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[Treatment] Central Sleep Apnea at high elevation
#1
Central Sleep Apnea at high elevation
Hey -- so long story short, I'm a 40 male that has always lived at sea level in North America. Moved to Denver, CO about 18 months ago and after about 6 months really noticed continuous problems sleeping, waking up with headaches, always tired, etc. Sure enough, got an o2ring and SP02s were wild, 200+ drops a night, average around 89% and drops as low as 76%. About 3 of 7 hours spent below 90%. Not great! 

After a bit of a long road of getting into sleep studies, waiting on equipment, I'm happy to report I'm "surviving" on an AirSense 11 now and seeing between 1-6 events per hour but generally below 1 event an hour if I observe all the procedures before sleeping (wash the nasal system with saline, sleep on my right side only propped up with pillows, etc etc). It works but it's not a life I want to live forever, especially since I know it can be solved if I move back to sea level which nobody in the family wants to do. We love it here. Doctor recently said this is working, this is all I've got and good luck - see you next year, and she's correct medically (I believe?)

Here's an idea that I'm tempted to experiment with, and wondering if anybody else has attempted the same already. There are companies out there that make sleep tents for altitude climatizing, simulating higher elevations for athletes or those that want to attempt climbing Everest. I've contacted two of them and they say they can also simulate lower elevations, ie. they can make the tent climate sea level. They offer rentals and I'm really tempted to try it out and see.

I can't post links yet so here are some manufacturers I've found:
- Hypoxico
- Higherpeak
- Boxaltitude
- Altitudecontrol

The last one is really interesting -- because if the tent actually works, I could do the whole bedroom instead (at a hefty price of $20K to start) which could mean I might be able to get back to living my best life and off of a CPAP. Worth it. These guys typically target older people that can't tolerate the elevation in places like Aspen, so surely there's some truth to it. Is there a possible non-scientifically-proven-not-doctor-certified-or-covered-by-insurance cure for CSA sufferers of elevation like me?

PS: attached two of my o2ring reports, one from Denver CO and the other in NYC. Can you tell which is which :-D


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#2
RE: Central Sleep Apnea sufferer at high elevation only. Altitude Tent?
i wonder if you could get a tent that could be configured to give you "below" sea level pressure, perhaps equivalent to the dead sea pressure? ---- as an experiment to see if this pressure difference would be helpful.
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#3
Doctor specializing in CSA in Denver area?
Hey guys --- shot in the dark but does anybody know a doctor who specializes in Central Sleep Apnea in the Denver area? Or possibly know of an institution actively studying it? I'm fairly frustrated with doctors pushing CPAP as the solution, which while it does help I think we can do better. I personally believe that supplemental oxygen is more suitable for CSA, not obstructive, and longer term I believe we can possibly even cure or vastly mitigate central sleep apnea with increasing our oxygen capacity in each breathe (I suspect shallow breathing could be one culprit). I personally did a self-driven study (more on this later) where I slept in an oxygen tent and completely eradicated all apneas and o2 drops for 30 consecutive days in a row - yet even with these results my doctor wants to continue pushing CPAP.

I have zero problems at sea level and only started having issues when I moved to Denver / high elevation. I bet there are a lot of others like me.


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#4
Treating Central Sleep Apnea with Supplemental Oxygen?
Related to my other thread: http://www.apneaboard.com/forums/Thread-...enver-area

Wondering if anybody out there is currently treating their Central Sleep Apnea with supplemental oxygen? What have your observations been, successes or side-affects? My doctor said they don't really treat CSA with oxygen anymore, that the gold standard is CPAP. But I've done some googling and it seems like it has been used to treat in the past (or maybe present). She also says treating with supplemental oxygen is dangerous, and I get that if you're YOLO'ing on your own but under the supervision of a doctor then surely its safe?

From my understanding, Central Sleep Apnea occurs because your brain doesn't trigger a breath. Breathing occurs when the acidity of your blood has reached a certain level due to CO2. CO2 is only released from cells when O2 is present. If you don't have enough O2 present in your blood, you don't get enough CO2 released and thus you don't trigger a breath. At high elevation you don't get enough O2 in each breath as you would at sea level (I personally have no problems with apneas at sea level, only at elevation e.g. Denver), likely due to shallow breathing, and thus you see a lot more central sleep apnea. By artificially increasing O2 in the air you breath, you could mitigate or even eliminate apneas.

