CPAP Settings to Stop Air coming out the Eyes

Success is no accident. It is hard work, perseverance, learning, studying, sacrifice and most of all, love of what you are doing or learning to do.”

- Pele (Brazilian – Retired Professional Footballer – 1940 -   )

From the previous blog post How to Stop Eye Tear Duct Air Regurgitation?, the CPAP settings being used are critical to stop or reduce greatly the air coming through the eye tear duct or nasolacrimal duct and air coming out the eyes. This side effect is also known as nasolacrimal air regurgitation into the eye. For a small number of people including myself, additional steps may be required as some air still comes out of one of my eyes. More details later in the post.    

The Secrets to Success to stop or reduce greatly the air were to do one or more of the following:

1. Reduce or stop using humidification from the humidifier;

 

2. Reduce the median/ average pressure from the sleep apnea machine;

3. Reduce the volume of air or Tidal Volume (TV) that you are breathing in.    

To assist all people having air coming through the eye tear duct and out of the eyes, at the end of this post is an actual CPAP settings example that I have used on a CPAP fixed pressure machine. Use these settings as a guide in applying to your own personal situation and preferences. The settings that you use will depend on a number of factors including whether you have had an eye dacryocystorhinostomy (DCR) operation, a Lester-Jones tube (LJT) insertion or have a faulty tear duct valve. Each of these may have different diameters and lengths which will affect the force and volume of air coming through the eye tear duct. 

Other factors to be considered include your pressure requirements, whether you need to use humidification due to nasal issues and the type of sleep apnea machine being used such as auto adjusting CPAP and Bilevel or BiPAP auto adjusting machine.

As noted on the blog post How to Stop Eye Tear Duct Air Regurgitation?, the biggest benefit was obtained when I stopped using the humidifier. When I did so, I was able to increase the maximum pressure by more than 33% to 12 cmH2O fixed pressure from 9 cmH2O using pressure support of 3 cmH2O. Using the Bilevel auto adjusting machine, the maximum pressure increased by more than 88% to 17 cmH2O using pressure support of 5 cmH2O or more. For those people using pressure of 12 cmH2O or lower, a CPAP machine may be all that you require. 

The settings for the auto adjusting CPAP machine can be between those of the CPAP fixed pressure and Bilevel auto adjusting machines. Auto adjusting CPAP machines will allow you to use a lower minimum pressure than a CPAP fixed pressure machine. They will adjust the pressure required during the night based on obstructive sleep apnea.  

Many people will not require maximum pressure up to 17 cmH2O as I do. When using lower maximum pressure such as 13 cmH2O; you will have a wider range of options in the settings that you are able to use. These options include increasing the minimum pressure and EPAP (expiratory pressure) and being able to use more humidification.  

The bilevel auto adjusting machine has many advantages over the other 2 types of machine as detailed in the blog post The Secrets to Success. In overcoming the problem of air coming out the eyes, the ResMed S9 VPAP bilevel machine that I use will allow you to do the following: 

1. Use greater than 3 cmH2O of pressure support. Pressure support up to 10 cmH2O is available which enables you to have a greater reduction in the median/ average pressure and use a lower minimum pressure and EPAP. Note that using pressure support may cause Central Sleep Apnea. More details on the blog post How to Overcome Central Apnea using Bilevel? 

  

2. Use more humidification with a higher maximum pressure.

3. Use other options being TI Min and TI Max (time spent inhaling) and Trigger and Cycle or inhale and exhale sensitivity settings.

By using TI Max of 1.2 seconds, pressure support up to 5.6 cmH2O and no humidification, I have been able to use maximum pressure of 17 cmH2O and reduce both the median pressure and the volume of air that I am breathing in. As a result, less air is coming through the eye tear duct and no air is coming out of one of my eyes. 

