CPAP Health Issues: 2021

15 August 2021

Can Alzheimer's be due to Sleep Position on Back using CPAP?

“Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.”

- Thomas Edison (American Inventor & Businessman – 1847 – 1931)

On previous blog posts, from personal experience using a bilevel auto adjusting pressure machine rather than CPAP, I was able to treat, stop and reverse a sequence of events occurring during the critical REM sleep period of 4 and 5 hours of sleep. These events caused and were associated with my symptoms of Dementia. The neurodegenerative disorders including Alzheimer’s Dementia and Parkinson’s disease may be partly due to sleeping in the supine or back sleep position including when using CPAP machines.

The sequence of events occurring during REM sleep which caused and are associated with my symptoms of Dementia were hypoxia or oxygen desaturation, sleep disordered breathing including obstructive sleep apnea and flow limitations, insomnia and Awake Bruxism.

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 stopped and reversed the symptoms of Dementia has been done on a practical level based on my own personal experience. Previous blog posts are listed at the end of this post. 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.

Medical research is showing that sleeping in the supine or back sleep position may be contributing to neurodegenerative disorders.

Sleeping in the lateral, or side position, as compared to sleeping on one’s back or stomach, may more effectively remove brain waste and prove to be an important practice to help reduce the chances of developing Alzheimer’s, Parkinson’s and other neurological diseases, according to researchers at Stony Brook University.

https://neurosciencenews.com/lateral-sleep-position-neurology-2363/

Sleeping more than 2 hours with one's head lying face upward (i.e., supine) was a significant nocturnal marker that characterized those with memory impairment, after controlling for factors such as age, sex, snoring, obstructive sleep apnea, and movements during the night.

The strength of the association, however, points to a potentially modifiable risk factor for neurodegenerative disease, similar to diet and exercise.

http://www.alzheimersweekly.com/2019/03/sleeping-on-back-linked-to-memory.html

Levendowski, Daniel J et al. “Head Position During Sleep: Potential Implications for Patients with Neurodegenerative Disease.” Journal of Alzheimer's disease : JAD vol. 67,2 (2019): 631-638. doi:10.3233/JAD-180697

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398535/

What are other reasons for sleeping on your side?

More than half of sleep apnea cases are referred to as “position-induced” where apnea is only experienced when the sufferer is on their back (supine).

When you sleep on your back, your airway becomes compressed. The weight from your neck, a recessed jaw and your tongue falling backwards all lead to a greater chance of airway obstruction and the ensuing noise.

https://www.snorelab.com/homemade-hacks-to-improve-your-sleeping-position/

Sleeping on your side is typically recommended because it helps with insomnia (and the resulting sleep deprivation) as well as digestive issues like gastroesophageal reflux disease (GERD). Sleeping on your back can cause pain in your lower back.

https://www.cpap.com/blog/body-position-cpap-therapy-side-sleeper-back-sleeper/

It’s estimated that more than half of all cases of OSA are “position-dependent,” meaning the severity of apneas significantly changes depending upon sleeping position. A person with position-dependent OSA may experience an increase of 50 percent or more apneas in their total AHI, or apnea-hypopnea index, while sleeping on their back.

That can make a big difference in both diagnosis and treatment. A person with an AHI of 5 while side sleeping, who isn’t tested while sleeping supine, may not receive a diagnosis at all. Meanwhile, they may actually test as having an AHI of 10 to 15, which would require therapy to treat.

https://sleepapnea.sleep-disorders.net/clinical/positional-therapy

If medical research is showing that sleeping in the supine or back sleep position may be contributing to neurodegenerative disorders as well as for the other reasons mentioned above; how do you stop sleeping in the supine position or on your back?

Personal experience is showing that up to the early stages of Alzheimer’s Dementia, the symptoms may be able to be stopped and reversed. I did so by using a ResMed Bilevel auto adjusting pressure machine rather than a CPAP machine to overcome sleep disordered breathing. Having cleared the symptoms of Dementia, I am back to waking up refreshed and energized each day!

