Breathing While Skiing — Sleep Apnea and CPAP, Altitude and Me

I’m a ski journalist — writer, filmer, editor — so it’s serious business when I have a skiing-related problem.

Three winters ago, I had one, a big one. Here’s what I wrote about it then:

Aging worsens the effects of altitude and alcohol. Yep, the older you get, the harder you fall, as I discovered my first morning in Aspen. I was meeting a local guy at 10 a.m. which gave me just enough time to take a warm-up run on Buttermilk. I chose Buttermilk because it tops off at 9,900 feet, not the 11,212 of Aspen or the 12,510 of Snowmass.

My friend arrived at the lift right on time. I watched him scan the crowd. Couldn’t find me. He looked again, this time a little lower. Ah ha — he spotted me. “Jules,” he asked, “why are you sitting under the ski rack?”

“Be. Cause. I. Can’t. Get. Up.”

“Oh, no! We don’t have to ski. We can meet in—”

“We’re. Gonna. Ski. But first. I need. A cuppa. Hotchocolate.”

“And a lot of water and a banana. Let’s go get it. If you can walk.”

I could walk. And after the hydration-and-potassium timeout, I could ski. Not elegantly. Fifty yards, then a break. By afternoon, 100 yards, then a break. The next day, 200 yards, and the day after that, I’d left Aspen and was skiing Telluride’s towering top —12,570 feet — with no break.

What caused my first day’s humiliation? Age. Plus living 200 feet above sea level — down by the San Francisco Bay — but mainly age. I was 76.

At the time, I’d wracked my brain looking for something other than age that would account for the problem. I found nothing . . . until last winter. Unlike in Aspen, I had zero altitude issues. And I’d been skiing high in the mountains of Montana. And come to them not just from sea level, but from summer. I hopped off the plane from Auckland, New Zealand and a few days later was skiing Big Sky, Montana. With no altitude problem whatsoever.

What was different? Aspen — undiagnosed sleep apnea. Big Sky — CPAP. Put another way, no CPAP, apnea and altitude issues. CPAP and problem-free skiing.

Let’s define our terms. Sleep apnea: a common, sometimes serious sleep disorder where you repeatedly stop breathing, then (hopefully) start again. CPAP: CPAP stands for Continuous Positive Airway Pressure and consists of a mask over your nose, attached to a small air-pump that helps you breathe during sleep by keeping your airway open.

Yes, freshly diagnosed with sleep apnea, I took my CPAP machine to Montana. During sleep, I stopped breathing for ten seconds or more once or twice an hour. The previous winter, before I got my CPAP, it was thirty-eight times an hour. Now I could ski the Montana heights without stopping every few yards and without trying to catch my breath while sitting under the ski rack.

With one small exception, I’ve found nothing in the medical literature or ski journalism about this. The exception is a preliminary communication published in JAMA, Journal of the American Medical Association, in 2012, titled “Traveling to High Altitude When You Have Sleep Apnea.”

The relevant summary line reads, “Patients with obstructive sleep apnea who travel to high altitude should continue to use their CPAP machine while traveling as they do at home.”

Unless I’ve missed something — always a possibility — with that brief exception, you’re now reading about altitude and apnea, skiing and CPAP for the first time.

Partly because of the dearth of mention, I had reservations about my discovery. Was the CPAP Effect real or did I just want it to be real? Real or placebo —the eternal question in human science.

This winter I found the answer. I skied the perfect place to put the CPAP Effect to the test, the high peaks of the Austrian Alps, Sölden and St. Anton.

Sölden came first. Though it was the first two days of my ski season, and though our gang whipped through fourteen linear miles and roughly 13,000 vertical feet in soft snow under bluebird skies, I never experienced that Aspen search for breath. I don’t mean I was skiing like an eighteen-year-old. I was 78, still jetlagged, and by far the oldest and slowest skier in our group. I felt tired thighs but not gasping lungs.

On Day Two, I was stronger, still. So, I went into the third day filled with confidence. Under still-sunny Austrian skies and comfortable few-degrees-above-zero temperatures, I was gonna breathe the hell out of St. Anton.

Only, I didn’t. Though never as bad as that day at Aspen, I was stopping every couple of hundred yards to gasp for breath. My frequent stops were holding up the group and leaving me feeling ashamed, disappointed and confused — what was going wrong? What was different?

Then, on the third run, it came to me. The night before, at our St. Anton lodge, I couldn’t find an electric outlet near the bed. For maybe the second time in more than a year, I’d slept without my CPAP.

At that moment, I knew that this was no placebo effect. The CPAP Effect was real — for sure, real. I’ll never ski without a CPAP night’s sleep again.

Jules Older is a clinical psychologist, medical educator, children’s author, and ski journalist.