On the blog page CPAP Vs Bilevel Settings Example, a large reduction of 22.1% in median/ average IPAP/ EPAP pressure and 9.1% in median Tidal Volume of air was achieved when using a Bilevel auto adjusting machine compared to a CPAP fixed pressure machine.   

These other options being TI Min and TI Max and Trigger and Cycle settings will also enable you to keep your breathing “under control” during the night especially when you go through different sleep stages. Some nights when I used CPAP, the average time inhaling was more than the time exhaling which caused side effects and issues using machine. In addition, the other options allow me to sync my breathing with the machine and give me better comfort, compliance, therapy and sleep quality when compared to both CPAP fixed pressure and auto adjusting CPAP machines. 

On the next blog post CPAP air coming out the eyes: Other options, I will detail the other things that I have done to stop air coming through the eye tear duct and coming out the eyes. This is due to the second eye DCR operation that I had in 2015 on my right eye being carried out slightly differently to the first eye DCR operation in 1996 on my left eye which caused an increase in the volume of air coming through the eye tear duct. 

Below is a Table showing the settings that I have used in my own sleep apnea therapy with a CPAP fixed pressure machine. Use these settings as a guide in applying to your own personal situation and preferences. 

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) which may cause air coming out the eyes. Top pressure during the night may be more than 20 cmH2O! 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?

 

Further details on how to overcome the issue of air through the eye tear duct and coming out the eyes using any sleep apnea mask and how two Aha moments gave me the answer are on the following blog posts:

Air through Eye Tear Duct - Introduction 

CPAP Air coming out of the Eyes 

 

How to Stop Eye Tear Duct Air Regurgitation? 

CPAP Air out Eyes and Tear Ducts: Other Options

CPAP Air out Eyes and Tear Ducts: Other Options (Part 2)

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

   

How to Stop Eye Tear Duct Air Regurgitation?

“The simple things are also the most extraordinary things, and only the wise can see them.”
- Paulo Coelho (Brazilian Novelist - The Alchemist - 1947 - Present)

On the blog post, Air through Eye Tear Duct, I mentioned that it was after I had two Aha moments that I came to realize what the solution was to stop or reduce greatly CPAP air coming through the eye tear duct or nasolacrimal duct. How to stop lacrimal duct air regurgitation into the eye and air coming out the eye? The solution had been staring me in the face for a long time; however I could not see it! The solution is SIMPLE not complex as the sleep medical specialists would have you believe. 

In addition, there is no need to use a total face mask as detailed in the previous blog post CPAP Air coming out of the Eyes. A person can use any type of sleep apnea mask including nasal and full face mask.

The first Aha moment came just after I filled a bucket with water to wash the car. There was dirt on the driveway and so I automatically put my finger over part of the end of the hose to wash the dirt away. It was at that precise moment that I realized that it was the increased force of water that was causing the air to come through the eye tear duct and out of the eyes. 

As noted in CPAP Air coming out of the Eyes, when using the sleep apnea machine, the increased “force of water” is the air coming out faster and further from the eye tear duct due to the small area or opening of the tear duct when compared to the nose. The water was from the heated humidifier in the sleep apnea machine combining with the air.  

Reduce or stop using humidification and you are left with a much lighter fluid in air. By doing so as well as reducing the median/ average pressure from the sleep apnea machine will for most people allow you to overcome the issue of air through the eye tear duct and coming out of the eyes. Details of how to stop using the Humidifier are on the blog posts Why NOT to use a CPAP Humidifier? and Stop CPAP causing Mask Leaks.  

 

The second Aha moment came a few days after the first Aha moment. I was standing in the kitchen and it started to rain. The rain was falling to the ground. Why was the rain falling and not going upwards? 

It was due to gravity and that water is heavier than air. So came the second Aha moment. When you lie on your side, the gravity together with the air combining with humidification from the humidifier causes the air to be heavier and drop faster down the eye tear duct. As more humidity is used, the heavier the air is as the air becomes more like water. This will lead to the air going under the eye lids leading them to “flap in the wind” and may wake you up constantly through the night. 

