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 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.

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!

Further details of the combination of REM sleep issues, obstructive sleep apneainsomnia 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 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?

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