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daytime oxygen levels, altitude and sleepiness
#1
daytime oxygen levels, altitude and sleepiness
I live outside of Denver CO at about 5400 feet. After failed rounds of APAP and bipap, I finally got a diagnosis of mixed (mostly central) apnea and an ASV, and as of January, an oxygen concentrator -- none of which would have happened without the help I received here. You can see that saga here:
http://www.apneaboard.com/forums/Thread-...-need-help

Since getting the ASV, and especially the extra oxygen, I've been doing better, especially over the last couple of months. Not 100%, but much less tired and sleepy and better able to function. My AHI is almost always below 1, usually below 0.5, and when it's higher it's generally due to awake/junk breathing. So success story so far.

However. . .we have been thinking for some time of moving to Santa Fe, which is about 2000 feet higher. We just spent 11 days there, and I was wiped out most of the time, despite having the ASV and a concentrator, which thanks to COVID I was able to have delivered for free. I have a pulse oximeter and was checking levels off and on during the day. The average was probably around 91 or 92, never above 94 and sometimes dipping to 88 or 87. We got home Saturday night, and it's now Monday. I was wiped out all day yesterday and am still way too tired. But my oxygen levels are back up to 96 or 97, rarely less than 95.

So what I am wanting to know is, can a difference of 3 or 4 percentage points lead to feeling so much worse? Am I nuts to think of moving to a higher altitude? Does it make sense that I am still tired after returning home? How long might it take to recover? And--is it possible that my central apnea and periodic breathing (before ASV) is partly or wholly altitude-induced?

I've been thinking it would be good to spend some time at sea level, or at least lower, to see how I do. If I did, how long would it take to get a good sense of that? It's probably not feasible to move someplace lower, but if it made a huge difference it might be worth considering.
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#2
RE: daytime oxygen levels, altitude and sleepiness
bump -- would love to hear from anyone with relevant experience
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#3
RE: daytime oxygen levels, altitude and sleepiness
I'm not exactly sure on your targeted aspect on the questions, but I'm approaching the oxygen level angle. I don't yet qualify for POC, but I can tell if my oxygen level gets down to 92%. I will have to sit for a rest if it does drop to that number. Mine swings between 92-98% most days.

I was placed on oxygen during the ambulance ride to the ER last July when I had pneumonia. Oxy was at 92% then as well. They kept me on oxy for 24 hours on 2 L/m as it held steady at 92%. After the first 24 hrs, they dropped the oxy to 1 L/m for the next 12 hours then removed it altogether.

An elevation increase would possibly mean you endure the troubles more constantly, as in the fatigue you encountered during the recent trip.
Dave

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#4
RE: daytime oxygen levels, altitude and sleepiness
Different individuals aclimate (or not) to altitude differently. I think considering your complications with altitude a move to even higher altitude should merit some second thoughts. There are ways to help with acclimating to higher altitude and those may have helped but as lovely as Santa Fe is, you might be more suited to ABQ.
Sleeprider
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#5
RE: daytime oxygen levels, altitude and sleepiness
Yes, I'm afraid that's the case. I haven't noticed a direct correspondence to a level decrease like SarcasticDave, more an overall effect. My husband won't be pleased, but better to know now rather than move and discover after the fact that it was a mistake.
Thanks!
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#6
RE: daytime oxygen levels, altitude and sleepiness
Best wishes on success regardless of what transpires. Guess you couldn't move to near sea level?
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: daytime oxygen levels, altitude and sleepiness
I agree that it seems from your experiences, it wouldn't be wise to move to higher altitude.

I have spent time at sea level and at 4,000'. My AHI is fantastic at sea level. At 4,000', my AHI increases markedly.
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#8
RE: daytime oxygen levels, altitude and sleepiness
Altitude and Central Apnea are not a good combination. If you go high enough everyone will experience Central Apnea. That is, even young people without Sleep Apnea will experience Central Apnea at higher elevations.
At one point I was thinking I would retire to the Mexican highlands...about 5000 to 7000 feet. Not now. It is Baja California for me.
If you moved to sea level, there is a good possibility that your central apnea could improve.
I've linked a couple of studies you might find interesting.
The first one is about altitude and Treatment Emergent Central Apnea.
The second study is a more general discussion, but I found it very interesting.
The first linked study concludes:
"This study demonstrates that central apnea becomes significantly more common at increasing altitude in both diagnostic and treatment portions of split-night polysomnography in patients with significant OSA. An apparent exponential increase in the percentage of OSA patients with a CAI > 5.0 occurs with increasing altitude. Altitude associated central apnea has a significant negative effect on the quality of OSA treatment obtained during PAP titration for patients living at the altitudes addressed in this study."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227706/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654241/
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#9
RE: daytime oxygen levels, altitude and sleepiness
Hey Bemused - I sent you a PM. Also a female in Denver with Central Apnea. I'm desperately looking for a decent doc. Could you send me the name of the woman you're working with? Thank you SO MUCH!
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#10
RE: daytime oxygen levels, altitude and sleepiness
Thank you all for your responses. I talked to my sleep doc last week and she referred me to a pulmonologist, whom I'm seeing next week. I do think even Denver may be too high, as my daytime levels have not improved much since getting home and even seem to be getting worse. So we've pretty much written off Santa Fe. A move to sea level is problematic but not out of the question -- waiting to see what the lung dr recommends. But we may try taking a vacation in Washington sometime soon.

I am curious -- in addition to the oxygen drops I have long-standing bradycardia. My pulse often hangs out in the low 50s and even dips into the 40s at times, none of which seems to concern any of my doctors to date. It seems like there must be a connection. Any experience with this?
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