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!
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
Air through Eye Tear Duct - Introduction
CPAP Air coming out of the Eyes
CPAP Settings to Stop Air coming out the Eyes
CPAP Air out Eyes and Tear Ducts: Other Options
"Have courage. Be adventurous and Go for it! Overcome your fear.”