-Me with Jackson cannula Me with Montgomery cannula
---
----Me with Montgomery cannula Close-up view of Montgomery Cannula
(or questions that you MAY have)
CPAP / BiPAP Related:
A. Under NORMAL
circumstances,
it takes around 4-5 nights to adjust. However, if
there are major
problems,
such as stomach bloating, you will NOT adjust.
Q. If the power goes out, would I suffocate in the mask?
A. No, you will NOT suffocate. Even if
you
have a quote "full mask", which covers both
the nose and
mouth,
a special valve in the mask will open so you can breathe normally.
Q. Do I really need a humidifier on the machine?
A. This is up to the individual. Some
people
get by with no added humidity, while others
have use a
humidifier
module.
Q. I see pictures of people with this crazy contraption on
their
heads when using a CPAP
or BiPAP machine. Is this uncomfortable?
A. It should not be significantly
uncomfortable.
Some people may not feel uncomfortable
at all. However,
some people who are claustrophobic (fears closed-in areas) MAY
have a problem
with the headgear. The network of straps is designed to hold the
mask firmly
against
the face. Please note that people that require high pressure settings
may have more
trouble getting the headgear to function correctly and be reasonably
comfortable.
Q. I hear some people say that they get a frightening
sensation
the first second or two when
they are first hooked up to the machine
and the power is turned on. What is this about?
A. This is a normal reaction when the
power
is first turned on or when the masked is put
into place while
the power is on. You will get a sensation as if it is taking your breath
away for a second
or two. Rest assured that it is not going to kill or even harm you.
This is a normal
thing that happens upon power-up and lasts only a second or two.
After a few
nights,
you will probably not think much of it anymore.
Q. The pressure seems to be too much for me. Can I turn it down?
A. Unfortunately, you should not change
the pressure settings without consulting your
doctor. Lower
settings may not be adequate for your particular case of sleep apnea.
Q. Every time a pressure setting needs to be changed, I am
having
to spend a night in the
sleep lab. Why is this?
A. When new pressures are being tested,
you need to be monitored for oxygen saturation
and brainwave
activity.
Q. I have a tendency to slobber in my sleep. How will this
affect
me when on a CPAP or
BiPAP machine?
A. You have a good question here. I had
this problem myself. A drug called Atrovent was
used to help
decrease
saliva production. Please note that this is more of a problem
when you have
to use a full mask (covers the nose and mouth), like I did.
Q. I noticed that CPAP and BiPAP machine pressures are
measured
in units of cm H20
(or centimeters of water). This doesn’t
make sense to me. What does this mean?
A. Sleep labs often have a device that
looks
like a barometer, but uses water instead of
mercury. Because
water has different chemical properties than mercury, the units are
different. When
a pressure of 10 cmH20 is used, it means that this pressure will raise
the water level
by 10 cm on the scale.
Q. I am a techie, and I want to know what the controls IPAP and EPAP mean.
A. If you have a CPAP machine, you will
have only one pressure setting. If you have a
BiPAP machine,
you are likely to see these controls. The EPAP setting determines
the pressure used
when you exhale. The IPAP setting determines the pressure used
when inhaling.
If these pressures are set the same, the BiPAP machine will become
an expensive
version
of a CPAP machine!
Q. I am about to get a BiPAP machine. Will I have to learn how to breathe differently?
A. Fortunately, you will NOT have to
"relearn"
how to breathe. The machine will work
with YOUR
breathing,
even if your rate changes. They are very intelligent when it
comes to this.
Q. I hear that some people complain of noise when using one of
these machines? Are
they really that loud?
A. When the mask is PROPERLY fitted and
such, noise is usually not a problem. HOW-
EVER, if the mask
has one or more air leaks, the noise problem can be substantial.
Also when there
are air leaks, the machine is not able to function as well as it should.
Please note that
it is NORMAL to have some noise when the machine is running.
Q. I have a humidifier module connected to my machine.
Sometimes,
I have water shoot-
ing out of it? Why is this?
A. This can result when you turn the
power
on BEFORE connecting the mask to your face.
This is because
the pressure BEHIND the water is much greater than the pressure on
the other end.
However, if you connect the mask to your face BEFORE turning on the
power, the
pressure
is roughly equal in the humidifier module, and you are not likely to
have water coming
through.
Q. I hear that humidifiers can spew germs of all sorts. How
can
I avoid this with the humidi-
fier module?
A. The humidifier module should be
emptied,
washed, rinsed, and allowed to dry everyday.
