23 August 2019

Athletes need Maximum Performance: Use Bilevel

“Do you want to know who you are? Don't ask. Act! Action will delineate and define you.”
Thomas Jefferson (Third U.S. President – 1743 -1826) 

To be a successful elite athlete, you need to be at your maximum performance on game day. You are required to be at your best and not tired and lethargic. By optimizing the settings on the machine, you can have a great night’s sleep every night so as to wake up feeling refreshed and energized. For those having side effects and issues using CPAP, should seriously consider changing to a Bilevel or BiPAP auto adjusting pressure machine. A comparison is at CPAP Vs Bilevel Settings Example.

For an Elite Athlete, what settings do you actually use on the sleep apnea machine? There is no one answer as it will depend on many factors. However, based on my own personal experience and recent research studies, I offer some observations and principles to follow.

In a 2018 research study, the conclusion was:
The sleep of elite athletes is influenced by many factors, both societal (e.g., electronic media devices) and sport-specific factors (e.g., training, seasonal phases, competition, travel). All these acute and chronic stressors experienced by elite athletes may partly account for large inter- and intra-individual sleep variabilities.

The Variability of Sleep among Elite Athletes
Nedelec M, Aloulou A, Duforez F, Meyer T, Dupont G. The Variability of Sleep among Elite Athletes. Sports Med Open. 2018;4(1):34. Published 2018 Jul 27. doi:10.1186/s40798-018-0151-2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063976/

In addition, it is common in some elite athletes to have obstructive sleep apnea due to the particular sport they play such as Rugby Union and American Football players. These athletes may have large body masses and “thick” necks or extra fat or muscle tissue on the neck. You can read more at this article:
How does sleep affect high performance athletes?
By Shawn Youngstedt, PhD

In another study conducted in 2018, it was shown that “Overall, success was obtained in 95% of cases of intolerance to CPAP”. This study included people with high BMI’s of 40 or more. Of particular interest in this study was that it noted that the settings may need to consider “pressure support, occurrence of air leaks and other variables such as inspiratory time, inspiratory and expiratory triggers, respiratory rate and estimated tidal volume, tolerance to air pressure and air humidity.”

Use of autobilevel ventilation in patients with obstructive sleep apnea: An observational study. Baiamonte P, Mazzuca E, Gruttad’Auria CI, et al. J Sleep Res. 2018;e12680. https://doi.org/10.1111/jsr.12680

An examination of the settings that I use on the bilevel machine as detailed on the blog page Different Bilevel Settings Example; you can see that it is essential that a person consider the above variables especially where you are having CPAP issues.

To overcome the many factors affecting sleep, I use 3 ResMed VPAP S9 Bilevel auto adjusting machines. Each machine has a different setting. The machine to be used on a particular day will depend on the situation including a competition game, a rest day and eating and drinking late. Further details are on the blog post Use Different CPAP and Bilevel Pressure Settings.

As mentioned on a previous blog post Elite Athletes need Bilevel, a major weakness of the CPAP and auto-adjusting CPAP Machines is that the machines are limited in their settings such as pressure support of 3 cmH2O. A bilevel machine has pressure support of up to 10 cmH2O. In addition, the CPAP machines do not have settings for Trigger and Cycle and TI Max and TI Min. These additional settings allow you to optimize the settings on the machine for you so that you can have a great night’s sleep.

As an example, when eating and drinking late at night, I use a bilevel auto adjusting machine with pressure support of 5.0 cmH2O. Using pressure support greater than 3.0 cmH2O stops me from hyperventilating or over-breathing when asleep and waking up feeling tired in the morning. Using pressure support greater than 3.0 cmH2O has good implications for those users who have a high BMI and /or gained weight since starting CPAP therapy. A discussion with a medical specialist at one of the major equipment suppliers supports this conclusion.

Should you consider using 3 bilevel machines with different settings on each machine, an example is provided of how I use these machines in a typical week. Observe what I have done and apply the principles to your own situation.                                                          
                                                                                  Pressure Support

Wednesday    Normal/ rest day                                           5.4

Thursday        Meeting & eat & drink late at night               5.0

Friday             Night AFTER a late night. I always        
                       use maximum pressure support as 
                       maximum pressure is normally at
                       its highest the night after.                             5.6

Saturday        Hard physical day and/or driving all day       5.6

Sunday          Normal/ rest day                                            5.4

Monday         Meeting & eat & drink late at night                5.0
Tuesday        Meeting at night & driving. No eating            5.6


Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 12.8 cmH2O (inhale and exhale pressure) to stop and reverse the symptoms of Dementia. I used the advanced ResMed Bilevel with iVAPS machine which will also be of great benefit to all athletes. This machine will enable an athlete to have great sleep every night and be able to perform at their very best when needed. More details are on the blog post:

Jul 21: Stop Alzheimer's Dementia using BiPAP with AVAPS or iVAPS

Should you be having side effects and 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