I led a healthy life. It is healthier to be sober and recover from anesthesia slowly than to drink heavily and clear anesthetic quickly.
Everything went well with the operation. No complications. Surgical team passed on my request, which she fulfilled.
At some point when drifting away, heard chatter of pharmacies, prescriptions, and medical certificates. Was advised to sleep at elevated angle, even at home.
Changing the moustache dressing induced a horrible scent. Thought it was from the new gauze. Spoke with surgeon, and thought it was from cauterizing throat wounds. Finally realized the source was the tape wrapped around my nose. I was asleep when it was applied, so I adjusted to the aroma unconsciously. Only noticed it again after my smell receptors cleared in the brief moments during the swap. That poor nurse, who thought she did something wrong performing a trivial task in her long list of responsibilities. Alas, good sign that my nasal airflow improved. Nauseating though. Despite the overwhelming suspicion that some important body parts were recently severed, I was able to quietly rejoice in the modern miracle of truly smelling the flowers for the first time ever, albeit a flower apparently made of burnt rubber.
Grogginess and headache from anesthetic. Dizziness from morphine. Nausea from the dressing tape. Head hurt more than my wounds. Given an anti-emetic; Gravol, I think. Was told to sleep and that the grogginess would fade. (Narrator: He did not, and it did not.)
Donned an eye mask in bed and polarized sunglasses for wandering about. Painfully bright.
Sucking on ice chips was supposed to help with the throat soreness. One nurse brought me a post-op popsicle (post-opsicle). It was cool, refreshing, and sweet, but no, the cold did not help with the pain. In fact, it sensitized the surgical site even further. Instead of my throat simply hurting, I could now sense the same pain level but in 4k.
“But wait, you did it wrong, Jon,” so saith my self-critic. “You’re supposed to keep chilling the area until it numbs.” Also tried that. Never happened. How much ice do you figure it takes to numb the nerves of intact tonsils in a warm-blooded person? Could barely open my mouth. Foisting ice cubes and post-opsicles onto my still-bloody wounds aggravated the nerve cells on the outside of my throat. I do not recommend this treatment.
ENT came back one last time before heading home for the day. Asked if I wanted to stay overnight in Day Surgery. Announced that I felt like puking, and she said maybe I should because I’d probably swallowed a lot of blood. Quietly wondered what stomach acid would do to my raw throat proteins (throateins). Responded that I’d be better off at home, dreading the cold drive. Reassured me again that everything went really well and to take my time getting better. Patient #4 was already sitting up and smiling, so clearly she knew what she was doing. Bade farewell, turned, and walked off into the night. Badasses rock Hello Kitty.
Tried to get some rest and relaxation unsuccessfully. Though the room cleared out of most staff, patients, and caregivers compared with the morning, a healthy composition of dings, beeps, clangs, and shouts gnawed at my soul. Felt more like a discarded pile of impulses than a person. Head spinning and stomach turning, I started packing up and limping toward the exit. Nope. Need to be wheeled out in a wheelchair. K.
Wheeled past my septoplastic comrade. Acknowledged moustaches.
Reached the ground floor unbothered, and detoured into a bathroom to hurl. Examining my work, all I could see was darkness -- blood plus the faint evidence of a post-opsicle. Thanked the Lord I didn’t vomit in or on the car.
Posted up near an exit to wait for my home nurse to swing around with the car, next to what turned out to be a one-way door that blended into the wall. Met the bewildered glances of a few hospital workers whose gaits caused the trick door to swing wide and lightly bump the foot of my wheelchair. Tried to push myself clear, only to discover the wheels had locked. So little life-force remained to address this non-problem that I endured several encores of this interaction. Everyone survived.
Winced all the way home. Only accosted my driver once for their elevated rates of acceleration and deceleration. It was cold and dark, and everyone was rushing home after work.
Intermission: Fun with words
Rhino-plasty. Rhinoceros getting a plastic horn.
Pharyngo sounds like Ringo.