Please see the
instruction manual for your humidifier module for proper cleaning
instruct-
ions.
A. Pressure- PSI = Pressure CPAP x 0.0147
Likewise, the opposite can be used:
Pressure CPAP = Pressure PSI x 68.02721
Tracheostomy Related:
Q. Will I lose my voice if I get a tracheostomy?
A. Fortunately, your voice WILL be left intact unless you have
cancer
in there.
Q. I am a singer. How will a tracheostomy affect my singing voice?
A. If you are getting a tracheostomy for sleep apnea, you’ll be
able
to plug it up during wak-
ing hours. When it is plugged, there is little or no effect on the
singing
voice (or speaking
voice). However, when the tracheal cannula is unplugged, you may be
lucky
to get three
or four words out in one breath. Fortunately, you will have it
open
mainly when in bed
or cleaning the cannula. If you get a Jackson cannula or one of its
variants,
you may have
a 20% decrease in voice performance (usually it is about 10
percent).
If you get a Mont-
gomery cannula or one of its variants, there is a good chance that it
will
have NO effect
at all on your voice.
Q. Would I still be able to breathe normally if I get a tracheostomy?
A. Fortunately, your breathing will not be affected, or at least
not much. Even if the cannula
clogs up, you’ll still have your native breathing route. However, it is
important that the
cannula be clear of debris when you are sleeping so it can do its job.
Q. I am very conscious of my appearance. How would a tracheostomy
affect my appear-
ance?
A. If you have a Jackson cannula or one of its variants, you
will,
unfortunately, have more
of a problem, for you will have a string or trach tie around your neck
in addition to a
faceplate over the hole in your neck. If you have a Montgomery cannula
or one of its
variants, then you are lucky. No trach ties or strings are needed
around
your neck,
AND the cannula is much less noticeable. HOWEVER, you may need to wear
shirts
that come up rather high on your neck in order to help hide the
cannula.
Also, you
may not be able to safely or comfortably wear a shirt tie for at least
six months to a
year.
-Me with Jackson cannula Me with Montgomery cannula
---
----Me with Montgomery cannula Close-up view of Montgomery Cannula
---
Q. I like to swim or lie in the tub. What are the implications here?
A. If you have a Jackson cannula or one of its variants, I’m
afraid
you have a problem!
While some people manage to tape or glue plastic in place, use EXTREME
caution
if you try this. If you have a Montgomery cannula or one of its
variants,
you may be
lucky. If you have a good airtight seal around the cannula, you may be
able to lie in
a tub or even swim as long as you don’t go down more than a few feet.
Q. I have a Jackson cannula in me, and I sometimes get water in
my
trachea when I take
a shower. However, I hear that some people with Jackson trachs don’t
have
this
problem. What can I do?
A. Probably the simplest solution would be to make a small
plastic
"bib" that would cover
the trach and would be tied around the neck. Below is an example of
such
a cover
made from a Glad white kitchen garbage bag. This should alleviate
probably
90% or
more of your problem. To be effective, it should be snug against the
neck,
but not too
tight. It should not be uncomfortable.
Homemade plastic trach cover Trach cover in use-----
----
If you are looking for something long-lasting, you can check out a site
at
http://www.kapitex.com/products/clothing/products-clothing3.htm.
Q. I am thinking about trying to go through with the tracheostomy
under just local anes-
thesia. Do you think I can withstand the surgery like this?
A. Believe it or not, but I went through it myself this way with
no overwhelming problems.
The worst parts is the skin numbing and the occasional pressure on the
neck. How-
ever, if you have a low pain tolerance, you may wish to ask to be put
to
sleep.
Q. How long does the surgery last?
A. It normally lasts about 45 minutes.
Q. How long would I be in the hospital if I have a tracheostomy done?
A. You can expect to stay about 1-2 nights in the hospital.
Q. How long does it take to recuperate from a tracheostomy?
A. The worst part is usually over within a week. However, it
takes
about six months to a
year to really heal up good.
Q. How soon can I expect to reap benefits from my tracheostomy?
A. There is a possibility that you may begin to reap benefits on
the first night! However,
I didn’t reap much benefit the first night due to chronic
bronchitis.
I did reap notice-
able benefit on the second night.
Q. I heard that some people’s rooms at home resemble an ICU. What
is the likelihood
that my bedroom would resemble a darn ICU?
A. Most people that have a tracheostomy for sleep apnea will NOT
have this problem.
