11 October 2019

Change or Reset your Circadian Rhythm on CPAP

“Many people will walk in and out of your life, but only true friends will leave footprints in your heart.”
- Eleanor Roosevelt (Former First Lady of the United States – 1884 – 1962)

One day it occurred to me that I could change or reset your circadian rhythm on CPAP. You can change the circadian rhythm on a particular night by using a CPAP and Bilevel or BiPAP machine with different settings. When I use a Bilevel auto adjusting machine with different settings, I have a different circadian rhythm or sleep cycle for each different setting. By using the Bilevel machine I have optimized my sleep every day.

By understanding that your circadian rhythm is your friend, you can optimize your sleep each day. Circadian rhythms are your body's internal clock or sleep/wake cycle which repeats roughly every 24 hours. Ideally, wake up at the end of a sleep cycle not in the middle of one otherwise you may feel tired and sleepy all day.
 
For some time, I could not understand why I was waking up at different times in the morning. Generally, the wake times can vary by up to 75 minutes. I thought everyone only had one circadian rhythm such as 90 minute sleep cycles during the night. In addition, I thought it was sleep apneas that were occurring that was waking me up at different times in the morning.

In a previous blog post, Use Different CPAP and Bilevel Settings, it was mentioned that I use 3 ResMed VPAP Auto adjusting bilevel machines with different settings on each to optimize my sleep every day. The machine I use each day is dependent on the situation that I am facing each day. The situations could be eating and drinking late, a hard day at work or doing a lot of physical activity and a normal day. 

The average sleep cycle length is as follows: 
 
Machine 1     Normal day                  75 - 80 minutes
 
Machine 2     Hard day at work/        80 - 83 minutes
                     Heavy physical day    
 
Machine 3     Eat/ Drink late              90 - 93 minutes 

Usually with Machines 1 and 2, I will sleep for 5 cycles or between 6 hours 15 minutes (375 minutes) to 6 hours 55 minutes (415 minutes) before waking up.

Machine 3, Eat/ Drink late usually results in either 4 or 5 cycles or 6 hours (360 minutes) or 7.5 hours (450 minutes) before waking up. 

Whichever machine is used, once I wake up, I will sleep/ doze until I reach 7 hours and 30 minutes to 8 hours. That is, I will go another sleep cycle if necessary, so I have consistency when I sleep and wake up. You can see with machine 3 that I may not wake for 7 hours 45 minutes (5 cycles x 93 minutes). Using Machine 1, sleeping 5 sleep cycles may be only 6 hours 15 minutes (5 x 75 minutes). 

In addition, I found the extra time from waking up at the end of the last cycle up to 8 hours of sleep and rest gives me that bit extra of up to 10% of wakefulness during the day. I no longer have a late afternoon/ early evening “little tired” period and falling asleep. The extra sleep time keeps me going strong till bed time of 11.30pm to 12.00pm. 

By working out what my body naturally requires, I have stopped using the alarm clock to wake up. Now I only use an alarm clock in emergencies as a backup when it is essential I get out of bed by a certain time. 

These sleep cycles will vary for each person. You can read more about 90 minute sleep cycles and the splitting up of sleep into two sleep sessions.  


Circadian rhythms are critical should I not be able to get 7 hours 30 minutes to 8 hours sleep/ rest. For example, when you need to get on a plane and have an urgent event to attend. I had to attend a funeral on Friday and get a plane. I had only 3-4 hours available to sleep. By working out the circadian rhythm for each machine, as I was on Machine 3 and had eaten and drunk late on Thursday, I knew the cycle would be normally 90 minutes. So, I had 2 cycles or 3.0 hours of sleep. 

I was on my feet nearly all day and did not arrive back home and go to sleep till 2.37am, Saturday morning some 23 hours later from when I first woke up. I was generally feeling great all day. Had a little tiredness in the afternoon but I kept going and was feeling fine. 

Saturday morning, I used Machine 2 and woke 8 hours 23 mins later. This is 6 cycles x 83 mins or 503 minutes. As it was the end of the cycle I got out of bed. I had to go to a meeting and function and did not get to Bed that night or Sunday morning to 2.51am. Again, I felt pretty good all day. 

As I had eaten late on Saturday night, I used Machine 3 and slept to 10.19am or 7 hours 28 mins later. This is 5 cycles x 90 mins or 448 minutes. 

This is an example of how I use the circadian rhythm cycles to my advantage. It is essential that you work out your own personal cycle as they will differ for each person. So when you find yourself in a similar situation you can work out when it is optimal for you to wake up and get out of bed. The alarm clock is set as a backup only. From personal experience, should I wake up in the middle of a sleep cycle, I will be tired and sleepy for the rest of the day. By using cycles, you can be refreshed and energized all day even though you have not had your normal amount of sleep. 

