11 August 2020

BiPAP Ventilator Settings COVID-19 Deaths

Are BiPAP and Ventilator Settings contributing to COVID-19 Deaths?

“Sometimes, less is more.” 

-William Shakespeare (English Poet and Playwright – 1564 - 1616)

Since last month’s blog post, COVID-19 or Coronavirus deaths have increased by over 150,000 to nearly 740,000 deaths worldwide. This figure is increasing at an alarming rate! Could any of these deaths and long term damage to patients have been avoided? Are BiPAP and Bilevel and Ventilator settings being used by medical specialists contributing to COVID-19 Deaths and long term damage to patients? 

To avoid confusion, BiPAP is a Registered Trademark owned by Philips Respironics. Bilevel refers to all other brands such as ResMed.   

The explanation of my concerns with some of the medical protocols over a number of blog posts is being done on a practical level based on my own personal experience, patient comments and various research studies. There will be others with more knowledge and a medical background who can explain better from a technical point of view.

I may be misunderstanding the medical situation as I am not a medical doctor working in the hospitals and have not looked at any patient history. However, I am hearing and reading articles and comments being made by various medical workers and patients.

There have been many deaths with a death rate as high as 70% to 80% using ventilators for elderly people aged 70 to 80 years and older.

https://www.washingtonpost.com/health/elderly-covid-19-patients-on-ventilators-usually-do-not-survive-new-york-hospitals-report/2020/05/19/ba20e822-99f8-11ea-89fd-28fb313d1886_story.html

A patient having COVID-19 and other serious chronic medical conditions such as heart diseases, cancer, diabetes and COPD (chronic obstructive pulmonary disease) are definitely reasons for this very high death rate.

Is there another reason partly responsible for the high death rate for the 70 years and over patients using Ventilators?

In previous blog posts Are CPAP and BiPAP Mistakes contributing to COVID-19 Deaths? and  Coronavirus Deaths due to Mistakes using Ventilators and BiPAP?, I outline mistakes that are being made during the COVID-19 pandemic. In addition, the patients are likely to be having various side effects and issues from using CPAP and BiPAP and Bilevel machines and Ventilators which may include insomniamask leaks and air coming out the eyes.

These mistakes and side effects and issues have likely caused anxiety, stress, pain and suffering to patients which may have contributed to their death or long-term lung damage or other serious medical issues.

Another reason for the high death rate amongst elderly patients may be due to the BiPAP and Bilevel and Ventilator Settings being used by the medical specialists. Some of the settings that are being used for patients are:

- High pressure of 15 cmH2O to 20 cmH2O or more;

- High pressure assist or pressure support of greater than 10 cmH2O; and

- Low breathing inspiration or TI time of 0.5 to 1.0 seconds.

Pressure assist or pressure support is the difference between IPAP (inhale pressure) and EPAP (exhale pressure) being used during sleep therapy.

During COVID-19, due to the lack of or shortage of Ventilators, medical specialists are converting BiPAP and Bilevel machines to Ventilators.  

Examples on YouTube are:

Converting Philips-Respironics V60 BiPAP to an Invasive Ventilators

https://www.youtube.com/watch?v=WAmHOp6gLck

ResMed VPAP ST for Invasive Mechanical Ventilation

https://www.youtube.com/watch?v=EnVp_HcE9lo

During the period 2010 to 2017, I learnt how to use the various sleep apnea machines and how they truly work. I made many mistakes in learning to optimize my sleep so as to wake up feeling refreshed and energized each day. Hundreds of different settings on the various machines were tried to achieve success. More details are on blog posts Secrets to Success: Answer is FREE and Guide to Success using CPAP and Bilevel. 

One of the biggest mistakes I made was using similar settings outlined above that are currently being used by the medical specialists during the COVID-19 pandemic.

Both the machines mentioned above have a Back-Up Respiratory Rate (BURR). This feature will be critical should a patient’s medical condition seriously deteriorate and breathing issues arise. The BURR assists in stopping a patient’s breathing rate to go below a certain limit such as 12 breaths per minute.  

