08 February 2020

CPAP Settings to Stop Air coming out the Eyes

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 12.8 cmH2O (inhale and exhale pressure). This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. More details are on the blog post:
Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep 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 

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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