As disclosed in my earlier post, I had undergone the “sleep apnea” surgery. What seemed like a firmed decision was actually the culmination of a drawn out process analysing the causes and evaluating the pros and cons. Here was the “origin story”.
I had been plagued with snoring issues for years. As I aged, it grew worse. It didn’t matter that I lost weight while I was in Canada. My theory is that ageing has a greater impact on the snoring severity.
During the pandemic, when we were all working from home, I started noticing that I stopped breathing while taking naps. I would jolt up from sleep after holding my breath for some time. Apparently, I was able to detect that as my naps were “light sleep”. There should have been similar incidences at night, during deep sleep, just that I wasn’t aware of the episodes.
Monitoring my sleep
The episodes got frequent enough for me to start consulting medical advice. I was referred to Seng Kang Hospital’s ENT, where the specialist sent me home with a monitoring device. The device was like a watch with an oxygen tracking device pegged to the finger. I was to wear it to sleep overnight and return the device to the clinic the following day.
The results confirmed my sleep apnea suspicions. However, since the number of incidents that night was borderline moderate, the specialist wanted to try out a less invasive solution first – the CPAP machine.
CPAP – Basics and Associated Costs
CPAP (continuous positive airway pressure) is a machine that uses air pressure to keep breathing airways open while one sleeps. I found the online explanation too mild. Since I was at borderline moderate risk, the intensity was tuned at the lower levels. Even then, the air pressure was great. The machine basically tried to force air into our lungs while we slept.
CPAP was also referring to the pump and the breathing apparatus attached to it. Some advanced CPAP machines had additional add ons, like the ability to send data to the cloud, minimising the need for frequent specialist visits. There were also those with attached humidifiers, while some were scaled down versions suitable for air travel.
Back to the clinic, the idea was for me to rent the machine for a month to try it out. Thereafter, I could decide whether to purchase the machine, which cost between SGD 1,000 to SGD 2,000. Even then, I had to purchase the breathing apparatus first, since it was like a mask and could not be shared.
The breathing apparatus came in 3 types – a “normal” one where it fits over the face like an oxygen mask we see on TV, a toned down version where the mask just covered the nose, and a last one where the breathing tube extends over the head. They cost different, and the one I chose that covered the nose only cost SGD 187.50 and SGD 27.50 for the tubing. Together with the rental fee of SGD 57.90, the rental cost SGD 272.90, excluding consultation fees.
The clinician explained how each type of apparatus worked, and also made sure the breathing apparatus was a fit for me. He also went through how to operate the device, and what to do when the mask came loose. Additionally, he introduced me to the various devices available on the market, so that I could take the time to consider what I’d eventually buy. Like the sleep monitor, I was to return the device at the end of the rental period.
Trying out the CPAP machine
The machine itself was easy to operate, since it was simply to turn it on and off. I was able to tweak the air pressure or fix a humidifier, but I didn’t have the need for either of them. What was more challenging was how we put on the mask. Simple as it might be to just secure the straps around the head and fixing the mask over the nose, it required some getting used to breathing with the device.
Once turned on, the machine pumps a steady stream of air out of the mask. Apparently, more expensive devices were quieter. Once the mask was fixed onto my face, I had to start breathing. The moment I hesitated, the air would be forced out of my mouth, resulting in a choking incident since it would be difficult to resume proper breathing with the combination of choking and air pumping into the nose.
This became a nuisance at night, but it usually occurred at the earlier stage of sleep. Once my body got used to the rhythm, breathing through the machine became natural.
Then came the other nuisance. I had to stay entirely still throughout the night. Even a slight change of my head’s tilt caused the mask to come loose. And when the mask came loose, the air started gushing out from the top into my eyes. That was enough to jolt me from sleep. The specialist noted that my sleep apnea incidents had reduced while I was using the machine, but since I was woken up several times during the night, my overall sleep quality didn’t improve at all.
This became the deal breaker for using the CPAP machine. None of the breathing apparatus could strike the balance between a suffocating fit and a mask that drops off at every slight movement. I didn’t spend all the time and money for a half-baked solution. Therefore, I opted for the surgery with my specialist.
Pre-Operation Diagnosis – Preparatory Consultation
My specialist then arranged for me to undergo a pre-operation diagnosis, where they would put me into an induced sleep and investigate the root cause of my sleep apnea using probes. Thereafter, it would be clearer what operation(s) would be conducted. That was also when I changed doctors.
