[Treatment] Central Sleep Apnea at high elevation

[shallbreathe]

@SBHill I hope you've been able to reduce your centrals...how has that been going for your?

Just my experience with altitude and using an O2 concentrator so far, for anyone who's interested. I'm in Colorado.

History: was struggling with 48AHI obstructive apnea and minor centrals according to home sleep study. I experienced major issues adjusting to CPAP and BIPAP, and while I was struggling with these machines for approx 3 months, I lost some weight and started doing various non-CPAP related therapies, and my obstructive apnea seemed to have disappeared or lessened dramatically. I am, however, still struggling with what seems like centrals or some type of altitude-related sleep issue. I frequently wake up on the verge of sleep because it felt like I would just "stop" breathing. And then only being able to sleep 2-3 hours a stretch.

Have not tried ASV yet because of expense and reluctance for the provider to prescribe it to me (still wants me to try CPAP/BIPAP for a few more months), and also for the fact I may just move to sea level at this point due to sleep issues. My recent visit to the coast was astonishing. The first time I visited (the height of my obstructive apnea), the altitude didn't seem to make a difference at all (unsurprising since my tongue literally felt like it was choking me, and altitude wouldn't make a difference with that) but 3 months later, after my obstructive apnea reduced/disappeared, I slept GREAT at sea level. The best I've slept in a couple of years. At sea level, I'd sleep through the night for at least 6-7 hours at a time, and on days where I didn't, I'd only wake up once to use the bathroom and I'd immediately fall asleep again, without lying in the dark and wondering why I didn't feel sleepy for 2-3 hours. It was blissful sleeping at sea level, but also disturbing because my body seems to be clearly telling me to move. I love living near mountains so it's a bittersweet message.

In the past few months, I've also experimented with oxygen concentrators, inspired by @knuddr's helpful posts. One was a Caire. Tried it about 3 times before giving up. Felt like it gave me a surge of energy, which is great for every situation that DOESN'T involve trying to fall asleep, haha. Insomnia all night long.

Because this was during the height of my struggles with obstructive apnea, CPAP/BIPAP, and an array of sleep meds, there was a lot of chaos going on and now that my obstructive seems to have vanished, I thought I'd give the concentrator one more go. Recently got a hold of a Devilbiss 5L last night and just tried 1L overnight but experienced the same issue. Lots of energy and tons of insomnia. Couldn't fall asleep with it at all. Finger oximeter was reading at 99% at 1L, so turned it down to .5L and was at 96-97% but wired and awake. I might try melatonin tonight to see if it gets me over the "hump" of the initial insomnia, but am a bit reluctant because I've had a wonky relationship with melatonin in the past.

I really don't know what to do at this point other than throw in the towel and relocate. My body seemed like it was fairly functional in the earlier years of living at altitude, but it seems aging(?) has made it less and less viable to live here. Even if I CAN get a CPAP/BIPAP/ASV to work at altitude, it seems like a very clear solution is sitting in front of me. That even if I still have apnea, I should probably get a machine and use it at sea level for optimum sleep since so many of my issues cleared up immediately. At sea level, I fall asleep without having that "jolt" that immediately wakes me up. And I stay asleep. Right now at high elevation, my sleep is very staggered...just 2 or 3 hours sessions at a time, and I seem to be "wide awake" every time I wake up so it's a real pain trying to fall asleep again.

I really wish the suppemental O2 worked for me since it feels easier to use than CPAP, but I can't seem to get over the energy surge it gives me enough to fall asleep with it on.

Edit: and I shoud mention that I did try the supplemental O2 WITH CPAP, but it just seemed like it exacerbated my insomnia twofold.

[TechieHippie]

From your description those episodes can be obstructive or central. I understand the feeling, I was surprised mine were obstructive. I'm in Colorado and also don't have apnea at sea level.

Not a doctor, but helped my dad manage his oxygen for quite some time - I have two thoughts on the oxygen - one is to try some supplemental 02 during the day for a several days to a week, to allow your system to adjust to it, and to see how it effects your nights. I wouldn't be surprised if daytime oxygen also helps the nighttime somewhat. Do you have a continuous pulse ox for overnight? If you can they are very helpful. Mine's a SleepU from Wellue.

If that doesn't work (or in addition), maybe you can go really low, like to .25L either at bedtime or perhaps an hour or so before bed. If you ever nap, you could try it then.