Pulled most of this from the "Breath: The new science of a lost art" book by James Nestor. As well as lots of googling.

My working theory that I've pretty much validated sleeping in a small tent with oxygen pumping into it seems to confirm this hypothesis. I'll do a full data dump and whatnot of this study soon and a full write up of my experiences of dealing with CSA over the past 2 years


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#5
RE: Doctor specializing in CSA in Denver area?
Altitude induced CSA is common and we often see it in members living in Colorado and other higher altitude locations. The problem gets much greater above 7000 feet and is often remedied at sea level. Try copying this search string into your browser: High altitude central sleep apnea site:apneaboard.com

Solutions vary, but CPAP and bilevel without backup rate does not resolve it in most cases, and can make it worse by reducing the available CO2. This is similar to therapy induced CSA, but is more likely to occur at higher altitudes. High altitude seems to lower the "apneic threshold" in sensitive individuals resulting in alternating hypoventilation and hyperventilation as the individual fluctuates between hypocapnea and hypercapnea. We have seen decent success with the use of Diamox which mitigates the effects of high altitude in many people and slightly acidifies the blood reducing the tendency for CSA that results from fluctuating CO2 levels, also EERS (Enhanced Expiratory Rebreathing Space) http://www.apneaboard.com/wiki/index.php...ace_(EERS) The "gold standard for altitude related CSA is the bilevel ASV which actively treats CSA of all types by using adaptive pressure support to induce a breath when spontaneous breathing is not present.
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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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#6
RE: Central Sleep Apnea at high elevation
I have merged all three threads with related questions into a single thread concerning high altitude CSA. I'll respond to your questions concerning supplemental oxygen and James Nestor's theories on respiration very briefly, and others are welcome to pick up on those conversations if they wish. Your understanding of respiratory drive as influenced by Nestor's theories is at best unconventional, and demonstrably false. A more conventional presentation of respiratory drive is available from many references. Here is one https://www.ncbi.nlm.nih.gov/books/NBK482414/ and a brief summary of the effects of altitude on sleep and respiration https://pubmed.ncbi.nlm.nih.gov/23690739/

The use of supplemental oxygen can improve the fraction of inspired oxygen, and may avoid hypoxia where respiratory function is inadequate or affected by breathing disorders including CSA, hypoventilation and other issues. I am not aware of supplemental oxygen being effective at stopping CSA or increasing the rate of CO2 production or retention..
Sleeprider
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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: Central Sleep Apnea at high elevation
Hey Sleeprider --  thanks for your reply and merging up the threads! I actually asked my doctor about the bilevel ASV as well and she wouldn't go for it, apparently it's only for extreme cases as there's a higher risk of heart failure associated with using it (I don't know if I buy that though). And/or insurance typically wouldn't go for it unless the CPAP absolutely isn't working due to the higher cost. Diamox was also something I've been tempted to bring up, but prefer solutions that are more natural in origin if I can.

So far it looks like I can likely eliminate the need for a CPAP entirely with supplemental oxygen using a nose cannula. My oxygen levels are very low at night and often dip below 90% so I suspect I could also benefit from elevated O2 throughout the night, more food for my cells Wink

I've put together a bunch of my observations already in this Google doc but couldn't share it until I hit a certain amount of posts here. Are you able to approve my account to share links? I slept within the altitude tent for 30 nights and every single night (with the exception where I knocked out the hose and suffocated -- oops!) showed consistent SPO2 levels at ~97% with no drops or apneas - really quite incredible! I've attached some more images here

It's pretty rough and I've been meaning to put some effort into it over the holiday break to tell the full story I've been experiencing so far, and the things I have tried. I've even been tempted to use these altitude machines to simulate sea level in my entire bedroom, but quotes have come back between $50-$70K to retrofit the room, add a separate (closed) HVAC unit, electrical, etc. I want to try my hand at increasing oxygen capacity in my breathing as a more long-term permanent solution though, before shelling out that kind of cash - which if it actually gives me quality of sleep and life back, I'd be more than happy to do.


