06 April 2019

Use Different CPAP and Bilevel Pressure Settings

“The definition of insanity is doing the same thing over and over and expecting different results.”
- Albert Einstein/ Others (German born Theoretical Physicist - 1879 - 1955)

By using different CPAP and Bilevel or BiPAP pressure settings for different situations, I now wake up feeling refreshed and energized each day. Should you be having some “bad” days or are having the feeling of “is this as good as it gets” using your CPAP and Bilevel machine, CHANGE what you are doing! 

Many users of sleep apnea machines will have experienced for themselves that at least 1 to 2 days per week up to every day of the week; they are waking up tired, lacking energy and are unrefreshed. I was once in the same situation that many people now find or have found themselves.

On the blog page Different Bilevel Settings Example, I show the results using my actual sleep data and SleepyHead reports of using the Bilevel auto adjusting pressure machine for three different situations. For a CPAP machine, apply the principles of what I have done. The different situations are: 

1. Normal day;
2. Eating and drinking late at night; and
3. Hard day at work and/ or many hours of driving. 

Your pressure needs may change on a daily basis and will depend on many factors. Such factors may include sleep hygiene and lifestyle factors such as exercising daily and eating food late at night and medication and other health conditions that you may have. Should you be doing similar activities each day, having the one set of pressure settings on your sleep apnea machine may be all that you require for optimal treatment. The machine that you are using may only require a little adjustment to optimize your sleep. 

When you consider the many benefits from waking up refreshed and energized each day, the cost of the bilevel machine has been recovered many times over as I have been able to resume full time work. Further, I wanted to be 100% refreshed each day as in the past, tiredness nearly caused me to have a major car accident on the highway when my life flashed before my eyes. Putting someone else’s life at risk is not something I want to do when I can take steps to prevent it.

I did not sleep properly every night for the first 4 years of using the sleep apnea machine, was fatigued and tired most days and struggled constantly to do any paid work. Some days I would get up out of bed, read emails and go back to bed 15 minutes later. I was “totally stuffed” to put it nicely! It was not until 2017, some 7 years after I was first diagnosed for obstructive sleep apnea that I woke up feeling great and energized each day. 
One of the key Secrets to Success using a sleep apnea machine was to change from using a CPAP machine to using a Bilevel auto adjusting pressure machine.
Another key Secret to Success was to use different pressure settings for different situations on the bilevel machine. More details are at Different Bilevel Settings Example.

I began using different settings on the machine when I realized that using the settings for a “Normal day” were not appropriate in all situations such as eating and drinking late at night. At the time, I was having issues such as hyperventilating or over breathing and feeling tired in the mornings. To overcome these issues, I tried using different settings on the machine depending on what was happening on a particular day. By trial and error, I succeeded in overcoming these issues and now wake up feeling refreshed and energized each day.  

When I eat and drink late at night, my breathing becomes faster than normal when asleep. My Minute Ventilation (MV) increases as I was not taking my normal full breath on inhale. Median/ average MV may rise up to 7 litres/ min or more from my normal 6.0 litres/ min or lower. In addition, the median respiratory rate may increase up to 16 breaths/ minute from 14 breaths/ minute. Minute Ventilation is the total volume of air entering the lungs in a minute. 

My solution was to reduce pressure support to 5.0 cmH2O from 5.4 and 5.6 cmH2O and reduce the minimum pressure. In addition, by using the same time for inhale, I was able to control and slow my respiratory rate down back to my normal median of 14 breaths per minute. Importantly, no matter what the situation, median MV stayed at 6 litres/ minute or lower. Examples of what I have done in three different situations are on the blog page Different Bilevel Settings Example.

Today, I have a separate bilevel machine for each of the three situations outlined above. Changing settings on the one machine late at night was getting annoying and I was prone to making errors when changing settings on the one machine due to tiredness. An example is provided of how I use these machines in a typical week at the blog post Athletes need Maximum Performance: Use Bilevel. Observe what I have done and apply the principles to your own situation.

On the blog post Change or Reset your Circadian Rhythm, when I use a Bilevel auto adjusting machine with different settings, I have a different circadian rhythm or sleep cycle for each different setting. By using the Bilevel machine I have optimized my sleep every day.

Circadian rhythms are your body's internal clock or sleep/wake cycle which repeats roughly every 24 hours. Ideally, wake up at the end of a sleep cycle not in the middle of one otherwise you may feel tired and sleepy all day.

In addition to sleep apnea, I also have a genetic disorder, Hemochromatosis. This disorder is characterized by having too much iron absorption from the foods that you eat. Where your iron levels are too high, you may feel incredibly tired and lethargic and may lead to health issues such as cirrhosis of the liver, heart disease and diabetes.

Body iron level helps regulate our circadian rhythms and their link to metabolism. You can read more at this article.

Importantly, Research is supporting that a brain's ability to clear a protein closely linked to Alzheimer's disease is tied to our circadian cycle.

Rensselaer Polytechnic Institute. "Clearance of protein linked to Alzheimer's controlled by circadian cycle: Ability of immune system to destroy Alzheimer's-related protein oscillates with daily circadian rhythm." ScienceDaily. 10 February 2022.


Some people may feel the cost of buying three machines is a lot of money and not necessary. As these were second hand machines, the total cost was far cheaper than buying one new bilevel machine. More importantly, my sleep medical specialist would only prescribe a CPAP fixed pressure machine and refused to prescribe an auto adjusting CPAP machine as “I did not need it”! For these reasons, I felt I had little chance of obtaining a bilevel auto adjusting pressure machine.

Based on discussions with a senior executive of a major equipment supplier, depending on country, only 2% to 4% of total patients get issued with a bilevel machine. This further supports the reason to buy the machines out of my own funds. I have purchased a few second hand bilevel machines with low machine use hours, saving plenty of money, from a company, Secondwind CPAP in the USA. Details are at: https://www.secondwindcpap.com.

Other benefits of having more than one machine include:

1. Having two backup machines should one machine fail to operate; 
2. Not having to worry about obtaining a new Bilevel machine for many years; and 
3. Having all three machines the same allows for continuity of using the same accessories such as the tubing and power adapter. 

Above all, by optimizing the settings on the bilevel machine and using different pressure settings for different situations, I have successfully overcome and stopped all the  CPAP side effects and issues caused by the machine. Side effects and issues include aerophagia, central sleep apnea, insomnia, mask leaks, tiredness and lacking energy issues even though AHI<1.0 and weight gain.

Should you be having issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day. 

“Have courage. Be adventurous and Go for it! Overcome your fear.” 

- Mrhelpful  

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