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[Equipment] Effect of altitude
#1
Effect of altitude
When I'm at sea level my AHI runs between 0.8 and 1.9 which I believe are very good numbers.  I feel rested.  Unfortunately I live in Reno, NV at an altitude of approximately 4823 feet above sea level and my numbers (AHI) shoots up to around 4.5 to 7.2.  I have spoken to several people in the field and asked what modification can I make to compensate for the change in altitude and I'm told "well those are still good numbers".  Not a lot of help. Does anyone have any recommendations?

wayne

ResMed AirSense 10 Autoset
ClimateLine Air tube
SimPlus FFM Medium
Min pres 10.0
Max pres 15.6
EPR set to ON
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#2
RE: affect of altitude
It is difficult to advise you without more data. I suggest you download the free OSCAR software and post some nightly data organized as described in the links below. Hopefully we will be able to get your AHI lower.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#3
Oscar results
   

first temp of posting OSCAR results at sea level:
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#4
OSCAR results at 4500 feet
   

AHI results are poor at home in Reno, NV do to elevations.
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#5
RE: affect of altitude
   
   

two examples one at sea level Jacksonville, FL most AHI below 1.5
and
one in Reno, NV at 4500 feet. most AHI above 5.0
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#6
RE: affect of altitude
Moderator, Please combine larricka  two threads

Your sea level results are fine.  Please note them so you can reset to them at will.

However, your 4500 ft results are another matter.
Your Obstructive events are clustered implying a positional element to your Apnea.  This is typically from the chin tucking.  This is fairly common and usually corrected with either a loose fitting soft cervical collar (Releaf is popular) or an anti-snoring collar (has just a strap in back) (Dr Dakota is popular)
Altitude.  It certainly looks like you have an Altitude induced Central Apnea.  Yours is showing as Mixed or Complex meaning you have both Obstructive and Central Apnea that is complex because it is Mixed.

Add Minute Vent, and Flow Limitation to your charts.  Make leak rate real small to help fit them all in. And drop your calandar so we can see more important info in the left sidebar.

Central Apnea cannot be treated with your machine.  It takes an expensive ASV to do that.  Central Apnea is "treated" by avoiding it on your non-ASV machine.  Altitude, in your case, increasing altitude increases Central Apnea so the simple solution is to never sleep above sea level.  What? That won't work you say?  I thought that was coming.  Seriously though be aware that altitude impacts your Apnea.
Higher Pressures, Pressure variances either from algorithmic changes from the AutoSet or from the implementation of EPR may also increase Central Apnea.  So the solution is to lower pressure and lower pressure variance to "treat" your Central Apneas.  
What?  You say you need higher Pressures and higher pressure variance to treat your Obstructive Apnea?  Boy you are good!!!  The actions to treat Central Apnea and Obstructive Apnea are polar opposites.  We need to find a balance.  A balance where both Obstructive and Central Apneas are both minimized and with a total of under 5 AHI.


First, let's get rid of the positional Apnea with either the soft cervical collar or the anti-snoring collar.
Next, let's remove one cause of variance, set EPR to 0 or to OFF.  If that is uncomfortable set it to 1.
Then set's re-evaluate and go from there.

I have no problems if you also use these settings at sea level, but do note your current sea level settings.  If you try to keep your sea level in synch your Obstructive elements may become more pronounced and you may need to maintain different settings for sea level and altitude.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: affect of altitude
I don't understand this stuff enough to help you, I'm sure someone else here will.

I want to thank you for posting these charts. They are fascinating from an intellectual point of view. Wow. What an incredible difference! It's like they're from totally different people.
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#8
RE: affect of altitude
Just another thought.

When people compare Jacksonville and Reno, the first thing that comes to mind is of course altitude. But the other difference is humidity. Are your sure your humidifier is functioning properly?

Sorry I couldn't edit my previous post. For some reason this forum, on random days, won't allow me to edit posts. On other days it's fine. I'm on Safari on MacOS High Sierra.
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#9
RE: affect of altitude
Once again, I agree with Fred's main recommendations:

Quote:First, let's get rid of the positional Apnea with either the soft cervical collar or the anti-snoring collar.
Next, let's remove one cause of variance, set EPR to 0 or to OFF.  If that is uncomfortable set it to 1.
Then set's re-evaluate and go from there.

I'm going to add one more.  Turn off ramp.  You are starting at a pressure of 7.0 and it appears that you may already have obstructive problems during ramp that become apparent when it transitions to therapy pressure.  Both sessions in this graph show the same obstructive pattern coming off ramp.  The OA events push the pressure to the maximum setting which then triggers the CA events.  It would be much better to start at 10 cm pressure and avoid this sudden increase in pressure.  I think the positional apnea treatment will significantly help avoid the OA as well.  If you are using multiple pillows or a thick pillow to prop up your head, you need to avoid that. The tucking of the chin is the main mechanism of positional apnea as discussed in the Optimizing Therapy wiki. http://www.apneaboard.com/wiki/index.php...onal_Apnea
[Image: attachment.php?aid=12389]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: affect of altitude
I would start by turning off EPR when sleeping at altitude. Then I would increase your min pressure until the obstructives are blown away, and then see what we have left. If you still have a ton of centrals, then your only options are an ASV, or to move to sea level.
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