I'm going on a week-long trip where taking the CPAP isn't an option - trekking and without power for part of it and need to travel light for all of it. Anyone have a similar experience and recommendations short of buying a travel machine? A travel machine won't help out enough to be worth it for this trip. Thanks.
When I go backpacking and can't take my CPAP, I just blow it off. One week without a CPAP or an oral appliance is not going kill you.
Actually, I would not make that assumption. Going from a state of treatment to no treatment cold turkey puts a tremendous strain on your body. Unfortunately, there are verified instances where a patient missed ONE night of CPAP after twenty plus years and paid the ultimate price for doing so. Arthur B. Luisi, Jr., D.M.D.
The OP posted once and hasn't returned but knowing the severity of OSA might allow for a medical professional to give a more educated idea of possible physical effects if CPAP was stopped for a few days. Also, did the person see significant SP02 drop prior to therapy. Perhaps the unfortunate patient who died after one night of non-CPAP use had a severe heart problem or had a stroke. Probably the range of medical danger runs a wide spectrum from doesn't matter to drop dead if you miss a night. I suspect virtually everyone is somewhere between the extremes of this scale.
According to all of the medical literature, even if someone did drop dead on the first night in twenty years they didn't use CPAP, stopping treatment was not the problem. If one little dip in their oxygen was going to kill them then they would have dropped dead the next time they laughed, walked up some stairs or held their breath for a few seconds. The physical damage that OSA does is the effect of the stress it places on your body every night accumulating over the long term and causing a major problem. I absolutely encourage everyone to use their CPAP (or other treatment) all night and every night, but don;t goo into a panic if there's a power outage.
About the only thing I could suggest to ExuberantApricotFrog8131 is to try propping yourself up a bit when you sleep. Perhaps sleep on a slope or leaning against your pack or something. Being propped up can reduce obstruction in some cases.
Well, actually the story about the patient demise after one night after lack of CPAP was told to me by a relative of the victim. I would therefore acknowledge that they may have been incorrect in blaming that particular incident. I am going to do some further research on this topic and will report back. Arthur B. Luisi, Jr., D.M.D.
"A study . . . suggests that patients with OSA are more likely to experience their sudden events [cardiac death] at night (12 AM to 6 AM) than are those without OSA, who are more likely to die in the well-recognized window between 6 AM and 12 PM. This study also reports a direct relationship between the severity of OSA (as measured by the apnea-hypopnea index) and the risk of sudden cardiac death at night. Recent data suggest that this predilection for nighttime events in patients with OSA can be explained, in part, by the greater number of nocturnal ischemic events that occur in these patients." -- [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147220/]
"Researchers suspect sleep apnea causes abnormal heart rhythms, which lead to sudden cardiac death, for a number of reasons, says sleep medicine expert Reena Mehra, MD, MS. 'Sleep apnea may lower oxygen levels, activate the fight-or-flight response and change pressure in the chest when the upper airway closes, stressing the heart mechanically,' she explains." -- [https://health.clevelandclinic.org/why-sleep-apnea-raises-your-risk-of-sudden-cardiac-death/]
A study that much of that may be based on:
"Apneic episodes elicit increased sympathetic activity, blood-pressure elevations, and platelet aggregation. Obstructive sleep apnea is associated with abnormalities in cardiac autonomic and electrophysiological factors, including heart rate variability, the duration of the QT interval, baroreflex function, and chemoreceptor sensitivity. Serious and potentially fatal arrhythmias occur during sleep in patients with obstructive sleep apnea and are attenuated by effective treatment. Thus, multiple pathophysiological mechanisms occur during sleep in persons with obstructive sleep apnea and may explain an increased risk of nocturnal sudden death from cardiac causes." -- [http://www.nejm.org/doi/full/10.1056/NEJMoa041832]
Does anyone think the following illustrated experience is actually safe? even for just one night? or even for just one event, especially when tired, weak, on allergy/sleep meds, or maybe even after a few beers?: [https://youtu.be/-gie2dhqP2c?t=8m53s]
The reason the cause of death sometimes given is "sleep apnea" rather than "an apnea" is only, I believe, because no doctor wants to say that someone died because he stopped breathing, since that is the case in every death. And every death that is not a sudden accident or a murder is always multifactorial beyond the incident itself that directly precipitates the outcome.
Hope that helps.
In my opinion, the answer to this particular question would be highly individual according to OSA severity AND other comorbidities, to the extent that only one's personal sleep doctor, and even then only one given full access to one's full medical files, could comment meaningfully on what is being proposed here, for any given PAP user.
I would hesitate to suggest to anyone that he or she make a choice that would lower the likelihood of getting good sleep. People die from accidents after bad nights of sleep, no matter how severe their OSA is or isn't classified. For me, I would consider it life-threatening to go one night without PAP. But that is based on my understanding of my condition. Dying in one's sleep while not using PAP is a real possibility for someone with a particular heart condition and a sleep-breathing issue in which long apneas are followed by being rudely jarred into breathing with panic hormones shocking the entire system. And that risk is on top of the dying-from-doing-something-stupid-the-next-day-while-half-asleep risk.
I like enjoying trips. I don't enjoy any day that I didn't sleep well the night before. That has affected my choices of what sort of trips I take and do not take. But hey, that's just me.
To the OP, if your doc thinks you to be a candidate, using a device to advance your jaw combined with something like Provent can sometimes lower some risks off PAP, depending. Sleeping sitting up or at an incline and not supine can also prevent extreme problems for some, according to their individual condition(s). But whatever you and your medical team come up with, you may want to try it for a week before you go (if you can safely do so) to assess how you would feel on that trip. Nothing is worse than taking an important/expensive trip and feeling miserable off PAP, even if it is determined to be relatively safe for you to do so!
I think that you did a great job with your research jnk. The video of the apnea was absolutely chilling. I am a professional and it even shocked ME. I was always taught by my mentors not the be casual about brief interruptions in treatment for OSA, but they never elaborated on why. I think that each person should take a serious, common-sense, balanced approach towards managing their condition. Nobody is asking you to live in a panic about, but neither should you be completely cavalier about the dangers and in denial. A certain amount of risk is inherent in the human condition and nobody can be completely protected. It would be like riding around in a Brink's armored car all day long to avoid an automobile injury. Everyone needs to understand that, with respect to the risk of being briefly untreated, we simply do not have all the answers at this time. Each person's situation is a mosaic of their personal medical condition and weaknesses and can we ever predict the interaction with an apnea at that exact second? I think not. So rather be safe than sorry. Do your best to maintain your chain of treatment. If you can not, odds are it will be O.K. Just get back on track as soon as possible. Arthur B. Luisi, Jr. D.M.D.
Well said, SleepDent2.
I tend to think in terms of moderate-to-severe OSA that went untreated for years, but your balanced perspective takes into account that someone with an untreated AHI or RDI of 4 is considered not even to "have" OSA. So an AHI of 6 shouldn't suddenly make going without PAP a while a life-threatening decision for someone, just as an example.
I believe every patient has the right to choose risks. But for that to be possible in a fully-informed way, the patient needs information on both the known risks and the possibilities of unknown risks--as they relate to that patient's medical history.
