15 March 2020

Lack of Coronavirus Ventilators: Use Bilevel and CPAP


“Remember, you cannot go anywhere, if you have not first imagined yourself there. People achieve that which they have imagined themselves achieving over and over in their minds. That which you have never dreamed of is that which you will never attain.”
-John Bertrand (Australian Yachtsman, Businessman and Philanthropist – 1946 -   )

With the rapid spread around the world of the Coronavirus (COVID-19), many experts are predicting a shortage or lack of life-saving Ventilators being available to all patients who require them. Should this situation happen, seriously consider obtaining and using a Bilevel or BiPAP auto adjusting pressure machine and adjusting the settings. As a last resort, use CPAP.    

In an Article published in the USA on 12 March 2020, Dr Sanjay Gupta and other experts are predicting that, as the coronavirus continues to spread, our country's need for ventilators for the 1% of those afflicted who require them - one million people - would completely overwhelm the available supply of only about 72,000 full ventilators, many of which are already in use for patients with other medical problems. He has suggested that CPAP machines might be used.

Expert estimates reveal that US hospitals may run short on life-saving ventilators as the coronavirus outbreak ramps up

Support for use of CPAP and Bilevel or BiPAP machines can be found in the following discussion paper published 5 March 2020.

Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2
By John L. Hick, Dan Hanfling, Matthew K. Wynia, and Andrew T. Pavia

A major epidemic or pandemic can overwhelm the capacity of outpatient facilities, emergency departments (EDs), hospitals, and intensive care units, leading to critical shortages of staff, space, and supplies with serious implications for patient outcomes.

Initial reports describe progression of lung injury in the second week of illness and severe cases may require prolonged treatment, including mechanical ventilation. Use of BiPAP or Continuous Positive Airway Pressure (CPAP) may forestall the need for intubation and has been broadly used in early case series and anecdotal reports. Additional CPAP machines might be available from home users for use in hospital settings, and adjusted criteria for intubation and weaning may reduce days on a ventilator. 

As mentioned previously, with the rapid spread around the world of the Coronavirus (COVID-19), many experts are predicting a shortage or lack of Ventilators being available to all patients who require them. Should this situation happen, seriously consider obtaining and using a bilevel auto adjusting pressure machine and adjusting the settings. 

Only as a last resort, I suggest using CPAP. This is due to a person needing to be able to breathe on their own as they will need to initiate all of their breaths. 

CPAP is a form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in people who are able to breathe spontaneously on their own, but need help keeping their airway unobstructed.


The ventilator itself does not cycle during CPAP, no additional pressure above the level of CPAP is provided, and patients must initiate all of their breaths.

Werman, Howard A.; Karren, K; Mistovich, Joseph (2014). "Continuous Positive Airway Pressure(CPAP)". In Werman A. Howard; Mistovich J; Karren K (eds.). Prehospital Emergency Care, 10e. https://en.wikipedia.org/wiki/Pearson_Education

Bilevel or BiPAP machines are used in assisting patients with COPD (Chronic obstructive pulmonary disorder) to breathe. In the ResMed Guide “VPAP COPD”, it advises “These patients often have difficulty exhaling air, which can lead to gas trapping and hyperinflation. The fast Rise time, high cycle (exhale) sensitivity and shortened TI Max (inhale time) all contribute to minimizing hyperinflation and improving synchrony and comfort.”

In the blog post Elite Athletes need Bilevel, I advised a major weakness of the CPAP and auto-adjusting CPAP Machines is that the machines are limited in their settings such as pressure support of 3 cmH2O. A bilevel machine has pressure support of up to 10 cmH2O. In addition, the CPAP machines do not have settings for Trigger and Cycle and TI Max and TI Min. These additional settings allow you to optimize the settings on the machine for you so that you can have a great night’s sleep.

On the blog page Guide to Success using CPAP and Bilevel, I provide the Steps to take to succeed using a sleep apnea machine. These additional bilevel settings I found from personal experience are also necessary as detailed in Blog Posts Stop CPAP causing Insomnia, Stop CPAP causing Weight Gain, and How to overcome Central Apnea.

