[Treatment] Central Sleep Apnea at high elevation

[DevinJones]

This thread is very interesting. After researching the subject, I can see why the OP found that nocturnal supplemental oxygen, even without PAP therapy, stabilized his breathing, reduced his central sleep apnea, and normalized his nocturnal oxygen saturation levels.

I wonder how he is doing now.

Many studies over decades show that nocturnal supplemental oxygen by itself:

(1) Reduces loop gain (i.e., the gain, or chemoreflex responsiveness, of the negative feedback loop that regulates ventilation) in people with high loop-gain sleep apnea (an unstable ventilatory control system).

(2) Reduces peripheral and central chemoresponsiveness in high loop-gain sleep apnea.

(3) Stabilizes the ventilatory control system in high loop-gain sleep apnea.

(4) Reduces Cheyne–Stokes respiration and periodic breathing pattern in high loop-gain sleep apnea.

(5) Reduces the AHI, especially the central component of the AHI, in high loop-gain sleep apnea.

(6) Stabilizes nocturnal oxygen saturation levels. 

Relying on the decades of research on oxygen therapy for high loop-gain sleep apnea, the following December 2020 study:

“Demonstrates for the first time in elderly adults without heart disease that intervention with supplemental oxygen in the clinical range will ameliorate central apneas and hypopneas by decreasing the propensity to central apnea through decreased chemoreflex sensitivity, even in the absence of a reduction in the plant gain. Thus, the study provides physiological evidence for use of supplemental oxygen as therapy for mild-to-moderate SDB [sleep-disordered breathing] in this vulnerable population.”

Amelioration of sleep-disordered breathing with supplemental oxygen in older adults
Ruchi Rastogi, M.S. Badr, A. Ahmed, and S. Chowdhuri
December 1, 2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792842/

[Sleeprider]

DevinJones, good post and interesting research. If you're ever interested in joining the Wiki Editor team we could use your help to put together articles discussing things like this. https://www.apneaboard.com/wiki/index.ph...iki_Editor

[knuddr]

Hey DevinJones,

I'm doing fantastic! Still in Denver, able to live my life here pretty successfully now. Completely off the CPAP, it made things enormously worse for me (morning headaches, weekly ocular migraines that lasted an hour, constant fatigue). I've been on supplemental oxygen every night, an Inogen At Home unit, and am currently testing a pulse system as well, which has been successful at night (planning on using this Inogen G5 for camping nights, or when traveling, etc). I have little-to-zero events every night. Oxygen is still fairly low during the day 90-93%, but seems to be okay.

** Insurance to this day still won't cover oxygen though, only CPAP for sleep apnea, despite all the evidence. Have been paying out of pocket **

I'm still occasionally trying different things, tried acetazolamide to see if it might help (didn't). Saw a doctor for my heart, did a ultrasound to see if it was pumping fine (it is). Checked in with a lung specialist to see if there was any obstructions or complications (all good).

This might be interesting, they're focused on obstructive but maybe once it comes around I'll give it a shot too:
https://www.incannex.com/clinical-trail/ihl-42x-osa/

Ultimately would like to get to the point where I don't need any machines to keep me alive, baby steps :-)

Jason

[DevinJones]

Thanks very much, Sleeprider, for your nice comment and for inviting me to help compose some articles for Apnea Board wikis.

I'll keep this in mind, look at your wikis on becoming a wiki editor, and see if I'll have time from work to do it.

[DevinJones]

That's great, Jason! I'm glad that your oxygen therapy is still effective and that all is well. An AHI of 0.0 or under 1.0 is hard to beat!

That's terrible what happened to you from using the CPAP. ASV would probably be more effective for sure, but the insurance often doesn't cover the most effective treatments.

That's good that you tried acetazolamide because it's also known to lower the loop gain in high loop-gain CSA, especially at high elevations.

That's also good your cardiologist and pulmonologist have cleared you. They don't know the cause of your decreased oxygen saturation during the day?

I'll look into Incannex a little more. It appears to be a combination of acetazolamide and THC.

I recently started to test nocturnal supplemental oxygen (by itself and combined with ASV) for my periodic breathing pattern and CSA. About 2.0 lpm of supplemental oxygen via nasal cannula very effectively stabilizes my breathing pattern and oxygen saturation levels. Even with only a nasal cannula and no PAP device, my oxygen saturation levels are like a relatively flat line around 97% or 98%. It's amazing to me! With just the nasal cannula and no full mask for the ASV, I felt so free and comfortable and found it much easier to sleep.

A combination of supplemental oxygen and ASV stabilizes and smooths out my breathing even more, so I'm continuing to test the combination therapy now.

