Stop CPAP causing Weight Gain: Use Bilevel

“When you get into a tight place and everything goes against you, till it seems as though you could not hang on a minute longer, never give up then, for that is just the place and time that the tide will turn.”    

- Harriet Beecher Stowe (American Author – 1811 – 1896) 

Many people including myself when using CPAP have had Weight Gain. A number of people have detailed their experience on the various sleep apnea forums (listed right hand side). In addition, some sleep medical specialists are unsure of how to stop CPAP causing weight gain and why more patients do not have weight loss. Should CPAP be causing weight gain, seriously consider using a Bilevel or BiPAP Auto adjusting pressure machine. From my personal experience, when you use a bilevel machine, you will be able to get rid of any weight gain and achieve weight loss!

You can read articles on CPAP and weight at:    

https://doctorstevenpark.com/cpap-use-found-to-cause-weight-gain

https://www.cpap.com/cpap-weight-loss/

As mentioned on the blog page Why is CPAP Compliance Rate Low? it is likely that up to an estimated 80% or more than 15 million users of the sleep apnea machines are non-successful, non-compliant and failing. I have detailed on various posts and pages what I did to finally overcome all the side effects and issues that I was having using the sleep apnea machines especially CPAP therapy. 

The question is: Should you be experiencing weight gain after starting CPAP therapy; what, if anything can be done about your sleep apnea therapy? 

After starting CPAP therapy, I gained weight of up to 2 kgs. The sleep medical specialists may consider that it is not much of a weight gain. However, I did not lose weight as I was lead to believe when I began using a CPAP machine. The weight gain happened despite exercising up to 5 times per week for greater than 30 minutes at a time including walking up and down hills. Also my diet was being watched every day and my body mass index (BMI) was 26. In addition, I was having yearly medical checkups including blood tests. I thought I was doing everything possible to lose the weight that I had put on even outlaying money to buy a CPAP auto adjusting machine. 

Though I did all these things, I still could not lose the weight that I had put on since starting CPAP therapy. This is the reason for the quote at the top of the post by Harriet Beecher Stowe. Just when you think you have run out of options, hang in there a bit longer, you have some luck and the tide turns! 

In 2014, after being unsuccessful for nearly 4 years with trying to resolve the various side effects and issues caused by using the CPAP fixed pressure and auto adjusting machines, I decided to purchase a ResMed VPAP S9 Bilevel Auto adjusting pressure machine. Now known as ResMed AirCurve 10 VAuto. More details at The Secrets to Success using CPAP and Bilevel.

It was after using the Bilevel machine and optimizing the settings on the machine that I was able to take off all the weight gain that I had put on after starting CPAP therapy. Further, my weight has now dropped more than 1 kg below my pre CPAP weight of nearly 9 years ago and I currently have a BMI of 25! 

Buying the Bilevel machine was a huge leap of faith and I did have some luck in buying the machine. I thought the machine would work great; however, at the time I had little knowledge of how the machine truly worked with all its various options. There was no way of knowing this until I actually used the machine each day. After some time using this particular machine, I was able to resolve all the issues that I was having with my sleep apnea therapy. Have a look at the improvement in a comparison of CPAP Vs Bilevel Settings Example.

On the blog post Use Different CPAP and Bilevel Pressure Settings and the blog page Different Bilevel Settings Example, I advised that using the one setting on your sleep apnea machine was not always appropriate in all situations. For example, when eating and drinking late at night, I use a Bilevel Auto machine with Pressure Support of 5.0 cmH2O. Using Pressure Support greater than 3.0 cmH2O stops me from hyperventilating or over-breathing when asleep and waking up feeling tired in the morning. Importantly, median Minute Ventilation rate at 6 litres/ minute or lower can be maintained.  

 

Based on my personal experience, using Pressure Support greater than 3.0 cmH2O has good implications for those users who have gained weight since starting CPAP therapy and/ or have a high BMI. A discussion with a medical specialist at one of the major equipment suppliers supports this conclusion. 

Unfortunately, a major weakness of both the CPAP fixed pressure and auto adjusting machines is that maximum pressure support is limited to only 3 cmH2O. 

As further discussed on the blog page Guide to Success using CPAP and Bilevel, the steps to take to optimize your sleep apnea machine settings are:  

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. Minimize 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/ average 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. 

