Thru-hiking with sleep apnea is a challenge. I’ve been under the watchful eye of a sleep physician for several years. She diagnosed me (Steve) with moderate obstructive sleep apnea. I learned all about this when I had issues with A-FIB for several years.
At home, I have a Dream Station CPAP machine that sits next to the bed. It’s very, very quiet. I found a strong correlation between my A-FIB and my sleep apnea. (My cardiologist AND sleep doctors had no idea what to do with me. I made graphs plotting my A-FIB versus my sleep apnea!) So, anyway, I take my heart health seriously. If wearing a dang CPAP device will help me have a happy heart, I’ll wear the darn device. So, I have a compliance rate of about 99%.
However, it’s a love-hate relationship between the CPAP and myself. The CPAP is a real intimacy killer. Each night I strap a device on my face when it’s time to sleep. There’s no conversation between Noelle and I once I buckle this baby down. It’s just “good night”!
I purchased a portable, battery powered CPAP several years ago when we began thinking about hiking the PCT. We thought that thru-hiking with sleep apnea may have challenges, so we took this small device backpacking a few times prior to our PCT trek. In addition, I took the portable CPAP machine on quite a few business trips to check it out with hotel travel. It’s a HDM-Z1 Auto Travel CPAP Machine. (I’ve since upgraded to a HDM-Z2)
So, how did the HDM-Z1 Auto work for backpacking? Let’s look at the weight first.
Weight of the CPAP
The combined weight was a bit problematic. If I’m shooting for a base weight of roughly twenty pounds, the CPAP device and attachments themselves are taking up roughly 25% of my total weight. Still, if I need a CPAP I need a CPAP, right? I can just carry a little more weight than I wanted, so that I could carry the CPAP along. So we took the (kind of heavy) HDM Z1-Auto out on the trail as part of a few shake down hikes. I found myself dropping a few curses here and there about the weight of my pre-PCT pack. Five pounds is a LOT of extra weight for a thru-hike….
Noise levels are subjective. What’s loud to me, may not be so loud to you, and vise versa. What’s not subjective though is the relative silence of the trail at night. There are animal noises to contend with along with wind/water/weather related noises and the odd assorted giggle, fart or conversation from other hikers. Other than these items, there’s not that much noise on trail.
Noise of the CPAP
We took the CPAP out on the trail…and the noise drove us crazy. At home we didn’t even really notice the noise of the CPAP…on the trail…Wow, it was really LOUD.
After two nights of noise, I started looking for options (other than turning it off) of quieting down the whole darn operation.
I swapped out the default tubing for a Travelhose collapsible CPAP tube. I had found a few mentions on other websites of the collapsible travel hose being quieter than the default tubing . It was still rather loud.
I added in the HDM Qtube muffler. I still didn’t notice any discernible improvement, but I did have issues with the muffler becoming dislodged from the tubing in the middle of the night. The noise level would spike and I’d wake up gasping for air. Not pleasant, not one tiny bit. The muffler also added additional components; an hose adapter, and replacable muffler filters.
I tried again and added in the HDM Heat/Moisture Exchanger (HME) Inline Humidification Solution Unit. I did observe that the noise level dropped when I used the muffler and the HME. But again, this is another component that I’d need to carry with me.
I installed an app on my phone and checked the noise level when I was using the CPAP. Roughly 66db on the exhale. Normal conversation is about 70db. So, the was basically like having a full blown conversation in the tent all night long!
So I wasn’t really in love with all the components that I’d need to carry with me on the trail to use this system. It just seemed like a lot of moving parts that would easily become lost or filthy.
How to Power the CPAP while hiking with Sleep Apnea
So how to power the CPAP? The CPAP device itself, including the power supply cord, was one purchase. The battery was an additional purchase. The battery life was rumored to be “two days”. What the heck did that mean? I went to the source/supplier and asked them for clarification. It was their advertisement after all that said a long distance hiker used the HDM system!
