31 December 2020

Stop CPAP REM Issues and Sleep Apnea causing Dementia: Use BiPAP

“It is during our darkest moments that we must focus to see the light.”

- Aristotle Onassis (Greek Shipping Tycoon, Businessman – 1906 - 1975)

To stop CPAP REM sleep issues and obstructive sleep apnea (OSA), seriously consider using BIPAP and Bilevel auto adjusting pressure machines. By using BiPAP and Bilevel machines and CPAP to a lesser extent, a person may be able to treat REM sleep issues, insomnia, awake bruxism and obstructive sleep apnea (OSA) which may cause Dementia, Alzheimer’s, Parkinson’s disease and other neurological disorders.    

To avoid confusion, BiPAP is a Registered Trademark owned by Philips Respironics. Bilevel refers to all other brands such as ResMed.  

The explanation of how I treated and stopped REM sleep and Obstructive sleep apnea issues is going to be done on a practical level based on my own personal experience. I am not a medical doctor and there will be others with more knowledge and a medical background who can explain better from a technical point of view.

On the previous blog post Use BiPAP and CPAP to treat REM sleep and OSA Issues, I mentioned that over the last few months, I have been grappling with the issues of awake bruxism, obstructive sleep apnea and insomnia occurring during REM (Rapid Eye Movement) sleep causing symptoms of Dementia. Awake Bruxism involves tooth clenching or tapping while you are awake which may drive you crazy and frustrated.

Unfortunately, there is currently no cure for the neurodegenerative disorders including Dementia, Alzheimer’s and Parkinson’s disease. These disorders alone affect many millions of people around the world.

From personal experience having had and currently cleared of the symptoms of Dementia; I believe that the 4 issues together mentioned above may be a very early warning or marker of various neurodegenerative disorders.

In addition, it is my belief that it is possible that by treating REM sleep issues, obstructive sleep apnea, insomnia and awake bruxism, a person may be able to stop or at least prolong the onset of REM Sleep Behaviour Disorder (RBD). By doing so, may prevent up to some decades later, RBD leading to a diagnosis of Parkinson’s disease, Dementia and Alzheimer’s and other disorders.    

One study found that 38 percent7 of men aged 50 or older with REM sleep behaviour disorder eventually developed Parkinson’s disease, Lewy body dementia, or multiple system atrophy, usually within 13 years. That number increased to nearly 81 percent8 in a follow up study conducted 16 years later.

https://www.sleepfoundation.org/rem-sleep-behavior-disorder

I am fully aware of the damaging and frustrating aspects of dementia and the suffering experienced by patients as well as their Carers. My grandmother, father and aunty have all had dementia.        

My personal experience is detailed to assist all people in treating their various medical disorders. In particular, those people who are in the early stages of these disorders and to give you hope that you may be able to stop or prolong the onset of any further deterioration in your medical condition. To keep focusing on the light even though you may only be able to see darkness at the moment!  

On the previous blog post, I mentioned that if the 4 issues together of REM sleep issues, obstructive sleep apnea, insomnia and awake bruxism are to be a possible early warning or marker of Parkinson’s and Dementia and other neurodegenerative disorders, this raises many questions including:

What specifically causes Awake Bruxism and how do you treat it?

Is it just REM sleep issues, obstructive sleep apnea and insomnia causing sleep disruptions during the night or is there something else involved?

Does obstructive sleep apnea occurring in all REM sleep periods cause Awake Bruxism or just one or two periods of REM sleep?

Can you treat all these issues of REM sleep, obstructive sleep apnea, insomnia and Awake Bruxism at the same time? If so, how do you do this?

Most importantly, what proof do I have that the combination of Awake Bruxism, REM sleep issues, obstructive sleep apnea and insomnia may be an early warning marker of Parkinson’s disease, Dementia and Alzheimer’s and other medical disorders? 

The last two questions were answered on the previous blog post.

From personal experience, using a BiPAP or bilevel machine similar to the one that I use, being the ResMed S9 VAuto or AirCurve S10 Bilevel machine can treat all the above issues at the same time.

For more serious cases of REM sleep issues and obstructive sleep apnea and those people who have a combination of serious issues including respiratory issues like COPD and Complex Sleep Apnea (obstructive and central sleep apnea), I suggest using a BiPAP or Bilevel ST machine with AVAPS or iVAPS.

These machines have additional settings of Back-Up Breathing or Respiratory Rate (BURR) and target alveolar ventilation rate or target tidal volume of air to control the ventilation of a patient. The BURR assists in stopping a patient’s breathing rate to go below a certain limit such as 12 breaths per minute.

