[Treatment] Central Sleep Apnea at high elevation

[DevinJones]

This thread is very interesting. After researching the subject, I can see why the OP found that nocturnal supplemental oxygen, even without PAP therapy, stabilized his breathing, reduced his central sleep apnea, and normalized his nocturnal oxygen saturation levels.

I wonder how he is doing now.

Many studies over decades show that nocturnal supplemental oxygen by itself:

(1) Reduces loop gain (i.e., the gain, or chemoreflex responsiveness, of the negative feedback loop that regulates ventilation) in people with high loop-gain sleep apnea (an unstable ventilatory control system).

(2) Reduces peripheral and central chemoresponsiveness in high loop-gain sleep apnea.

(3) Stabilizes the ventilatory control system in high loop-gain sleep apnea.

(4) Reduces Cheyne–Stokes respiration and periodic breathing pattern in high loop-gain sleep apnea.

(5) Reduces the AHI, especially the central component of the AHI, in high loop-gain sleep apnea.

(6) Stabilizes nocturnal oxygen saturation levels. 

Relying on the decades of research on oxygen therapy for high loop-gain sleep apnea, the following December 2020 study:

“Demonstrates for the first time in elderly adults without heart disease that intervention with supplemental oxygen in the clinical range will ameliorate central apneas and hypopneas by decreasing the propensity to central apnea through decreased chemoreflex sensitivity, even in the absence of a reduction in the plant gain. Thus, the study provides physiological evidence for use of supplemental oxygen as therapy for mild-to-moderate SDB [sleep-disordered breathing] in this vulnerable population.”

Amelioration of sleep-disordered breathing with supplemental oxygen in older adults
Ruchi Rastogi, M.S. Badr, A. Ahmed, and S. Chowdhuri
December 1, 2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792842/

[Sleeprider]

DevinJones, good post and interesting research. If you're ever interested in joining the Wiki Editor team we could use your help to put together articles discussing things like this. https://www.apneaboard.com/wiki/index.ph...iki_Editor

[knuddr]

Hey DevinJones,

I'm doing fantastic! Still in Denver, able to live my life here pretty successfully now. Completely off the CPAP, it made things enormously worse for me (morning headaches, weekly ocular migraines that lasted an hour, constant fatigue). I've been on supplemental oxygen every night, an Inogen At Home unit, and am currently testing a pulse system as well, which has been successful at night (planning on using this Inogen G5 for camping nights, or when traveling, etc). I have little-to-zero events every night. Oxygen is still fairly low during the day 90-93%, but seems to be okay.

** Insurance to this day still won't cover oxygen though, only CPAP for sleep apnea, despite all the evidence. Have been paying out of pocket **

I'm still occasionally trying different things, tried acetazolamide to see if it might help (didn't). Saw a doctor for my heart, did a ultrasound to see if it was pumping fine (it is). Checked in with a lung specialist to see if there was any obstructions or complications (all good).

This might be interesting, they're focused on obstructive but maybe once it comes around I'll give it a shot too:
https://www.incannex.com/clinical-trail/ihl-42x-osa/

Ultimately would like to get to the point where I don't need any machines to keep me alive, baby steps :-)

Jason

[DevinJones]

Thanks very much, Sleeprider, for your nice comment and for inviting me to help compose some articles for Apnea Board wikis.

I'll keep this in mind, look at your wikis on becoming a wiki editor, and see if I'll have time from work to do it.

[DevinJones]

That's great, Jason! I'm glad that your oxygen therapy is still effective and that all is well. An AHI of 0.0 or under 1.0 is hard to beat!

That's terrible what happened to you from using the CPAP. ASV would probably be more effective for sure, but the insurance often doesn't cover the most effective treatments.

That's good that you tried acetazolamide because it's also known to lower the loop gain in high loop-gain CSA, especially at high elevations.

That's also good your cardiologist and pulmonologist have cleared you. They don't know the cause of your decreased oxygen saturation during the day?

I'll look into Incannex a little more. It appears to be a combination of acetazolamide and THC.

I recently started to test nocturnal supplemental oxygen (by itself and combined with ASV) for my periodic breathing pattern and CSA. About 2.0 lpm of supplemental oxygen via nasal cannula very effectively stabilizes my breathing pattern and oxygen saturation levels. Even with only a nasal cannula and no PAP device, my oxygen saturation levels are like a relatively flat line around 97% or 98%. It's amazing to me! With just the nasal cannula and no full mask for the ASV, I felt so free and comfortable and found it much easier to sleep.

A combination of supplemental oxygen and ASV stabilizes and smooths out my breathing even more, so I'm continuing to test the combination therapy now.