Guide to Success using CPAP and Bilevel

“The definition of insanity is doing the same thing over and over and expecting different results.”
- Albert Einstein/ Others 

Many sleep medical specialists keep prescribing CPAP and Auto Adjusting CPAP pressure machines to patients despite the high non-successful rate of patients of up to 80%! More details are on the blog page Why is CPAP Compliance Rate Low? This blog post is to provide a Guide to The Secrets to Success and the Steps to take to succeed using CPAP and Bilevel or BiPAP sleep apnea machines. 

Should your sleep apnea therapy not work or you are having various issues, most people would try and find a way of overcoming the issue or problem. Unfortunately, the sleep medical specialists are not changing what they are doing and they are letting patients have pain and suffering and lack of great sleep. 

As mentioned on the blog page Secrets to Success: Answer is FREE as the sleep specialists are not educating themselves and the patients; it will be up to you to educate yourself! I issue a challenge to all the people in the 80% non-successful group to CHANGE what you are doing so you can wake up feeling energized and refreshed each day. 

On the blog page The Secrets to Success, I discussed Bilevel or BiPAP sleep machines and the huge benefits of using this machine over CPAP and Auto Adjusting CPAP pressure machines. 

The Steps that you will need to take are based on my own personal experience with CPAP and Bilevel machines. By using a bilevel auto adjusting pressure machine, I was able to overcome all the side effects and issues I was having using a CPAP machine except for nasal congestion and nose bleeding. You can read about the various issues at the blog page Stop CPAP Side Effects and Issues: Use Bilevel. On the blog page Stop CPAP Nasal Congestion and Nose Bleeding, I share a secret with you and show a little trick that has stopped both nasal congestion and bleeding.  

For those people with air coming through the eye tear duct and out of the eyes issue, additional steps may need to be taken to resolve this issue. Further details on this issue are provided on blog posts starting from November 2019 at Air through Eye Tear Duct.

I spoke to 3 medical practitioners regarding the high non-successful rate of patients and the reasons why they may be non-compliant and failing. All 3 medical practitioners gave the same 2 reasons:
1. The pressure is too high; and
2. The machine does not work.That is, many patients felt that there was no improvement in their continued sleepiness and fatigue. 
The question is: How do you as a patient overcome these issues? By answering this question, you will be able to feel refreshed and energized each day.  

The explanation of what I have done is going to be done on a practical level based on my own personal experience. There will be others with more knowledge and a medical background who can explain from a technical point of view. 

My understanding is similar to someone who drives a car. They put their foot on the brake and the car will slow down and stop. Push the accelerator and the car will move forward. I do not know all the nuts and bolts/ parts that go to making up a braking system.  

There are 4 steps that I believe are The Secrets to Success: 

1. Have a regular Apnea-Hypopnea Index (AHI) of 1.5 or lower. Does not have to be daily, but ideally most of the time; 

2. Minimise Leaks from the Mask and Mouth Breathing. Ideally reduce Leaks to Nil so that a Zero appears on your sleep machine every morning; 

3. Reduce median 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. Note the CPAP machine operates at maximum pressure all night; and 

4. 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.  

For tidal volume settings, I use Ideal Body Weight (IBW) on CPAP and Bilevel or Predicted Body Weight (PBW) not my actual body weight. This was one of the reasons I was able to Stop CPAP Weight Gain and achieve weight loss of greater than 1 kg below my pre CPAP weight! 

Further information on Minute Ventilation and the Buteyko Method of Breathing is at:   

Normal MV rate is considered to be 6 litres/ minute per Medical Textbooks. “Under Control” means that you try and keep MV to a maximum 10 litres/ minute otherwise you may be considered to be hyperventilating. Hyperventilation is to breathe at an abnormally rapid rate or over breathe causing low levels of carbon dioxide in your blood. This results in less blood and oxygen being transported to all vital organs such as the brain. For me, this was one of the reasons why I sometimes woke up tired and feeling worse in the morning than when I went to bed! 

Each morning after getting out of bed, ask yourself “How do I feel?” The answer to this question will assist you in determining whether changes are required to be made to the settings on the sleep apnea machine.  

Many of the numbers will show on your detailed report available on your sleep machine each day. The numbers for 3 above and the 95% to 100% Minute Ventilation rate will be available by using SleepyHead software reports. The software is available for Free at the link on the right hand side. 

It was after I reduced the median IPAP and EPAP pressures and Minute Ventilation rate that I was able to finally overcome all the problems that I was having. I did not sleep properly every night for the first 4 years of using the sleep apnea machine, was fatigued and tired most days and struggled constantly to do any paid work. Some days I would get up out of bed, read emails and go back to bed 15 minutes later. I was “totally stuffed” to put it nicely! 

It was not until 2017, some 7 years after I was first diagnosed with obstructive sleep apnea that I woke up feeling great and energized each day. Some days I feel so energized, that I feel I could climb Mt Everest and conquer the World! This situation is a total turn-around from my early days on the CPAP machine in 2010 and 2011. In addition, my back and neck problems have gone. 

From personal research, sleep medical specialists may argue that there is not sufficient research to support the use of the Buteyko Method of Breathing. However, as mentioned, there is currently up to an 80% non-success/ non-compliance rate using the sleep apnea machines. By applying the principles of the Buteyko Method of Breathing and changing to the ResMed S9 VPAP Auto Bilevel sleep apnea machine from a CPAP machine, I was able to achieve enormous success. I believe that you too can achieve the same level of success by using the appropriate sleep apnea machine and optimizing the settings on the machine for you. 

What does this particular ResMed Bilevel machine have that other sleep machines do not have? 

It has a number of options which are not available on the less advanced machines such as CPAP. Options include adjusting the breathing sensitivity on inhale (trigger setting) and exhale (cycle setting). All up there are 25 possible combinations. In addition, there are many settings to adjust how long the time you inhale/ breathe in for (TI Min and TI Max settings). Finally, you can have much greater pressure support up to 10 cmH2O. CPAP machines have a maximum of 3 cmH2O. The increased pressure support makes it much easier to exhale/ breathe out and get great sleep. 

On CPAP vs Bilevel Settings Example, I compare the Bilevel auto adjusting pressure machine to the CPAP fixed pressure machine. The improvement using Bilevel as compared to CPAP using SleepyHead reports and my actual sleep results. These reports show a large reduction of 22% in median IPAP/ EPAP pressure and 13% in median Minute Ventilation achieved by using a bilevel machine when the AHI on both bilevel and CPAP machines are the same. Other people may achieve much higher reductions.  

On blog posts, I explain Use Different CPAP and Bilevel Pressure Settings and Different Bilevel Settings Example on the bilevel machine to optimize your sleep apnea therapy every day. These different situations could range from going out late at night and eating and drinking to doing a hard day at work with many hours of driving to just a “normal” day. 

By doing the 4 steps mentioned previously that I believe are The Secrets to Success, I was able to overcome all the side effects and issues using sleep apnea therapy. Such issues included treating and stopping REM sleep issues and obstructive sleep apnea which may cause Parkinson's and Dementia.

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.”

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