25 June 2019

Use Ideal Body Weight on CPAP and Bilevel

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” Lao Tzu (Chinese philosopher – 600 – 470BC) 

In the Setting of the sleep apnea machine, I use Ideal Body Weight (IBW) or Predicted Body Weight (PBW) not my actual body weight on CPAP and Bilevel or BiPAP. By using IBW, I have optimized my sleep and stopped any CPAP side effects and issues such as weight gain and insomnia and constant waking up during the night. 

Understand the principles of what I have done and then apply the principles to yourself and your own circumstances. Throughout this blog, I have mentioned to apply the Buteyko Breathing Method to your sleep apnea machine. By doing so, I have optimized the settings on the machine so that I wake up feeling refreshed and energized each day. 

Use Minute Ventilation (MV) as your guide is one of The Secrets to Success for sleep apnea therapy using a sleep apnea machine. Minute Ventilation is the total volume of air entering the lungs in a minute.
From personal experience, I found that reducing median Minute Ventilation to 6 litres/ minute or lower and keeping the 95% to 100% rate “under control” each night optimized my sleep apnea therapy. “Under Control” means that you try and keep MV to a maximum of 10 litres/ minute. Otherwise you may be considered to be hyperventilating or breathing at an abnormally rapid rate or over-breathing.

Normal MV rate is considered to be 6 litres/ minute per Medical Textbooks. Further information on Minute Ventilation and the Buteyko Breathing Method is at: https://www.normalbreathing.com/.
The two components of Minute Ventilation are breathing/ respiratory rate (RR) and volume of air/ tidal volume (TV) that you are breathing in.

The question to ask is: Is there an optimal breathing rate and tidal volume to be used for you?
From my personal experience, the answer is a resounding YES!

The two components will differ for each person for various reasons such as other health issues besides sleep apnea and medication.

1. Tidal Volume (TV)

The first component that I optimally set was Tidal Volume. On the blog page Different Bilevel Settings Example, an Example is shown using the bilevel auto adjusting pressure machine in 3 different situations such as a hard day at work and eating and drinking late at night.  

Note that the median Tidal Volume is 400 ml in all 3 situations. How did I arrive at 400 ml?

I used Ideal Body Weight (IBW) instead of actual body weight. IBW was used as I found with higher Tidal Volume, my breathing would slow down. Sometimes my breathing slowed to a median of 12 to 13 breaths/ minute. When my breathing slowed down too much, I found from personal experience that the sleep apnea machine was too slow to react to apneas that were occurring and I would wake up feeling tired in the morning. 

IBW was actually introduced to estimate dosages for medical use, and the formulas that calculate it are not at all related to how a person looks at a given weight. It has since been determined that the metabolism of certain drugs is more based on IBW than it is total body weight. Today, IBW is also used widely throughout sports, since many sports classify people based on their body weight. 

Further details on Ideal Body Weight and to calculate your Ideal Body Weight are at: https://www.calculator.net/ideal-weight-calculator.html

Applying the ideal body weight calculator to me:

My height is 170 cm and therefore ideal body weight is 66 kgs to 67 kgs. Tidal Volume should be between 396 ml to 402 ml using 6 ml/kg. (66kgs - 67kgs x 6 ml/kg).

My median Tidal Volume is 400 ml using the sleep apnea machine.
2. Breathing/ Respiratory Rate (RR)

Once I set the sleep apnea machine to attain a median Tidal Volume of 400 ml, my breathing rate became optimized at 14 breaths/ minute. At 14 breaths/ minute, I found that the bilevel machine worked perfectly and enabled me to have a great night’s sleep. My apneas were 1.5 AHI or lower nearly every night and importantly, all issues caused by using the CPAP machine were overcome.

When my breathing is at a median of 16 breaths/ minute or higher, I have dizziness and vertigo and ear blocking. Further, I may end up with a high median minute ventilation of up to 7.5 litres/ minute. This caused me to wake up feeling tired in the morning and wanting to have a sleep in the afternoons. 

By optimizing the settings on my ResMed S9 VAuto bilevel machine (now ResMed AirCurve 10 VAuto), I have overcome an extensive list of issues caused by the CPAP machine. These issues are outlined on the blog page Stop CPAP side effects and issues. The issues include chest pain, mask leaks, teeth grinding, weight gain, insomnia, constant waking up during the night, too much pressure and tiredness and lacking energy issues even though AHI<1.0.
I believe a bilevel or BiPAP auto adjusting pressure machine should be considered for many of the 80% non-successful, non-compliant and failing patients who are using a CPAP machine. More details are at Why is CPAP Compliance Rate Low?

Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 13.0 cmH2O (inhale and exhale pressure). Ideal Body Weight was used in setting the median Tidal Volume and Minute Ventilation. This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. More details are on the blog post:

What BiPAP Settings prevent Alzheimer's due to REM sleep breathing issues? 
Should you be having side effects and issues with your sleep apnea therapy; CHANGE what you are doing so that you wake up feeling refreshed and energized each day. 

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

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