In addition, it is my belief that the neurodegenerative disorders in their later stages may also be able to be reversed to some extent or at least delayed in their progress providing a better quality of life for a person. On the previous blog post, I mentioned to overcome very difficult breathing issues causing Alzheimer’s Dementia; consider using BiPAP with AVAPS (average volume assured pressure support) or Bilevel with iVAPS (intelligent volume assured pressure support) machines.

Currently there are a number of different options to stop or minimize sleeping in the supine position or on your back. Details of these options are detailed on the following article:

https://www.verywellhealth.com/what-is-positional-therapy-for-snoring-and-sleep-apnea-3015313

These options range from the simple to the sophisticated and from cheap to expensive.

1. Sewing Tennis Ball into a T-shirt

Whenever you roll onto your back, the discomfort from the ball will turn you back to your side.

2. Backpack

Wearing a backpack to bed at night by placing a firm baseball into the pack can add some discomfort that will keep you sleeping on your sides.

3. Zzoma and Bumpers

Zzoma is an example of the fabric and foam bumper belts including a block and Velcro strap that keeps you from being able to sleep on your back. These are a little more expensive, and some require prescriptions from a doctor.

4. Night Shift Device

For the technology inclined, the Night Shift device is a simple plastic band worn around the neck that vibrates when you shift onto your back. At a cost of about $350, it is definitely a more expensive option.

5. Wedges and Stacked Pillows

6. Adjustable and Adjusting Beds

Buy an adjustable bed or alternatively, at a reduced cost, it is possible to stack books, bricks, or even cinder blocks under the feet at the head of the bed to put it on an incline.

As the article points out, “long-term adherence to these therapies is usually low.” This is not surprising having tried the first two options and options 5 and 6 not being practical when travelling away from home. In addition to discomfort, I also had insomnia which is not good when you want to have great sleep.

How do I stop sleeping in the supine position and stay of my back?

What is a sleep option for FREE that will not cause discomfort?

This is the reason for the quote at the top of the page.

“Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.”

- Thomas Edison (American Inventor & Businessman – 1847 – 1931)

I will share a secret with you and show a little trick that has stopped and minimized sleeping in the supine position or on my back. Importantly, when I am travelling away from home, I can easily reproduce what I am about to show you.

Let me ask you a few questions:

Why do people sleep on a flat bed?

Have you ever considered sleeping on a bed that is curvy?

By having the edges or sides of the bed curling up by using padding such as old towels and blankets, I am able to have a great night’s sleep! The bed allows me to have variations on the three main positions that many people have; sleeping on their left and right side and on their back.

A curvy bed allows you to move the body’s centre of gravity to the middle of the bed making it less likely you will end up on your back. In addition, throughout the night when you move; due to being on different parts of the curve of the bed you end up in slightly different sleep positions on your side. This will move the body pressure points throughout the night as I am not in the one position such as on the one specific point of my left shoulder and left hip all night. By doing so, has greatly assisted in overcoming neck, shoulder and back issues.

An additional benefit for those people that have positional sleep apnea is by having a curvy bed; your face will be slightly downwards and reduce the likelihood of your tongue falling backwards and blocking your airway. By reducing the severity and number of apneas, less machine pressure may be required with your sleep apnea therapy.

Less machine pressure should reduce CPAP side effects and issues including aerophagia, potential mask problems including mask leaks and air coming through eye tear ducts and out the eyes.

When travelling away from home and staying at say a hotel, use the spare linen, towels and blankets in the room to make the bed curvy.

Should you also suffer from reflux and indigestion, consider lifting up the head of your curvy bed 5 to 6 inches.

Below are pictures using padding to make a curvy bed, before and after.

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 Alzheimer’s Dementia and Parkinson's disease and other neurodegenerative disorders are on the following blog posts:

Oct 20: Use BiPAP ST with iVAPS or AVAPS for REM sleep issues

Nov 20: Use BiPAP and CPAP to treat REM Sleep and OSA issues which may cause Parkinson's and Dementia

Dec 20: Stop CPAP REM Issues and Sleep Apnea causing Dementia: Use BiPAP

Jan 21: Stop Hypoxia, Alzheimer's, Bruxism using CPAP and BiPAP

Feb 21: Stop Insomnia, Hypoxia, REM sleep issues causing Alzheimer's: Use BiPAP

Mar 21: Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues

Apl 21: What BiPAP Settings prevent Alzheimer's due to REM sleep breathing issues?

