11 April 2020

CPAP Air out Eyes and Tear Ducts: Other Options (Part 2)

“Have the courage to follow your heart and intuition. They somehow already know what you truly want to become.”
- Steve Jobs (American Inventor, Designer & Entrepreneur – 1955 - 2011) 

On the 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 settings on the sleep apnea machine. This post continues on from Part 1, CPAP Air out Eyes and Tear Ducts and provides 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. 

In Part 1, I mentioned that 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.  

As detailed on CPAP Settings to Stop Air coming out the Eyes and How to 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. However, some people may have issues such as needing to use a humidifier due to nasal problems. 

Other Options are available and these may be critical to you to stop air coming out the eyes. As detailed in Part 1, the first 3 options are as follows:

1. Obtain and use a Bilevel Auto adjusting pressure machine; 

2. Swimming Goggles with medical gauze swabs inside each goggle; and 

3. Nexcare Eye Patches. 

Options 4 to 10 are as follows: 

4. Night Time Gel 

Use Systane Night Gel or Genteal Night Gel. The gel is like grease and will last the night. Do not buy the normal day time gel or artificial tears as they are too watery and thinner and will not last the night. The gel will allow an extra 0.3 to 0.4 cmH2O pressure or 3% to 4% increase in maximum pressure based on average pressure of 10 cmH2O. However, using gel will cost money compared to using swimming goggles with medical gauze. 

5. Put Medical Tape over part of the Nostrils 

On the blog post  Stop CPAP Nasal Congestion and Nose Bleeding, I cover a portion of both nostrils at the middle section of each nostril with Nexcare Micropore First Aid tape. Note I am using a nasal mask. By using medical tape over part of my nostrils reduces the volume of air by 3% to 4% making it easier to overcome air coming out the eyes. 

The tape is also gentle to the skin, highly breathable and holds well on damp skin. The paper tape works brilliantly every night! It stops the nose from becoming irritated and now I have no nasal congestion or nose bleeding. I wake up in the morning with a clear nose breathing freely. It’s a great feeling! 

6. Stents 

The Ophthalmologist, eye specialist may suggest putting in a stent. Having had a temporary stent as part of the eye DCR operation, I would not recommend doing so. I found the air coming through the stent made my eye red and sore for 3 to 4 hours each morning after waking up. This was before I worked out how to stop air coming out the eye using a sleep apnea machine. When I had no stents, whilst my eyes hurt on waking up in the morning, the pain was gone within one hour. 

In addition to the cost of a medical specialist, I was advised that the stent may come out if you blow your nose too hard! Also, I could feel the stents next to my eye which became annoying after a few days. 

7. Punctal Plugs 

My Ophthalmologist advised that if you have “normal” eyes and your tears are flowing normally, then do not put in punctal plugs. Should you put the punctal plugs in with normal eyes, your eyes will become like a blocked tear duct and tears will pour down your cheeks all the time. I was advised to only put in the plugs should you have “Dry Eyes”. 

8. Lift your bed up at one end 

Due to reflux, I have lifted my bed up 14 cms or 5.5 inches. An added bonus was that for every 5 inches you lift the bed up, you can increase the pressure by an estimate of 0.2 cmH2O. At one time I had the bed up 22.5 inches at one end.  By doing so, I was able to increase the maximum pressure by 1.0 cmH2O or 10% on average pressure of 10 cmH2O. This is due to gravity and that the air from the sleep apnea machine will have to travel up the eye tear duct.

The obvious question that arises is how do you stay up on the bed without slipping and ending on the floor? By using anti slip mats on the bed and tied around my body! I found at 38 cms or 15 inches I had no trouble staying up on the bed. Most people will not need to go to this extreme measure as optimizing the settings on the CPAP and Bilevel machines will be all that is required.    

9. Total Face Mask 

As explained on the blog post CPAP Air coming out of the Eyes, a total face mask is not the answer for many people as the sleep medical specialists and equipment suppliers may advise to stop air coming through the eye tear ducts and out of the eyes. It is a very hard mask to tolerate for many people and is considered a mask of “last resort” when all other masks such as nasal pillows and nasal have failed. 

In addition, as detailed on The Secrets to Success using CPAP and Bilevel, a senior executive of a major equipment supplier advised that “depending on Country, only 2% to 4% of total patients get issued with a bilevel machine. The medical specialists will not issue more bilevel machines as they fear that the machine will not work and that they will get sued!” For this reason, should your sleep medical specialist not issue a Bilevel or BiPAP machine and you are having issues obtaining one, a total face mask together with using the Other Options may be your only answer to stop air coming out the eyes. 

10. Sleep upright in a Recliner or on a Wedge Pillow. 

I have slept upright in a Recliner and on a high Wedge Pillow a few times before I worked out how to stop air coming out the eyes using a sleep apnea machine. It was very uncomfortable and I just could not get into a proper sleep position during the night. I was awake off and on all the time. For me having back and neck issues and wanting to sleep on my side, this option would be an option of “last resort” when nothing else worked. By using this option, you will be able to increase the maximum pressure as noted at Option 8, Lift your bed up at one end.   

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

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) 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: 

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 
How to Stop Eye Tear Duct Air Regurgitation? 

CPAP Settings to Stop Air coming out the Eyes  

CPAP Air out Eyes and Tear Ducts: Other Options  

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