Living at 5500 feet versus sea level

[grayjoanne1966]

I am a newbie on CPAP and night oxygen due to sleep apnea. I live at 5500 feet elevation. Would it be to my benefit to move to sea level. Has anyone out there actually made the move and if so, tell me about your CPAP and oxygen deprivation experiences. etc. Were you able to get off of supplemental oxygen? Were you able to discontinue your CPAP therapy?

[chunkyfrog]

Most of the newer, better cpaps now adjust automatically, so that altitude would not be a problem with cpap.
With the oxygen, it is hard to tell. --and I am quite ignorant about therapeutic oxygen.
If you are on oxygen 24/7, I doubt that sea level would be much help.
Someone will chime in with an answer. This forum is crawling with smart people.

[rjezuit]

If you've lived there a while, the body acclimates. If you just moved there, it might take a while. People all over the world live at high altitude, and are not 02 deprived.The body is an amazing thing.

[avi123]

I have no experience with this but if I was in your situation I would try to avoid living at the elevation of 5,000' b/c of the possible problem of Periodic Breathing (Central Apnea) at such elevation, in addition to my OSA problem.

Check:

http://www.altitudemedicine.org/index.p ... physiology

[rjezuit]

Please read the article again. This only happens if you are NOT acclimated to the altitude. If you live there, you ARE acclimated.

[chunkyfrog]

Common sense says your oxygen need will not go away unless the underlying cause is rectified,
but if you really want to move to a lower elevation, do so for really good reasons, not a barely possible "cure".

[JDS74]

At altitude, 5,500 feet is at altitude, becoming acclimated entails a higher breathing rate and larger minute vent rate because the amount of oxygen in the air is decreased. The percentage remains the same but there is less air there.
So your respiration rate goes up but your creation of CO2 does not. That means the CO2 in your blood gets flushed out faster so the breathing reflex triggered by higher CO2 level is delayed.

So what is seen is a series of rapid breaths (until the O2 level gets high enough). Then a pause in breathing until the blood CO2 gets back up and you start over. That's periodic breathing and is a normal reaction to higher altitude.

If you already have a non-obstructive breathing disorder, altitude makes it worse. Supplementary oxygen and some meds can limit this effect and make breathing more nearly normal. OSA does not get worse at altitude.

This problem really gets bad above 10,000 feet, way above where you live.

If you like where you live AND your doctor can help you keep things under control, there's not much point in moving.
OTOH, moving to a sunny beach location could be fun

[avi123]

Please read the article again. This only happens if you are NOT acclimated to the altitude. If you live there, you ARE acclimated.

Comment,

If it's correct what you're saying then patients who suffer from Periodic Breathing (a component of Central Sleep Apnea Syndrome) who live at lower altitudes, could move to higher altitude, become acclimatized there, and cure themselves from their illnesses. Is it correct?

[Wulfman...]

I am a newbie on CPAP and night oxygen due to sleep apnea. I live at 5500 feet elevation. Would it be to my benefit to move to sea level. Has anyone out there actually made the move and if so, tell me about your CPAP and oxygen deprivation experiences. etc. Were you able to get off of supplemental oxygen? Were you able to discontinue your CPAP therapy?

NO! N O.....NO!

You're on a CPAP machine and supplemental O2 BECAUSE you have Sleep Apnea. Sleep Apnea reduces the amount of oxygen you're taking into your system. Moving to a lower altitude will not cure you of Sleep Apnea.
You're in denial. Use the machine and the supplemental oxygen. At some point, after you've been on the CPAP machine for awhile, ask for an overnight pulse-oximetry test WITHOUT OXYGEN to see if successful use of the machine has improved your oxygen intake. (key words are "successful use")

From a personal standpoint, I've lived at 5800 ft. elevation for 40 years. Nine years ago I was prescribed 2L of O2 when I started my CPAP therapy but declined to use the O2.......and a subsequent pulse-oximtry overnight study proved that I didn't need the extra O2 with my successful CPAP therapy.


Den

.

[apw5746]

I am a newbie on CPAP and night oxygen due to sleep apnea. I live at 5500 feet elevation. Would it be to my benefit to move to sea level. Has anyone out there actually made the move and if so, tell me about your CPAP and oxygen deprivation experiences. etc. Were you able to get off of supplemental oxygen? Were you able to discontinue your CPAP therapy?

