26 April 2021

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

 “If somebody offers you an amazing opportunity but you are not sure you can do it, say yes – then learn how to do it later!”

- Richard Branson (English Business Magnate – 1950 -)

What BiPAP or Bilevel machine settings did I use in the treatment and stopping of my symptoms of Dementia due to REM sleep disordered breathing issues? Potentially I have stopped or prevented from having up to some decades later a diagnosis of REM Sleep Behaviour Disorder (RBD). Subsequently, a possible diagnosis of Dementia, Alzheimer's and Parkinson's disease and other serious medical conditions such as heart attack and strokes, kidney disease and Type 2 Diabetes.

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 the symptoms of Dementia 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.

As detailed on previous blog posts, my dementia symptoms were due to hypoxia or oxygen desaturation occurring BEFORE obstructive sleep apnea during the REM sleep period between 4 and 5 hours of sleep. By using a BIPAP or Bilevel machine, I was able to stop hypoxia due to Sleep Disordered Breathing and a sequence of events from occurring. These events were obstructive sleep apnea, REM sleep issues, insomnia, Awake Bruxism and symptoms of Dementia.

On the blog posts Secrets to Success using CPAP and Bilevel and Guide to Success, I provide the explanation of how sleep apnea therapy using CPAP and Bilevel or BiPAP machines truly work so that you can have a 2nd opportunity at life. To be free of sleep issues controlling your life so that you can do all the things that you wanted to do such as visiting the grandchildren, travel overseas, work full-time and run a successful business.

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

“If somebody offers you an amazing opportunity but you are not sure you can do it, say yes – then learn how to do it later!”

- Richard Branson (English Business Magnate – 1950 -)

The medical specialists and researchers seem to be a number of years away from coming up with a possible drug cure to stop and prevent Dementia, Alzheimer’s and Parkinson’s disease and other neurodegenerative disorders. More details are on these articles:

https://www.insidescience.org/news/failure-upon-failure-alzheimers-drugs

https://www.foxbusiness.com/lifestyle/alzheimers-brain-pharmaceutical-drug-test

It may seem difficult to teach yourself and/ or your carers how to use and adjust BiPAP and Bilevel machine settings. Having had and now cleared of the symptoms of dementia, I provide this opportunity for everyone to learn about BiPAP and Bilevel auto adjusting pressure machines to maximize your enjoyment of the rest of your life!    

Recent medical research is supporting my view that it is essential that you sleep through what I believe is the critical REM sleep period of 4 to 5 hours of sleep:

Sleeping less than 6 hours a night in midlife raises risk of dementia 30%, study finds.  

After following nearly 8,000 people for 25 years, the study found a higher dementia risk with a "sleep duration of six hours or less at age 50 and 60" as compared to those who slept seven hours a night.

In addition, persistent short sleep duration between the ages of 50, 60 and 70 was also associated with a "30% increased dementia risk," independent of "sociodemographic, behavioural, cardio metabolic, and mental health factors," including depression, the study said.

https://edition.cnn.com/2021/04/20/health/sleep-dementia-risk-study-wellness/index.html

Other reasons to seriously consider using BiPAP and Bilevel auto adjusting machines rather than CPAP is that they may improve any back and neck issues and CPAP use has been found to cause weight gain. From personal experience, on changing to a bilevel machine, my back and neck issues improved by 5% to 10% and I had weight loss instead of weight gain of 2 kgs. More details are on the blog post Stop CPAP causing Weight Gain: Use Bilevel.   

Dr Steven Park, Medical Surgeon wrote on a blog post 7 October 2020:

It turns out that overall, CPAP use has been found to increase weight significantly, in proportion to how long you use CPAP. The more hours you use CPAP every night and the more number of years, the higher the amount of cumulative weight gain.

https://doctorstevenpark.com/can-cpap-make-you-gain-weight

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What BiPAP or Bilevel settings do I use to bring order and control to sleep disordered breathing during REM sleep when your breathing may become erratic, irregular and shallow?