CPAP machines will do so to a lesser extent as they treat obstructive sleep apnea. However, CPAP machines are limited in treating REM sleep issues. To do so, will likely require the additional machine settings for Trigger and Cycle breathing sensitivity, TI Min and TI Max (time spent on inhalation) and pressure support of greater than 3 cmH2O. 

Doctors still don’t completely understand what causes Awake Bruxism. However, it may be due to a combination of genetic, physical, psychological, and psychosocial factors such as anxiety, stress, frustration or tension.

https://www.newmouth.com/oral-health/bruxism/awake/

How did I get awake bruxism and anxiety, stress, frustration or tension?

By understanding the answer to this question may assist you to stop REM sleep issues and obstructive sleep apnea and a later diagnosis of Parkinson’s disease, Dementia and Alzheimer’s and other neurodegenerative disorders. 

Over the last few months, I was very tired and fatigued and my medical condition deteriorated very fast. The Awake Bruxism worsened very quickly and the symptoms of Dementia appeared. As detailed further on last month’s blog post, I couldn’t remember what I was to do and would forget what I went to a room for. Adding up two numbers even though I was normally good at doing this was causing trouble. It was a struggle to focus on tasks and I was easily distracted and having difficulty explaining something or finding the right words to express themselves.  

The three unanswered questions from above are:

What specifically causes Awake Bruxism?

Is it just REM sleep issues, obstructive sleep apnea and insomnia causing sleep disruptions during the night or is there something else involved?

Does obstructive sleep apnea occurring in all REM sleep periods cause Awake Bruxism or just one or two periods of REM sleep?

I will now cover the last question and some of the first two questions. Further answers to the first two questions will be on the next blog post.

1. My awake bruxism occurred due to a combination of issues occurring during REM sleep including obstructive sleep apnea and insomnia. REM sleep issues are a precursor to a diagnosis of REM sleep behaviour disorder. Below are the symptoms of REM sleep behaviour disorder of which I have had many of them.  

REM sleep is believed to benefit learning, memory and mood. It is also thought to contribute to brain development in infants. A lack of REM sleep and having obstructive sleep apnea may have adverse implications for physical and emotional health including dementia, Type 2 diabetes and mortality.

https://www.aan.com/PressRoom/home/PressRelease/1574

https://aasm.org/obstructive-sleep-apnea-occurring-during-rem-sleep-is-significantly-associated-with-type-2-diabetes/

https://www.webmd.com/sleep-disorders/news/20200707/as-rem-sleep-declines-life-span-suffers

With REM sleep behavior disorder, instead of experiencing the normal temporary paralysis of your arms and legs (atonia) during REM sleep, you physically act out your dreams.

The onset can be gradual or sudden, and episodes may occur occasionally or several times a night. The disorder often worsens with time.

Symptoms of REM sleep behavior disorder may include:

- Movement, such as kicking, punching, arm flailing or jumping from bed, in response to action-filled or violent dreams, such as being chased or defending yourself from an attack

- Noises, such as talking, laughing, shouting, emotional outcries or even cursing

- Being able to recall the dream if you awaken during the episode

https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920

2.  During a typical night, a person may have 5 REM periods based on a 7 hour sleep. Our sleep cycles move between REM and non-REM sleep, with each cycle repeating at about 90-minute intervals. The deeper non-REM sleep stages usually occur earlier in the night.

On the October 2020 blog post Use BiPAP ST Machines with iVAPS or AVAPS for REM sleep issues, I showed a diagram of the Stages of Sleep. 

https://2012books.lardbucket.org/books/beginning-psychology/s09-01-sleeping-and-dreaming-revitali.html

Note the REM period between 4 and 5 hours of sleep. This period makes up a large proportion of total REM sleep for a night.

Out of the 5 REM periods, my awake bruxism was due to issues arising during the period between 4 and 5 hours of sleep.  

3. Sleep bruxism episodes as opposed to awake bruxism occurs during the 2nd half of the night. Below is a schematic diagram of a night’s sleep for children and adolescents. The sleep bruxism episodes (shown in green) usually occur at stage II of non-REM Sleep; particularly in the period before REM sleep, and more rarely during REM sleep.

Note the period between 4 and 5 hours of sleep. As mentioned, my awake bruxism occurred due to REM sleep issues during this time. 

 

Paul Saulue, Maria-Clotilde Carra, Jean-Fran├žois Laluque, Emmanuel d’Incau,

Understanding bruxism in children and adolescents,

International Orthodontics, Volume 13, Issue 4, 2015

https://doi.org/10.1016/j.ortho.2015.09.001.