The machine that I use being the ResMed S9 VAuto bilevel machine does not have this feature. However, on the above machines, having a BURR will not stop a patient’s breathing from going faster. That is, a patient’s breathing rate may go to 25 to 30 or more breaths per minute especially during REM (rapid eye movement) sleep. The breathing rate will also be fast should the BURR be set high such as 30 breaths per minute as shown in the ResMed VPAP ST YouTube video.    

Personal experience from using similar settings outlined above caused me chest pain, vertigo, ears blocking and heart palpitations. This was due to the combination of the following:

- High breathing/ respiratory rate;

- High pressure;

- High pressure assist or pressure support; and

- Low inspiration time.

As you are probably aware, heart palpitations are a warning sign of possible heart attack! In addition, sometimes I would wake up having a bad dream or even worst, a nightmare.

Using the above machine settings may have serious consequences such as death where a person has COVID-19, on medication and has other serious chronic medical conditions such as heart diseases, cancer and COPD (chronic obstructive pulmonary disease).

These other serious medical conditions are more likely to be present in older or elderly patients who are the larger proportion of patients that are currently dying or having long term damage should they survive in hospital. As noted above there is a death rate of 70% to 80% for 70 to 80 years old when using Ventilators.

Read more about heart palpitations at the following website:

https://www.mayoclinic.org/diseases-conditions/heart-palpitations/symptoms-causes/syc-20373196

In addition to COVID-19 and other serious medical conditions, a person can have a high breathing/ respiratory rate due to a high back-up respiratory rate (BURR) set on the machine and/ or during REM (rapid eye movement) sleep. 

During non-REM sleep (about 80% of an adult's sleeping time), you breathe slowly and regularly. But during REM sleep, your breathing rate goes up again. That's the time we typically dreamBreathing also becomes more shallow and less regular during this sleep phase.

https://www.webmd.com/sleep-disorders/qa/what-happens-to-your-breathing-when-you-sleep#:~:text=During%20non%2DREM%20sleep%20(about,regular%20during%20this%20sleep%20phase.

There is considerable evidence that cardiac function may be stressed during sleep. Rapid eye movement (REM) sleep, in particular, may redline the system with increasing risk towards morning.

https://www.verywellhealth.com/why-do-people-die-in-their-sleep-4098302

During REM stages of sleep during the night, my breathing rate rises and gets fast, which is when nightmares tend to happen.

http://sleepeducation.org/sleep-disorders-by-category/parasomnias/nightmares

In a recent news article 6 August 2020, it was mentioned that some patients are “having hallucinations.” As my experience shows, the reason may be due to the settings outlined above being used on the BiPAP and Bilevel and Ventilators. 

In the article, Dr Chris van Tulleken, an infectious diseases doctor at UCLH in central London advised:

“…the disease is throwing up some unexpected outcomes. The doctors are astounded at how many confused patients there are having hallucinations – with one seeing lions, tigers and monkeys in their house. In the hospital, half of those coming into the intensive care unit are dying, which is causing much concern.”

https://www.msn.com/en-au/health/medical/crying-doctor-sees-twin-brother-s-heart-stop-amid-coronavirus-recovery-terror/ar-BB17BLTr?ocid=msedgntp

How did I overcome the issues of chest pain, vertigo, ears blocking and heart palpitations? 

On the blog post Guide to Success using CPAP and Bilevel, I detail the 4 steps that I believe are the Secrets to Success.

Two of the steps critical to achieving success are:

1. Reduce median/ average pressure of IPAP (inhale pressure) and EPAP (exhale pressure) as much as possible. The maximum or top pressure is only required as necessary to cover obstructive sleep apneas; and

2. Reduce median Minute Ventilation (MV) to 6 litres/ minute or lower and keep the 95% to 100% rate “under control”.

The Secret is to slow your breathing/ respiratory rate (RR) down and reduce the volume of air/ tidal volume (TV) that you are breathing in. Ideally, apply the principles of the Buteyko Method of Breathing to your sleep apnea machine. Minute Ventilation is the total volume of air entering the lungs in a minute.  

