08 September 2019

Stop CPAP causing Insomnia: Use Bilevel


“Believe in yourself. You are braver than you think, more talented than you know, and capable of more than you imagine.”
Roy T. Bennett, Author of The Light in the Heart

Various CPAP users have insomnia even though they are taking steps advised by sleep medical specialists and equipment suppliers. Have you considered that the CPAP machine and the way it works is causing insomnia? Insomnia can occur in getting to sleep initially as well as when waking up during the night. How do you stop CPAP causing Insomnia? Consider using a Bilevel or BiPAP machine.

Steps that you can take to overcome insomnia include:
1. Maintain good sleep hygiene such as no coffee after late afternoon, go to bed only when you are tired, have a good mattress and pillow and exercise regularly.
2. Make sure your CPAP mask is comfortable; and
3. Switch off all technology such as laptops at least one hour before going to bed.
 

You can obtain more details at:

https://www.resmed.com.au/blog/7-tips-for-falling-asleep-using-your-cpap 
https://www.resmed.com.au/insomnia/insomnia-causes     

From my personal experience, the CPAP machine did cause insomnia! There is nothing worse than waking up in the middle of the night and not going back to sleep. You lie awake in bed for a while and eventually as you cannot get back to sleep, you decide to get up. 

A sleep medical specialist is unlikely to advise you that a CPAP machine may cause insomnia or many other issues as listed on the blog page Stop CPAP Side Effects and Issues. I’m sure that you would agree that saying that a CPAP machine may cause insomnia and other issues such as tiredness, chest pain, aerophagia, nose bleeding and constant waking up would not be a great selling point to new patients! 

How do you stop insomnia and overcome other issues when using a CPAP machine? Seriously consider obtaining a second hand ResMed S9 VPAP Auto bilevel machine which can be purchased for a reasonable cost. By doing so, may save you a lot of time and money when compared to obtaining a new machine. I have purchased a few second hand machines with low machine use hours from a company, Secondwind CPAP in the USA. https://www.secondwindcpap.com/
 

A comparison of CPAP Vs Bilevel is at CPAP Vs Bilevel Settings Example. 

Support for what I have done is found in a recent research study published online in August 2019. Essentially, I have set my bilevel machine to work like a basic Adaptive Servo-Ventilation (ASV) machine at a much lower cost. 

Prospective Randomized Controlled Trial on the Efficacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia. Barry Krakow, Natalia D. McIver, Victor A. Ulibarri, Jessica Krakow, Ronald M. Schrader

https://www.sciencedirect.com/science/article/pii/S258953701930104X?via%3Dihub 

In addition to not being able to go to sleep initially, there are 4 levels of waking up during the night.
1. Wake up and not go back to sleep. You may get up out of bed.
2. Wake up and go back to sleep after some time, say 15 minutes to 20 Minutes or more.
3. Wake up and go back to sleep straight away.
4. Sleep through the night for at least 6 hours without waking up.

You want to be in levels 3 and 4 above; otherwise you will wake up feeling tired and lacking energy and be lethargic all day.

What can you specifically do and what are the settings that I use on the bilevel machine to stop insomnia?

1. Apply the 4 steps as outlined on the blog page Guide to Success using CPAP and Bilevel. Minimize leaks and reduce your breathing rate and median minute ventilation (MV) to 6 litres/ minute or lower. In addition, reduce median pressure of IPAP (inhale pressure) and EPAP (exhale pressure) as much as possible and the maximum or top pressure is only required as necessary. 

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.org/. Reduce median/ average Minute Ventilation (MV) to 6 litres/ minute or lower and keep the 95% to 100% rate “under control”. Apply the principles of the Buteyko Breathing Method to your sleep apnea machine by slowing your respiratory rate down and reducing the volume of air that you are breathing in. For tidal volume settings, I use Ideal Body Weight (IBW) on CPAP and Bilevel or Predicted Body Weight (PBW) not my actual body weight. 

2. Apply the principle of the 4-7-8 breathing method to your bilevel machine. This is a way of breathing to relax to go to sleep by inhaling about 25% of the total time spent holding your breath and exhaling. Save money by not using sleeping aids such as melatonin and prescription sleeping pills. Read more at: https://noselife.com/breathe-nose-fall-asleep-faster/

Step 2 is a critical step which I consider absolutely essential to stop insomnia. This step has worked without fail, 100% of the time in getting to sleep initially and importantly when I have woken up during the middle of the night in being able to go back to sleep quickly.

I apply the principle of the 4-7-8 breathing method as follows:

1. Set the Inhale at 1.1 seconds to 1.2 seconds using the TI Min and TI Max settings; and

2. When setting the exhale, I allow 5.5 to 6 seconds to exhale, before the machine prompts me to start inhaling again, by using Trigger sensitivity of High. 

To achieve 5.5 to 6 seconds to exhale, I use Pressure Support of between 5.0 to 5.6 cmH2O. More details are at Different Bilevel Settings Example. In addition, to overcome Central Sleep Apnea, I use Cycle sensitivty of high/ very high. Refer blog post How to Overcome Central Apnea using Bilevel? 

With these machine settings, the inhale:exhale or I:E ratio is 1:5 (one to five). That is, my inhale time is only 20% of the total time that I exhale. Just before I go to sleep, my breathing normally slows down to 7 to 9 breaths per minute. Once asleep, my breathing will go back up to 14 breaths per minute.  

When reviewing the whole night and due to different sleep stages; the median ratio is about 1:2.7. This median ratio is far better than when I was using the CPAP machine when I:E ratio was 1:1 or even worse at 0.8:1. I was spending more time inhaling or breathing in air than I was exhaling. This is one of the main reasons that I had many issues using the CPAP machine! 

In addition, I use very low pressure on exhale (EPAP) of 4.2 cmH2O and minimum inhale (IPAP) of between 9.2 cmH2O to 9.8 cmH2O. By using these settings, you are breathing out against very low pressure when initially going to sleep and when you wake up during the night. By doing so will assist you to stop insomnia as well as overcoming other side effects and issues. Note that these settings are despite my maximum or top pressure may go over 15 cmH2O during the night. 

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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