Using CPAP At An Altitude of 12,500'

[moresleep]

I would worry about you, not the cpap machine. The cpap may not adjust enough, but it will still work. At that altitude, you are at risk for "mountain sickness," also called "altitude sickness," which causes central apneas and other unpleasant things. If you google the term, you'll find a lot of information. Acetazolamide is a recognized preventative/treatment. You might want to talk to your doctor about it, and get a prescription.

Thanks, moresleep. I've done both high altitude trips as well as the medication before, and had very minimal symptoms of altitude sickness. In fact, the last such journey was a year before I was diagnosed with OSA, and I did not experience more than 1-2 days of feeling a little drunk.

You should be fine, then; just keep that Acetazolamide handy

I have no personal experience with Cpap's at high altitude. But, if it were me, I would probably set the 420e in straight Cpap mode (i.e., not Auto), and adjust the pressure using an external manometer. That is, I would not simply assume an error of 1cm for each 1,000 feet or anything like that; I would adjust the machine to the actual pressure I wanted. Of course, you need a manometer accurate at high altitudes, which might cause me to doubt electronic devices and opt for a simple water manometer.

[plr66]

I have no personal experience with Cpap's at high altitude. But, if it were me, I would probably set the 420e in straight Cpap mode (i.e., not Auto), and adjust the pressure using an external manometer. That is, I would not simply assume an error of 1cm for each 1,000 feet or anything like that; I would adjust the machine to the actual pressure I wanted. Of course, you need a manometer accurate at high altitudes, which might cause me to doubt electronic devices and opt for a simple water manometer.

Thanks for your suggestions, moresleep. I do use straight cpap, and usually travel with my trusty Everest machine, which auto-adjusts to 8000'. I am considering taking a different machine with good read-out of AHI's, etc. on this trip, however. I've not used a manometer before. Can you tell me about why not an electronic one, and what's involved with a water manometer?

[moresleep]

An electronic/digital manometer might be fine, depending on whether its method of measurement assumed a particular atmospheric pressure, and, if so, whether it was easy to adjust it for different altitudes. Just some questions you would have to ask about the particular device.

Hard to go wrong with a simple water manometer. It's just an upright "U shaped" tube. With no pressure applied and both ends open to the atmosphere, the water equalizes at the same height on both sides. If you apply a pressure at one end (i.e. Cpap), it will push the water down that side and up the other side. The difference between the levels is the applied pressure. There are variations on this, such as having a tank on the side where pressure is applied. In fact a F&P sells a $50 manometer made with a humidifier tank. See Cpap.com. Cpap-supply.com has instructions for building one from tubing: http://www.cpap-supply.com/Articles.asp?ID=132

[rocklin]

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. . . unnecessarily dramatic . . .

When I write that long-simmering novel, may I quote you on the inside jacket, sir?

alarmist for anyone else reading this thread who might be interested in continuing to travel and enjoy life, while not compromising their therapy.

I must respectfully disagree, plr66

To me, "travel and enjoy life" means visiting any of the world's wonders that are well below 10,000 feet. .The pyramids of Egypt, the gardens of Kyoto, the butes of Monument Valley, the ice deserts and mountains of Antarctica. .Even the great museums, restaurants and hotels of Europe if that is your speed.

But if you want to travel the world by high-speed motorcycle, I recommend wearing a helmet.


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By the same token, posting that you are going to climb above 12,500 with your xPAP, and expecting serious answers as to the safety of that adventure to be found on a CPAP board, seems to me to be the height of drama queenism.

For pure, granular results (and at a cheap price), a couple of hours spent inside a decompression chamber with your particular, unique body, and your particular, unique CPAP unit (it may have an outlier defect, ya never know), seems to me to be both scientifically sound and prudent.

But I may be wrong, I often am. .Enjoy your trip.

In any case, please take pictures and post 'em here!



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[plr66]

I see you have been on this forum for all of 2.5 months, rocklin; and I think you've made your point for whatever you feel it is worth. Time to drop it. Name-calling seems pretty silly, and sure does nail your input for what it is.

Thanks to those with constructive ideas and suggestions made here.

[Bear100]

My top altitude with CPAP has been just over 11,000 feet on multiple occasions.

My old Resperonics, was built like a tank and weighed as much. However it performed far better than my newer model (see signature). Not sure why nor can I find what they are rated for.