Since writing the blog post last month, I have adjusted the machine settings:

- increased starting EPAP (exhale pressure) to 13.0 cmH2O reducing pressure support to 5.2 cmH2O. Starting IPAP (inhale pressure) has stayed the same at 18.2 cmH2O. 

- changed breathing sensitivity for the cycle or exhale setting to Very High from High. The Trigger or inhale setting is the same at High.

These settings were changed as my breathing changed a little at night as I became more accustomed to the very high pressure. I was having tiredness in the afternoons and started waking up at night during REM sleep periods including the period of 4 to 5 hours of sleep.

More importantly, when pressure went over 19.3 cmH2O, I may have ZERO or low readings for Minute Ventilation (MV), Respiratory/ breathing rate (RR) and Tidal Volume of air (TV) and the sleep pattern outlined last month and shown below occurs.  That is, with the previous settings, I had no guarantee that ZERO readings would not happen for a night. On those nights I did not have ZERO readings, the sleep pattern still appeared and I had very low MV, RR and TV. Minute Ventilation is the total volume of air entering the lungs in one minute.

As detailed on the blog post Stop Insomnia, Hypoxia, REM sleep issues causing Alzheimer's, having ZERO readings or a 100% or total obstruction of the airway means that you may be only a few seconds from beginning to be unconscious! Should you have this sleep pattern, urgent consideration be given to amending your current machine settings or obtaining a BiPAP or Bilevel machine to stop the above sleep pattern occurring.

Below are sleep reports for a recent night with the amended settings. Slept through the night for 6 hours 33 mins waking up at 6.23am then slept/ dozed to 6.55am. Note the change in the Minute Ventilation, respiratory rate and tidal volume of air after this time. 

 


How did I work out that IPAP (inhale pressure) of 18.2 cmH2O and EPAP (exhale pressure) of 13.0 cmH2O were to be the starting pressures on the machine using pressure support of 5.2 cmH2O? How these pressures were the “sweet spot” or optimal starting pressures for me? 

The starting pressure of IPAP of 18.2 cmH2O and EPAP of 13.0 cmH2O was arrived at by “trial and error”. In the early stages of increasing the pressure, I was still having ZERO readings. I thought IPAP of 13 cmH2O to 14 cmH2O may be enough to stop these ZERO readings. When this pressure was attained I found it wasn’t enough. So I kept increasing the pressure until the ZERO readings stopped happening on a regular basis which was IPAP of 16.8 cmH2O and EPAP of 11.4 cmH2O.

When the ZERO readings didn’t occur, initially the minimum or bottom numbers were very low such as MV of 1.0 litre/minute, TV of 60 ml/ breath and RR 2 breaths/ minute. These numbers improved as the pressure was increased to IPAP of 18.2 cmH2O and EPAP of 13.0 cmH2O.

Looking at the latest sleep report compared to the previous month’s report, you can see the numbers have improved as follows:

                                             BEFORE                  AFTER         

                                            22.03.2021             23.04.2021

Minute Ventilation (min)        2.63                          3.0

    (litres/ minute)

Respiratory Rate (min)           5.20                          6.40 

    (breaths/ minute)

Tidal Volume (min)                 180                           160 

    (ml/ breath)

Min Vent (median/ av)            5.75                          6.38 

    (litres/ minute)

Tidal Volume (median)          380                            400

    (ml/ breath)

Exhale time (max)                  8.06                           5.58

    (seconds)

The “sweet spot” was when the pressure was increased until there was order and control during REM sleep in particular the critical period of 4 to 5 hours of sleep and there was consistency from one night to the next so that I slept for at least 6 hours before waking up. It was when my breathing and the machine were in sync with each other all night. As detailed on the latest medical research, less than 6 hours of sleep has an additional 30% risk of a person being later diagnosed with having Alzheimer’s Dementia.

It is my belief that every person needs to get themselves through the period of 4 to 5 hours of sleep, ideally without waking up. You need to preserve this period of REM sleep for as long as possible as detailed on the blog post Stop CPAP REM issues and Sleep Apnea causing Dementia. Otherwise, from personal experience you may start going down the path of having the symptoms of dementia and other neurological degenerative disorders.

