"Retinal re-attachment: how to sleep face down"

I've had this procedure done twice recently. The admin, technical and nursing staff have been superb, as have the surgeons. Their care, skill and dedication were exemplary.

However, there's a problem that could be perhaps handled better, and I've set it out in the rest of this note.

The night after the operation, the patient needs to sleep face down (as part of 'posturing'). 

On the first occasion, the nurse didn't explain how this should be done, no aids were offered and the leaflets were silent. I went home and tried to figure it out for myself. I tried putting my head face down in an inflated airline-style neck pillow. This didn't really work because the pillow doesn't raise the head enough - your nose is flattened against the mattress and you can't breathe. Also, you can get serious pressure points in other parts of the body (eg, feet, neck and back). I tried numerous combinations of pillows, supports, towels, blankets, and eventually rest my head in a child's foam toilet seat (yes, I laughed, too), but soon gave up with that too as again it was too shallow. The result was that I had a sleepless and uncomfortable night, which was not conducive to healing.

On the second occasion, I planned to go home again but asked the nurse how I was supposed to sleep face down. She suggested using towelling to create a U-shape. I said I didn't think it would work and after a bit of discussion she kindly arranged to get me a bed in Ward 55 where I could use a postural aid for the night. This proved to be a good-quality, deep, U-shaped air cushion that came with a stand. Again, though, this was very hard to use and the nursing staff seemed unclear about my options. In the end, I took the cushion off the stand and rested my head in it face down, and asked the nurses to let me have several pillows so that I could support the rest of my body without causing back pain, neck pain and foot discomfort (feet aren't happy to be kept flexed at the instep). I still didn't get any sleep but at least I had a radio with headphones to get me through the night.

We tried tilting the bed at the foot end and putting my head at that end, but again, it didn't work.

The problem is that you're trying to create a supported hole above mattress level when the rest of the body is at mattress level. This means the head and neck are badly supported and kept inclined upright (certainly if the stand is used).

There must be a better solution: perhaps it is a bed with a hole in it, rather like a physio's massage table – expensive and maybe not feasible. Perhaps it is some cunning arrangement of pillows and other supports that, in my feeble state, I couldn't devise by myself. 

Hanging with the head off the bed end doesn't really work as it's hard to breathe with the throat restricted like that.

The risk is that if patients can't find a way of sleeping face down for the first night, they'll give up on posturing and hope for the best without it, which is not ideal.

It may be that a nurse who has experienced this for himself or herself after surgery has a bright idea that could be adopted.

So the overall point is: 'How can a person sleep comfortably face down in a constrained posturing position so that the body doesn't just shift in sleep and stop posturing?' What should be said to someone who's going home for the night and to someone who's staying on the ward?

There may not be a one-size-fits-all solution but at present there's not really any workable solution being offered. This must be a problem that's been raised many times before, so maybe there isn't a solution and patients just have to do the best they can and suffer a bit.