Interesting, using the plane example, after 3.0 hours when I needed to get up out of bed, I awoke automatically and did not need to use the alarm clock. It was as if my body knew I needed to get up! 

If I was using Machine 1, normal day and 75 minute cycles instead of Machine 3, eat/ drink late and had 3.0 hours of sleep, you can see I would have woken up in the middle of a sleep cycle. 2 cycles x 75 mins = 150 mins or 2 hrs 30 mins. 3 cycles x 75 mins = 225 mins or 3 hours 45 minutes. 

You will note that I have average cycle length for each machine and I do not have a precise circadian rhythm like other people such as 90 minute cycles. There are a few reasons. 

1. Sometimes there is a crossover in what I am doing for a particular day. For example, I may have a Normal Day with a lot of walking and a very large lunch. Using Machine 1, the cycle length will normally be 80 minutes rather than 75 minutes as shown above. That is, the cycle length will move towards the cycle lengths of Machines 2 and 3. Read more at: Different Bilevel Settings Example.  

2. Using different machines may cause the first day of switching to have a slightly different sleep cycle. By the next night and thereafter should I stay on the same machine, the sleep cycle stabilizes and the length of the cycles are the same. 

3. In addition to sleep apnea, I have a genetic disorder, Hemochromatosis. This disorder is characterized by having too much iron absorption from the foods that you eat. Where your iron levels are too high, you may feel incredibly tired and lethargic and may lead to health issues such as cirrhosis of the liver, heart disease and diabetes. As an aside, when my iron levels are too high, my skin colour starts having an orange tinge to it. 

Body iron level helps regulate our circadian rhythms and their link to metabolism. You can read more at this article.

https://theconversation.com/bleed-me-why-excess-iron-can-be-dangerous-41339    

Importantly, Hemochromatosis is a medical condition associated with Alzheimer's Dementia. More details are on the blog post: 

In additon, Research is supporting that a brain's ability to clear a protein closely linked to Alzheimer's disease is tied to our circadian cycle.

Rensselaer Polytechnic Institute. "Clearance of protein linked to Alzheimer's controlled by circadian cycle: Ability of immune system to destroy Alzheimer's-related protein oscillates with daily circadian rhythm." ScienceDaily. 10 February 2022.

https://www.sciencedaily.com/releases/2022/02/220210154215.htm

To have great sleep every day, I use different settings on the sleep apnea machine. These settings depend on the situation that I am facing for a particular day. Using different settings changes my circadian rhythm. By using circadian rhythms as my friend and to my advantage, I can optimize my sleep every day.
 
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
 

08 September 2019

Stop CPAP causing Insomnia: Use Bilevel

“Believe in yourself. You are braver than you think, more talented than you know, and capable of more than you imagine.”
Roy T. Bennett, Author of The Light in the Heart

Various CPAP users have insomnia even though they are taking steps advised by sleep medical specialists and equipment suppliers. Have you considered that the CPAP machine and the way it works is causing insomnia? Insomnia can occur in getting to sleep initially as well as when waking up during the night. How do you stop CPAP causing Insomnia? Consider using a Bilevel or BiPAP machine.

Steps that you can take to overcome insomnia include:
1. Maintain good sleep hygiene such as no coffee after late afternoon, go to bed only when you are tired, have a good mattress and pillow and exercise regularly.
2. Make sure your CPAP mask is comfortable; and
3. Switch off all technology such as laptops at least one hour before going to bed.
 

You can obtain more details at:

https://www.resmed.com.au/blog/7-tips-for-falling-asleep-using-your-cpap 
https://www.resmed.com.au/insomnia/insomnia-causes     

From my personal experience, the CPAP machine did cause insomnia! There is nothing worse than waking up in the middle of the night and not going back to sleep. You lie awake in bed for a while and eventually as you cannot get back to sleep, you decide to get up. 

A sleep medical specialist is unlikely to advise you that a CPAP machine may cause insomnia or many other issues as listed on the blog page Stop CPAP Side Effects and Issues. I’m sure that you would agree that saying that a CPAP machine may cause insomnia and other issues such as tiredness, chest pain, aerophagia, nose bleeding, constant waking up and weight gain would not be a great selling point to new patients! 

