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Sleep Apnea - Backpacking - Developments Long
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James D Buch
(rocketman) - F

Locale: Midwest
Sleep Apnea - Backpacking - Developments Long on 06/10/2010 07:51:35 MDT Print View

A few years ago, there was a Sleep Apnea thread here. I thought I would add some information.

=============================
Historical Lead-up

I was diagnosed with moderate Apnea last year, following my complaints of lack of endurance. The Continuous Positive Air Pressure machine or CPAP was prescribed and I am doing extremely well on it. The endurance is certainly up.

In 2008, I hiked part of the Superior Hiking Trail, and after 10 days was completely out of energy. So, I had to quit and come home early. This was one of the sources of my complaint of lack of endurance.

My, then, physician dismissed the complaint claiming that I was the healthiest senior citizen in her practice. My subsequent (older, wiser) physician is the one who prescribed the sleep test for apnea.

For sleep apnea, I actually consult a Pulmonary specialist.

I discussed my plans to hike a couple of hundred miles of the Appalachian Trail in 2009 and he was enthusiastic. We discussed side sleeping and the ball in the back pocket trick. And of course, to be sure to quit if it became too much of a chore. With the low elevation of the trail segment (Harper's Ferry to South of Shenandoah)he didn't anticipate any great altitude problem.

By the time I was nearing the southern end of the Shenandoah Park, I was getting pretty tired. The second to last day, I had 13 miles to go to the next shelter and 11 miles to the next water. About half way through that stretch I hit the highway and hitched. The last uphill stretch to the shelter and spring were done slowly and with rest stops.

By the time I caught the airplane home, I had backpacked about 200 miles, and felt good.

=============================
Recent Developments

I began thinking about sending the CPAP machine ahead to selected resupply points along the trail and then laying over a day or two or more to sleep with the CPAP and recharge my energy.

The other day, one of the CPAP companies had a "Mask Fitting ... etc" evening get together at the local sleep lab. Of course I went.

I talked some time with one of the CPAP reps about the idea. He agreed that it works. I pressed for more details and it took a while, but was painless.

The rep wasn't aware of any published work on this subject. He knows of cases where people who hike the AT have done this.

Evidently, there are no guidelines for how long it takes on the CPAP to "recover" the poor sleep and poor breathing for the period off the machine. You have to experiment and find it out for yourself.

The rep has a reclusive friend on CPAP who hikes the AT. He is going to try to get him to call me to talk about his experiences. He wasn't optimistic about the reclusive friend following up with any kind of open discussion, however.

Evidently, I missed the opportunity to evaluate my "recovery" period after my hike last year. Within a day or two, I was riding my bike several miles every day, but mostly I remember that it didn't take long to feel normal once I was back on CPAP. I don't have any recollection of whether or not I slept more to make up for any deficit.

The main health guideline the rep had to offer was to sleep as much as possible under those conditions. Simply, with a poorer sleeping environment (no CPAP), do what you can to compensate.

================================

If anyone else here backpacks with sleep apnea, I would be interested in hearing your experiences.

Later this year, I'm going back to the AT for a 100 mile segment from the Smoky Mt. Park to Erwin, TN. No current plans for a CPAP layover in Hot Springs NC.

Ike Mouser
(isaac.mouser) - F
Pocket on 06/10/2010 08:01:37 MDT Print View

What's the ball in the back pocket trick?

James D Buch
(rocketman) - F

Locale: Midwest
Ball In Pocket Trick on 06/10/2010 09:08:17 MDT Print View

The ball in a pocket trick may be known by other names.

Originally, the idea was to take a T-shirt with a pocket on the chest. Put a tennis ball in the pocket. Put the T-shirt on backwards so the ball sticks out from your back. This is supposed to aid in keeping you from sleeping on your back, the position where obstructive sleep apnea is maximized. So, it encourages side sleeping.

You can also jury rig something with a stuff sack and some webbing or cord and an elastic pocket (or non-elastic) sewn in/on the stuff sack that will keep the tennis ball pressing into your back if you lie on your back.

This is multiple use. A stuff sack, which may carry something like clothing or just an organizer. Then a "sleep on side appliance", and a tennis ball to throw around for play. Especially if you have a good dog along. :-)

John L Collins
(WVCubDad) - MLife

Locale: Not too far off the Tuscarora Trail
re: Sleep Apnea - Backpacking - Developments Long on 06/12/2010 16:54:29 MDT Print View

James,

Thanks for posting this, I've always wondered how many BPL'ers have a similar problem. I was diagnosed with severe obstructive sleep apnea about 4 years ago and prescribed a CPAP which has really made a dramatic difference in my quality of sleep (now if I would only stop staying up too late and getting up too early...)

