“There are some things that can beat smartness and foresight? Awkwardness and stupidity can. The best swordsman in the world doesn’t need to fear the second best swordsman in the world; no, the person for him to be afraid of is some ignorant antagonist who has never had a sword in his hand before; he doesn’t do the thing he ought to do, and so the expert isn’t prepared for him; he does the thing he ought not to do; and often it catches the expert out and ends him on the spot.”
- Mark Twain (American Author – 1835 - 1910)
On an earlier blog post Elite Athletes need Bilevel, I posed a question: How did the most successful elite athletes and wealthiest people become that way? Many did not go to university. They did things their way and did not follow what others had done. I have not followed what the sleep medical specialists have advised in using a CPAP machine. Using a BiPAP or Bilevel machine has enabled me to overcome all CPAP side effects and issues. By using these machines and CPAP to a lesser extent, a person may be able to treat REM sleep and obstructive sleep apnea (OSA) issues which may cause Parkinson’s and Dementia and Alzheimer’s and other neurodegenerative disorders.
To avoid confusion, BiPAP is a Registered Trademark owned by Philips Respironics. Bilevel refers to all other brands such as ResMed.
The explanation of how I treated and stopped REM sleep and Obstructive sleep apnea issues is going to be done on a practical level based on my own personal experience. I am not a medical doctor and there will be others with more knowledge and a medical background who can explain better from a technical point of view.
Why have I not followed what the sleep medical specialists have advised? There is ample evidence showing that there are up to an estimated 80% or more than 15 million people who are non-compliant, failing and non-successful on sleep apnea therapy. Further details are on the blog pages Why is CPAP Compliance Rate Low? and Secrets to Success: Answer is FREE.
By teaching myself how to use the various sleep apnea machines from a CPAP fixed pressure machine up to the advanced ResMed ST-A machine with iVAPS (intelligent volume assured pressure support), I have been able to overcome many side effects and issues associated with sleep apnea therapy.
On the previous blog post Use BiPAP ST machines with iVAPS and AVAPS for REM sleep issues, I mentioned that over the last few months, I have been grappling with the issue of obstructive sleep apnea (OSA) occurring during REM (Rapid Eye Movement) sleep causing Awake Bruxism (AB). The bruxism involves tooth clenching or tapping while you are awake which may drive you crazy and frustrated.
In addition, Awake Bruxism gets progressively worst during the day after waking up. Some days I have had to wear a mouthguard after lunch to soften the tooth clenching or tapping.
When you are having obstructive sleep apnea during REM sleep, this may lead to disruptions in your sleep. From personal experience, waking up during REM sleep may lead to insomnia and you not being able to go back to sleep. This will cause further issues with you feeling a lot of sleepiness and fatigue after waking up for possibly the rest of the day. In addition, you may also have Awake Bruxism.
REM sleep issues can get worst for a patient and subsequently the patient may be diagnosed with REM Sleep Behaviour Disorder (RBD). The significance of obstructive sleep apnea and RBD is that it may directly cause or is associated with many serious medical conditions including:
- Parkinson's Disease (PD)
Bollu PC, Sahota P. Sleep and Parkinson Disease. Mo Med. 2017 Sep-Oct;114(5):381-386. PMID: 30228640; PMCID: PMC6140184.
- Multiple System Atrophy (MSA)
Giannini G, Provini F, Cortelli P, Calandra-Buonaura G. REM Sleep Behaviour Disorder in Multiple System Atrophy: From Prodromal to Progression of Disease. Front Neurol. 2021 Jun 14;12:677213. doi: 10.3389/fneur.2021.677213. PMID: 34194385; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238043/
- Multiple Sclerosis (MS)
- Amyotrophic Lateral Sclerosis (ALS)/ Motor Neuron disease/ “Lou Gehrig’s” disease
Boentert M, Glatz C, Helmle C, et al Prevalence of sleep apnoea and capnographic detection of nocturnal hypoventilation in amyotrophic lateral sclerosis Journal of Neurology, Neurosurgery & Psychiatry 2018;89:418-424. http://dx.doi.org/10.1136/jnnp-2017-316515
- Kidney disease
- Cardiovascular disease (CVD) and Heart Attack and Strokes
Unfortunately, there is currently no cure for the neurodegenerative disorders including Parkinson’s disease and Dementia and Alzheimer’s. These disorders alone affect many millions of people around the world.
