Coping with Obstructive Sleep Apnea When There is No Grid Power, by Chris X.

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Obstructive Sleep Apnea (OSA) is a breathing disorder which is caused by the narrowing or total occlusion of the airway while sleeping.  The study of sleep using electroencephalogram electrodes, chest and abdominal effort belts, breathing sensors, and blood oxygenation sensors is called polysomnography.  The advent of Continuous Positive Airway Pressure (CPAP) machines in the 1980s started the home treatment revolution of OSA.  Studies have shown that untreated OSA can cause high blood pressure, heart disease, stroke, depression, excessive daytime somnolence, fatigue, occupational accidents, and motor vehicle accidents.  More recent studies have shown that OSA is linked to adult-onset diabetes, fibromyalgia and attention deficit disorder.  OSA is just one of the disorders in the Sleep Disordered Breathing realm.  Depending on the diagnosis and appropriate treatment, a person may utilize a CPAP, Auto-PAP, BiLevel, Auto Servo Ventilation (AutoSV), or Variable Positive Airway Pressure (VPAP) machine.  For the rest of this article, I will refer only to OSA and CPAP for simplicity.

OSA is a common problem in our nation.  One study shows that about 1 in 5 men and 1 in 10 women in the United States have Obstructive Sleep Apnea (1).  While many people have been tested and treated for OSA in the past two or three decades, it is still suspected that more people have been undiagnosed than have been diagnosed.  One of the first things that will be seen without electricity is a die-off of people afflicted by many life-threatening ailments.  People sustained by ventilators will be gone in minutes after a large scale power failure.  People who require dialysis for kidney failure will be gone in a matter of days or weeks.  The vast majority of people with OSA will not expire in the short term without their CPAP machines.  However, they would likely become miserable, exhausted, and experience physical and mental breakdowns from not getting restful sleep.
I am a respiratory therapist and sleep technologist.  I also have OSA and use a CPAP machine.  I love and endorse it.  In a national crisis and utility collapse, I would miss running my CPAP on AC current.  However, here are some ways to cope.

Run your machine on DC power.

Most of the modern CPAP machines have a 12 VDC power input port.  Cords can be obtained from Home Medical Equipment (HME) providers but are not a prescription item and insurance does not cover them.  It is least expensive to find what you need on the internet.  I have a cable with a DC jack on one end and a male cigarette lighter plug on the other.  This cable alone could be used to power the machine in a vehicle from the cigarette lighter.  I have second cable which has a female cigarette lighter socket and splits into two jumper cable type battery connectors.  When connected to a fully charged deep cycle marine battery, I get at least two nights of power for my CPAP.  This is what I do when I go ice fishing in a sleeper house in the winter.  Hiking with a deep cycle marine battery is cumbersome to say the least and not practical when on the move.  A small number of CPAP machines have internal batteries but they usually only offer about 8 hours of power before being depleted.  Heated humidifiers really consume battery power.  If you use a humidifier, it is best to use the humidifier passively and just let the air pass over the water in the chamber.  You won’t get nearly as much humidification but it’s better than none at all.  Use saline to moisturize your nasal passages and drink water to stay hydrated.  The number of hours you get out of a deep cycle battery varies depending on the battery’s amp-hour rating, the ambient air temperature, and the pressure(s) that your ventilatory device operates at.  To recharge the battery, photovoltaic mat or panel can be used to trickle charge it.  I have looked into portable military grade solar mats and panels  They are expensive, running a few hundred to over $1,000.  However, they can also be used to recharge cell phones, GPS devices, and any other battery powered gear.  It may be worth it to you to invest in a good one.

[JWR Adds: Be sure to get a charge controller, to avoid over-charging your battery bank. For a typical CPAP machine, plan on a battery bank with at least 260 amp hours of capacity. Generally, this means buying four deep cycle ("marine" or "golf cart") 6 volt batteries, and cabling them in a series-parallel arrangement, to provide 12 Volts, DC. I recommend using 6 gauge cables. Your local golf cart shop should have a 6 gauge cable terminal crimping tool available, and can fabricate the cables for you, for a nominal fee. These days, the copper in the cables will probably cost you much more than the terminals and the labor charge.]