I live in Colorado Springs, CO - about 6035 feet elevation, I've got an ResMed S9AutoSet CPAP, and have no problems, supplemental oxygen isn't needed, yet, nor believe, that I know of, that once you're diagnosed with OSA, put on CPAP therapy, do you come off. Someone chime in on this subject, as I'm not a doctor, or have experience on this forum. Pugsy, where you at?

apw

[Wulfman...]

I am a newbie on CPAP and night oxygen due to sleep apnea. I live at 5500 feet elevation. Would it be to my benefit to move to sea level. Has anyone out there actually made the move and if so, tell me about your CPAP and oxygen deprivation experiences. etc. Were you able to get off of supplemental oxygen? Were you able to discontinue your CPAP therapy?

I live in Colorado Springs, CO - about 6035 feet elevation, I've got an ResMed S9AutoSet CPAP, and have no problems, supplemental oxygen isn't needed, yet, nor believe, that I know of, that once you're diagnosed with OSA, put on CPAP therapy, do you come off. Someone chime in on this subject, as I'm not a doctor, or have experience on this forum. Pugsy, where you at?

apw

For all intents and purposes, once diagnosed and prescribed, XPAP is a life-long therapy. The Obstructive variety is due to physical conditions/obstructions in the air passages.....through the nose or throat (or both). Central Apnea is neurological in nature. Some people have "Mixed Apnea".......a combination of both. If you can't breathe properly, you can't get enough oxygen into your system. For most, just effective CPAP therapy will do the job. For others, they may also need additional oxygen.


Den

.

[JDS74]

avi123
No that is not correct. Moving from a lower altitude with higher air pressure to a higher altitude with lower pressure makes Periodic Breathing / Central Apnea symptoms worse because of the increased breathing rate.

Supplemental oxygen has the effect of slowing breathing rate and thereby reduces the flushing effect on the serum CO2 level that a higher breathing rate induces. The slowing occurs because it increases the SpO2 level faster and you get to the level sufficient to turn off the oxygen-driven breathing impulse.

[avi123]

grayjoanne1966, notice that Periodic Breathing improves only SOMEWHAT with acclimatization at higher altitudes. So you might have it during the night times as well as during daytimes.

"Clinical manifestations

High-altitude periodic breathing begins within the first few days after reaching high altitude. Although it may sometimes appear at altitudes as low as 2000 m (6,165 feet), it usually occurs in 25% of people who ascend rapidly to altitudes higher than 2500 m and in two thirds of those who ascend to 4000 m or higher. High-altitude periodic breathing improves somewhat during a week or more of acclimatization. Patients often have difficulty falling asleep and frequently report a sensation of restless sleep or sleepless nights. They have a decrease in total sleep time and sleep efficiency, and a decrease in both stages N3 and R (de Aquino Lemos et al 2012). There have also reports of restless legs syndrome and myoclonic jerks disrupting sleep (Finsterer 2007). Brief awakenings with the feeling of suffocation and the need to take a deep breath are also reported. Symptoms usually appear in conjunction with anorexia, nausea, vomiting, fatigue, malaise, headache, cognitive and mood disturbances, and lightheadedness, as well as other manifestations of acute altitude sickness. Despite similar degree of hypoxemia and hyperventilation children tend to have significantly less periodic breathing compared to adults at same altitudes. This is presumably due to a more stable control of ventilation in children related to lower apnea threshold for CO2, a larger CO2 reserve, and a shorter circulation time (Kohler et al 2008). However, even healthy children have sleep breathing disturbances at altitudes of 3500 meters or higher, which appear to be associated with changes in right middle cerebral artery blood flow velocity (CBFv) (Gavlak et al 2013). This very change in CBFv, presumably in reaction to PCO2 changes, is in turn linked to improvement in periodic breathing. Apnea hypopnea indices (AHI) tend to increase after a few days at 5050 meters as CBFv decreases to baseline (Burgess et al 2013). Preexisting anxiety is correlated with higher rate of sleep-related symptoms, even after 40 days of acclimatization (Dong et al 2013)."


Source: http://www.medlink.com/medlinkcontent.asp

The remainder of this Clinical Summary is available to subscribers only. Current subscribers, please log in at the MedLink Home page.