The procedure required me to undergo general anaesthesia (GA), so it was treated like a surgery itself. I first had to go for a check up and blood test to determine if I’m suitable to undergo the procedure. At the same time, they conducted a consultation on the anaesthesia (to explain the process, pros and cons of undergoing GA) and a financial consultation (to explain how the cost would be racked up).
Pre-Operation Diagnosis – Performing the Scope under general anaesthesia (GA)
The actual pre-operation diagnosis took place about 2 weeks after the consultation. I reported to the same day admission clinic early in the morning, changed into the gown before laying out on the bed to be pushed to the operating theatre. Very much like what I had described in my earlier post for my actual surgery.
The process took about an hour, and I was woken up at a holding area outside of the operating room. Over there, they monitored my vitals, and once confirmed that I was OK, transferred me to the short stay ward.
The short stay ward was an airconditioned ward shared with several other patients. It was meant for me to wait till the GA wore off before I got discharged. However, since GA usually takes 1 day to completely wear off, I had to arrange for someone to fetch me upon discharge. All in all, I was out of the clinic in under 8 hours.
Perhaps because the actual surgery required me to be under GA for a longer duration, I recovered rather quickly from the pre-operation diagnosis. In fact, by the second day, I could go about my usual activities.
Diagnosis
After pinpointing the root cause, the specialist proposed 3 surgeries. The first was to widen my breathing passage with uvulopalatoplasty. The other 2 – inferior turbinoplasty and septoplasty – had got to do with my nose. It was found out that my nose bone was crooked, hence resulting in a narrower breathing passage. The surgery aimed to remove the bone, and at the same time shave down the inferior turbinate to even widen my breathing capacity. I’ll leave readers to read up on the specific medical terms online, as this post is meant only for sharing my personal journey of undergoing the operation to treat my sleep apnea.
The specialist took special care to explain the details of the various surgery to me. She also covered the possible side effects. Other than the usual bleeding and pain, she noted some other issues like patients being conscious of the scar in the mouth. I sort of expected the pain to be at the same level of my gout flares, or when the anaesthetic wore off after my lasik surgery. Been there, done that. So pain was not the top of my concern.
But truth be told, it was still information overload, especially as it was the first time I got to know those terms. We fixed the appointment first, during which I could ponder over the decision. My specialist assured me I could still change my mind, as long as it was not a last minute decision.
It took me about a week of reading up on the surgeries before deciding to stick with the decision.
Official Preparation
Upon confirming my intention to proceed with the operation, we fixed a date and the official preparation process started rolling. I underwent the pre-operation consultation like I had for the pre-operation diagnosis, but this time it was for my sleep apnea operation. The only thing different was that I spent more time with the anaesthetic expert to find out how I could prepare for the operation. I also made arrangements to stay in ward B1, to fully make use of my Medishield benefits that I had been paying premium for decades.
Before Surgery- Personal Preparation
On the personal front, the preparation was both straightforward and complex. I half expected that I wouldn’t be capable of performing daily tasks effectively in the first few days after the operation. As such, I had to anticipate my needs to prevent situations where I have to scramble for solutions.
The first was to stock up on food. Staying alone meant I had to settle my meals by myself. I also didn’t expect to have a good appetite, so ordering takeaway in the first few days would be a waste. Instead, I shopped for instant porridge online. They were in small servings, requiring minimal effort for preparation and clean up.
Next, it was the great clean up. I knew I couldn’t leave the cleaning till after my surgery, since these are after all quite intensive activities. So on the day prior, I washed my sheets, dusted all surfaces, and mopped the floor twice. Just to ensure my environment for recovery was as hygienic as possible.
One thing that I missed out was the need for distilled water for my nasal wash post-surgery. Well, I wasn’t informed of the need to do this before that. Luckily, as a hoarder, I have various mineral water stashed away from past McDonald’s purchases.
Parting Words
This part of the journey could be regarded as the beginning of the end. The actual journey started way beyond, when I lived with snoring and sleep apnea issues for years. Starting a specialist consultation was the best decision to end this journey.
Of course, surgery is an invasive method, so it was always to be considered as a last resort. We explored the use of a CPAP machine, which might have its pros, but had great limitations. The next alternative would be a surgery. One of my main decision drivers was: if not now, when? If surgery is one of the better options now and after, it’s better to do it now while I’m still young and can recover quickly. Pain and discomfort is all part of undergoing surgery, the only difference is the age factor. And that, is why I made the decision to go for the sleep apnea surgery.
Read on for more of my journey going through the surgery itself, the hospitalisation immediately after, and my recovery journal.
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