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#8
RE: Central Sleep Apnea at high elevation
Your doctor is not familiar with ASV and is misinformed on risk. The risk group involves individuals with existing congestive heart failure and left ventricular ejection fraction less than 45%. The ASV does not cause an increased risk of cardiac death in any other cohort. The risk was found in a study called SERVE-HF (2015) and a subsequent study ADVENT-HF which is ongoing has refuted that the risk exists and points to faulty methodology in the SERVE-HF. Read my wiki here http://www.apneaboard.com/wiki/index.php...nd_Summary If you have idiopathic CSA or altitude and CPAP induced CSA, then ASV is an effective and safe therapy that works extremely well for most.

The purpose of CPAP is to mitigate obstructive sleep apnea by stenting the upper airway to prevent breathing cessation by occlusion of the airway. Many conditions exist that might cause hypoxia without apnea or hypopnea, including hypoventilation, sometimes associated with obesity, but certainly more acute in higher altitudes where partial pressure of oxygen is lower. Many people with low oxygen saturation can resolve the problem with supplemental oxygen (increasing FiO2) or by moving to a lower elevation. Looks like that might be your situation.

You should now be able to post links in your posts as you have enough posts to move from "New Member" to Member as described here. It may take some time for the system to automatically update your account status. http://www.apneaboard.com/forums/Thread-...-explained
Sleeprider
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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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#9
RE: Central Sleep Apnea at high elevation
This is all very useful, thanks! Yeah I think, "misinformed" as you said of my doctor is perhaps too courteous. I'm looking for someone more familiar with CSA in my area hence my other thread. It was my impression as well that ASV was the way to go and should have been already prescribed. Even with all the proof of supplemental oxygen benefits she wouldn't budge. It's pretty frustrating to say the least.

I’m certainly a bit overweight but not obese, coming in around 210lbs @6ft tall. Blood pressure and all the usual health metrics have come back pretty good. I’m not particularly athletic mind you, and could benefit from an increased amount of exercise.

Here's my Google document with all of my observations so far:
https://docs.google.com/document/d/14KLm9DfIHWxBLby8uY218X7oUXDZ5RrS_005gAaD3Mg/edit?usp=sharing

The main points within are that sleeping within the altitude tent, which increased the O2 in the air to simulate sea level, completely mitigated my CSA issues and kept my SpO2 levels consistently at 97%. I performed this self-study over a period of 30 days. I could sleep in any position, and was even observed snoring by my wife. Alcohol didn't seem to have much effect either. Other interesting things of note is that I started having ocular migraines around the time I started using the CPAP (~Apr22), these would occur weekly. Since coming off the CPAP, and using the tent, I have no longer had a single occurrence. My eyes were checked out through a lot of studies and everything was clear, that it was neurological in nature. The timing is pretty suspicious but could be coincidental. Well, welcome to my 40’s right!

Either way I can't completely explain why the increased O2 resolved my issues but wanted to get this data out there for other people, as it might also mitigate their CSA at altitude, or maybe even elsewhere. It's worth exploring and I think, quite harmless if done properly. This is not medical advice though 

I'll continue to post as I venture down this path of trying to convince my doctor (or a new one) to prescribe supplemental oxygen. But also hope to explore how to increase oxygen capacity with every breath naturally, so maybe one day I can even live without needing supplemental oxygen.
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#10
RE: Central Sleep Apnea at high elevation
I'll make a wild guess that with supplemental oxygen your needs are met with less tidal volume, respiration rate and minute vent rates. That would reduce loss of CO2. Think of what happens with hyperventilation as you try to meet your respiratory needs. That will reduce CO2 and cause the CA events. Supplemental oxygen makes sleeping more like the experience at lower altitude. Without getting in to the complexity of that, scenario, it stands to reason you are compensating for altitude. For someone with altitude induced central apnea, rather than obstructive sleep apnea, that could be a complete solution as an alternative to moving to a lower elevation. As far as I know, there has not been a study to prove or disprove that theory, and the FDA has not approved supplemental oxygen to relieve CSA at higher altitude, so the doctors are going to dismiss it.
Sleeprider
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____________________________________________
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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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