May 21: Can Different BiPAP Machines prevent Alzheimer's Dementia?

Jul 21: Stop Alzheimer's Dementia using BiPAP with AVAPS or iVAPS

Feb 22: How to stop Alzheimer's Dementia and Amyloid Protein using BiPAP?

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

05 July 2021

Stop Alzheimer's Dementia using BiPAP with AVAPS or iVAPS

“The two most powerful warriors are time and patience.”

- Leo Tolstoy (Russian Writer – 1828 – 1910)

Stop and possibly reverse Alzheimer’s Dementia using different BiPAP and Bilevel auto adjusting pressure machines. As explained on previous blog posts, from personal experience, it is likely that CPAP will not be able to treat and stop a sequence of events occurring during the REM sleep period of 4 and 5 hours of sleep. This sequence of events led to my symptoms of Dementia. To overcome very difficult breathing issues causing Alzheimer’s Dementia, use BiPAP with AVAPS (average volume assured pressure support) or Bilevel with iVAPS (intelligent volume assured pressure support) machines.

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

The sequence of events which caused and are associated with my symptoms of Dementia were hypoxia or oxygen desaturation, sleep disordered breathing including obstructive sleep apnea, central sleep apnea and flow limitations, insomnia and Awake Bruxism. It is my belief that this sequence of events occurring during the critical REM sleep period between 4 and 5 hours of sleep may lead to Alzheimer’s Dementia, Parkinson’s disease and other neurodegenerative disorders.

Personal experience is showing that up to the early stages of Alzheimer’s Dementia, the symptoms may be able to stopped and be reversed. By using BiPAP and Bilevel auto adjusting pressure machines, significant improvement can be made to a person’s medical health condition. Having cleared the symptoms of Dementia, I am back to waking up refreshed and energized each day.

With time and patience, I believe using BiPAP and Bilevel machines rather than CPAP will stop and prevent hypoxia and sleep disordered breathing including obstructive and central sleep apnea by bringing order and control to a person’s breathing. In addition, the neurodegenerative disorders in their later stages may also be able to be reversed to some extent or at least delayed in their progress providing a better quality of life for a person.

On the blog post in October 2020 Use BiPAP ST with iVAPS or AVAPS for REM sleep issues, I explained these machines in more detail. In summary, these machines when compared to the basic bilevel machine have two additional settings being Back-Up Breathing or Respiratory Rate (BURR) and target ventilation rate or target tidal volume for breathing which will be critical to a person with serious medical conditions with difficult breathing issues.

In addition, as mentioned on previous blog posts, should using the basic BiPAP and Bilevel machines not provide optimal treatment, try an Adaptive Servo-Ventilation (ASV) machine with variable pressure support settings. An ASV machine will allow a person to have a lower starting IPAP and EPAP (inhale and exhale pressure) with higher pressure only “kicking in” when required to have a person to breathe properly again.

An issue that some people may find using a ResMed ASV machine is that the automatic back-up rate of 15 breaths per minute is a bit too high. That is, the machine “kicks in” when you have not fully exhaled.

More details on ASV machines and bilevel therapy can be found at the following:

https://sleepbreathe.org/asv-and-bilevel-therapy-for-sdb-with-ifl/

https://sleepbreathe.org/response-to-sleepbreathe-asv-and-bilevel-therapy-for-sleep-disordered-breathing-with-flow-limitation-by-barry-krakow-md/

The ResMed S9 Bilevel iVAPS machine that I use has an adjustable back-up rate (BURR) and uses target alveolar ventilation (Philips DreamStation BiPAP AVAPS uses target tidal volume) for breathing which is customizable for you. For example, I use a BURR of only 10 breaths/ minute which was a reason why I did not go for an ASV machine. This ResMed S9 iVAPS model of machine also uses a fixed EPAP. The later ResMed model and Philips AVAPS have a variable EPAP which will be an advantage should extremely high pressure support and maximum pressure above 20 cmH2O be required.