More details on applying the Buteyko Method of Breathing to Ventilators and COVID-19 are at the following: 

https://medium.com/@jeancampbell_25104/the-buteyko-breathing-method-improves-ventilator-outcomes-517400fd93e5

https://www.breathingcenter.com/buteyko-breathing-blog/covid-19-why-mechanical-ventilation-doesn-t-help 

Applying these 2 steps to me as follows:

1. Limiting the maximum pressure to 17.4 cmH2O on my machine.

Once the pressure went over this amount, the issues such as vertigo and heart palpitations would reoccur. 

2. Reducing the pressure support to maximum of 5.6 cmH2O.

3. Using minimum inspiration time or TI Min of 1.1 seconds. 

4. Slowing my breathing to a median rate of 14 breaths per minute.

By doing so enabled me to have an Inspiratory: Expiratory (I: E) ratio of 1:2.7 giving me plenty of time to exhale. 

5. For Tidal Volume (TV), using 6 ml/kg ideal body weight (IBW) or predicted body weight (PBW) instead of actual body weight.  

6. Using maximum starting IPAP of 9.8 cmH2O and EPAP of only 4.2 cmH2O.  

I use 4.2 cmH2O as below this number I had a number of sleep apneas occurring. Depending on the patient requirements, a higher IPAP and EPAP may be required. For example, an EPAP of 5 cmH2O or more may be required.  

More details of the bilevel settings that I use are shown on the blog post Different Bilevel Settings Example.

After optimizing the settings on the patient’s machine, I suggest that oxygen is added or increased as necessary.

Personal experience has also shown that once my median breathing rate goes above 15.5 breaths per minute, I will start having chest pain and vertigo in the mornings after waking up. For me, the breathing rate when asleep is critical to successful sleep apnea therapy. 

By setting a tight range for inspiration of TI Min of 1.1 seconds to TI Max of 1.2 seconds, I found that these settings controlled my breathing and made it more regular when sleeping. I have better breathing rhythm giving me better sleep quality.   

Your heart and body rely on a consistent, steady beat to best move blood throughout your body. If the beat gets out of rhythm, this could be a sign you’re having a heart attack.

https://www.healthline.com/health/heart-disease/warning-signs-heart-attack

In 2014 and 2015 when I was learning how the various sleep apnea machines truly work, I recall thinking that it was counter-intuitive to do the opposite of what I was currently doing and that “Sometimes, less is more.” That is, it is possible to overdo something. By using less median pressure and pressure assist or pressure support would lead to better results with sleep apnea therapy.

At the time, I thought that whilst I may have more obstructive sleep apnea; this was far better than having chest pain, vertigo and heart palpitations every day! In time, I realized that to do the opposite of what I was currently doing would actually lead to success and not make my sleep apnea worst. Now I wake up refreshed and energized each day and some days I am ready to climb Mount Everest!

In the previous blog post, I mention that in the early stages of coronavirus and in the recovery stage to consider using a similar machine and settings that I use, being the ResMed S9 VAuto or AirCurve S10 Bilevel machine. There would seem to be plenty of these machines available as they are used by many people around the world.

By having great therapy and quality sleep, a patient especially the elderly will be able to build up their immunity system to best overcome the coronavirus. A patient may recover faster and leave hospital without the physical and mental scars from using a Ventilator. Such treatment may reduce the horrific death toll and the current high death rate using Ventilators.

My concerns with some of the medical protocols being used and mistakes that I believe are being made during COVID-19 are also detailed on the following blog posts:

Lack of Coronavirus Ventilators: Use Bilevel and CPAP 

Coronavirus Deaths using Ventilators, BiPAP and CPAP 

Coronavirus Deaths due to Mistakes using Ventilators and BiPAP? 

Are CPAP and BiPAP Mistakes contributing to COVID-19 Deaths? 

Are BiPAP and Bilevel and Ventilators reducing Deaths during Coronavirus? 

If the world’s going to get better, it’s going to be up to you, the medical specialists to CHANGE it!

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