“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 Compliance Rate Low?. This blog post is to provide a
Guide to The Secrets to Success and the Steps to take to succeed using a sleep
apnea machine.
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 Secrets to Success (Part 1), I discussed
Bilevel/ BiPAP sleep machines and the huge benefits of using this machine over
CPAP and Auto Adjusting CPAP pressure machines.
On this blog post, I will explain the Steps you need to take which is based on my own personal
experience, no matter what machine you are using. By using a bilevel auto
adjusting pressure machine, I was able to overcome all the 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 pages Side Effects and Issues using Machine and Stop Nasal Congestion and Nose 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 in
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.
My
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.
Further
information on Minute Ventilation and the Buteyko Method of Breathing is at:
https://www.normalbreathing.org/
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!
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
good 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 Why use Different Settings on Machine? and Different Settings for Different Situations 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 the machine.
Should you be
having 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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