Note that my maximum pressure has gone to nearly 25 cmH2O with pressure support greater than 12.0 cmH2O. However, using this high amount of pressure support was disrupting my sleep through the night and causing insomnia. It is a situation that you want to avoid and I have now limited the maximum pressure support to 7.2 cmH2O and using maximum pressure of 19.8 cmH2O. This setting does let through some hypopneas during the night however these are not of concern when you are having great sleep and waking up refreshed and energized each day.

The iVAPS machine that I use is an absolutely fantastic machine and in my opinion would be able to handle most if not all sleep breathing issues up to going on Invasive Mechanical Ventilation or Ventilators. In addition, a person can have total control and flexibility of the machine in overcoming any sleep issues by having the machine work as they would like it to work. For example, adjust the target ventilation rate and the time taken to inhale; adjust the breathing rise time when going from exhale to inhale and changing breathing sensitivity.

Most importantly, from personal experience the machine will enable a person to get themselves through the REM sleep period of 4 to 5 hours of sleep, ideally without waking up. It is my belief that by doing so will stop and prevent a person going down the path towards Alzheimer’s Dementia, Parkinson’s disease and other neurodegenerative disorders.

On the blog page The Secrets to Success using CPAP and Bilevel, I mentioned that these machines can be likened to Televisions.

CPAP fixed pressure Black and white TV

CPAP auto adjusting pressure Colour TV

BiPAP/ Bilevel auto adjusting High Definition TV

Which machine would you prefer to sleep with every night given that you may be using these machines for 30 to 40 years or more?

What’s it like using variable pressure support of AVAPS and iVAPS? The best way to describe the various machines and the “kicking in” using variable pressure support to get you to breathe properly again is by using an analogy comparing to Chilli sauce.

CPAP No chilli sauce

BiPAP/ Bilevel auto adjust Mild chilli sauce

ASV Hot chilli sauce

ST Very hot chilli sauce

AVAPS and iVAPS Can be any chilli sauce

due to being fully

customizable for you

The ResMed ST machine has fixed pressure support and a back-up breathing rate. The machine has no target ventilation rate and from personal experience, a number of people may find this machine a bit “harsh” with breathing and sleeping as it will “kick in” getting you to breathe on every breath you take.

Below is the sleep report for the ResMed Bilevel S9 auto adjusting pressure machine which was shown on the April 2021 blog post. Slept through the night for 6 hours 33 minutes waking up at 6.23am then slept/ dozed to 6.55am.Note the starting pressure is IPAP or inhale pressure of 18.2 cmH2O and EPAP or exhale pressure of 13.0 cmH2O.

Here is the sleep report for the ResMed S9 Bilevel ST-A with iVAPS machine. This is the night before I had an important event. Woke briefly at 2.45am, turned over and went back to sleep till 6.51am for 7 hours 8 minutes of sleep. Felt refreshed and energized all day. Note the following:

- The starting pressure for IPAP or inhale pressure is 15.6 cmH2O and EPAP or exhale pressure is 12.6 cmH2O. The starting inhale pressure is more than 14% lower than the bilevel auto adjusting pressure machine. This lower pressure leads to less side effects and issues including aerophagia and mask problems and issues such as mask leaks.

- With Bilevel iVAPS the pressure only increases when needed during the night.

- The minimum Respiratory Rate is 6.6 breaths per minute or two-thirds of the back-up breathing rate of 10 breaths per minute. The machine will not let your breathing go below this lower number.

The BiPAP and Bilevel machines are currently expensive. However, when you have great sleep and are waking up feeling refreshed and energized each day, you are able to work harder for longer hours and earn more income. I have been able to recover the cost of these machines many times due to not falling asleep during the day and being fit and healthy.

It is for this reason I suggest for those people with full-blown or later stage Alzheimer’s Dementia, Parkinson’s disease and other neurodegenerative disorders to try BiPAP with AVAPS or a Bilevel with iVAPS machine to stop or reduce the effects of their disorder.