The air will also lead to irritation of the eyes and you will wake up with terrible, painful red sore eyes in the morning as well as being totally exhausted from lack of quality sleep. I did not look forward to going to sleep at night as I knew each morning I would wake up with the same pain and suffering as the previous morning! 

Without adequate tears, you may have an increased risk of eye infection. In addition, damage may occur to the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcer and vision problems. Further details are at:

https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes

The easiest solution is to turn over to your other side so that the “good” eye or the eye that has had eye dacryocystorhinostomy (DCR) surgery is on top and you stay on the one side all night. This means that the air will have to go up rather than down with gravity. 

In addition, the friction caused by the tear duct itself will also assist. However, for this solution to work will depend on the sleep apnea machine pressure and that you have no other issues such as an eye DCR surgery on the other eye and neck and shoulder issues.

From the two Aha moments and the principle of filling up a bucket with water using a hose as detailed in CPAP Air coming out of the Eyes, I realized that The Secrets to Success to stop or reduce air coming through the eye tear duct and out of the eyes were to do one or more of the following:

1. Reduce or stop using humidification from the humidifier; 

2. Reduce the median/ average pressure from the sleep apnea machine;

3. Reduce the volume of air or Tidal Volume (TV) that you are breathing in.

Note that should you stop using the humidifier, consideration still needs to be given to the humidity in the room where you sleep. Even when I stopped using the humidifier, I found that the humidity in the air can affect the sleep machine maximum pressure that you can use by up to 1 cmH2O. In addition, for some people extra steps may need to be taken to resolve the problem of air coming out of the eyes. More details are on later blog posts CPAP Air out Eyes and Tear Ducts: Other Options and Other Options (Part 2).

Should you have nasal issues when you stop or reduce using humidification, I recommend you read Stop CPAP Nasal Congestion and Nose Bleeding for a quick, easy and very cost effective solution which may work for you. I put medical paper tape over a portion of both nostrils at the middle section of each nostril. An added bonus is that by using the tape, there is an estimated small reduction in the volume of air of about 3% to 4% coming out the eyes.

For points 2 & 3, for further details, refer to Guide to Success using CPAP and Bilevel.

Importantly, whilst I use a Bilevel or BiPAP Auto Adjusting machine, for those people using pressure of 12 cmH2O or lower, a CPAP machine may be all that they require. Even though my maximum or top pressure may go up to 17 cmH2O during the night, the bilevel machine has been set to only use the top pressure required as necessary to cover obstructive sleep apnea. This contrasts with the CPAP fixed pressure machine which operates at maximum pressure all night. 

The biggest benefit for those people who have air coming out of the eyes is that when I stopped using the humidifier, I was able to increase the maximum pressure by more than 33% to 12 cmH2O fixed pressure from 9 cmH2O using pressure support of 3 cmH2O.Using the Bilevel Auto Adjusting machine, the maximum pressure increased by more than 88% to 17 cmH2O using pressure support of 5 cmH2O or more!  Details are on blog pages CPAP Vs Bilevel Settings Example and Different Bilevel Settings Example. 

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) which may cause air coming out the eyes. Top pressure during the night may be more than 20 cmH2O! This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. In addition, eye cataracts are also associated with Alzheimer's Dementia. 

More details are on the blog posts: 

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

 

How to stop Alzheimer's Dementia and Amyloid Protein using BiPAP? 

 

Further details on how to overcome the issue of air through the eye tear duct and coming out the eyes using any sleep apnea mask and how two Aha moments gave me the answer are on the following blog posts:

Air through Eye Tear Duct - Introduction 

CPAP Air coming out of the Eyes  

CPAP Settings to Stop Air coming out the Eyes

CPAP Air out Eyes and Tear Ducts: Other Options

CPAP Air out Eyes and Tear Ducts: Other Options (Part 2)

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