You can use the full name of the procedure or abbreviate it, depending on how much time you want to save. Bilateral turbinate reduction rhinoplasty becomes bilateral turbinoplasty for short, or biturbinoplasty for shorter.
Home Recovery
Made it into the parking garage and up the elevator. Stumbled into the door in time to regurgitate into the porcelain throne. Perfect aim. More darkness. Raw blood was not sitting well gastronomically.
Grabbed the big pillows. Bed. Siri, turn off all the lights. Deputized a nearby bin as a spittoon/drool tank.
Meds
Home nurse left to retrieve the ingredients for a drug cocktail:
Prednisone
Steroid to reduce inflammation
Three per 24 hour period
Amoxicillin
Antibiotic
Once daily for a fortnight
Tramadol + acetaminophen
Short-acting painkiller
aka Tramacet
Technically valid alternate names that pharmacists don’t recognize yet:
Trylenol
Trymadol
Tyledol
Every four hours. Did not miss a single dose.
Tramadol XR
long-acting painkiller (eXtended Release)
Also had acetaminophen
One per 24 hours
Rhinaris
Nasal spray
Hydrates the surgical site
Thrice per solar cycle
Oxycodone
Apparently also loaded with acetaminophen/paracetamol.
Puts the -cet in Percocet.
Max four times every 24 hours
Didn’t get the Percs until the next morning. Pharmacist from the night before was confused why I was prescribed so much acetominophen and advised my home nurse to come back if pain didn’t subside.
Kept track of dosages with a paper notepad and clicky pen. Didn’t want to deal with my phone and swiping away notifications or failing Face ID with my cotton ‘stache. Don’t usually take my phone into bed anyways. Had to set the lamp brightness to 1% multiple times in the middle of the night to log the timestamps for a couple weeks, but otherwise, an easy tradeoff.
I was to keep my regular medication schedule following the procedure, but it made little sense to take my stimulant during recovery. Pharmacist asked “is there something he needs to be focusing on?” Sleep. Just sleep.
Dine-In Menu
With pain registering from opening my mouth or moving my tongue in the range of mere millimetres, dietary options were limited.
Types of foods that were not on the menu:
Crunchy
Chips
Pointy
Chips
Spicy
Chips with salsa
Acidic
Coffee
Scratchy
Many
Tall
Most
What I consumed:
Bowl of oatmeal (boatmeal) with scoops of chia seeds, dark brown sugar, and peanut butter
Get your dietary fibre, kids.
Obstruction from painkillers is real. Popped some stool softener pills after a few days.
Chia seeds have greater fibre density and nutritional value than fibre supplements.
Tofu
Soft and chilled
Mostly the flavoured dessert type
More soothing than ice cubes
Takumi!
Miso soup
Simple to make
More soothing than ice cubes
Bone broths
Warm
Hydrating because salt
More soothing than ice cubes
Cadbury Dairy Milk
Is there no more joy left in this life?
Taller than I would have liked but worth it
Pedialyte
Hydrating because salt
$13.49/L + tax
Oral Rehydration Solution
Hydrating because salt
WHO recipe: 1.06 L water, 3 g salt, 30 g sugar.
$0.03/L
Day 2 of recovery, the Foothills Sleep Clinic called and said it was my turn in line for a CPAP machine trial. Poetic. Only a two-year wait. I hope that someday our government provides adequate funding for all medical programs rather than slowly ushering in private healthcare. A boy can dream.
Fumbled the refilling of painkillers before the first weekend. Unpleasant.
My breathing rate showed a lower trend after six days, 13.1 breaths/min vs. 16.6. Turns out the reduction was from not taking stimulants. Rate increased after I resumed.
Pain became “manageable” at precisely the one week point. To the hour. Fascinating. Hard to describe the difference. During the first week, they reduced some of the pain by 20%. For the second, maybe 30%? Continued to break through, but felt different.