The Bilevel S9 auto adjusting pressure machine that I am using is a great machine. The advantage of using the more advanced iVAPS machine is the consistency with your sleep therapy every night. You know the next day you will feel refreshed and energized. The less advanced bilevel machine provides great sleep therapy 90% to 95% of the time. The remaining 5% to 10% is still good, just not great.

The reasons for the consistency in iVAPS sleep therapy every night is due to the back-up breathing rate (BURR) and target ventilation rate. When my machine is set with a BURR of 10 breaths/ minute, the machine will “kick in” with a large increase in pressure support when my breathing goes to two-thirds of this number. That is 6.6 breaths/ minute. The large increase in pressure support feels like a great whoosh of air to get you to breathe again properly.

To give you a better idea on the “whoosh of air” compared to the basic bilevel machine, to have the pressure go from say 13 cmH2O to 17 cmH2O or 4 cmH2O may take 4 to 5 or more minutes. With the iVAPS machine, an increase in pressure support of 7.2 cmH2O may only take 7 to 8 seconds or a few breaths.

The machine is precise and my breathing rate has never gone below the 6.6 breaths/ minute mentioned above. Most of the time, you are not aware the machine is increasing the pressure support as you do not wake up. Note any increase in pressure support will only happen when needed.

With the Target Ventilation rate, when you have the machine operating at say average median 400ml/ breath the machine will target this number all night. That is, from one day to the next, you may see an average median 400ml/ breath appearing on your sleep reports every day.

The back-up breathing rate and target ventilation rate have stopped any under or over ventilation during the night. This situation may happen due to a person’s medical condition and going through different sleep stages and REM sleep periods which affect your breathing during the night.

As detailed on previous blog posts and from personal experience; by bringing order and control to your Sleep Disordered Breathing (SDB) during REM sleep may stop and prevent you from going down the path towards Alzheimer’s Dementia, Parkinson’s disease and other neurodegenerative disorders.

You can read more about Breathing on a recent article.

Understanding the power of breathing

Intentionally changing the cadence and mechanics of your breathing gives you the ability to influence other aspects of your nervous system. The way you breathe impacts your heart rate, blood pressure, stress response and even your brain state.

When you understand the power of your breathing, you can leverage a slower, more measured breathing pattern to tap the parasympathetic "rest and restore" aspect of your nervous system to help you calm down, increase your concentration, go to sleep and more.

https://edition.cnn.com/2021/06/16/health/breathing-better-training-wellness/index.html

For an Elite Athlete and Athletes need Maximum Performance where it is essential they perform at their very best on any given day, the Bilevel with iVAPS and BiPAP with AVAPS would in my personal opinion be the machines that I would be using.

By having a less advanced bilevel machine not providing great therapy all the time, I run the risk that when an important event comes up, I may not be able to perform at my very best due to not having a great night’s sleep the day before.

As Murphy’s Law says “whatever can go wrong will go wrong!”

The iVAPS machine is used when I am very tired or when an important event is coming up. Should I be using the less advanced bilevel machine, maximum pressure may go to 20 cmH2O or more. In this situation, I may have zero readings for Minute Ventilation and its two components being breathing/ respiratory rate and tidal volume of air as detailed on the February 2021 blog post.

Currently, the zero readings may be for only a fraction of a second and not 8 seconds. In addition, hypoxia or oxygen desaturation is much reduced at up to 1.5 minutes rather than being for may be more than 5 minutes when I had the symptoms of dementia detailed on previous blog posts.

The risk using the less advanced bilevel machine is that I may not able to go back to sleep during the night due to insomnia and I will be tired in the morning on waking up. Whilst this situation hasn’t happened since increasing starting pressures for inhale to 18.2 cmH2O and exhale to 13.0 cmH2O as detailed on the March 2021 blog post the risk is still there. One day the situation outlined above could happen.

When an important event is coming up and there needs to be certainty or guarantee that I will have great sleep and be refreshed and energized in the morning, I will use the iVAPS machine for a few days leading up to the event.

Whilst every person’s situation is different, it is my belief that for the majority of people the ResMed Bilevel auto adjusting pressure machine will be all that you require to have a great night’s sleep!