4. 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. 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/.

By optimizing the settings on a Bilevel Auto adjusting pressure machine, the tide turned and I was able to stop CPAP causing weight gain. In addition, I was able to get rid of any weight gain and achieve weight loss of more than 1 kg from my sleep apnea therapy! A comparison of the two machines is at CPAP Vs Bilevel Settings Example. 

Dr Steven Park, Medical Surgeon wrote on a blog post 7 October 2020:

It turns out that overall, CPAP use has been found to increase weight significantly, in proportion to how long you use CPAP. The more hours you use CPAP every night and the more number of years, the higher the amount of cumulative weight gain.

Go onto the Comments section and see many people who have put on more than 10 pounds or 5 kgs since starting CPAP! 

https://doctorstevenpark.com/can-cpap-make-you-gain-weight

An additional reason to seriously consider using BiPAP and Bilevel auto adjusting machines rather than CPAP is that they may improve any back and neck issues that you may have. From personal experience, on changing to a bilevel machine, my back and neck issues improved by 5% to 10%!

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 can wake up feeling refreshed and energized each day. 

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

- Mrhelpful

Use Different CPAP and Bilevel Pressure Settings

“The definition of insanity is doing the same thing over and over and expecting different results.”

- Albert Einstein/ Others (German born Theoretical Physicist - 1879 - 1955)

By using different CPAP and Bilevel or BiPAP pressure settings for different situations, I now wake up feeling refreshed and energized each day. Should you be having some “bad” days or are having the feeling of “is this as good as it gets” using your CPAP and Bilevel machine, CHANGE what you are doing! 

Many users of sleep apnea machines will have experienced for themselves that at least 1 to 2 days per week up to every day of the week; they are waking up tired, lacking energy and are unrefreshed. I was once in the same situation that many people now find or have found themselves.

On the blog page Different Bilevel Settings Example, I show the results using my actual sleep data and SleepyHead reports of using the Bilevel auto adjusting pressure machine for three different situations. For a CPAP machine, apply the principles of what I have done. The different situations are: 

1. Normal day;

2. Eating and drinking late at night; and

3. Hard day at work and/ or many hours of driving. 

Your pressure needs may change on a daily basis and will depend on many factors. Such factors may include sleep hygiene and lifestyle factors such as exercising daily and eating food late at night and medication and other health conditions that you may have. Should you be doing similar activities each day, having the one set of pressure settings on your sleep apnea machine may be all that you require for optimal treatment. The machine that you are using may only require a little adjustment to optimize your sleep. 

When you consider the many benefits from waking up refreshed and energized each day, the cost of the bilevel machine has been recovered many times over as I have been able to resume full time work. Further, I wanted to be 100% refreshed each day as in the past, tiredness nearly caused me to have a major car accident on the highway when my life flashed before my eyes. Putting someone else’s life at risk is not something I want to do when I can take steps to prevent it.

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 for obstructive sleep apnea that I woke up feeling great and energized each day. 
    
One of the key Secrets to Success using a sleep apnea machine was to change from using a CPAP machine to using a Bilevel auto adjusting pressure machine. Another key Secret to Success was to use different pressure settings for different situations on the bilevel machine. More details are at Different Bilevel Settings Example.

I began using different settings on the machine when I realized that using the settings for a “Normal day” were not appropriate in all situations such as eating and drinking late at night. At the time, I was having issues such as hyperventilating or over breathing and feeling tired in the mornings. To overcome these issues, I tried using different settings on the machine depending on what was happening on a particular day. By trial and error, I succeeded in overcoming these issues and now wake up feeling refreshed and energized each day.  

When I eat and drink late at night, my breathing becomes faster than normal when asleep. My Minute Ventilation (MV) increases as I was not taking my normal full breath on inhale. Median/ average MV may rise up to 7 litres/ min or more from my normal 6.0 litres/ min or lower. In addition, the median respiratory rate may increase up to 16 breaths/ minute from 14 breaths/ minute. Minute Ventilation is the total volume of air entering the lungs in a minute. 