4. From personal experience having had and currently cleared of the symptoms of dementia, I believe the period between 4 and 5 hours of sleep is absolutely critical to prevent, stop or delay the onset of Parkinson’s disease, Dementia and Alzheimer’s and other neurodegenerative disorders. In addition, that it is essential for a person to preserve as much of the REM sleep period between 4 and 5 hours of sleep for as long as possible. 

This is best illustrated by the graphical representation below. Note the lack of REM sleep and the periods of wakefulness during the period between 4 and 6 hours of sleep when comparing the sleep pattern of a Young Person to that of an Elderly Person.   

This is a graphical representation of the amount of time a person
spends in wakefulness and in the different stages of sleep throughout the night. It is easy to see how the young and the old sleep differently during the night by looking at their hypnograms. The elderly have more periods of wakefulness and less time spent in the slow wave sleep of stages 3 and 4.

https://drconley.org/infographics/sleep-and-aging/

It is clear from various research articles that REM sleep is critical and essential for everyone to have in sufficient quantity and quality. Unfortunately, during REM sleep a person’s breathing becomes irregular and erratic. The challenge with obstructive sleep apnea, insomnia and Awake Bruxism occurring with REM sleep issues is how to overcome these issues using sleep apnea therapy with CPAP and BiPAP and Bilevel machines.

In a research study:

Grimaldi D, Beccuti G, Touma C, Van Cauter E, Mokhlesi B. Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications. Diabetes Care. 2014;37(2):355-363.

https://care.diabetesjournals.org/content/37/2/355.long

When sleep apnea is untreated and obstructs rapid eye movement (REM) sleep, in particular, control of blood sugar worsens in diabetics. Sleep apnea during REM sleep (dream sleep) is more significantly associated with poor glycemic control in Type 2 diabetics than sleep apnea during non-REM sleep.

REM sleep is the most restful form of sleep. It typically occurs during the early hours of the morning, when people are in their deepest state of rest and experience dreams. The brain is highly activated during REM. Breathing levels and cardiovascular functions are also heightened.

“We think sleep apnea during REM sleep is more consequential because it leads to larger drops in blood oxygen levels. The apneas tend to be longer in duration, and as a consequence, the heart rate and blood pressure can rise higher during REM sleep than non-REM sleep,” Dr. Mokhlesi said.

Note that factors such as high blood pressure, lack of physical exercise and smoking – all of which lead to narrowing of the arteries – increase the risk of developing Alzheimer’s disease and vascular dementia. There is evidence that a healthy lifestyle, especially in mid-life, can help reduce the risk of dementia. Regular physical exercise (for example, cycling, swimming, brisk walking), maintaining a healthy weight, not smoking, and drinking alcohol only in moderation, if at all, are linked to a reduced risk of dementia.

A healthy balanced diet also helps to reduce a person’s risk. A balanced diet is one which is low in saturated fat, does not have too much salt, sugar or red meat, and includes plenty of fish, starchy foods, and fruit and vegetables. All these healthy lifestyle choices will also reduce the risk of other serious conditions such as stroke, heart disease and cancer.

It also seems that keeping mentally and socially active into later life may help lower a person’s risk of dementia. Being mentally active could include doing puzzles or reading, or learning a new skill. Being socially active could include visiting friends or going to a place of worship. Volunteering could offer both mental and social activity and many organisations offer opportunities for people looking to donate their time or skills.

https://www.alzheimers.org.uk/about-dementia/types-dementia/can-dementia-be-prevented#content-start

Further details of the combination of REM sleep issues, obstructive sleep apneainsomnia and Awake Bruxism and how they may be an early warning or marker of a diagnosis of REM Sleep Behaviour Disorder (RBD) and subsequently Parkinson's disease, Dementia and Alzheimer's and other neurodegenerative disorders are on the following blog posts:

Oct 20: Use BiPAP ST with iVAPS or AVAPS for REM sleep issues

Nov 20: Use BiPAP and CPAP to treat REM sleep and OSA issues which may cause Parkinson's and Dementia

Jan 21: Stop Hypoxia, Alzheimer's, Bruxism using CPAP and BiPAP 

Feb 21: Stop Insomnia, Hypoxia and REM sleep issues causing Alzheimer's: Use BiPAP 

Mar 21: Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues 

Apl 21: What BiPAP Settings prevent Alzheimer's due to REM sleep breathing issues? 

May 21: Can Different BiPAP Machines prevent Alzheimer's Dementia?  

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

Aug 21: Can Alzheimer's be due to Sleep Position on Back using CPAP?

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