How do you stop insomnia and overcome other issues when using a CPAP machine? Seriously consider obtaining a second hand ResMed S9 VPAP Auto bilevel machine which can be purchased for a reasonable cost. By doing so, may save you a lot of time and money when compared to obtaining a new machine. I have purchased a few second hand machines with low machine use hours from a company, Secondwind CPAP in the USA. https://www.secondwindcpap.com/
 

A comparison of CPAP Vs Bilevel is at CPAP Vs Bilevel Settings Example. 

Support for what I have done is found in a recent research study published online in August 2019. Essentially, I have set my bilevel machine to work like a basic Adaptive Servo-Ventilation (ASV) machine at a much lower cost. 

Prospective Randomized Controlled Trial on the Efficacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia. Barry Krakow, Natalia D. McIver, Victor A. Ulibarri, Jessica Krakow, Ronald M. Schrader

https://www.sciencedirect.com/science/article/pii/S258953701930104X?via%3Dihub 

In addition to not being able to go to sleep initially, there are 4 levels of waking up during the night.
1. Wake up and not go back to sleep. You may get up out of bed.
2. Wake up and go back to sleep after some time, say 15 minutes to 20 Minutes or more.
3. Wake up and go back to sleep straight away.
4. Sleep through the night for at least 6 hours without waking up.


You want to be in levels 3 and 4 above; otherwise you will wake up feeling tired and lacking energy and be lethargic all day.

What can you specifically do and what are the settings that I use on the bilevel machine to stop insomnia?

1. Apply the 4 steps as outlined on the blog page Guide to Success using CPAP and Bilevel. Minimize leaks and reduce your breathing rate and median minute ventilation (MV) to 6 litres/ minute or lower. In addition, reduce median pressure of IPAP (inhale pressure) and EPAP (exhale pressure) as much as possible and the maximum or top pressure is only required as necessary. 

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.  
 
Reduce median/ average Minute Ventilation (MV) to 6 litres/ minute or lower and keep the 95% to 100% rate “under control”. Apply the principles of the Buteyko Breathing Method to your sleep apnea machine by slowing your respiratory rate down and reducing the volume of air that you are breathing in. 
 
For tidal volume settings, I use Ideal Body Weight (IBW) on CPAP and Bilevel or Predicted Body Weight (PBW) not my actual body weight. 

2. Apply the principle of the 4-7-8 breathing method to your bilevel machine. This is a way of breathing to relax to go to sleep by inhaling about 25% of the total time spent holding your breath and exhaling. Save money by not using sleeping aids such as melatonin and prescription sleeping pills. Read more at: https://noselife.com/breathe-nose-fall-asleep-faster/

Step 2 is a critical step which I consider absolutely essential to stop insomnia. This step has worked without fail, 100% of the time in getting to sleep initially and importantly when I have woken up during the middle of the night in being able to go back to sleep quickly.

I apply the principle of the 4-7-8 breathing method as follows:

1. Set the Inhale at 1.1 seconds to 1.2 seconds using the TI Min and TI Max settings; and

2. When setting the exhale, I allow 5.5 to 6 seconds to exhale, before the machine prompts me to start inhaling again, by using Trigger sensitivity of High. 

To achieve 5.5 to 6 seconds to exhale, I use Pressure Support of between 5.0 to 5.6 cmH2O. More details are at Different Bilevel Settings Example. In addition, to overcome Central Sleep Apnea, I use Cycle sensitivity of high/ very high. Refer blog post How to Overcome Central Apnea using Bilevel? 

With these machine settings, the inhale:exhale or I:E ratio is 1:5 (one to five). That is, my inhale time is only 20% of the total time that I exhale. Just before I go to sleep, my breathing normally slows down to 7 to 9 breaths per minute. Once asleep, my breathing will go back up to 14 breaths per minute.  

When reviewing the whole night and due to different sleep stages; the median ratio is about 1:2.7. This median ratio is far better than when I was using the CPAP machine when I:E ratio was 1:1 or even worse at 0.8:1. I was spending more time inhaling or breathing in air than I was exhaling. This is one of the main reasons that I had many issues using the CPAP machine! 

In addition, I use very low pressure on exhale (EPAP) of 4.2 cmH2O and minimum inhale (IPAP) of between 9.2 cmH2O to 9.8 cmH2O. By using these settings, you are breathing out against very low pressure when initially going to sleep and when you wake up during the night. These settings are despite my maximum or top pressure may go over 15 cmH2O during the night. 
 
By doing so will assist you to stop insomnia as well as overcoming other side effects and issues. These issues include treating and stopping REM sleep issues and obstructive sleep apnea which may cause Parkinson's and Dementia and Stop Insomnia, Hypoxia, REM sleep issues causing Alzheimer's: Use BiPAP.

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