As shown below, a number of the common symptoms of COPD are similar to those of the Coronavirus (COVID-19). This is the reason why I believe serious consideration should be given to using a bilevel auto adjusting pressure machine should there be a shortage or lack of Ventilators. I use a ResMed S9 VPAP Auto machine. This machine has been superseded by the ResMed S10 AirCurve VPAP machine. I understand that both machine algorithms may be pretty similar.

Used 2nd hand ResMed VPAP Auto machines can be purchased as well as other brands and machines such as Philips Respironics for a much lower price than buying a new machine. 

I have purchased a few second hand machines with low machine use hours from a company, Secondwind CPAP in the USA. If you live outside the USA, you should be able to purchase the machine without having to see a doctor and obtain a prescription and no sleep study is required. One of the machines I purchased only had 2 weeks of use or approximately 120 hours on the machine. This company as well as others are listed on a supplier list on one of the sleep apnea forums and its web address is as follows: https://www.secondwindcpap.com/ 

Support for the use of Bilevel or BiPAP machines with COPD is detailed in the following article:  

“BiPAP for COPD: How it works, benefits, and risks”

COPD makes it more difficult for a person to take air into their lungs. Their lungs are often less elastic, and so they may find it much harder to breathe deeply and their lungs can fill with mucus.

Doctors believe that daily use of BiPAP not only improves the quality of sleep for people with severe COPD, but it can also extend a person’s life. The use of BiPAP machines may also reduce the rate of hospital admissions among people with COPD.

BiPAP machines can also be used in emergency situations. In a flare-up of COPD symptoms, a BiPAP machine can take some of the load off a person’s breathing muscles and heart, allowing them to breathe more easily. It also boosts oxygen levels and normalizes carbon dioxide levels. 

A number of the common symptoms of COPD are similar to those of the Coronavirus (COVID-19). This is the reason why I believe serious consideration should be given to using a bilevel auto adjusting pressure machine should there be a shortage or lack of Ventilators. 

Common Symptoms of COPD are:
- Shortness of Breath (Breathlessness)
- Frequent respiratory infections
- Persistent cough
- Chest tightening and wheezy
- Increased mucus production
- Fatigue


Common Symptoms of Coronavirus (COVID-19) according to the World Health Organisation are:
- Shortness of Breath and breathing difficulties
- Respiratory symptoms
- Cough
- Fever

Other symptoms may include fatigue and tiredness, sore throat, headaches, nasal congestion or a runny nose. 

In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. People of all ages can be infected by the new coronavirus. Older people and people with pre-existing medical conditions (such as asthma, diabetes and heart disease) appear to be more vulnerable to becoming severely ill with the virus. Severe pneumonia can lead to respiratory failure, which is the leading cause of death from coronavirus.

One of the key Secrets to Success using a sleep apnea machine was to change from using a CPAP machine to using a Bilevel/ BiPAP auto adjusting pressure machine. More details are at the Blog Page CPAP Vs Bilevel Settings Example. Another key Secret to Success was to use different bilevel settings for different situations

On the Blog Pages, you can see that I have used the principles of bilevel pressure being applied to COPD in the settings of my own machine. 

In addition, there are plenty of masks available as more than 20 million sleep apnea machines have been sold worldwide. Importantly, oxygen therapy can be easily connected should it be required. Some masks have an oxygen port otherwise use an adapter and attach to your tubing. 

Over the next few blog posts, I will detail my concerns with some of the medical protocols being used and the mistakes that I believe are being made during Coronavirus or COVID-19. These posts are:
 
 
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

08 March 2020

CPAP Air out Eyes and Tear Ducts: Other Options


“Many of life's failures are people who did not realize how close they were to success when they gave up.”
- Thomas Edison (American Inventor & Businessman – 1847 - 1931)

On the previous blog post CPAP Settings to Stop Air coming out the Eyes, I mentioned that I had DCR operations on both eye tear ducts and that air still comes out of my right eye. This was after adjusting the CPAP and Bilevel or BiPAP settings on the sleep apnea machine. On this Post, I provide details of Other Options that I have used to stop CPAP air coming out the eyes and air regurgitation through the eye tear ducts. Use these other options together with adjusting the CPAP and Bilevel or BiPAP settings where necessary. These other options have varying degrees of success which will be outlined below. 

