05 January 2020

How to Stop Eye Tear Duct Air Regurgitation?


“The simple things are also the most extraordinary things, and only the wise can see them.”
- Paulo Coelho (Brazilian Novelist -
The Alchemist - 1947 - Present)

On the blog post, Air through Eye Tear Duct, I mentioned that it was after I had two Aha moments that I came to realize what the solution was to stop or reduce greatly CPAP air coming through the eye tear duct or nasolacrimal duct. How to stop lacrimal duct air regurgitation into the eye and air coming out the eye? The solution had been staring me in the face for a long time; however I could not see it! The solution is SIMPLE not complex as the sleep medical specialists would have you believe. 

In addition, there is no need to use a total face mask as detailed in the previous blog post CPAP Air coming out of the Eyes. A person can use any type of sleep apnea mask including nasal and full face mask.

The first Aha moment came just after I filled a bucket with water to wash the car. There was dirt on the driveway and so I automatically put my finger over part of the end of the hose to wash the dirt away. It was at that precise moment that I realized that it was the increased force of water that was causing the air to come through the eye tear duct and out of the eyes. 

As noted in CPAP Air coming out of the Eyes, when using the sleep apnea machine, the increased “force of water” is the air coming out faster and further from the eye tear duct due to the small area or opening of the tear duct when compared to the nose. The water was from the heated humidifier in the sleep apnea machine combining with the air.  

Reduce or stop using humidification and you are left with a much lighter fluid in air. By doing so as well as reducing the median/ average pressure from the sleep apnea machine will for most people allow you to overcome the issue of air through the eye tear duct and coming out of the eyes. Details of how to stop using the Humidifier are on the blog posts Why NOT to use a CPAP Humidifier? and Stop CPAP causing Mask Leaks.  
 
The second Aha moment came a few days after the first Aha moment. I was standing in the kitchen and it started to rain. The rain was falling to the ground. Why was the rain falling and not going upwards? 

It was due to gravity and that water is heavier than air. So came the second Aha moment. When you lie on your side, the gravity together with the air combining with humidification from the humidifier causes the air to be heavier and drop faster down the eye tear duct. As more humidity is used, the heavier the air is as the air becomes more like water. This will lead to the air going under the eye lids leading them to “flap in the wind” and may wake you up constantly through the night. 

The air will also lead to irritation of the eyes and you will wake up with terrible, painful red sore eyes in the morning as well as being totally exhausted from lack of quality sleep. I did not look forward to going to sleep at night as I knew each morning I would wake up with the same pain and suffering as the previous morning! 

Without adequate tears, you may have an increased risk of eye infection. In addition, damage may occur to the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcer and vision problems. Further details are at:

The easiest solution is to turn over to your other side so that the “good” eye or the eye that has had eye dacryocystorhinostomy (DCR) surgery is on top and you stay on the one side all night. This means that the air will have to go up rather than down with gravity. 

In addition, the friction caused by the tear duct itself will also assist. However, for this solution to work will depend on the sleep apnea machine pressure and that you have no other issues such as an eye DCR surgery on the other eye and neck and shoulder issues.

From the two Aha moments and the principle of filling up a bucket with water using a hose as detailed in CPAP Air coming out of the Eyes, I realized that The Secrets to Success to stop or reduce air coming through the eye tear duct and out of the eyes were to do one or more of the following:

1. Reduce or stop using humidification from the humidifier; 

2. Reduce the median/ average pressure from the sleep apnea machine;

3. Reduce the volume of air or Tidal Volume (TV) that you are breathing in.

Note that should you stop using the humidifier, consideration still needs to be given to the humidity in the room where you sleep. Even when I stopped using the humidifier, I found that the humidity in the air can affect the sleep machine maximum pressure that you can use by up to 1 cmH2O. In addition, for some people extra steps may need to be taken to resolve the problem of air coming out of the eyes. More details are on later blog posts CPAP Air out Eyes and Tear Ducts: Other Options and Other Options (Part 2).

Should you have nasal issues when you stop or reduce using humidification, I recommend you read Stop CPAP Nasal Congestion and Nose Bleeding for a quick, easy and very cost effective solution which may work for you. I put medical paper tape over a portion of both nostrils at the middle section of each nostril. An added bonus is that by using the tape, there is an estimated small reduction in the volume of air of about 3% to 4% coming out the eyes.       

For points 2 & 3, for further details, refer to Guide to Success using CPAP and Bilevel.

Importantly, whilst I use a Bilevel or BiPAP Auto Adjusting machine, for those people using pressure of 12 cmH2O or lower, a CPAP machine may be all that they require. Even though my maximum or top pressure may go up to 17 cmH2O during the night, the bilevel machine has been set to only use the top pressure required as necessary to cover obstructive sleep apnea. This contrasts with the CPAP fixed pressure machine which operates at maximum pressure all night. 

The biggest benefit for those people who have air coming out of the eyes is that when I stopped using the humidifier, I was able to increase the maximum pressure by more than 33% to 12 cmH2O fixed pressure from 9 cmH2O using pressure support of 3 cmH2O.Using the Bilevel Auto Adjusting machine, the maximum pressure increased by more than 88% to 17 cmH2O using pressure support of 5 cmH2O or more!  Details are on blog pages CPAP Vs Bilevel Settings Example and Different Bilevel Settings Example

In the next post, I detail the CPAP settings to stop air coming out the eyes.

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    
 

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