Altitude Related Issues

What is Periodic Breathing during Sleep?

periodic breathing, difficulty sleeping at altitude, cheyne stokes breathing, high altitude peripheral edema, high altitude flatus expulsion, high altitude syncope, chronic mountain sickness, sleeping at high altitude, camping at high altitude, Himalayan climbingThis condition, which can cause trouble sleeping, happens quite frequently but is not associated with altitude illness. It results from a battle within the body over control of breathing during sleep. Oxygen sensors in the body command the brain to increase breathing, which causes the lungs to blow off CO2. But CO2 sensors in the body then tell the brain to stop breathing, because CO2 is getting too low. So breathing then stops for about 12 seconds, until the oxygen sensors take over again. The result is an irregular pattern of breathing, with 4 or so large breaths followed by no breaths. The first large breath will sometime wake up a person, with a sensation of feeling breathless or suffocated. This pattern may continue throughout the day as well, but typically is most disturbing at night as it frequently wakes a person multiple times. Although uncomfortable it is not dangerous. It is easily treated with a small dose of Diamox® (62.5 or 125 mg) taken before bedtime; this smooths out the breathing and improves sleep and raises blood oxygen.

What can I take to help me sleep?

  • If you are not sleeping well because of periodic breathing, Diamox® should be the first choice of medication to improve sleep.
  • Benzodiazipines such as temazepam (Restoril®), lorazepam (Ativan®), diazepam (Valium®), and alprazalam (Xanax®) should generally be avoided as they decrease the breathing drive, especially when combined with alcohol. Sleep medication such as zolpidem (Ambien®) and eszopiclone (Lunesta®) are safe at altitude and seem to work well without affecting the breathing drive.
  • Some folks use over-the-counter sleep aids such as Tylenol PM® which contains Benadryl®, an antihistamine. Antihistamines have not been shown to affect breathing and may be taken safely.
  • If you are taking trazadone for sleep, there is no evidence that it decreases the breathing drive and is likely safe at altitude.
  • If you have obstructive sleep apnea (OSA), this can worsen your sleeping symptoms at altitude. If you sleep with CPAP (continuous positive airway pressure) you should make sure to use it at altitude.

Why do I get swelling in my hands and feet?

Swelling sometimes occurs in the arms, legs and even the face at altitude and is called peripheral edema. It is sometimes associated with altitude illness but occurs frequently in people without any other symptoms. Women experience peripheral edema more than men do. Exercise may increase edema. Edema will improve with Diamox® or another mild diuretic, but it also resolves spontaneously.

High Altitude Flatus Expulsion

While not serious, this condition can be quite discomforting to those experiencing it as well as those in close proximity. During ascent to altitude barometric pressure decreases resulting in expansion of gas in the bowel. This creates a larger volume of gas needing to be passed as well ensuing abdominal discomfort and unpleasant odors. Simethicone (Gas XTM) over the counter as well as some digestive enzymes may help relieve some of the discomfort. Certain foods known to cause gas may need to be temporarily avoided.

High Altitude Syncope

Occasionally, travelers to moderate altitude will experience a brief fainting episode during the first 24 hours. This generally has to do with changes in blood pressure that occur at altitude. It happens only once, generally after eating a meal or drinking alcohol. These episodes are not serious and do not indicate a problem with your heart. They are unassociated with altitude sickness.

Chronic Mountain Sickness

This uncommon condition occurs in those who have lived for an extended period of time at altitude. Symptoms include headache, fatigue, difficulty sleeping, muscle aches, and difficulty with memory and concentration. They typically have an abnormally high level of red blood cells (polycythemia), abnormally low blood oxygen levels (hypoxemia), elevated blood pressure in the lungs (pulmonary hypertension), and a blunted breathing response to low oxygen levels. Occasionally, it can lead to right sided heart failure. It occurs more commonly in children and males who were born or lived at altitude for an extended period of time. Certain medications such as acetazolamide as well as oxygen therapy can improve breathing. Blood draws (phlebotomy) help relieve the abnormally high blood counts, but the only definitive treatment is descent