“Do not go where the path may lead, go instead where
there is no path and leave a trail.”
- Ralph Waldo Emerson (American Essayist & Poet – 1803 - 1882)
Over the next few blog posts I will detail how to stop CPAP air coming out of the eyes using a sleep apnea machine. Before doing so, I will make some comments about a research study published online in August 2018. In addition, I will explain why using a total face mask is not the answer for many people as the sleep medical specialists and equipment suppliers may advise to stop air coming through the eye tear ducts or nasolacrimal ducts and out of the eyes.
- Ralph Waldo Emerson (American Essayist & Poet – 1803 - 1882)
Over the next few blog posts I will detail how to stop CPAP air coming out of the eyes using a sleep apnea machine. Before doing so, I will make some comments about a research study published online in August 2018. In addition, I will explain why using a total face mask is not the answer for many people as the sleep medical specialists and equipment suppliers may advise to stop air coming through the eye tear ducts or nasolacrimal ducts and out of the eyes.
A Novel Treatment for Nasolacrimal Air Regurgitation Into
the Eye With CPAP: The Total Face Mask. Wrede JE, Parsons EC, Watson NF. J Clin Sleep Med.
2018;14(8):1415–1417.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086962/
1. The sleep medical researchers are saying that they have come up with a “Novel” treatment of using a total face mask. However, a review of the various sleep apnea forums shows that using a total face mask has been mentioned many times on the forums since at least 2004. That is, nearly 14 years before this research study was published!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086962/
1. The sleep medical researchers are saying that they have come up with a “Novel” treatment of using a total face mask. However, a review of the various sleep apnea forums shows that using a total face mask has been mentioned many times on the forums since at least 2004. That is, nearly 14 years before this research study was published!
http://www.cpaptalk.com/viewtopic.php?t=16093
2. The study
uses just 1 patient as the basis of its research using mean pressure of only 9
cmH2O. Also noted is that the patient used the mask for what I consider a low average
of 4 hours and 44 minutes per night for 90% of nights over a 30 day period. In
addition, the patient had a high average AHI of 3.7 events/ h when compared to
successful users on the various sleep apnea forums.
Given that
only 1 patient was used and the average for all patients is estimated at 10
cmH2O, it is considered this is insufficient research to justify the use of a
total face mask by sleep medical specialists and equipment suppliers. In
addition, when I use a total face mask with pressure up to 17 cmH2O, air still
comes through one of my eye tear ducts and out of the eye.
3. A total
face mask is a very hard mask to tolerate for many people. It is a mask of
“last resort” when all other masks such as nasal pillows and nasal have failed.
I found the mask a little claustrophobic due to the mask covering the whole
face and it felt hot on the face due to the large thickness of the silicone
mask surface sitting on your face. In addition, I could not sleep properly on
my side due to the mask being bulky and the mask at times leaked badly, waking
me up during the night.
4. On the
Blog Post Why NOT to use a CPAP Humidifier? I advised to breathe through your nose.
Breathing through your mouth using a Full Face Mask and a Total Face Mask will
lead to dry sore throat and dry mouth and possible dental health issues such as
bad breath.
The nose is
like a humidifier whereby it will warm, humidify and moisten the air that you
are breathing in. In addition, breathing through your nose kills deadly
bacteria and viruses and traps dust particles. This is one of the reasons
serious consideration should be given to using nasal pillows and nasal masks
where possible.
5. Many patients have found their “perfect” or at least their preferred mask. Why would they want to change from their existing mask such as a nasal mask and use a total face mask with all its potential drawbacks?
5. Many patients have found their “perfect” or at least their preferred mask. Why would they want to change from their existing mask such as a nasal mask and use a total face mask with all its potential drawbacks?
One of the hardest and most difficult
aspects of using a sleep apnea machine is to find your “perfect” mask. A mask
that is properly fitting and comfortable will strongly enhance a person’s
experience, acceptance and long-term use of the sleep apnea machine. Why change
mask after spending in some cases, a lot of time and money working out the
“perfect” mask for them? Details of my "perfect" mask being a nasal mask are on the blog post Stop CPAP Mask Problems and Issues.
6. The research study states that the reason the patient was able to use a total face mask is that “a total face mask allows equalization of pressure on both sides of the lacrimal system.” This is absolute NONSENSE! Take this statement from someone who regularly uses a sleep apnea machine, uses maximum pressure up to 17 cmH2O, has used a total face mask and had 2 eye tear duct dacryocystorhinostomy (DCR) operations, one on each eye. This is more than most if not 100% of all the sleep medical specialists!
Why has the pressure not equalized as stated by the sleep medical researchers? The reason is that the pressure has not changed. For example, should I use CPAP fixed pressure of 9 cmH2O, then the pressure stays all night at 9 cmH2O! The pressure of 9 cmH2O does not change when air is coming out of the eye tear duct. It is the velocity or force of the air that has changed.
Force = Pressure x Area of opening of the tear duct Vs Area of the whole eye.
To explain further the reason why, I use an everyday example. Go into the backyard and fill up a bucket with water using a hose. Put your finger over part of the end of the hose, what happens? The water comes out or shoots out faster and further. This is similar to the eye tear duct which is very narrow compared to the whole area of the eye. Whilst the air pressure is the same; the air is coming out faster and further from the eye tear duct due to the smaller area or opening of the tear duct.
6. The research study states that the reason the patient was able to use a total face mask is that “a total face mask allows equalization of pressure on both sides of the lacrimal system.” This is absolute NONSENSE! Take this statement from someone who regularly uses a sleep apnea machine, uses maximum pressure up to 17 cmH2O, has used a total face mask and had 2 eye tear duct dacryocystorhinostomy (DCR) operations, one on each eye. This is more than most if not 100% of all the sleep medical specialists!
Why has the pressure not equalized as stated by the sleep medical researchers? The reason is that the pressure has not changed. For example, should I use CPAP fixed pressure of 9 cmH2O, then the pressure stays all night at 9 cmH2O! The pressure of 9 cmH2O does not change when air is coming out of the eye tear duct. It is the velocity or force of the air that has changed.
Force = Pressure x Area of opening of the tear duct Vs Area of the whole eye.
To explain further the reason why, I use an everyday example. Go into the backyard and fill up a bucket with water using a hose. Put your finger over part of the end of the hose, what happens? The water comes out or shoots out faster and further. This is similar to the eye tear duct which is very narrow compared to the whole area of the eye. Whilst the air pressure is the same; the air is coming out faster and further from the eye tear duct due to the smaller area or opening of the tear duct.