After a lot of back and forth email I touched bases with “Stuart the hiker”. Stuart has hiked part of the Colorado trail and part of the PCT. Stuart said he set the system on the lowest pressure setting possible, 4 or 5 psi. He would go to sleep, sleep for a few hours, wake up, strap up, and then sleep until dawn before disconnecting. So in essence he was extending the battery life by limiting the psi and daily use time. Hmm…
So how did he handle recharging the batteries? (The HDM won’t recharge a battery while you’re using the system.) Stuart indicated that he carried two batteries and charged up every four days in town at a hotel or motel. The math didn’t add up for me; recharging the battery can take twelve to sixteen hours. How could he recharge the batteries without spending two days at a hotel? Stuart responded that he had forgotten that he actually had a third battery that he carried and had a bounce box with a second re charger.
At this point I considered the HDM to be a bust for a thru-hike attempt. The noise, the weight and the battery charging issues were too much for me to overcome.
What do other hikers do?
I reached out to the friendly Facebook PCT hikers group and asked for their input. Is anyone else thru-hiking with sleep apnea? The response wasn’t particularly helpful. Here’s my summary of the responses;
I checked with my primary sleep doc about the dental device and she advised me to buy a cheap one on-line and not to spend much money on it; her input was that it wasn’t going to work, so save my money.
I went to my dentist, who said “oh heck yeah, we create Mandibular Advancement Device’s (MAD) all the time!” I opted to have my dentist create a MAD for me. It took a few weeks from the molding process to the fitting.
I’ve come to have a love hate relationship with the mouth guard. Does it work? Yes. The device locks down onto the upper and lower molars. The top of the mouthpiece is connected to the bottom of the mouth piece. The device “pulls” the bottom jaw “forward” and that opens up the breathing airway and eliminates the snoring.
The pros and cons of the Mouth Guard
The Pros: It’s small, easy to clean with a toothbrush and requires no recharging.
The Cons: It’s uncomfortable, my dentist really had no idea what she was doing, it’s painful after a few hours and I’m slobbering like a dog with a juicy ham hock when I’m wearing the device.
The initial feedback from my dentist was “wear it and continue to increase the the tension” until the tension (forward thrust of the lower jaw) was maximized.
I initially found the device to be uncomfortable and I could only wear it for a few hours per night. I tried to sleep on my side when I wasn’t wearing the device. After a month or two I found that I could wear it for five or six hours, but usually woke up and removed it around 4 AM. I increased the lower jaws “forward tension” once every few weeks until it was maximized.
Somewhere around month four of the hike my jaws really started to bother me. I recognized in the mornings that my jaws were no longer “aligned”. The upper molars no longer fit correctly with the lower molars. I had a difficult time chewing for the first few hours of each day. Chewing meats/hard objects became a tad difficult. I was able to logic through what was happening, but I was kind of stuck without too many options.
I found myself waking up at night after only a few hours and spitting the device out. It hurt my teeth. It felt like there was a little person in my mouth using a tiny little crowbar on my teeth. I was worried that my teeth were moving all around in conjunction with my weight loss. Apparently, thru-hiking with sleep apnea causes issues beyond just poor sleeping.
How about after the hike?
So….Three months after I stopped hiking, and stopped using the mouth guard, I went back to my dentist. I said “hey, this darn thing moved my teeth all around”. The dentist said, “oh no, these devices don’t move teeth. If your teeth moved it was normal movement.” How strange then that I have just about a centimeter (yes, a centimeter!) of movement on my two bottom teeth where the device attached to my teeth? I think the dentist was in a complete ass cover mode, perhaps, just perhaps, the tension was set too high based on her input to keep cranking it “up”.
The centimeter gap is problematic. I have a new hobby called excessive flossing. The gap is big enough that pretty much everything gets caught in my bottom teeth where the MAD connected to the molars. Not a big deal in the scope of life, but it kinda hurts when it happens. The Good Dentist’s advice is to have two crowns replaced to close the gap’s. We’ll see how this plays out over time. Since I JUST had two crowns installed prior to the PCT hike, I’m not so game to just swap them out!
Bottom line: CPAP or MAD? I’d take the MAD option, but I’d really hunt to find a dentist who has experience with the devices. It’d be ideal to find a dentist who has been thru-hiking with sleep apnea. Anyone know one?