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