Talking Sleep High Altitude Central Sleep Apnea: Diagnosis and Treatment
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Feb 27, 2026 David McCarty, a Colorado-based sleep medicine physician and CMO at REBIS Health, shares his altitude expertise. He discusses how low CO2 and loop gain drive central events, patterns across elevations, and mixed obstructive-central presentations. Practical topics include testing and device adjustments for travelers, mask and pressure strategies, and treatment options like oxygen, acetazolamide, and ASV.
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PLMs And Mouth Opening Amplify CSA
- Non-respiratory factors like posture, open-mouth recovery breaths after PLMs, and arousals amplify central instability at altitude.
- Example: PLM-triggered large mouth breaths can drop CO2 below the apnea threshold and produce central hypopneas.
Start Low Pressure And Use Nasal Interfaces
- Score and discuss central hypopneas at altitude and favor nasal interfaces to avoid oronasal-driven overventilation.
- Start therapy at lower pressures, avoid wide auto ranges and minimize EPR to reduce treatment-emergent CSA.
Assess Stability And Prevent Overventilation
- For patients likely to develop unstable breathing at altitude, prioritize nasal breathing, limit pressures/EPR, reduce leaks, and monitor AHI stability across nights.
- If instability threatens health, recommend avoiding ascent or provide supplemental oxygen.