Other notes available free:

Contributors

Hrayr P Attarian MD, author. Dr. Attarian, Director, Northwestern University Sleep Fellowship at Northwestern University, has no relevant financial relationships to disclose.

Antonio Culebras MD, editor. Dr. Culebras of SUNY Upstate Medical University and the Sleep Center at Upstate University Hospital at Community General in Syracuse, New York, has no relevant financial relationships to disclose.

Publication dates

Originally released March 17, 1999; last updated April 6, 2013; expires April 6, 2016

Key points

• High-altitude periodic breathing affects about a quarter of people who ascend to 2500 meters and almost 100% of those who ascend to 4000 meters or higher.

• It is characterized by central apneas, periodic breathing, insomnia, and sleep fragmentation.

• There are a variety of medications that may be beneficial, including sedative hypnotics, acetazolamide, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs).

• Pregnant women at high altitudes tend to have increased neonatal complications and high risk of low birthweight in newborns.

Historical note and nomenclature

High-altitude insomnia is no longer a diagnostic category in the 2005 International Classification of Sleep Disorders, 2nd edition (American Academy of Sleep Medicine 2005). It has been incorporated into high-altitude periodic breathing, which is characterized by cyclic periods of central apnea and hypopnea, usually accompanied by frequent awakenings, poor quality sleep, sense of suffocation, and fatigue at high altitudes.

[chunkyfrog]

Grayjoanne is considering moving from 5500 feet to sea level in hopes of discontinuing therapy.
The underlying causes are in her--not the environment, so any initial good symptoms
will diminish with time; and I would not advise her to discontinue therapy.
'Another important point: Very low altitude areas often have high humidity,
which may cause additional breathing problems in those with existing breathing disorders.

[sierragail]

I lived at 8000 feet for almost 8 years and my health slowly went from good to total crap. Last year I was diagnosed with Monge's Disease, aka Chronic Mountain Sickness (CMS) (I was diagnosed at National Jewish Clinic in Denver.) I no longer can live at altitudes over 4000 feet. Chronic mountain sickness comes on after long term residence at high altitude and is caused by a loss of adaptation brought on by the transcription of 2 genes which are triggered by hypoxia. Before we moved down, I had to use supplemental oxygen at night along with cpap. If I didn't use supplemental oxygen at night, I had lots of periodic breathing and woke up feeling awful each morning (hypoxia sucks). Periodic breathing is almost universal at high altitude.

Moving to a lower altitude could very well mean that you won't have to use supplemental oxygen at night. On doctor's orders we moved down to 3000 feet 6 months ago and I haven't used supplemental O2 since day one after moving. My sleep is so so so much better, no periodic breathing, polycythemia is gone, heart palps gone, blood pressure under control with one third less medicine, no shortness of breath, no stomach infections, O2 sats are 97 and up while walking or gardening (at 8000 feet the O2 sats dropped to the mid 80s while gardening or walking). I wonder if I even need cpap down here at 3000 feet.

An interesting Science Direct article: Whole-Genome Sequencing Uncovers the Genetic Basis of Chronic Mountain Sickness in Andean Highlanders http://www.sciencedirect.com/science/ar ... 9713003315

Use this handy calculator to see how much O2 is available at the altitude where you are located: http://www.altitude.org/air_pressure.php For example, at 8000 feet (2500 meters) where I lived, the standard barometric pressure is 76 kPa (570 mmHg) and there is only 75% of the oxygen available at sea level. For an information on how high altitude affects sleep, click on the top tab "Altitude Sickness," then click on "Sleep at High Altitude" which is found in the left-side menu.

Many people insist that everyone eventually adapts to high altitude and simply living at high altitude for years mean you have automatically adapted. This is not true. If you are like me, your body will never adapt due to the expression of those 2 genes. The best thing you can do for yourself, and for those you love, is to move down. Chronic mountain sickness can cause embolism, heart attack, stroke, right-side heart failure, pulmonary artery hypertension, carotid body tumors, higher levels of cortisol, muscle wasting, facial flushing, dangerously high blood pressure, high blood glucose, confusion, chronic depression, anxiety, headache, frequent infections due to weakened immune response, endocrine disorders......the list is long. I hope you are able to move down soon. It took me a long time to accept that I simply could not acclimate. I even used Diamox for a period of time, and you might want to consider it, of course ask your doctor first. It is often prescribed for those with CMS who, for various reasons, are not able to move to lower altitudes.