I don't do a lot of long backpacking trips, most of my current outdoor adventures are with my Cub Scout Pack - 2 night car camping trips, week long Resident camps. That said the first few nights at Resident Camp usually involve waking every hour or so, adjusting my position and trying to fall back asleep. After 2 am I can usually manage a longer period of rest. On the car camping trips I am restless the first night and able to sleep the second.

I have not tried the tennis ball trick, but I did get a BA AirCore mattress that makes life very bearable for me after trying to use a Thermarest UL pad.

If I fall asleep on the couch at home I do notice that if I am on my back I struggle to breath but on my side it's okay. Same sleeping in camp. I have not actually timed my recovery from a trip, but notice a nice restful sleep that first night home. I can not sleep in a bed more than 6 hours or my lower back starts to kill me.

After reading the article a few months ago about making ourselves UL, I am now working on shedding about 70 pounds and hope to go in for a new sleep test by the end of the year.

I did try to take my CPAP and a small inverter with me on a Pack overnighter but to my mind it was too darn loud so I just deal with it on these trips. After my son crosses to the Troop next year I'll have to see how a longer trip goes, but by that time I should be a lot lighter and in better physical condition!

John

James D Buch
(rocketman) - F

Locale: Midwest
re: Sleep Apnea - Backpacking - Developments Long on 06/13/2010 07:23:04 MDT Print View

John,

The research on sleep apnea supports a 10% or more body weight loss as a positive factor in reducing the effects of obstructive sleep apnea (evidently, central sleep apnea, failure of the normal nerve impulses to star at a breath cycle isn't so strongly affected by body mass).

In about 2003 or 2004 I lost about 79 lbs by diet and exercise ( lots of bicycle camping and continuing to live an automobile free lifestyle). At that time, my sleep apnea was undiagnosed, if it was even fully developed.

Hopefully, you will see substantial improvement provided you can stick with diet/exercise strongly enough to eliminate that much weight. With the body weight savings, you might be able to carry a portable HDTV into the wilderness :-). Or, one of those Lithium battery powered CPAP machine$.

Wishing you success on the weight loss, and hopefully a positive trip report on the effects.

Arapiles .
(Arapiles) - M

Locale: Melbourne
apnea ... kind of on 06/14/2010 05:30:57 MDT Print View

About 20 years ago I was living in Tokyo and started waking up in the middle of the night unable to breathe and then feeling terrible during the day - headaches, lethargic etc. So I took myself off to the hospital - they did tests, said it sounded like apnea but it was unusual because I wasn't obese. This happened a few times then stopped altogether.

A year or so ago I was talking about it with my wife, who was my girlfriend when I was in Tokyo. She said yeah that was me - I used to hold your nose to stop you snoring.

James D Buch
(rocketman) - F

Locale: Midwest
Sleep Apnea Backpacking Developments - Continued on 06/16/2010 19:15:12 MDT Print View

Developments

1)CPAP Assisted Layover in Hot Springs

I looked into this a little more. The Hot Springs Resort and Spa were contacted by telephone. I explained I would like a campsite with power for my CPAP and they said they could provide that - as a campsite for an RV which has power. If that was what I wanted, it would be the same rate as an RV, $40/night. Advance reservations really recommended. (Of course, any motel, hotel or hostel room would also have an electrical outlet).

They would be happy to accept shipment of the CPAP and hold it for me, and it could probably be shipped out (home or next rest stop) pretty easily.

I imagine that getting this kind of help from any lodging facility along a hiking route should be fairly easy.

2)Better Ball In Pocket Trick?

Back Pillow for sleep apnea.
http://sleepapnoeapillow.com/html/technical_____________________.htm

There are a number of nearly conventinal pillows sold for sleep apnea. The above link isn't for that type. It is a pillow-like cylinder that is attached to your back where the cylinder is something like 5 or 6 inches in diameter and 10 or more inches long.

Think of a stuff sack stuffed with soft clothing or balloons or an inflated cylinder.

This large (lightwight) object held onto your back provides a large comfortable solid objectr to prevent back sleeping and apnea maximization. I improvised something like this from two stuff sacks, the outer one converted into a "backpack" with soft cord for the shoulder straps and a web and buckle waist strap. I had an inflatable plastic air pillow in the inner sack to provide the lightweight large object attached to my back.

I used it at home a little, but by then my CPAP arrived, and I left this to age in the "unfinished project" box. When I was thinking of moving, I took it apart into the basic components and managed to misplace them.

I am mentioning this because it might be time to move beyond the old "tennis ball in a pocket" trick. Especially for backpacking and trying to keep the weights and volume of any sleep aids down to a minimum.

jimbo jones
(hawaiicruz) - F
my portable apnea solution on 07/07/2010 12:53:49 MDT Print View

I'm not sure how this sight is with spamtards so I'll try to keep this vague. I recently started using a device that pulls my tounge forward as I sleep, It's small light and fits in you're pocket. It was a pain to get used to, but it works and I'm back on the trail!!