My solution was to reduce pressure support to 5.0 cmH2O from 5.4 and 5.6 cmH2O and reduce the minimum pressure. In addition, by using the same time for inhale, I was able to control and slow my respiratory rate down back to my normal median of 14 breaths per minute. Importantly, no matter what the situation, median MV stayed at 6 litres/ minute or lower. Examples of what I have done in three different situations are on the blog page Different Bilevel Settings Example.

Today, I have a separate bilevel machine for each of the three situations outlined above. Changing settings on the one machine late at night was getting annoying and I was prone to making errors when changing settings on the one machine due to tiredness. An example is provided of how I use these machines in a typical week at the blog post Athletes need Maximum Performance: Use Bilevel. Observe what I have done and apply the principles to your own situation.

On the blog post Change or Reset your Circadian Rhythm, 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.

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.

In addition to sleep apnea, I also 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.

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, 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

Some people may feel the cost of buying three machines is a lot of money and not necessary. As these were second hand machines, the total cost was far cheaper than buying one new bilevel machine. More importantly, my sleep medical specialist would only prescribe a CPAP fixed pressure machine and refused to prescribe an auto adjusting CPAP machine as “I did not need it”! For these reasons, I felt I had little chance of obtaining a bilevel auto adjusting pressure machine.

Based on discussions with a senior executive of a major equipment supplier, depending on country, only 2% to 4% of total patients get issued with a bilevel machine. This further supports the reason to buy the machines out of my own funds. I have purchased a few second hand bilevel machines with low machine use hours, saving plenty of money, from a company, Secondwind CPAP in the USA. Details are at: https://www.secondwindcpap.com.

Other benefits of having more than one machine include:

1. Having two backup machines should one machine fail to operate; 
2. Not having to worry about obtaining a new Bilevel machine for many years; and 
3. Having all three machines the same allows for continuity of using the same accessories such as the tubing and power adapter. 

Above all, by optimizing the settings on the bilevel machine and using different pressure settings for different situations, I have successfully overcome and stopped all the  CPAP side effects and issues caused by the machine. Side effects and issues include aerophagia, central sleep apnea, insomnia, mask leaks, tiredness and lacking energy issues even though AHI<1.0 and weight gain.

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  

Stop CPAP Mask Problems and Issues

“If you are going through hell, keep going.”

- Winston Churchill (Former British Prime Minister – 1874 – 1965) 

To stop CPAP mask problems and issues, I went back to using an “old” nasal mask being ResMed Mirage Micro and to use a Bilevel or BiPAP auto adjusting pressure machine. It is an “old” mask as the mask is no longer manufactured by ResMed although the mask and cushions are available online. A picture of the mask is at the end of the blog post.  

Masks are very personal. A great mask for one person may be a terrible mask for someone else. No matter what mask you end up with, by stopping mask problems and issues in particular leaks and constantly waking up, you will not be losing quality sleep and waking up tired and unrefreshed each day. 

As noted in CPAP Air coming out of the Eyes, one of the hardest and most difficult aspects of using a sleep apnea machine is to find your “perfect” mask. A mask that is properly fitting and comfortable will strongly enhance a person’s experience, acceptance and long-term use of the sleep apnea machine. Otherwise you may end up being one of the 80% non-compliant, failing and non-successful people on sleep apnea therapy as detailed on Why is CPAP Compliance Rate Low? 

At the sleep medical specialist and equipment supplier, make sure they explain and you try the different types and brands of masks. Use a mask that is comfortable and suits your style of sleeping. This is critical as it is you who will be sleeping with the mask each day not the equipment supplier. It is best that the equipment supplier have a return policy should the mask not meet your satisfaction. 

The sleep staff need to ask you questions including what sleep positions you sleep in and whether you move from side to side and lie on your back, what pillow you had and whether you may need to change, are you claustrophobic wearing the mask and do you want to read a book with your mask on before going to bed? 

Due to smallness, I recommend you first try with nasal pillows and nasal masks. Generally, the smaller the mask is, the smaller the leaks. I look at leaks in an earlier blog post Stop CPAP causing Mask Leaks: Use Bilevel. 

Be aware, there are conflicts of interest in the sleep apnea industry. Avoid them at all costs as it may be to your detriment. The blog post details my first mask and personal experience and how I had no choice in selecting the mask.

There are many reasons for using an “old” mask and a bilevel or BiPAP auto adjusting pressure machine. 