In fact, my sleeping quarters does not look much different because of
my
tracheostomy.
However, I have a FEW extra things in the bathroom for daily trach
care.
Even if you
have a lot of mucous, phlegm, and/or pus, you will probably just need
some
swabs,
tissues, and possibly a small bottle of saline solution so that you can
do a "quick fix" in
the night if the cannula clogs up.
Q. Is a tracheostomy reversible?
A. Fortunately, all tracheostomies are technically reversible.
However,
some of them are
designed to be EASILY reversible. However, more permanent
tracheostomies,
such
as mine, are much less problem-prone.
Q. I hear stuff about Montgomery cannulas, button cannulas,
Jackson
cannulas, Shiley
cannulas and more. What are the differences and which is the best?
A. A Jackson cannula has a curved tube that goes into and down
the
trachea. Shiley is
a brand of Jackson cannulas. A button cannula is straight and simply
goes
into the
hole in the neck and SLIGHTLY into the trachea. A Montgomery cannula is
one
kind of button cannula. Button cannulas are used mainly for severe
obstructive
sleep
apnea, such as mine. For obstructive sleep apnea, button cannulas are
far
superior
to their Jackson counterparts.
Q. I hear all this stuff about tracheal cannulas. Why do I need a cannula in the first place?
A. If you go too long without a cannula in the hole in your neck,
the hole will eventually
shrink and possibly even close up! This is much more of a threat with
new
tracts
(tracheostomy pathways that are less than three weeks old). I had
a problem where
my original Montgomery cannula was shot out, and the hole nearly closed
up in only
six hours! However, this was only five days after the surgery.
Q. I hear that some people use a sterile technique when doing
trach
care while others don’t.
Why the discrepancy?
A. People who have impaired immune systems are much more
susceptible
to respiratory
tract infections and must use sterile techniques. However, people that
have a trache-
ostomy for sleep apnea should not have to worry about this.
HOWEVER,
you should
have good hygiene and wash your hands before doing trach care.
Q. I need some saline solution for doing my trach care. However,
I can’t get the bottles of
saline solution like the hospitals use. What can I do?
A. Fortunately for trach care, you can whip up your own saline
solution.
To make it, mix
one tablespoon of salt per quart of water and boil this stuff for about
15 minutes. After
it cools, you can put it into a clean jar or bottle for later
use.
It also does not hurt any-
thing to mix some hydrogen peroxide solution with the saline solution
in
about a 50:50
mixture (does not have to be exact). This will make the mixture more
effective
for
cleaning stubborn debris and also help the solution remain usable over
a longer period.
Q. My friend had a tracheostomy and is just coughing his head
off!
Am I headed in this
direction?
A. Your friend may have bronchitis, which MAY have been present
before
the trache-
ostomy. A tracheostomy can aggravate pre-existing bronchitis,
especially
if a Jackson
cannula is used.
Q. I hear that some people get along with a tracheostomy very
well
while others have a
horrible time with it. Why is there such a range here?
A. Those that have short-term temporary tracheostomies or have
their
voice box removed
have a much harder time. If your tracheostomy is long-term or permanent
and you have
obstructive sleep apnea, the prognosis is much brighter for you.
Q. I hear some people saying that it would be weird breathing
through
your neck! Is this
true?
A. Believe it or not, but you will probably adjust to it very
quickly.
Please remember that
your NATIVE breathing routes will still work. The tracheostomy creates
a BACKUP
breathing route just in case if your normal route gets obstructed, such
as when you
sleep.
Q. What are the implications if I get a cold and/or flu?
A. Probably the most bothersome problem will be increased
drainage
from the stoma area
and probably more junk in the cannula. You may have to clean out
your cannula more
frequently. If you get a lot of drainage around your stoma, you
may
need to tape a
gauze pad below your stoma and cannula. However, be sure to
remove
this and clean
the area with at least saline solution at least once a day. At
night,
you may need to place
a clean bath towel under your head and upper body area so that this
drainage
does not
land on your bed and cause an infection later on.
Q. Q. I get a lot of drainage from my cannula. It is making
a mess out of my bed! What can
I do? I’m afraid that this stuff may cause me an infection later
on.
A. You have a very good question
here.
Yes, the stuff is ugly, messy, and possibly infectious.
You can try draping a clean bath towel over your pillow and the top 1/3
or so of your bed.