To find the “sweet spot” or optimal starting pressures, I did the following:

1. Increased starting IPAP to 18.2 cmH2O and EPAP to 13.0 cmH2O and using auto adjusting pressure mode;

2. Have a tight range for inhale time TI Min of 1.1 seconds and TI Max of 1.2 seconds;

3. Using breathing sensitivity settings of Very High Cycle and High Trigger;   

4. Using pressure support being the difference between IPAP and EPAP of 5.0 to 5.4 cmH2O; 

5. Used Ideal Body Weight (IBW) or Predicted Body Weight (PBW) in setting the median Tidal Volume at 400 ml/ breath and Minute Ventilation at 6 litres/ minute; and

6. Have a median breathing rate of 14 to 15 breaths per minute. 

Using these settings will allow me to be adequately ventilated quickly and control the inhale time. Otherwise, the time may go to 3-4 seconds or more and throw your breathing out especially using high pressure resulting in central sleep apnea (no airway obstruction and no breathing) and sleep disordered breathing.

Central sleep apnea is a sleep disordered breathing issue and may happen when transitioning from exhale to inhale. This issue can be resolved using bilevel settings outlined above and using the high pressure to my advantage. You will note from the sleep reports that I have none or minimal central sleep apneas.

During the night my breathing will drop when asleep to a median/ average ratio of inhale/ exhale of 1 to 2.5 to 2.7 or high 14 to 15 breaths per minute. From the sleep report you can see that the maximum exhale time has now reduced to 5.58 seconds from 8.06 seconds. This was done to bring order and control to my breathing during the night and prevent central sleep apnea from occurring.    

To set the exhale pressure and exhale time to some extent (there is no exhale time limit on the machine), I count to 5 seconds and set the machine so that I finish breathing out and start inhaling in using the high trigger breathing sensitivity, tight range for TI Min and TI Max and very high EPAP pressure. These settings provide a little “kick” to get me to inhale. Essentially, I have set my bilevel machine to work like a basic Adaptive Servo-Ventilation (ASV) machine at a much lower cost. It has a little “kick” in it to get you to breathe. The ASV gives a bigger “kick”.

The advantage of having up to 5 seconds for exhale time is that should I wake up during the night, I found getting myself back to sleep could be done by controlling and slowing my breathing down especially during REM sleep. Otherwise, you may have insomnia as during REM sleep your breathing can become erratic, irregular and shallow. Further details on overcoming insomnia are on the blog post Stop CPAP causing Insomnia: Use Bilevel.      

Using IPAP of 18.2 cmH2O and EPAP of 13.0 cmH2O was the “sweet spot” or optimal starting pressures. When I set the starting pressures higher, I started having trouble with exhaling against the pressure and my breathing may go out such as starting to inhale before I had finished exhaling normally. It is going to be critical to you in order to attain quality sleep at very high pressure to have the timing of your breathing on inhale and exhale “spot-on” or optimal for you.      

A great advantage of having very high pressure means that pressure changes and disruption to your sleep during the night are minimized. You can see on the sleep report that the pressure is quite smooth and there is minimal “up and down” pressure.

In addition, I have stopped on some nights, two to three “flat” periods of 20 to 40 minutes of relatively low minute ventilation of 5.0 to 5.5 litres/ min and tidal volume of air of 300 to 350 ml/ breath. This has brought better order and control to my breathing during the night and I am back to waking up each day refreshed and energized each day. This may be a reason why some people are waking up tired and lethargic even though their AHI (apnea-hypopnea index) is less than 1.0. 

By having better oxygen saturation and not waking up during REM sleep, I am having better quality sleep and as a result now need less sleep every night. 7.0 to 7.5 hours of quality sleep is all that I now require. Previously 7.5 to 8 hours was the normal sleep. Every day, I have an average 30 minutes of extra time each morning. This is great especially when you need to be somewhere in the morning!  

Further details of the combination of REM sleep issues, obstructive sleep apnea, insomnia and Awake Bruxism and how they may be an early warning or marker 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 machines 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 

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

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

Aug 21: Can Alzheimer's be due to Sleep Position on Back using CPAP?

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 

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