Provent nasal valves.

Provent is made by Ventus Medical Inc., Belmont, California.  These nasal devices were introduced a couple years ago.  They look like a pair of penny-size adhesive bandages.  In the center, each contains a small valve.  Provents are peeled and adhered over each nasal opening.  The valves allow air to easily be inhaled through the nostrils, but when exhaling, the valves close, leaving only a small hole to exhale through.  This creates backpressure which props the airway open much like CPAP.  A chin strap is recommended to keep the mouth closed.  Studies have shown that they are quite effective in treating OSA and are used primarily for people who fail to tolerate CPAP (2).  They are also used by people with OSA who go on extended outdoor trips where there is no electricity.  It requires a doctor’s specific prescription for Provent Therapy and cost about $60 to $70 for a month supply.  Like prescription medications, it could be difficult to stockpile large quantities that would last you many months or years with no electricity. 
See Proventtherapy.com for more information.

Get fitted with an OSA dental appliance now.
This may be the best option, in my opinion.  No power needed.  These are very effective and portable.  I am not referring to the television infomercial “boil and bite” anti-snoring mouth pieces.  Those usually deteriorate within a matter of months.  There are several different styles of dental appliances used to treat OSA.  Very strong materials are used including high tech hard plastics, titanium, micro screws, and springs.  These are not cheap devices.  They can cost anywhere from $1,500 to $5,000 to have them custom molded, fitted, and tested by a dentist specializing in treating OSA with dental devices.  They advance the lower jaw, creating a mild under bite, advancing the tongue, and opening the airway.  Care must be taken to optimize the effectiveness of the appliance without causing temporal mandibular joint (TMJ) problems or pain.  If you wear dentures or have bridges, you will likely not be a candidate for a dental appliance like this. 

See www.abdsm.org for a list of dentists who specialize in this area.    

Positional sleep therapy.
When there are no other options, at least try to sleep on your side with upper body elevated.  A significant angle helps overcome gravity and prevents airway tissues and the tongue from drooping and blocking the airway.  Sleep at angle on a hillside if outdoors.  In your survival retreat, use a wedge or several pillows to significantly elevate your head.  45 to 60 degrees may be required for desired effect.  Many people note an improvement in sleep when in a reclining chair.  It can help.  However, I’ve rarely seen anyone sleep on their side in a recliner.  They are still essentially supine and still can exhibit obstructive apneas and flow-limited breathing.  Sleeping prone is no guarantee of a patent airway either.  I’ve seen many people snore and have respiratory events while sleeping on their stomach.  There are several pillows on the market which claim to treat OSA.  However, your head must stay in the correct position for it to work.  For anyone who has taken a CPR course, you know the head-tilt, chin lift method to opening the airway of an unconscious victim.  This head position would work great at treating obstructive sleep apnea, but who would ever stay in that perfect position while sleeping?  One positional method includes wearing a backpack with a soccer ball or basketball inside.  It prevents turning to supine position while sleeping.  If you are in the woods with a full backpack, wear it while you sleep to stay on your side.  There’s still the possibility of airway collapse when sleeping laterally and elevated but it’s less likely than totally supine.    

Lose weight now.

