Central Apnea spike at 9,600 Elevation

[texmex]

Hello,

My AHI over the last couple of years has been 2-7.

I am on vacation at 9,600 elevation and my AHI is 22-40.

Unfortunately, I am on a laptop and OSCAR does not display nicely. Due to this, I am not able to follow protocol on screenshots. I've had to make individual shots.

I can sleep through it for about 4-5 hours and then I cannot sleep any more as the out of breath feeling is too great. I have a bottle of Boost Oxygen which helps to the extent the anxiety goes away but the centrals come back as soon as I go back to sleep.

Any thoughts or suggestions would be greatly appreciated!

Thank you in advance,

Bill

https://imgur.com/a/7LJtAtN

[Miss Emerita]

As you probably know, central apnea can be caused by sleeping at high altitudes. There's not a lot you can do, as far as I know, aside from turning off pressure support and keeping your pressure as low as you can. I'll be interested to learn from other forum members whether there are additional things to try.

You may also be finding that you're light-headed during the day, get out of breath easily, feel queasy, experience headaches, and are unusually susceptible to alcohol.

After a rough couple of days and nights at an altitude of 2000 feet several years ago, I've realized I just can't be up that high any more. Sigh.

[chunkyfrog]

Boost oxygen is not continuous bleed, is it?
I would ask my doctor if I needed O2 while sleeping at altitude.
If I am wrong, please ignore me.
(It's easy--some do it when I am right.)

[lazarus]

I will visit places during the day at higher elevations, but I arrange to sleep at lower elevations to prevent those "centrals."

Everyone is different in reaction to elevation.

If it is a brief visit, there's probably not much to be done, other than maybe going to straight CPAP mode at a pressure that as simply as possible prevents obstruction with a straight pressure, if that's OK for you to do. (I hate it how much that sentence sounds like the YouTube anti-APAP and anti-EPR alarmists.)

Sometimes and for some people, elevation centrals could be considered an unmasking of issues to be explored later. But my understanding is that for an otherwise healthy adult whose only known significant issue is OSA, elevation centrals from PAP when vacationing may be something that can be ignored--as long as O2 is OK (day and night) and no symptoms of actual moderate-to-severe altitude complications present.

KNOW the symptoms, the important distinctions and differences in severity of those symptoms, and especially when medical action needs to be taken:

(https://my.clevelandclinic.org/health/d ... e-sickness).

But treatment-machine-reported centrals in the short term while vacationing are not, in isolation, considered a symptom of anything other than having vacationed at altitude, as I understand it. And vacation is rarely the time to start needlessly fiddling with settings in a way that could make your vacation less than comfortable.

[colomom]

As others have stated some can get central’s at elevation. Both my son and I use cpap and we live at 7000 feet. When we stay at a family cabin that’s at about 9400 feet my son’s AHI spikes like yours does, but higher elevations don’t impact my AHI at all.
The thing that raises a little red flag in your post is your description of waking up out of breath. Are you having any other symptoms such as headaches or nausea?
How are you feeling during the day? My guess is it’s most likely nothing to worry about assuming the shortness of breath is what you describe as possible anxiety and you aren’t feeling any other symptoms like bad headaches or nausea.

The boost canisters give you a quick little boost of O2, I doubt if it would help with the CAs. I believe there is a medication called acetazolamide that can be prescribed that might help which you could ask your doc about prior to any future trips to elevation.

Otherwise my best advice is hydrate, hydrate, and hydrate! With the nice cooler temps at a higher elevation it can be easy to forget to drink water, which is unfortunate because one of the best ways to prevent altitude sickness is hydration. If not contraindicated for you maybe try a baby aspirin regimen. Ideally you want to take baby aspirin before and during a visit to elevation if you have trouble with high elevations but it’s worth trying. I’ld also recommend skipping alcohol if you partake. Alcohol can have a much greater affect when at high elevation.

Finally as Lazarus pointed out be aware of the signs of altitude sickness. Many get headaches or easily winded at elevation, but if you start getting more serious symptoms like severe headaches, bad nausea, or you start stumbling around head down the mountain.

[texmex]

Thank you to each of you for your replies!

The oxygen boost is not continuous. The brand is "Boost" and a 10l bottle has 200 one second shots of 95% pure oxygen. It takes the edge off of breathlessness. It does nothing for CA.

Other than shortness of breath, I don't have any altitude sickness symptoms. My shortness is getting better. The first day I arrived, I walked a hill 15 minutes up and down to develop a benchmark for breaching. It has gotten better in the last 7 days.

I've exercised at least 30 minutes every day since July 2nd when I arrived.

I will be here until August 11th. I hope I adjust at some point.

The iwatch says my o2 has trended down 5 points over the last week and the resting heart rate increased from 45 to 50.

The iwatch says I'm sleeping about 4 hours on the bad nights and 6 hours on the good. Normal is 7.5 hours.

If you've ever startled awake just as you were drifting off, that is what is happening, but it is me not breathing that causes it. I've checked o2 on the iwatch and sometimes it is a 88-90 but most of the time it is 92-95.

