Success is no accident. It is
hard work, perseverance, learning, studying, sacrifice and most of all, love of
what you are doing or learning to do.”
- Pele
(Brazilian – Retired Professional Footballer – 1940 - )
From the
previous blog post How to Stop Eye Tear Duct Air Regurgitation?, the CPAP settings
being used are critical to stop or reduce greatly the air coming through the eye tear duct or nasolacrimal duct and air coming out the eyes. This side effect
is also known as nasolacrimal air regurgitation into the eye. For a small
number of people including myself, additional steps may be required as some air
still comes out of one of my eyes. More details later in the post.
The Secrets to Success to stop or reduce greatly the air 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.
To assist all
people having air coming through the eye tear duct and out of the eyes, at the
end of this post is an actual CPAP settings example that I have used on a CPAP
fixed pressure machine. Use these settings as a guide in applying to your own
personal situation and preferences. The settings that you use will depend on a
number of factors including whether you have had an eye dacryocystorhinostomy
(DCR) operation, a Lester-Jones tube (LJT) insertion or have a faulty tear duct
valve. Each of these may have different diameters and lengths which will affect
the force and volume of air coming through the eye tear duct.
Other factors
to be considered include your pressure requirements, whether you need to use humidification
due to nasal issues and the type of sleep apnea machine being used such as auto
adjusting CPAP and Bilevel or BiPAP auto adjusting machine.
As noted on the
blog post How to Stop Eye Tear Duct Air Regurgitation?, the biggest benefit
was obtained when I stopped using the humidifier. When I did so, 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. For those people using pressure of 12
cmH2O or lower, a CPAP machine may be all that you require.
The settings
for the auto adjusting CPAP machine can be between those of the CPAP fixed
pressure and Bilevel auto adjusting machines. Auto adjusting CPAP machines will
allow you to use a lower minimum pressure than a CPAP fixed pressure machine.
They will adjust the pressure required during the night based on obstructive
sleep apnea.
Many people
will not require maximum pressure up to 17 cmH2O as I do. When using lower
maximum pressure such as 13 cmH2O; you will have a wider range of options in
the settings that you are able to use. These options include increasing the
minimum pressure and EPAP (expiratory pressure) and being able to use more
humidification.
The bilevel
auto adjusting machine has many advantages over the other 2 types of machine as
detailed in the blog post The Secrets to Success. In overcoming the problem
of air coming out the eyes, the ResMed S9 VPAP bilevel machine that I use will
allow you to do the following:
1. Use greater
than 3 cmH2O of pressure support. Pressure support up to 10 cmH2O is available which
enables you to have a greater reduction in the median/ average pressure and use
a lower minimum pressure and EPAP. Note that using pressure support may cause
Central Sleep Apnea. More details on the blog post How to Overcome Central Apnea using Bilevel?
2. Use more
humidification with a higher maximum pressure.
3. Use other options
being TI Min and TI Max (time spent inhaling) and Trigger and Cycle or inhale
and exhale sensitivity settings.
By using TI
Max of 1.2 seconds, pressure support up to 5.6 cmH2O and no humidification, I
have been able to use maximum pressure of 17 cmH2O and reduce both the median
pressure and the volume of air that I am breathing in. As a result, less air is
coming through the eye tear duct and no air is coming out of one of my eyes.
On the blog
page CPAP Vs Bilevel Settings Example, a large reduction of 22.1% in
median/ average IPAP/ EPAP pressure and 9.1% in median Tidal Volume of air was
achieved when using a Bilevel auto adjusting machine compared to a CPAP fixed
pressure machine.
These other
options being TI Min and TI Max and Trigger and Cycle settings will also enable
you to keep your breathing “under control” during the night especially when you
go through different sleep stages. Some nights when I used CPAP, the average time
inhaling was more than the time exhaling which caused side effects and issues using machine. In addition, the other options allow me to sync my
breathing with the machine and give me better comfort, compliance, therapy and
sleep quality when compared to both CPAP fixed pressure and auto adjusting CPAP
machines.
On the next blog
post CPAP air coming out the eyes: Other options, I will detail the other things that I have done to stop air coming
through the eye tear duct and coming out the eyes. This is due to the second
eye DCR operation that I had in 2015 on my right eye being carried out slightly
differently to the first eye DCR operation in 1996 on my left eye which caused
an increase in the volume of air coming through the eye tear duct.
Below is a
Table showing the settings that I have used in my own sleep apnea therapy with a
CPAP fixed pressure machine. Use these settings as a guide in applying to your
own personal situation and preferences.
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) which may cause air coming out the eyes. Top pressure during the night may be more than 20 cmH2O! 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?
Further details on how to overcome the issue of air through
the eye tear duct and coming out the eyes using any sleep apnea mask and how two Aha moments gave me the
answer are on the following blog posts:
Air through Eye Tear Duct - Introduction
CPAP Air coming out of the Eyes
Air through Eye Tear Duct - Introduction
CPAP Air coming out of the Eyes
How to Stop Eye Tear Duct Air Regurgitation?
CPAP Air out Eyes and Tear Ducts: Other Options
CPAP Air out Eyes and Tear Ducts: Other Options (Part 2)
CPAP Air out Eyes and Tear Ducts: Other Options
CPAP Air out Eyes and Tear Ducts: Other Options (Part 2)
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