I can tell you I slept much better than others on the trip, who constantly complained of poor sleep. I should also add the trips were in winter and the humidifer really was great, as the cold thin air became moist and far thicker with the CPAP.

Bear100

[plr66]

My top altitude with CPAP has been just over 11,000 feet on multiple occasions.

My old Resperonics, was built like a tank and weighed as much. However it performed far better than my newer model (see signature). Not sure why nor can I find what they are rated for.

I can tell you I slept much better than others on the trip, who constantly complained of poor sleep. I should also add the trips were in winter and the humidifer really was great, as the cold thin air became moist and far thicker with the CPAP.

Bear100

Thanks for your experience-based feedback, Bear! Logic has told me that the results you describe would be the case. Were you using the Respironics M Series, or the earlier model that Wulfman (Den) has always used? (I'm asking because I do have the M-Series model still on hand). Did you adjust your pressure for that elevation, and if so, how did you decide what to adjust to? I do use passive (pass-over) humidifier, and wonder whether you used heated humidification at that elevation.

[rocklin]

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Let me begin with an apology: I intended information, not offense. .But my presentation was not consistent with that goal.

So, please accept my sincerest apologies, plr66.

That being said, I feel I must try this once (and absolutely guaranteed final) time to make a couple of points.

If you'll consider indulging me for a brief moment more:


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I think you've made your point

Plr66, the hidden subtext of my remarks to you was made with genuine concern that you might end up injured.

That you seem not to have received that message is clearly my fault.

My presentational instincts tend toward the dramatic, especial since I deeply believe that Speed Reading Kills (SRK), and thus, write dramatically in order to be read, my message actually understood instead of skimmed over.


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Thanks to those with constructive ideas and suggestions

I might just qualify to be on your list..Let me briefly recap, sans my over-the-top style, and see if you agree:



1) Even brilliant divers (and climbers) miscalculate a simple dive / climb, with tragic results.

If you read that Sheck Exley link closely ( http://www.stationr.org/caving/exley.htm ), and mull it over, it's possible you might agree with me on this: that even the most brilliant, experienced divers and climbers miscalculate.


2) With all due respect, plr66, I'm guessing you're not a world-class climber (if you are, again my apologies), and thus, possibly, even more prone to miscalculation than the eminent, deceased, Mr. Exley.


3) Your PAP device's manufacturer claims that the Everest 2 "automatically adjusts up to 11,000 feet". .And that claim may—just may—be . . . a tad optimistic.

In any case, you plan to exceed that claimed limit by one thousand and five hundred feet. .That number might seem like a trifle, but have you ever had to descend when you're utterly exhausted and suffering from generalized hypoxia, possibly showing symptoms of HAPE or HACE? . Under those conditions, I can say from personal experience that a slow, controlled, unassisted descent of nine hundred feet feels like . . . ten miles.


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4) Please consider this (nearly) worst-case scenario:


You have an untitrated AHI of 30+.

You climb to 12,500 and, surprisingly, find yourself exhausted. .Then, despite the sunny weather forecast, you suddenly find yourself stuck in a furious sqaull.

You tent up, oxygen deprived, badly in need of a good night's sleep when night falls.. When that time to sleep comes, you put on your trusty UltraMirageFFM, and turn on your trusty Everest 2.

It won't start.

Maybe it's the humidity, maybe the cold, maybe a broken wire, maybe it's that you blithely exceeded the manufacturer's claimed limit (fully tested or just kinda spitballed — 11,00 feet is such a nice round figure, that I have to wonder) by one thousand, five hundred feet.


5) As night falls, and the storm intensifies, you remember this idiot (who didn't seem to know his a** from his elbow) on a CPAP board who posted a self-aggrandizing message . . . and—despite your best efforts not to—you have laugh at the surreal irony of it all.

Morning arrives, the storm is gone. .You're fine, a day older and perhaps, just a tiny bit wiser.


6) You make a mental note:. that on your next climb — boldly planned for K2 — you'll test your new, (tank-tough, custom-built) cPAP unit—and your body—in the cheap safety of a decompression chamber.


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Time to drop it.

As you wish. .Again, my sincerest apologies if I've caused you any offense, that most certainly was not my purpose.

Sincerely Yours,

roc

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[deltadave]

One person posted recently that doing that burnt their machine right out. It was an older model that they used for travel and back up.

Do you remember where that was? I can't find it.

