Elite Athletes Need Bilevel

“There are some things that can beat smartness and foresight? Awkwardness and stupidity can. The best swordsman in the world doesn’t need to fear the second best swordsman in the world; no, the person for him to be afraid of is some ignorant antagonist who has never had a sword in his hand before; he doesn’t do the thing he ought to do, and so the expert isn’t prepared for him; he does the thing he ought not to do; and often it catches the expert out and ends him on the spot.”      - Mark Twain (American Author – 1835 - 1910)

Ask yourself how the most successful elite athletes and wealthiest people became that way. Many did not go to university. They did things their way and did not follow what others had done. On this blog post, I will explain why Elite Athletes need Bilevel or BiPAP Auto Adjusting pressure machines rather than use a CPAP machine.

I have not followed what the sleep medical specialists have advised in using a CPAP machine. Why? There is ample evidence showing that there are up to an estimated 80% non-successful, non-compliant and failing patients who are using a CPAP machine. Further details are on the blog page Why is CPAP Compliance Rate Low?

I have purchased out of pocket Bilevel Auto Adjusting machines to treat obstructive sleep apnea. Further, I have taught myself as much as possible on how to use this particular machine and optimize the settings for me. By doing so, I am having a great night’s sleep every night so as to wake up feeling refreshed and energized. 

In my younger years, I played a lot of competition sport, so I am totally aware of how important sleep is to maximize performance. You need to be able to perform on any given day at your best. Just 1% to 2% from your best may be the difference between winning and losing the game. 

Great sleep is critical to an elite athlete to perform at their maximum performance. When an elite athlete has lack of quality and quantity of sleep, they will feel tired and lacking energy and may make mistakes during a game. This may be due to a reduction in focus and judgement from less reaction time to what’s coming at you and what the opposition player or team is doing. 

Lack of sleep may also lead to lack of motivation and memory in players and increase the risk of illness and injury. Potentially, illness and injury may prematurely end a person’s sporting career. 

Did you know that elite athletes such as Roger Federer, Usain Bolt and Maria Sharapova get up to 10 to 12 hours of sleep a night? Serious consideration needs to be given by everyone to the quality and quantity of sleep that they are having. 

It is common in some elite athletes to have obstructive sleep apnea due to the particular sport they play such as Rugby Union and American Football players. These athletes may have large body masses and “thick” necks or extra fat or muscle tissue on the neck. 

You can read more at these articles:

7 Athletes with Sleep Apnea – The Common Misconception about OSA

https://www.cpap.com/blog/athletes-with-sleep-apnea

Seven sports stars who get plenty of zzz’s. https://www.sleep.org/articles/athletes-and-sleep

From personal experience, by using a Bilevel Auto Adjusting machine for maximum performance, you can perform at your very best on game day. You want to be feeling great every day, not just 4 or 5 or fewer days each week. Some days I feel I could climb Mt Everest with an extra 3,000 to 4,000 feet on top and “conquer the world”! 

Optimize the settings on the sleep apnea machine for you and change the settings on the machine depending on the situation that you find yourself facing each day. Such situations may be a hard physical game, heavy training, competition schedules, eating and drinking late and a day with little activity. A fixed pressure CPAP machine is only a best estimate of what pressure you require each night. 

For more details, refer to blog post Use different CPAP and Bilevel pressure settings and blog pages Different Bilevel Settings Example and Guide to Success using CPAP and Bilevel.

A major weakness of the CPAP machine is that the machine is limited to Pressure Support of 3 cmH2O. The pressure support on a bilevel machine is up to 10 cmH2O making it much easier to breathe against the pressure on exhale. In addition, the CPAP machine does not have settings for Trigger and Cycle and TI Max and TI Min like the machine that I use, which is the ResMed S9 VPAP Auto. This is an auto adjusting bilevel machine which is now known as the ResMed AirCurve 10 VAuto bilevel machine. These additional settings allow you to optimize the settings on the machine for you so that you can have a great night’s sleep. More details at CPAP Vs Bilevel Settings Example. 

Note that you will also see the bilevel machines known as BiPAP machines. BiPAP stands for Bilevel Positive Airway Pressure. BiPAP is a Registered Trademark owned by Philips Respironics. This company’s machine is known as Philips Respironics DreamStation Auto BiPAP. 

Recent medical research supports the use of a bilevel machine when CPAP is not effective or the patient cannot tolerate the CPAP pressure. In a 2019 study, the median average daily usage increased by greater than 23% when comparing a bilevel machine to a CPAP machine. Refer to the following article:

Benjafield AV, Pepin J-LD, Valentine K, et al. Compliance after switching from CPAP to bilevel for patients with non-compliant OSA: big data analysis. BMJ Open Resp Res 2019;6:e000380. doi:10.1136/ bmjresp-2018-000380

https://www.researchgate.net/publication/332761759 - Compliance after switching from CPAP to Bilevel for patients with non-compliant OSA

Throughout this Blog, I have detailed how I stopped many CPAP Side Effects and Issues using Bilevel by doing sleep apnea therapy differently to others. 

In later blog posts, I will show how to overcome the relatively rare issue of air through the eye tear duct using a CPAP machine. The sleep medical specialists have made this issue complex. Fortunately, for many people, the answer is simple! 

In the next Blog Post, Athletes need Maximum Performance: Use Bilevel, I will show how Elite Athletes may set and use the Bilevel Auto Adjusting Machine. 

Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 12.8 cmH2O (inhale and exhale pressure) to stop and reverse the symptoms of Dementia. I used the advanced ResMed Bilevel with iVAPS machine which will also be of great benefit to all athletes. This machine will enable an athlete to have great sleep every night and be able to perform at their very best when needed. More details are on the blog post:

Stop Alzheimer's Dementia using BiPAP with AVAPS or iVAPS

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
 

Use Ideal Body Weight on CPAP and Bilevel

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” Lao Tzu (Chinese philosopher – 600 – 470BC) 

In the Setting of the sleep apnea machine, I use Ideal Body Weight (IBW) or Predicted Body Weight (PBW) not my actual body weight on CPAP and Bilevel or BiPAP. By using IBW, I have optimized my sleep and stopped any CPAP side effects and issues such as weight gain and insomnia and constant waking up during the night. 

Understand the principles of what I have done and then apply the principles to yourself and your own circumstances. Throughout this blog, I have mentioned to apply the Buteyko Breathing Method to your sleep apnea machine. By doing so, I have optimized the settings on the machine so that I wake up feeling refreshed and energized each day. 

Use Minute Ventilation (MV) as your guide is one of The Secrets to Success for sleep apnea therapy using a sleep apnea machine. Minute Ventilation is the total volume of air entering the lungs in a minute.

From personal experience, I found that reducing median Minute Ventilation to 6 litres/ minute or lower and keeping the 95% to 100% rate “under control” each night optimized my sleep apnea therapy. “Under Control” means that you try and keep MV to a maximum of 10 litres/ minute. Otherwise you may be considered to be hyperventilating or breathing at an abnormally rapid rate or over-breathing.

Normal MV rate is considered to be 6 litres/ minute per Medical Textbooks. Further information on Minute Ventilation and the Buteyko Breathing Method is at: https://www.normalbreathing.com/.

The two components of Minute Ventilation are breathing/ respiratory rate (RR) and volume of air/ tidal volume (TV) that you are breathing in.

The question to ask is: Is there an optimal breathing rate and tidal volume to be used for you?

From my personal experience, the answer is a resounding YES!

The two components will differ for each person for various reasons such as other health issues besides sleep apnea and medication.

1. Tidal Volume (TV)

The first component that I optimally set was Tidal Volume. On the blog page Different Bilevel Settings Example, an Example is shown using the bilevel auto adjusting pressure machine in 3 different situations such as a hard day at work and eating and drinking late at night.  

Note that the median Tidal Volume is 400 ml in all 3 situations. How did I arrive at 400 ml?

I used Ideal Body Weight (IBW) instead of actual body weight. IBW was used as I found with higher Tidal Volume, my breathing would slow down. Sometimes my breathing slowed to a median of 12 to 13 breaths/ minute. When my breathing slowed down too much, I found from personal experience that the sleep apnea machine was too slow to react to apneas that were occurring and I would wake up feeling tired in the morning. 

IBW was actually introduced to estimate dosages for medical use, and the formulas that calculate it are not at all related to how a person looks at a given weight. It has since been determined that the metabolism of certain drugs is more based on IBW than it is total body weight. Today, IBW is also used widely throughout sports, since many sports classify people based on their body weight. 

Further details on Ideal Body Weight and to calculate your Ideal Body Weight are at: https://www.calculator.net/ideal-weight-calculator.html

Applying the ideal body weight calculator to me:

My height is 170 cm and therefore ideal body weight is 66 kgs to 67 kgs. Tidal Volume should be between 396 ml to 402 ml using 6 ml/kg. (66kgs - 67kgs x 6 ml/kg).
My median Tidal Volume is 400 ml using the sleep apnea machine.

2. Breathing/ Respiratory Rate (RR)

Once I set the sleep apnea machine to attain a median Tidal Volume of 400 ml, my breathing rate became optimized at 14 breaths/ minute. At 14 breaths/ minute, I found that the bilevel machine worked perfectly and enabled me to have a great night’s sleep. My apneas were 1.5 AHI or lower nearly every night and importantly, all issues caused by using the CPAP machine were overcome.

When my breathing is at a median of 16 breaths/ minute or higher, I have dizziness and vertigo and ear blocking. Further, I may end up with a high median minute ventilation of up to 7.5 litres/ minute. This caused me to wake up feeling tired in the morning and wanting to have a sleep in the afternoons. 

By optimizing the settings on my ResMed S9 VAuto bilevel machine (now ResMed AirCurve 10 VAuto), I have overcome an extensive list of issues caused by the CPAP machine. These issues are outlined on the blog page Stop CPAP side effects and issues. The issues include chest pain, mask leaks, teeth grinding, weight gain, insomnia, constant waking up during the night, too much pressure and tiredness and lacking energy issues even though AHI<1.0.

I believe a bilevel or BiPAP auto adjusting pressure machine should be considered for many of the 80% non-successful, non-compliant and failing patients who are using a CPAP machine. More details are at Why is CPAP Compliance Rate Low?

Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 13.0 cmH2O (inhale and exhale pressure). Ideal Body Weight was used in setting the median Tidal Volume and Minute Ventilation. This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. More details are on the blog post:

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

Should you be having side effects and issues with your sleep apnea therapy; CHANGE what you are doing so that you wake up feeling refreshed and energized each day. 

“Have courage. Be adventurous and Go for it! Overcome your fear.”
- Mrhelpful