One study found that of men aged 50 or older with REM sleep behaviour disorder eventually developed Parkinson’s disease, Lewy body dementia, or multiple system atrophy, usually within 13 years. That number increased to in a follow up study conducted 16 years later.
What is the significance of Awake Bruxism?
Research has shown that Awake Bruxism was investigated in two studies describing a 22.1% to 31% prevalence in adults.
, , , Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013; 27(2): 99, . ‐ 110.
Does this mean that as I have Awake Bruxism, that AB is an early warning sign or marker of a possible diagnosis of REM Sleep Behaviour Disorder and Obstructive Sleep Apnea and subsequently of Parkinson’s disease and Dementia and other neurological disorders? This is despite PD and Dementia may not be diagnosed for 1-2 decades or more.
From personal experience, I believe that it is possible for Awake Bruxism to be an early marker. By treating REM sleep issues, obstructive sleep apnea, insomnia and Awake Bruxism, it is my belief that a person may be able to stop or at least prolong the onset of REM Sleep Behaviour Disorder and possibly a later diagnosis of Parkinson’s disease and Dementia and Alzheimer’s and other disorders. More details on insomnia are on the blog post Stop CPAP causing Insomnia: Use Bilevel.
If the 4 disorders together mentioned above are to be possible early warning signs or markers of Parkinson’s and Dementia and other neurodegenerative disorders, this raises many questions.
What specifically causes Awake Bruxism and how do you treat it?
Doctors still don’t completely understand what causes Awake Bruxism. However, it may be due to a combination of genetic, physical, psychological, and psychosocial factors such as anxiety, stress, frustration or tension.
Currently the treatment consists of a variety of things such as medication, stress or anxiety management and splints and mouth guards.
More details are at:
Is it just REM sleep issues, obstructive sleep apnea and insomnia causing sleep disruptions during the night or is there something else involved?
Does obstructive sleep apnea occurring in all REM sleep periods cause Awake Bruxism or just one or two periods of REM sleep?
Can you treat all these issues of REM sleep, obstructive sleep apnea, insomnia and Awake Bruxism at the same time? If so, how do you do this?
Most importantly, what proof do I have that the combination of Awake Bruxism, REM sleep issues, obstructive sleep apnea and insomnia may be an early warning marker of Parkinson’s disease and Dementia and Alzheimer’s and other medical disorders?
Over the next few blog posts, I intend to answer all these questions based on personal experience. I will answer the last question first.
I detail my personal experience to assist all people in treating their various medical disorders. In particular, those people who are in the early stages of these disorders and to give you hope that you may be able to stop or prolong the onset of any further deterioration in your medical condition.
In addition, I am fully aware of the damaging and frustrating aspects of dementia and the suffering experienced by patients as well as their Carers. My grandmother, father and aunty have all had dementia.
There is an increased risk that I may also end up with dementia. In fact, about 10-15 per cent of people with Familial Frontotemporal Dementia (FTD) have a very strong family history of the condition. This means having three or more relatives with FTD across at least two generations. The word “frontotemporal” refers to the two sets of lobes (frontal and temporal) in the brain that are damaged. FTD occurs when disease damages nerve cells in these lobes.
In a research study, the conclusion was:
This study suggests that awake bruxism is encountered not infrequently in various diseases in geriatric hospitals. It is frequently observed in FTD and normal pressure hydrocephalus, which characteristically shows frontal lobe dysfunction. These facts and SPM analysis show that awake bruxism can be regarded as a frontal neurological sign of various neurological disorders.
Kwak YT, Han IW, Lee PH, Yoon JK, Suk SH. Associated conditions and clinical significance of awake bruxism. Geriatr Gerontol Int. 2009 Dec;9(4):382-90. doi: 10.1111/j.1447-0594.2009.00538.x. PMID: 20002758.
As mentioned earlier, over the last few months I have been grappling with the issue of obstructive sleep apnea (OSA) that occurs during REM sleep. This issue has caused Awake Bruxism (AB).
What I didn’t mention on last month’s blog post was that I had at the same time many of the early symptoms of Dementia. Such symptoms included:
- Language problems and impairment or loss of speech
- Lack of judgment
These are symptoms of frontotemporal dementia. My father has these two symptoms as well.
- Sleep disturbances
- Periods of being alert or drowsy, or fluctuating levels of confusion
- Failing sense of direction – whilst driving the car, could not remember where I was.
