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High AHI's in Mexico City
#1
I have been using a cpap for several years, with, until recently good success. My AHI levels for over a year were between 2.3 and 3.7 according to Sleepyhead. I was living in New York City during that period. I went to Mexico City at the end of January 2017 and my AHI's showed a marked increase to a range of 8.8 to 15.2 in February and March, with a sharp increase in centrals. I returned to NYC and saw my sleep doctor this week. He thought that there might be a connection between the high altitude of Mexico City and the increase of centrals, but the centrals are only one component of my AHI's. He said that he would do some research about the relationship between altitude and apneas. I mentioned the possibility of switching to an apap and he told me that apap's were not good for central apneas.  Our plan now is for me to use my current cpap and settings while I am in New York and see what happens. I will do an overnight oxygenation test, come back to see him nd then possibly do a cpap titration test to check my pressure. He also mentioned the possibility of switching to a bipap. One person recommended a bipap on one of my previous posts, that may actually be the solution. If my doctor recommends it it will be paid by medicare as I would have gone through using CPAPS. I guess I should start researching bipaps. I know that there are a couple of Dreamstation models and the resmed aircurve 10. Does anybody have any recommendations?
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#2
Mexico City is at quite a high elevation. Elevation is in the 7500 ft above sea level region. (7380 to 12890 at the highest point.

CPAPs are self compensating up to a point. That point in in the neighborhood of 7500 ft MSL.

This could very well be an issue for you. For central apnea, bipaps are not the best solution. Often people are forced by insurance to fail on bipap before getting an ASV machine which best treats CA. However, even an ASV may not do the job at 7500 ft and above.

The reason APAPs don't help with centrals is: They intentionally do not increase pressure upon detection of a central. In fact, higher pressure can induce centrals. So, they can score a CA, but they cannot do anything about it.
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
Just to add to what JM said:  

If you look in the specs for your manual it will give you the guaranteed operating altitude max.  For Resmed's airsense/aircurve 10 line it is 8500 ft.  PR machines only go to 7800.  I would imagine the s9 is very similar.   I routinely spend nights at >9000 ft and I find the machines to still be effective, but my Apnea is worse/more complex.

As for an ASV:  I have actually been experimenting with an ASV machine because my obstructive Apnea turns into complex at higher altitudes.  The ASV is incredibly effective, and my sleep doc seemed to think it might alleviate my issues when I travel to higher altitude.  He is correct, but my insurance won't buy the machine, so I'm out of pocket if I want it!

I have had a number of 0.0 days with the aircurve 10 ASV at 9300 ft (I've never had 0.0 with apap/bipap).
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#4
We actually live just outside Mexico City at, maybe 1000 feet higher altitude. I will mention your comments to my doctor and ask about the possibility of the aircurve 10 asv, which, according to its specs works up to 8500 feet, but fro what you all are writing, that and $3.00 will get me on the New York City subway as far as insurance coverage. I will probably need to work through bipaps first.

Just a note of ignorance, what is the difference between a bipap and asv?

Thank you for your help
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#5
I have been skiing in Colorado this week and using my bilevel with remarkably better results than I get at sea level. Mostly less than 0.5 with a 0.0, 0.1, 0.2. Amazing. I think we all have different responses to altitude, but the one thing that may help is that my auto bilvel doesn't change pressure very much since it is pretty optimized.

If your events include a lot of CA events, consider reducing EPR and possibly reducing maximum pressure. I think it is very premature to be considering bipap or ASV before we get a look at what is currently going on. Post some charts.
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#6
A biPAP has two working pressures. IPAP and EPAP. Where IPAP > EPAP.
It's sort of a CPAP with a wider range of EPR. A BiPAP with a timed backup rate is sometimes tried for CA.

The ASV is able to follow and correct breathing on a breath by breath basis.
It's a non-invasive ventilator. Miss a breath, and it will use a pressure pulse to make up for it.

If you can afford to buy out of pocket, Supplier #2 has the ResMed S10 VPAP ASV for $2149.
That's about half the retail price. Still expensive though.
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
(04-01-2017, 09:06 AM)Sleeprider Wrote: I have been skiing in Colorado this week and using my bilevel with remarkably better results than I get at sea level.  Mostly less than 0.5 with a 0.0, 0.1, 0.2.  Amazing.  I think we all have different responses to altitude, but the one thing that may help is that my auto bilvel doesn't change pressure very much since it is pretty optimized.  

If your events include a lot of  CA events, consider reducing EPR and possibly reducing maximum pressure.  I think it is very premature to be considering bipap or ASV before we get a look at what is currently going on.  Post some charts.

Boy I wish I had that response.  I seem to do quite poorly at altitude.  At sea level I'm not even sure I need a machine!
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#8
(04-01-2017, 10:46 AM)C0mbe Wrote:
(04-01-2017, 09:06 AM)Sleeprider Wrote: I have been skiing in Colorado this week and using my bilevel with remarkably better results than I get at sea level.  Mostly less than 0.5 with a 0.0, 0.1, 0.2.  Amazing.  I think we all have different responses to altitude, but the one thing that may help is that my auto bilvel doesn't change pressure very much since it is pretty optimized.  

If your events include a lot of  CA events, consider reducing EPR and possibly reducing maximum pressure.  I think it is very premature to be considering bipap or ASV before we get a look at what is currently going on.  Post some charts.

Boy I wish I had that response.  I seem to do quite poorly at altitude.  At sea level I'm not even sure I need a machine!

My minimum  pressure is 12/9.0 and may average pressure is 13.1/10.1 and 90% 13.6/10.6 at altitude.  You might try getting your minimum pressures up to within 2 cm of the 90% and see if that serves you better.
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#9
(04-01-2017, 09:06 AM)Sleeprider Wrote: I have been skiing in Colorado this week and using my bilevel with remarkably better results than I get at sea level.  Mostly less than 0.5 with a 0.0, 0.1, 0.2.  Amazing.  I think we all have different responses to altitude, but the one thing that may help is that my auto bilvel doesn't change pressure very much since it is pretty optimized.  

If your events include a lot of  CA events, consider reducing EPR and possibly reducing maximum pressure.  I think it is very premature to be considering bipap or ASV before we get a look at what is currently going on.  Post some charts.

The data (charts) is where it's at.  Data.  Please post some charts.
If SR say to try bilevelor asv, that is when I would consider that.
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#10
Well, the point of this thread is to give the OP points for discussion with his doctor.
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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