[shallbreathe]

Wondering how anybody upthread (or anyone else) might be doing with their O2 therapy thus far. Looking into it myself because with CPAP my central apneas seem like they're uncontrollably worse (I'm also at elevation.) I think I'm still a long way out before I'm allowed(?) to try an ASV machine.

[knuddr]

Wondering how anybody upthread (or anyone else) might be doing with their O2 therapy thus far. Looking into it myself because  with CPAP my central apneas seem like they're uncontrollably worse (I'm also at elevation.) I think I'm still a long way out before I'm allowed(?) to try an ASV machine.

O2 has been infinitely better of a treatment for me, and still to this day. Use it every night, and have a portable machine now when I go camping up in the mountains (runs on battery) with spare battery. It's non-invasive, and a lot more comfortable (simple nose cannula). The only thing that was more comfortable with the CPAP was that it was heated! I have a small water canister that the oxygen runs through, so it gets some moisture which is more pleasant than without. Maintenance is almost zero -- just change the nose cannula every 2-4 weeks and they're dirt cheap! Which is a big plus cause my insurance refused to cover this treatment vs CPAP, its not the thing to do for "sleep apnea" so I'm out of pocket, but after the initial cost of the machine it's negligible. 

I'll have somewhere between 2-5 drops an ENTIRE night vs ~250-300. Oxygen stays pretty consistent at 94-95%, except some nights where my nose might get overly clogged (winter w/heating for an example) but then I might get upwards of 10 drops hah. I do use an ointment for my nose: "Matys Organic Simply Breathe Nasal Ointment" is my preferred, and that helps keep things moving properly. I also have washable/reusable ear protector and cheek protector sleeves so I don't have any markings in the morning. But that's about all there is to it. Plus the noise of the machine which doesn't bother me but its more noticeable than the CPAP machine. 

It's still not 100% ideal -- in 4 or so years I might move back to sea level so this all could go away. But in the meantime I'm still trying to convince myself there's an actual cure 


----
Quick edit: the oxygen machine can also be plugged into your CPAP, so if the oxygen isn't enough or CPAP isn't enough for you, perhaps a combination of the two would be your best solution. I'd say experiment first with just oxygen and measure with an O2Ring or something similar (I think the O2Ring measures O2 the most frequently and is what I use). My sleep doctor wanted me with this setup but I showed her repeatedly that just oxygen alone was solving all of my problems. Anyway, I don't see that doctor any more

[SarcasticDave94]

Not to hijack the thread, but if you have the stats to get ASV, shallbreathe, be a squeaky wheel. Get demanding. Irritate the medicals, bug them, make their ears bleed with your complaint. Remind them they're not suffering yet from your poor sleep therapy.

I had to force my way to get ASV to treat Central Apnea, and my constant complaints helped speed it along, skipping a normally required step.

Make the medicals suffer for your bad therapy.

[shallbreathe]

Thank you so much for your detailed update knuddr! Glad it's been working out for you!
And thank you for the advice Dave...my CPAP numbers look pretty frightening (I think) so hopefully moving forward to something better.

[SBHill]

I just joined this board after spending months reading so many wonderful posts trying to figure out how to decrease my centrals.   

I want too respond to the thread that i've recently been using oxygen at high altitude (10,300ft) and I've had NO improvement in my AHI but only in the O2 while sleeping. 

Im in my early sixties and live in Denver 80% of the time 5,280 ft and the rest in Breckenridge 10,300 ft. I'm very active, play tennis and pickle ball 4-5 times week.   I was diagnosed with sleep apnea last september because I was telling my Dr I was getting more and more headaches in Breckenridge and thought my O2 was in the mid to high 80's sometimes during the day.  He tested me with the wabtchpat in Breckenridge and saw I was having <10 apneas and O2 desaturations in the mid to low 80's.  So he ordered a Resumed 11 for me. Pressure 7 constant but i changed i to Apap 4-8 pressure with a nasal PHILLIPS Respironics head gear. 

Ive been consistent with the APAP for about 8 months and have been almost instantly reducing my AHI down from as high as 2.2 to as low as .44it fluctuates in those ranges.  However, almost immediately after a month, I developed all central apneas. My Dr said it was cpap induced. Also, took my Resmed 11 to Florida this summer to test at sea level and nothing changed or improved further on the AHI numbers still ranges below 2.0  

Onto the discussion of Oxygen supplementation: I finally got my dr to prescribe me oxygen in Breckenridge last month and ONLY while I sleep; my O2 is well above 92 all night every night.  So my APAP has not improved at all from the use of Oxygen (use 1.5 liters pm). FYI in Denver I have the same amount of centrals and my desaturation is only once at 86-88 per night.  No Oxigen supplementation use.

I actually will be asking the group later this week on how to improve my AHI eventually and clear my centrals  I know they are low but im committed to decreasing my centrals to under 1.