- Thinking problems – having difficulty with attention, planning and reasoning.
- Short term memory changes - could not remember what I had for dinner.
My father has all of these symptoms and has additional symptoms to these ones listed.
My medical condition deteriorated very fast over the last few months. I had a little Awake Bruxism in the months prior. Once COVID-19 came and I was mostly at home, my “normal” bilevel machine was being used every day. Previously, I was using bilevel machines with different settings depending on the situation. More details are on the blog post Different Bilevel Settings Example.
The Awake Bruxism worsened very quickly and the symptoms of Dementia appeared. In addition, a slight shaking or tremor in my hand started happening.
A tremor while at rest such as sitting is a common early sign of Parkinson's disease.
By this time, I was very tired and fatigued and had stress and anxiety. I couldn’t remember what I was to do and would forget what I went to a room for. Adding up two numbers even though I was normally good at doing this was causing trouble. In addition, I was struggling to focus on tasks and was easily distracted and was having difficulty explaining something or finding the right words to express themselves.
The great news is that I now have very little Awake Bruxism and no longer have any symptoms of Dementia! Time will tell whether I have just prolonged the onset of Dementia. I did this by changing the settings on my bilevel auto adjusting pressure machine.
On the blog post for May 2021, I mention that after a few months of using the adjusted bilevel/ BiPAP machine settings, the Awake Bruxism issue together with all the symptoms of Dementia and slight shaking or tremor in my hand have now completely gone.
This may have huge implications for all people in the stopping or prolonging of any diagnosis of REM Sleep Behaviour Disorder (RBD) and possible later diagnosis of Parkinson’s Disease (PD) and Dementia and Alzheimer’s and other neurodegenerative disorders!
From personal experience, using a BiPAP or bilevel machine similar to the one that I use, being the ResMed S9 VAuto or AirCurve S10 Bilevel machine can treat all the above issues at the same time. These issues being, REM sleep issues, obstructive sleep apnea, insomnia and Awake Bruxism.
CPAP machines will do so to a lesser extent as they treat obstructive sleep apnea. However, CPAP machines are limited in treating REM sleep issues. To do so, will likely require the additional machine settings for Trigger and Cycle breathing sensitivity, TI Min and TI Max (time spent on inhalation) and pressure support of greater than 3 cmH2O.
For more serious cases of REM sleep issues and obstructive sleep apnea, I suggest using a BiPAP or Bilevel ST machine with AVAPS or iVAPS. These machines have additional settings of Back-Up Breathing or Respiratory Rate (BURR) and target alveolar ventilation rate or target tidal volume of air to control the ventilation of a patient. The BURR assists in stopping a patient’s breathing rate to go below a certain limit such as 12 breaths per minute.
Other people who may benefit from these machines are those that have a combination of serious issues including respiratory issues and Complex Sleep Apnea (obstructive and central sleep apnea).
In a later blog post, I will detail how I have set up this particular machine.
Currently, obstructive sleep apnea is treated mainly by CPAP. For insomnia, medical doctors are using various prescription sleeping pills which may have side effects.
For REM Sleep Behaviour Disorder, the medical doctors are using medications including melatonin and the prescription drug, clonazepam.
From personal experience, I would argue that the optimal and easiest treatment is to treat the above issues including REM sleep issues, obstructive sleep apnea, insomnia and Awake Bruxism with the one sleep apnea machine similar to the ones that I use.
In addition, as the sleep medical specialist is already prescribing a CPAP machine, I believe it would make more logical sense to prescribe a more advanced BiPAP or Bilevel machine and cover all sleep issues at the same time.
As the BiPAP and bilevel machines are more expensive than CPAP, I suggest using a trial period where the patient uses a CPAP machine for a few weeks. Where it is clear that the patient is not tolerating CPAP or is not being treated optimally, a new trial period using BiPAP or Bilevel machines should be tried. After trialling BiPAP or bilevel machines, should there be no or little improvement in a person’s health condition, consider using medical drugs at this time.
Further details of the combination of REM sleep issues, obstructive sleep apnea, insomnia and Awake Bruxism and how they may be early warning signs or markers of a diagnosis of REM Sleep Behaviour Disorder (RBD) and subsequently Parkinson's disease, Dementia and Alzheimer's and other neurodegenerative disorders are on the following blog posts:
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.”