The implication is that running a machine flat-out, no load, would cause the motor to burn out. In the above example, I would look to see:

• What the set pressure was
• If there were large leaks, or a total disconnect
• Was the machine damaged in transit
• Was it subject to countries with unreliable power grids
• Was it subject a country with a reliable power grid, but it was 220V and compensation was not made
• Was the intake filter clogged to prevent proper fan cooling
• Specifically, what "burnt". If the bearings went, then that wouldn't be an altitude issue (directly).

http://chestjournal.chestpubs.org/conte ... 7.full.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864887/

[sheldons65]

Hello All,

I am at 14 cms of water on my machine. 14 cms of water is the same here in Texas as it is at 12,500 ft in the Andes. No need to change my machine. The machine has to work a bit harder to produce a higher volume of air is all. I have not checked my AHI in awhile at high alt but everything seemed to be fine and I slept pretty good at 14,500 ft. It was not the cpap way up high but rather hypoxia affects that caused any sleep issues.

I carry mine all over high altitude places in South America because I work focused on the mining industry. Never had a problem except for maybe a little more rainout because of the cold or maybe lower pressure. Anyway it was not a big issue. For water I use bottled water and clean my humidifier with white vinegar and then the regular Ivory dish soap wash when I return home.

I cannot comment on any other machines just mine in my profile.

If you have never been that high before it is very important to follow some guidelines I have learned:

- no alcohol
- avoid a lot of caffeine, a cup of coffee or tea is ok
- drink lots and lots of water before you go and continue drinking a lot throughout the trip, your body needs to be fully hydrated to help carry O2
- as you begin driving up to high altitude make a conscious effort to breath deeply and more regularly
- do not, repeat, do not go to sleep in the vehicle while going to altitude
- start drinking the Coca leaf tea before, on the way up and as soon as you arrive at altitude (unless you will need to take a drug test in the next week).
- avoid large meals
- stay well hydrated.

I am not saying you won't have altitude sickness following these guidelnes but I bet it will be less.

[GumbyCT]

14 cms of water is the same here in Texas as it is at 12,500 ft in the Andes.

I wonder about that! 14cm=14cm

If the machine is calibrated correctly then it should compensate.

[deltadave]

14 cms of water is the same here in Texas as it is at 12,500 ft in the Andes.

I wonder about that! 14cm=14cm

If the machine is calibrated correctly then it should compensate.

There's a lot of things that "should".

Like the Sox "should" be in the playoffs.

And the altitude compensation ability of CPAP machines "should" be infinite:

Altitude Adjustment —The REMstar and REMstar Plus models require manual altitude adjustment (1=<2500 feet, 2=2501-5000 feet, 3=5001-7500 feet). The REMstar Pro, REMstar Auto, BiPAP Plus and BiPAP Auto models have automatic altitude adjustment.

http://mseries.respironics.com/FAQs.aspx

[plr66]

14 cms of water is the same here in Texas as it is at 12,500 ft in the Andes.

Thanks for your experiential input and pm's Sheldon. Can you explain what you mean here? I completely agree with your list of other recommendations and have always stuck to the same rules, with good results.

[plr66]

14 cms of water is the same here in Texas as it is at 12,500 ft in the Andes.

I wonder about that! 14cm=14cm

If the machine is calibrated correctly then it should compensate.

Up to 8-9,000' anyway....
I've never seen a machine that goes higher. So above that elevation will likely mean the need for slight increase in pressure setting, as has been mentioned earlier. I just want to be sure that the motor is capable of running harder to achieve the pressure at higher elevation and "thinner air." I am being reassured that this would not be a problem.

[Mark184]

Have you slept at these altitudes? I was mountaineering in Bolivia. No real problems during the day climbing, but the higher I got past 13,500 feet, the more difficulty I had sleeping. I did not have a CPAP at the time, so I'm afraid I can't help you with your original posting issue. But I can confirm that the lack of O2's create a sleeping challenge by itself. The normal issue is that your normal sleeping breathing rhythm doesn't account for the low O2's, therefore you often wake up in jolts breathing quite heavy. This is relatively normal for non-apnea sleepers, and it takes a while to acclimate (some longer, some shorter than others).

You might check into taking Diamox, unless you really have a lot of high altitude experience. This stuff makes acclimation a bit easier.

Sounds like a great trip! Please re-post what you learn about altitude effects on CPAP!