1. To reduce mask leaks showing on my machine each morning to zero even though I use maximum pressure up to 17 cmH2O. For some of you, leaks from the mask are going to make you frustrated and drive you crazy. Just when you go to sleep as well as during the night, the mask may leak, waking you up constantly. 

Using a bilevel machine has assisted greatly in reducing mask leaks to zero. More details are at the above blog post and Guide to Success using CPAP and Bilevel. In these posts, I detail the 4 steps that I believe are The Secrets to Success to using a sleep apnea machine. 

2. For a ResMed machine, once leaks are constantly over a certain level being 24 litres per minute during the night, your sleep therapy will be less effective than it should be and may lead to sleep disruption and constant waking up during the night. Should this happen, you will wake up tired and not refreshed in the mornings. 

The ResMed machine will blow more air to compensate for the leaks and so you end up going around in a circle with mask leaks. More air may lead to more mask leaks and more waking up during the night. By using a bilevel machine, I have reduced substantially the likelihood of mask leaks occurring by reducing the median/ average pressure and tidal volume of air. 

3. The mask does not leak when the pressure moves from a low EPAP (exhale pressure) of 4.2 cmH2O to my maximum pressure of up to 17 cmH2O and vice versa. It does not lose its seal even though the range of pressure is quite large. 

An issue I found with other masks is that when the pressure went above 11 cmH2O, the mask would begin to leak. Once the pressure went above 12 cmH2O, the mask would leak badly. The bilevel machine allows me to have a large difference between inhale and exhale pressure reducing mask leaks and enabling me to optimize my sleep and wake up feeling energized and refreshed.  

4. As noted in the blog post Why NOT to use a CPAP Humidifier? by having zero or minimal leaks, even though I do not use a humidifier and have maximum pressure up to 17 cmH2O, I do not have a sore throat and dry mouth each day due to CPAP air. In addition, by not using a humidifier has simplified my sleep apnea therapy. I no longer need to obtain clean water and to remember to fill the humidifier with water.  

5. I have been using the same mask cushion with the sleep apnea mask for more than 5 years and still have Zero leaks showing on my machine each morning. This particular mask has saved me a lot of time and money as I do not need to regularly obtain new mask cushions. My first mask, the ResMed LT Activa would completely “lose” its seal after 3 to 6 months and leak badly. 

When a senior executive at ResMed asked me what mask I was using and I advised ResMed Mirage Micro, the reply was “That was a good mask!” Why is this mask no longer manufactured by ResMed? Is it because not enough patients needed to change their mask cushions on a regular basis and ResMed was not making enough money? 

6. When using the “old” mask, I stopped having skin rashes. My first mask, ResMed LT Activa would give me skin rashes from the mask cushion. Changing to an “old” mask stopped the rashes overnight. Did ResMed change the silicone formula in the Activa mask? 

7. The mask is very comfortable and seals easily. It is a small mask and not heavy and bulky making it comfortable to sleep with on a normal pillow. With the forehead support, the mask does not lose its seal and leak when moving a lot in bed such as side to side or lying on my back. The forehead support is of great benefit and you are able to adjust the support and together with the mask cushion have maximum comfort for you. 

8. For those people who have CPAP air through the eye tear duct and air coming out the eyes, the nasal mask allows me to cover a portion of both nostrils at the middle section of each nostril with medical paper tape. By doing so, I have reduced the volume of air coming out the eyes by an estimated 3% to 4% as well as to stop nasal congestion and nose bleeding. 

Whatever mask problems you are having including other CPAP side effects and issues, keep going and using your sleep apnea machine. Some patients on the sleep apnea forums have tried more than 10 different masks! There are hundreds of different masks available and there is a “perfect” mask for you to stop mask problems and issues. 

Below is a picture of the ResMed Mirage Micro mask.

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). This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. More details are on the blog post:

 

Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues    

Due to long COVID and bad flu in 2022, I had to increase the starting IPAP to 21.8 cmH2O and EPAP to 16.6 cmH2O. This was due to hypoxia and sleep disordered breathing reoccurring. The ResMed Mirage Micro mask that I use has worked great using very high pressure. To stop mouth leaks, I now tape my mouth using 3M Nexcare Micropore paper tape. The tape is much more effective and comfortable than wearing a chin strap especially during the summer.      

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