Obesity is a contributing factor in OSA.  That’s not to say that all obese people have OSA or that slender or fit people don’t have OSA.  People I see in the sleep lab come in all shapes, colors, and sizes.  One of the loudest snorers I’ve ever heard was a petite, middle-aged woman who was 5’ 4” and 125 lbs.  The longest obstructive apneas with the most severe oxygen desaturations I’ve ever seen were exhibited by a man who was 5’10” and 185 lbs.  People can be predisposed to having OSA due to the size of their tongue, tonsils, soft palate, and uvula.  They may have a small and / or recessed chin (micrognathia and retrognathia).  Their neck circumference, alcohol and tobacco use, age, and gender are all contributing risk factors.  However, weight gain is a major cause in developing OSA, especially during middle age.  In a survival situation, calories will be a commodity hard to come by and many will no longer have a choice in the matter.  Today while we still have all the modern conveniences, it’s a lot easier said than done to lose weight and keep it off.  If you are obese, significant weight loss is likely to reduce the severity or presence of OSA but is no guarantee that you will be “cured”.  Your goal should be to get your weight and Body Mass Index (BMI) into a normal range.  Refer to this National Institute of Health chart, to see where you are and where you should be.

Surgical treatments for OSA.
Surgeries are not always the best solution to treating OSA.  All too often, people arrive at the sleep lab and state, “If I have obstructive sleep apnea, I just want to have ‘the’ surgery and fix it once and for all”.  Unfortunately it’s just not that easy.  There are many different types of surgical procedures.  There are too many to go into in this article.  However, I will state that most surgical procedures focus on removing, shrinking or toning the tissues of the upper airway.  Depending on which surgeon is selling you their services and which procedures they specialize in, results vary greatly.  I see many people in the sleep lab who were diagnosed with OSA, disliked CPAP, had surgery, and still had OSA and had to continue with CPAP.  The surgeries are invasive, costly, painful, and require weeks of healing time with no guarantee of success.  The only surefire and drastic way to surgically treat OSA is with a tracheotomy, which people rarely agree to.  Proceed with caution and research the surgeon and the procedure they want to perform on you.

Use Breathe-Right nasal strips to decrease snoring. 

High nasal resistance is a contributing cause to snoring.  Narrow nasal passages, a deviated septum, history of nasal fractures, polyps, and congestion all contribute to increased nasal resistance.  Perform Cottle’s maneuver (3) by placing your index fingers on your cheekbones about an inch under your eyes.  Gently pull the skin on the cheekbones outwards toward your ears.  If you note your nasal passages open and you can move air easier, then you likely have some nasal resistance.  A Breathe-Right strip can help decrease nasal resistance and the likelihood of snoring from nasal issues.  Remember that snoring and OSA are two different things.  Often, Breathe-Right nasal strips do little to alleviate respiratory events caused by a compromised airway in OSA.  However, they are a great adjunct therapy in combination with wearing a CPAP mask or dental appliance to help a person exchange air nasally.  They are extremely small, portable, and light.  I feel that the treatment of snoring is also important as it could be a security risk.  Snoring while outdoors can give away your position, whether in the day or night.

In Summary:

In a world where there is a bed, bedroom, and electrical power, I will take my CPAP any day.  If there is no grid power or I’m out in the wilderness, my strategy would be to sleep laterally with my head elevated, using a dental appliance in conjunction with a chin strap and Breathe-Right nasal strip.  However you decide to manage your OSA in a world without electricity, it is my hope that you find a way to get some quiet, refreshing sleep, as it is imperative to your mental and physical acuities to be alert and sharp in order to survive.
God bless and keep you!

References
1.  Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine.  1993;328:1230–1235.

2.  Walsh J, Griffin K, Forst E, Ahmed H, Eisenstein R., Curry D, Hall-Porter J, Schweitzer P.  A convenient expiratory positive airway pressure nasal device for the treatment of sleep apnea in patients non-adherent with continuous positive airway pressure.  Sleep Medicine. 2011;12: 147-152.

3.  Tikanto J, Pirila T.  Effect of the Cottle’s maneuver on the nasal valve as assessed by acoustic rhinometry.  American Journal of Rhinology.  2007 Jul-Aug;21(4):456-9.


About the Author: Chris X. is a Registered Respiratory Therapist, Registered Polysomnographic Technologist, and a Registered Sleep Technologist

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