I've looked into an oxygen concentrator, but I am not certain how that would work. Oxygen concentrator is a continuous feed of oxygen. These devices are all over this town. Babies here use them until they get strong enough to breath the thin air. I don't think I could get both the bipap and concentrator to work at same time. Even if I could, I am not certain the concentrator would help.

Thanks again for the past replies and any future replies.

I've I figure anything out, I will update the post.

[ozij]

I don't think I could get both the bipap and concentrator to work at same time. Even if I could, I am not certain the concentrator would help.

Thanks again for the past replies and any future replies.

I've I figure anything out, I will update the post.

Of course you could.
The oxygen from the concentrator gets "bled into" your or tube through an adaptor, and what you get when you sleep is pressurized, oxygenated air.
You won't be the first, nor the last to have nightly oxygen added to your CPAP (Bi-Level or otherwise) therapy.

Not saying you need it, just saying it's feasible, and not that uncommon.

All

https://www.cpap.com/productpage/oxygen ... nt-adapter

And ResMed on its site mentions a

ClimateLineAir Oxy is a variant of ClimateLineAir that comes with a built‐in oxygen connector for patients who require supplemental oxygen.

[palerider]

Unfortunately, I am on a laptop and OSCAR does not display nicely. Due to this, I am not able to follow protocol on screenshots. I've had to make individual shots.

Why not? I'm on a laptop and can make fine Oscar screenshots.

Do you have a really low res laptop screen? or one of those with insane resolutions? (if so, the beta that's being tested right now should fix that).

If we don't know what the issue is, we can't fix it.

[texmex]

Of course you could.

Interesting. I did not know that.

[texmex]

Why not? I'm on a laptop and can make fine Oscar screenshots.

Do you have a really low res laptop screen? or one of those with insane resolutions? (if so, the beta that's being tested right now should fix that).

I was not complaining about OSCAR, it is AWESOME. I wanted to preface that I broke protocol because of the laptop screen.

I've tried on a Surface Book 2 and a Surface Pro 8. I attempted to attach a screenshot but received "Sorry, the board attachment quota has been reached." I'm pleased to PM an image to you.

The cause is the way the Surface manages its odd aspect ratio.

The characters overlap and the graphs are squished such that they are unreadable.

[colomom]

Other than shortness of breath, I don't have any altitude sickness symptoms. My shortness is getting better. The first day I arrived, I walked a hill 15 minutes up and down to develop a benchmark for breaching…
The iwatch says my o2 has trended down 5 points over the last week and the resting heart rate increased from 45 to 50…
If you've ever startled awake just as you were drifting off, that is what is happening, but it is me not breathing that causes it. I've checked o2 on the iwatch and sometimes it is a 88-90 but most of the time it is 92-95.

Sounds like you’re doing great! Very few people who come from lower elevations could climb a hill at 9600 feet without getting winded. It takes time to acclimate to high elevation, the fact that you aren’t feeling many daytime symptoms and have built up to a tolerance to exercising at high elevation is great!

As others have stated you could add an O2 bleed to your cpap, but if I were in your shoes I wouldn’t waist my money. An average O2 of 92-95 at such a high elevation is actually pretty good.
Enjoy your time in the mountains!

[zonker]

I've tried on a Surface Book 2 and a Surface Pro 8. I attempted to attach a screenshot but received "Sorry, the board attachment quota has been reached." I'm pleased to PM an image to you.

The cause is the way the Surface manages its odd aspect ratio.

The characters overlap and the graphs are squished such that they are unreadable.

no. the forum has become too full for any further attachments. and our moderator, pugsy, has no way to free up that space.

so, see this link here for instructions on how to post images here-

viewtopic/t183806/Attachment-storage-is ... MENTS.html

if after reading this you need help, please don't hesitate to ask.

good luck!

[texmex]

The oxygen from the concentrator gets "bled into" your or tube through an adaptor, and what you get when you sleep is pressurized, oxygenated air.
You won't be the first, nor the last to have nightly oxygen added to your CPAP (Bi-Level or otherwise) therapy.

Ozij,

Thanks for the tip. I'm using an o2 concentrator now.

Admittedly I shot gunned adding an o2 concentrator the same night I upped pressure from 5.6/10 to 7/11.

CA lowered from 22-66 range to 1-13 range.

Since making these two changes, I've had some of the best night's sleep I've had in a long time.

Thank you!

[texmex]

if after reading this you need help, please don't hesitate to ask.

I updated original post to use Imgur

The screenshots from last night are shown on the link below.

This is on a Dell XPS laptop with 17" screen.

I'm pleased to test beta.

https://imgur.com/a/zyLQ1Hr

[ozij]

The oxygen from the concentrator gets "bled into" your or tube through an adaptor, and what you get when you sleep is pressurized, oxygenated air.
You won't be the first, nor the last to have nightly oxygen added to your CPAP (Bi-Level or otherwise) therapy.

Ozij,

Thanks for the tip. I'm using an o2 concentrator now.

Admittedly I shot gunned adding an o2 concentrator the same night I upped pressure from 5.6/10 to 7/11.

CA lowered from 22-66 range to 1-13 range.

Since making these two changes, I've had some of the best night's sleep I've had in a long time.

Thank you!

I'm glad that helped!
And thanks for giving us the info.