If problems are more severe, you may need to even place a sheet of
plastic
under this area,
and then place the towel over the plastic. WARNING: If you
must use plastic to help
contain the mess, be SURE to use plastic that is at LEAST 2 mils
thick.
Using plastic
thinner than this will increase the likelihood of it finding a way to
cling
to your face and
possibly cause suffocation. If there is any danger of things
getting
turned over during the night,
you may wish to even tape or strap the plastic and towel down against
the
bed so that it can’t
find a way it get itself wrapped around your head while sleeping.
Q. My cannula is getting occluded by my shirt, even though I try
to keep the area exposed.
What can I do?
A. Well, I’m afraid that you have three
options.
One option is to sleep with no shirt on.
However, this may be a problem in the Winter. Another idea is to
wear a tank top to bed.
Again, this may be a problem in the Winter. The other option is
to
take a pair of scissors
and cut out a nice area for your trach. Since you probably would
just wear this shirt to
bed, it should not be a problem cosmetically.
Q. I am having a problem with my cannula getting occluded by my
chin
when I sleep!
What can I do about this problem?
A. You have a very good question
here!
While attachments and such can be made or
purchased, these may create problems of their own, such as if you need
to momentarily
occlude your cannula in order to cough or talk. Attaching a long
tube may alleviate the
immediate problem, but cause increased respiratory resistance and
reduced
gas
exchange, in addition to creating the danger of accidentally lying down
on and compress-
ing the tube. In addition, adding anything heavy and/or bulky can
increase
the risk of
accidental decannulation. So called “lengthening” your cannula by
adding a stiff tube can
increase risk of injury to your trachea in the event that the cannula
would
get pushed into
your trachea too far. About the best solution that I can think of
is to attach a short
FLEXIBLE tube that can’t easily be pitched closed or kinked. This
should not protrude
more than about 2-3 inches from your cannula. Also, the tube
should
preferably fit OVER
the cannula rather than IN it in order to improve efficiency.
WARNING:
Be sure to smell
the tube before installing it for the first time, for many tubes have
an
odor that can cause
major problems when connected to your cannula.
Q. I had a tracheostomy for sleep apnea. However, my waking
hours are not improved
much, if any! What do I do now?
A. You likely have at least one of two
problems.
First of all, your cannula may be too
small for your particular needs. Sufferers of obstructive sleep
apnea
generally need a
least a size #6 cannula. In rare cases, you may even need a size
#8. The other culprit
is the presence of CENTRAL sleep apnea. In either case, talk to
your
doctor about
possible solutions. You may even have another sleep problem on
top
of your sleep
apnea, such as narcolepsy and/or depression. Also be sure to take
into account any
medications that you may be taking. A LOT of medications have
drowsiness
listed as
one of their potential side effects. Also, if your “biological
clock”
is out of kilter (hours
all screwed around), it may take 2-3 weeks to get your system back into
“sync” with
a normal schedule. Also, a heavy breakfast and/or lunch could be
feeding your problem.
In addition, even a low grade infection can cause drowsiness and poor
daytime
per-
formance. Some infections can go on forever until they are successfully
treated.
Q. In the event that I would accidentally knock my cannula out or
it would take a while
to clean it, how long can I safely have the cannula out of my stoma?
A. If your tracheostomy was recent (within
5-7 days), you need to work quickly. You
need to IMMEDIATELY clean your cannula and try to get it
reinserted.
If you are
not sure about what to do, call your doctor IMMEDIATELY. If your
tracheostomy
is less than 5-6 months old, it is preferrable to get your cannula back
in within 5-15
minutes. If your tracheostomy is at least 6 months old, you
should
be able to have
up to about a half hour or even an hour. However, going more
than
four hours
may necessitate the need for another surgery!
Other Miscellaneous Questions:
Q. I was diagnosed with SEVERE obstructive sleep apnea. What
would
be the least painful
and/or easiest solution for my problem?
A. If the sleep apnea is severe, probably a tracheostomy would be
the best way to go. Suff-
erers of severe OSA (obstructive sleep apnea) do not fare well on CPAP
or BiPAP
machines, because they have to use such high pressure settings.
While
mandibular
advancement may offer significant benefit, it is a horrible surgery to
go through.
Q. Is there such thing as "outgrowing" sleep apnea?
A. I’m afraid it is time to break out the pipe organ and start
playing
"Toccata and Fugue!"
Unfortunately, sleep apnea tends to get worse if not corrected. The
main
exception to
this rule is if the obstruction was caused by fatty deposits in the
throat,
and weight loss
alleviated this.