Ached when speaking, so whispered. Audience couldn’t always hear, so repeated myself in agony. Had randomly created a Personal Voice on my phone some time ago, so used that for a bit.
Mustered up the courage to look inside my mouth. Seeing the scabbing helped to make sense of the sensations. Existentially, suffering is meaningless, but you can create your own meaning from it, and I did so by opening my mouth and saying “Ah.” Scabs looked rectangular. Still dark red after a week.
Noticed when the stitches in my mouth flaps dissolved. It was like a fish bone, stuck in between my molar and tongue, dislodging itself. Minor but sweet relief.
Another list of random observations collected during the remainder of recovery:
Can’t exert your body because you need to reserve energy for rebuilding tissue.
The AHS handout recommended that I go for short walks to lightly load my body and gradually increase the distance every day, but the cold irritated my airways.
Still preferable to surgerize outside of the precious summer months.
Hurt to:
smile
laugh
pop ears
yawn
pick food out of teeth with tongue
Antibiotics reset all the hard work I did on my gut microbiome since the last course of antibiotics. Better than getting an infection, but damn.
Sense of smell comes and goes in intensity. Sometimes stronger than before, sometimes fainter. Food doesn’t taste as strong at the moment.
Uvula feels funny still, one month out. Inflamed. Larger than normal. Sometimes gets in the way of breathing through my nose when laying on my back.
I’ve been more sneezy lately.
Allergies? Three years into shots, out of five.
More airflow than ever, so could be an irritant like dust?
Hard reset
Quite a long while since I got back to basics. Like, learning how to eat, breathe, sleep. How to function.
Every little idea, project, work-in-progress stopped for the greater good. Most still in limbo.
ADD meds hit a bit different with all this extra oxygen, so titrating again.
Energy curve
Sleep schedule bounced all over the place while skipping Vyvanse. Multiple hours-long naps per day early on.
Fascinating to be able to reliably fall asleep within minutes now.
After third week, ENT stopped refilling pain med scripts. Advised to switch to Tylenol or Advil, unless I really needed more. I did, so she prescribed mar-karalatol. Shortly after, I stopped taking painkillers altogether. Main pain sensation now is from yawning.
Since I chose late autumn, recovery has been funny because everything isn’t “real life.” At work, it’s year-end and holidays. Socially, people are travelling, though some folks were able to sneak in a little meal before the new year. The climate is cooler, so physical activity is generally lower. The combined effect is that recovery is hard to gauge since aspects of the environment are outside of normal limits.
Worth?
Yes, I would do it again.
Forecast said minor improvement with major pain. I would say moderate improvement, qualitatively. Suppose a new sleep study after six months or so would render a clearer judgement.
Funny thing about pain and the brain is that I can’t even remember what it felt like anymore, six weeks out.
Using mouth guard and CPAP still. While I can, and do, go without, my overall sleep duration and quality are vastly better when combining all therapies. I actually even feel refreshed some mornings. There isn’t such intense pressure to prep them every single day or to wear them every hour of the night.
Struggled with stress management before, and now I have greater executive functioning to improve decision-making and avoid what used to seem like unavoidable stressors. Able to “sleep it off” now.
Nighttime anxiety improved after the operation, though technically inconclusive while still on painkillers. Derived from at least two sources: struggling to breathe during bedtime and daytime. Nervous system calmer now. Wind down routine actually works for a change. All it took was five procedures paid for by a single payer healthcare system, a $500 3D printed resin mouth guard, and a $2,500 CPAP machine with accessories. Easy peasy. What is there even worth worrying about anymore in this existence?
Still too early to provide a complete review, but initial impressions are extremely positive.
Wrap It Up
Sleep apnea surgery. Straightened septum. Reduced turbinates. Enlarged nostrils. Removed tonsils. Moved flaps.
Ouch. Painkillers. Slept lots. Ate simpler.
Still recovering. Sleeping better with CPAP and mouth guard.
Feels like waking up for the first time. Grateful. Humbled. Shopping for Hello Kitty merch as a thank you.