CPAP not effective at high altitude in New Mexico

[Jimo]

I have a diagnosis of Complex Sleep Apnea with moderate Central Apnea and Severe Obstructive Apnea identified on a 2019 sleep study. Fortunately, my apneas have been well controlled with CPAP while living in South east. In the past when I traveled to Arizona I experienced more central apneas. I am now 66 years old and recently traveled to New Mexico Sante Fe, Taos and Albuquerque and had a huge number of Central apneas and large number of Obstructive Apneas, about half the number of Central’s.

I contacted my pulmonologist who could not see me for several months and a previous neurologist nurse practitioner who treated my sleep apnea met with me this week She pulled the data off the RESMED AIRVIEW that noted Cheyne-Stokes respiration, average of 1 hour and 26-minutes per night while in New Mexico for 1-week. Total Central Apnea count for the one week in New Mexico was 1196 or 21 CAI per hour with 551 Total Obstructive Apnea Count with AHI Average 27.5. Normally my apnea is well controlled with CPAP where I live, with AHI average of only 2 AHI. The Cheyne-Stokes respiration issues averaged 1 hour and 26 minutes per night (16%) and Median pressure used was 6.52.

Since they identified me with a Complex Sleep Apnea with the Central Apneas I have wondered why they didn’t try to get an ASV machine approved, although the apnea resolved with CPAP other than High Altitude travel. My concern is that I am planning on traveling more to the West coast where altitude is higher. My nurse practitioner feels that Medicare and Federal BC/BS would not approve an ASV machine because I will be spending several months a year in high altitude. I was disappointed that she was not willing to at least try to get it approved as I am concerned that re-experiencing these episodes with large number of Central Apneas and Cheyne-Stokes respiration being detected could be medically dangerous. I mentioned that I would be willing to consider out of pocket purchase of an ASV if this would be the most appropriate apnea machine to utilize. The NP said they can raise the pressure when I travel, although I have read that this is frequently not recommended with the central apnea history. They recently set me up with the new RESMED AIRSENSE 11, three months ago and I mentioned that I would prefer to try and switch machines now before I own this one and cant qualify for new equipment for several years.

Any guidance would be appreciated as I plan to be taking more trips and I have not done well with higher pressure settings in the past when we went up to 10. I have read some of the past posts about altitude issues. Thanks.

[Nocibur]

My nurse practitioner feels that Medicare and Federal BC/BS would not approve an ASV machine because I will be spending several months a year in high altitude. I was disappointed that she was not willing to at least try to get it approved

What she says is irrelevant. Contact physician directly.

as I am concerned that re-experiencing these episodes with large number of Central Apneas and Cheyne-Stokes respiration being detected could be medically dangerous.

Maybe. Are you measuring oximetry? Consider acetazolamide.

The NP said they can raise the pressure when I travel, although I have read that this is frequently not recommended with the central apnea history.

Yeah but if your obstructive index is 27.5 increased pressure would address that.

That said, you should look at those. They could actually be misidentified centrals and your CAI is really 50.

Any guidance would be appreciated as I plan to be taking more trips

So this is getting to be AFU. Did the NP advise not to go to altitude? Is she refusing to treat (you should see if they're all centrals (which they probably are) and then depending on what state you reside in go to the state medical boards or AASM). Or tell your physician to set up an emergency teleconference. Or pick another physician.

Or speaking of acclimatization, get used to the fact that as we get older, we just aren't able to do everything we want.

[Nocibur]

OTOH, there is that little bit about needing a PSG for ASV:

With use of a positive airway pressure device without a backup rate (E0601 or E0470), the polysomnogram (PSG) shows a pattern of apneas and hypopneas that demonstrates the persistence or emergence of central apneas or central hypopneas upon exposure to CPAP (E0601) or a bi-level device without backup rate (E0470) device when titrated to the point where obstructive events have been effectively treated (obstructive AHI less than 5 per hour).

[Nocibur]

Plan B: Jailbreak the Airsense 11.

[Nocibur]

Plan C: Get a physician and schedule a PSG in New Mexico.

[Nocibur]

I would be willing to consider out of pocket purchase of an ASV if this would be the most appropriate apnea machine to utilize.

Plan D: Black Market ASV and self-treat.

[Janknitz]

I have plain vanilla OSA, plus asthma and a heart condition, and I had a lot of trouble when I visited my daughter in AlbQ and worse when we visited Santa Fe because of altitude. But thankfully, I had good nights with the CPAP, and after I got a mild case of altitude sickness in Santa Fe, the first thing I did when we returned to AlbQ was lie down with my CPAP which helped a lot. But I do not have complex apnea as you do.

If you are regularly visiting high altitude places, the I second the notion to get your own ASV (check with our member LSAT who seems to be able to get his hands on them in good condition for reasonable cost).

Santa Fe is over 7000 ft. Most cities on the west coast, even deep in the Sierra like Tahoe, are not that high, except for Mammoth Lakes in California. Are you planning on Mountain climbing?

[Jimo]

Thank you for your suggestions as well as others, I haven't pursued anything yet but will soon. Jim