James D Buch
(rocketman) - F

Locale: Midwest
Oral Appliance Sleep Apnea on 07/14/2010 18:54:26 MDT Print View

Some people have reported good success with various of these oral appliances.

I bought one, one of the ones that you place in boiling water to heat it up and then you put it in you mouth with your jaw forward and let it cool and take this shape.

The theory is that the movement of the jaw to a forward position will open up the tissues in the back of the neck.

Some of this critical positioning stuff I learned after I had placed my order. I have "overbite" and there is very little room to move the jaw forwards with my bite.

So, I never used it. It was called a SnorBan sport mouthpiece and was pretty affordable.

There are threads, possibly on BPL, that discuss some of these devices, including the ones made by dentists from patented designs and materials that they purchase in order to fit you. These are more expensive. I don't have any decent data on the effectiveness, but it is one of those "best effort" approaches and mileage varies a lot between individual patients and possibly fitting dentists. I used to have a bunch of websites for these devices bookmarked, but I appear to have misplaced or erased those bookmarks.

If you have had good results with one device, I envy you.

jimbo jones
(hawaiicruz) - F
apnea device on 07/14/2010 22:16:10 MDT Print View

this one actually sucks on to your tongue and pulls it out of your mouth. I was leery at first but it has worked for me. I just got back from a four night trip, and while it didn't stop my snoring it did stop the apnea

James D Buch
(rocketman) - F

Locale: Midwest
Positional Sleep Apnea on 07/29/2010 18:47:01 MDT Print View

Various people have marketed devices that are supposed to keep an individual with sleep apnea from sleeping on his/her back.

"Positional Sleep Apnea" is a term to describe sleep apnea that depends upon body position - namely apnea in supine sleeping but little or no apnea when side sleeping.

Here is one article on the observation of this set of traits.

http://cme.medscape.com/viewarticle/514608

__________________________________________

Positional Sleep Apnea May Be Common

News Author: Laurie Barclay, MD



Oct. 17, 2005 — Positional sleep apnea is common and not usually diagnosed on split-night testing, according to the results of a retrospective chart review published in the October issue of Chest.

"Body position during sleep influences the frequency of apneas and hypopneas in 50 to 60% of individuals with obstructive sleep apnea (OSA)," write M. Jeffery Mador, MD, from the State University of New York at Buffalo and the Veterans Affairs Western New York Healthcare System (VAWNY), and colleagues. "Various estimates indicate that positional therapy alone could be used to treat approximately 30 to 50% of all patients with OSA."

The primary objective of this study was to determine the prevalence of positional OSA, defined as a total apnea-hypopnea index (AHI) greater than 5, with a greater than 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI less than 5) in the nonsupine posture. The secondary objective was to determine if positional sleep apnea could be accurately diagnosed during a split-night study.

The investigators reviewed records of 326 patients, including 57 patients who underwent a split-night study and 242 patients who underwent polysomnography.

Positional sleep apnea was diagnosed in 49 (49.5%) of 99 patients with mild sleep apnea (AHI, 5 - 15/hour), 14 (19.4%) of 72 patients with moderate sleep apnea (AHI, 15 - 30/hour), and 5 (6.5%) of 77 patients with severe sleep apnea (AHI greater than 30/hour). Sleep time did not exceed 15 minutes in both postures in 104 (38.7%) of 269 patients at the VAWNY and in 80 (33.1%) of 242 overnight studies at the Associated Sleep Center nor in 47 (82.5%) of 57 split-night studies. The percentage of studies with insufficient sleep time in both postures was greater for split-night studies ( P < .0001).

"Positional sleep apnea is common particularly in patients with milder disease who have smaller neck circumferences," the authors write. "Positional therapy has the potential to be an effective therapy in a significant proportion of patients with sleep apnea. Rigorous outcome studies evaluating the efficacy of this treatment modality are urgently needed in patients with mild-to-moderate sleep apnea."

Chest. 2005;128:2130-2137

Jeff Moody
(BigTiki) - F
Re: apnea device on 07/29/2010 21:07:52 MDT Print View

Jimbo,

Is the one you purchased the MPowRx? Thanks.

jimbo jones
(hawaiicruz) - F
apnea on 08/03/2010 12:45:52 MDT Print View

It's called aveo tsd I think it comes out of new zealand

James Ennis
(JimEnnis) - F

Locale: South
sleep apnea on 09/04/2010 08:51:07 MDT Print View

I suffered from moderate/severe sleep apnea for several years. I tried the CPAP machine, but it and I didn't get along at all. So, in 1998, I had surgery to correct an elongated soft-palate and have not had any problems since. This was the best thing that I have ever done. I don't suggest that surgery is the best option for everyone, but it did wonders for me.