[Treatment] Central Apnea and Altitude

[jackwhittemore]

A year ago I went to high altitudes in the Andes and had horrible nights. I went to a doctor, had a full sleep exam, and was diagnosed with Central and Obstructive Sleep Apnea, the first time I had heard of such a problem. When young I often slept at high elevations, 15,000 ft. and higher. I never had problems with sleeping/breathing or traditional Altitude Sickness, sometimes (self-diagnosed) Cheynes-Stokes Syndrome just before waking.

For the past year my machine has been very effective, usually recording 1 AHI or 2 AHI. But that was always at sea level. Recently I returned to the mountains. My symptoms got progressively worse the higher I went, up to 30 AHI at 9000 ft. I retreated quickly to sea level and felt better.

What can I do to be able to sleep at altitude comfortably (and healthily)? I'm rather confused by all the acronyms, but would a BPAP or APAP or VPAP be effective? I'm reasoning that I need a machine that will initiate a "breath" when it senses an AHI, not just respond when I initiate a breath.

This ignorant newbie would appreciate any ideas, info, insights. Sorry for being so long-winded (HaHa!), but I hoped to present all pertinent information. Thanks for any help. From a distraught mountain-lover.

I don't have support from a regular sleep doctor or DME. I was diagnosed at a very competent clinic by a US trained doctor while in Peru and bought the prescribed machine online. I'm long-term traveling again. If needed, I hope my insurance will cover another sleep exam and whatever is recommended.

[retired_guy]

Hi Jack,
Welcome to our little sea-level corner of the world.

I'm thinking when you go to higher altitudes, especially once you get about about 7,000 feet, you would need to increase the pressure on your machine a little. At any rate I know I had to jack up the old woodstove to get the eggs to boil back in the day.

There probably are resources for high-altitude medicine that could address this issue. Try Mr. Google and see what you can discover.

[trish6hundred]

Hi jackwhittemore,
WELCOME! to the forum.!
Hang in there for more answers to your question and best of luck to you.

[bwexler]

The first thing that comes to mind is a prssurized cabin (like in an airplane).
Second best, add an oxygen concentrator to your hardware.
I would also add a puls oximiterlike the CMS 50i that I use.
I like as much info as I can get.
Sleepyhead beginers guide at the top of the main forum page should shed some light on the alphabet soup.

[PaytonA]

A year ago I went to high altitudes in the Andes and had horrible nights. I went to a doctor, had a full sleep exam, and was diagnosed with Central and Obstructive Sleep Apnea, the first time I had heard of such a problem. When young I often slept at high elevations, 15,000 ft. and higher. I never had problems with sleeping/breathing or traditional Altitude Sickness, sometimes (self-diagnosed) Cheynes-Stokes Syndrome just before waking.

Here is a link to an article about high altitude and centrals. http://www.ncbi.nlm.nih.gov/pubmed/22171199

Here is a link to a thread concerning high altitude. http://www.apneaboard.com/forums/Thread-...4#pid44414

Thread includes some data including a rule of thumb that one needs to add about 0.6 cm/H2O to your CPAP pressure for each 1500 feet above 8500 feet. I think there are more that you can search for.

Best Regards,

PaytonA

[MAPnea]

Hi, jackwhittemore,

I live at 5,600' and use an oxygen concentrator at night since starting CPAP amost 2 years ago. When I travel - even down to 3,000', I don't seem to need added O2 at night. No problems below 1,000' and sea level is perfect.

I would suggest getting a recording pulse oximeter (got mine from Supplier #19) and using that to see how you are doing at different elevations. But if you are at very high altitudes, then I agree with bwexler… oxygen concentrator is the only way to go (and there are portable ones).

Best of luck - and if you find a sleep clinic at a high altitude, let me know!

[vsheline]

Thread includes some data including a rule of thumb that one needs to add about 0.6 cm/H2O to your CPAP pressure for each 1500 feet above 8500 feet. I think there are more that you can search for.

I think the key thing to remember is our tendency toward having central apneas may change (increase) very strongly with increasing elevation. And Supplemental O2 may solve the issue.

But please be aware that too much supplemental O2 (or unneeded supplemental O2) can be very harmful to our health, because too much O2 in our blood can render some prescription medications ineffective, can increase "oxidative stress" on our systems and can lead to many illnesses.

So we should never take supplemental O2 without monitoring our SpO2 with a pulse oximeter. SpO2 of 94-96 % is considered optimal, less than 89 or 90 % is considered low, less than 75% is considered severely low. And I think 97% or higher (if sustained for hrs) can lead to health problems.

By the way, I think the 0.6 cm H2O of needed increase in pressure per 1500 ft increase in elevation may have applied to the amount of manual adjustment needed on an old CPAP machine which did not automatically adjust its pressure according to its elevation. Maybe other old machines which did not adjust their pressure automatically required a similar amount of pressure increase, but I am not sure. However, recent xPAP machines (those designed within the last 5 or 10 years, such as the ResMed S8 and S9 and the Philips Respironics System One machines and no doubt many others) do this automatically, up to around 8500 ft above sea level. I am not sure how valid it would be to apply the same amount of adjustment manually when traveling to higher elevations than 8500 ft. But I suppose calling the manufacturer of our xPAP machine might let us know.

[jackwhittemore]

Thanks to everybody for their help and suggestions. I'm researching all those options. But nobody followed up my query about Auto-PAP machines. Does anyone have any ideas if this might be an option for my problems at altitude? Since (I think) the problem there is my Central Apnea, if a machine could take over, would that solve my problem? Thanks again for any help.

Jack

[justMongo]

Thanks to everybody for their help and suggestions. I'm researching all those options. But nobody followed up my query about Auto-PAP machines. Does anyone have any ideas if this might be an option for my problems at altitude? Since (I think) the problem there is my Central Apnea, if a machine could take over, would that solve my problem? Thanks again for any help.

Jack

Jack:

I don't think anyone has a definite answer to your question. Most machines of recent manufacture can adjust up to a certain altitude limit. 9000' exceeds that limit.

Short of an actual ventilator, the machine used to treat central apneas is the ASV (Auto Servo Ventilation.) It tries to force air into the lungs when it detects you have not initiate a breath for some set time.

In your original post, you said it was centrals that became a problem at 9000'. It's possible that at 9000', your machine could not accurately score an apnea by type.

I recommend you have a workup before attempting high altitude again.
(Yes, I read your post.) This is an area for a professional.

[PaytonA]

Thanks to everybody for their help and suggestions. I'm researching all those options. But nobody followed up my query about Auto-PAP machines. Does anyone have any ideas if this might be an option for my problems at altitude? Since (I think) the problem there is my Central Apnea, if a machine could take over, would that solve my problem? Thanks again for any help.

Jack

The auto machines do not treat central apneas. The CPAPs, VPAPs, and BiPapsof this world are not meant to stimulate you to take a breath but to hold your airway open so that you can take a breath. Centrals require an ST machine or an SV machine(servo ventilator) with a back-up respiratory rate. I think I have this right. I am not very knowledgeable about the machines that treat centrals

Best Regards,

PaytonA