For my left eye, no air comes out the eye when using maximum pressure up to 17 cmH2O. However, for my right eye, some air comes out the eye. 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. The second operation used a temporary stent which is removed after a few weeks. The stent resulted in a wider tear duct than the first operation which causes an increase in the volume of air coming through the eye tear duct.  

Should you be thinking about or intending to have eye DCR surgery, I recommend you ask the Ophthalmologist, eye specialist to not put in temporary stents. By doing so, a person should have a smaller diameter in the tear duct. This will reduce the air coming through the eye tear duct and no air regurgitation into the eye should occur. Your sleep apnea therapy will be much easier in overcoming air through the eye ear duct especially when you consider that you may be using the sleep apnea machine for the next 30 to 40 or more years. 

Success rates of DCR surgery without stenting are excellent and studies have failed to show any clear benefit of stenting. When I last saw the Ophthalmologist in 2015, I was advised that “my left eye was perfect!” 

Furthermore, the practice is not entirely benign and stent-related complications include prolapse, corneal abrasion, canaliculi is, adhesions, false passage creation during intubation and cheese wiring of the puncta.

Feng Y, Cain J, Zhang J, Han X. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol 2011;46:6:521-527

The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis.

There are a number of different options available to stop air coming out the eyes and air regurgitation into the eye when you use CPAP. These other options may be critical to you should you have an issue including using a lot of pressure support or you need to use the humidifier due to nasal problems. 

As detailed in previous blog posts CPAP settings to stop air coming out the eyes and Stop eye tear duct air regurgitation, using a humidifier and/ or little pressure support will increase the air coming through the eye tear duct and out the eyes. This CPAP side effect may cause you a lot of eye pain and suffering and lack of quality sleep at night. 

1. Bilevel or BiPAP Auto adjusting pressure machine
 
Seriously consider obtaining a Bilevel or BiPAP Auto adjusting machine. This is a great option for many of you with CPAP air coming out the eyes and is one of The Secrets to Success should you be having issues using CPAP. It is a great option due to the various options on the machine in particular the TI Min and Max to control the time you inhale and pressure support of up to 10 cmH2O when compared to CPAP with only 3 cmH2O. This option is the best especially where you are using pressure greater than 12 cmH2O and/ or you are having issues with your sleep apnea therapy such as nose issues. 

From my personal experience, the issue of air coming out of the eyes can be resolved for most people by reviewing and optimizing the settings being used on their sleep apnea machine. 

2.  Swimming Goggles with medical gauze swabs inside each goggle 

Using medical gauze swabs inside goggles is my next preferred option as it stops air coming through in my right eye and is cheap. The cost was only $2.00 for the googles and will save money compared to other options. The medical gauze is soft and molds to the shape of your eye and together with the googles puts just a little pressure on the eye. I find the goggles very comfortable and do not get hot and sweaty on your eyes. 

The other advantage of using swim goggles is that with the medical gauze it blocks the light in the early morning allowing me to sleep longer without being woken. My room faces east and in the morning especially in summer, the rising sun was waking me up too early. By blocking out the light you increase the odds of sleeping longer and more deeply. In addition, you are saving money by not buying sleeping aids such as Melatonin and more expensive sleep masks. 

3. Nexcare Eye Patches 

The Nexcare Eye Patches work as effectively as the swimming goggles when you put medical gauze swabs underneath the patch. Using the gauze puts just a little pressure on the eye. However, these are more expensive as the patch will last only one night. With the eye patches only, the CPAP air may get under the eyelid depending on your pressure requirements. 

You may also consider using the eye patches should you only want to cover one eye and do not wish to have any inconvenience of having an additional item of the goggles around your head. They are also good should you want a backup to the goggles. 

In the post next month Part 2, CPAP Air out Eyes and Tear Ducts, I will continue with the other options that are available to you to stop air coming out the eyes. 

Using the other options together with adjusting the CPAP and Bilevel settings, from personal experience all patients will be able to continue to use their sleep apnea machine and have a great night’s sleep. 

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