Adjusting to high altitude, over 6000 ft

[marzNC]

For those of us who are flatlanders, taking into account high altitude when planning a ski trip to a big mountain is important. For me, one reason I ski Utah instead of Colorado is altitude. Not the primary reason, but definitely a factor. Having the option to sleep at under 5000 ft for at least the first few days and still have a short, easy drive for prime skiing can be helpful.

There is a good EpicSki article about Altitude Adaptation and Acute Mountain Sickness (AMS) written in 2006 by a physician associated with the Colorado Center for Altitude Medicine and Physiology.

Good tips in this Diva thread from a few years ago:
https://www.theskidiva.com/forums/index.php?threads/coping-with-altitude-and-long-runs.2711/

For most people, dealing with high altitude is a minor issue with a bit of planning. How long does the adjustment usually take for you?

 

[altagirl]

I've had issues sleeping over 9000' for sure - Brian Head (base elevation of 9800'), Silverton (9305'), even Winter Park (9050') has occasionally not agreed with me. And I live at 4800'. I don't really have issues skiing or biking at elevation - a little out of breath climbing at 10-11,000', but nothing I would consider an issue - it's just sleeping that's sometimes an issue for me. It's like my body forgets to breathe and I wake up with a migraine, feeling like I'm suffocating. I can stay awake and do breathing exercises and feel better for a bit, but fall asleep and it starts over again. Heh, and needless to say, staying awake all night doesn't do anything for making me feel good either.

The thing is that it's very inconsistent for me. Some trips - not a problem. Others - just awful. Doesn't seem to be related to my physical conditioning. Alcohol doesn't help, that's for sure, but not drinking is no guarantee that I'll feel good either. The absolute worst I felt was 2 years ago and I didn't drink anything other than a ton of water. That time I thankfully had driven separately to Brian Head and drove down a couple thousand feet for a few hours, didn't really feel better and just gave up and went home. Felt 100% better halfway back to Sandy.

Part of my problem is that I can't take pain killers for the headaches without making my stomach utterly miserable, so once it starts, I'm kind of a mess. But we were just in Winter Park last weekend, and no issues at all. In fact, I actually felt good climbing up on the mountain last weekend too - no shortness of breath that I would even find normal exerting myself at 11000' or so. Fingers crossed. We're going to Brian Head this coming weekend...

 

[abc]

Similarly for me, it's sleeping that presents the most challenge. I'm guessing Altagirl nail it that perhaps the body simply forgot to breath?

Awake, we can adjust our breathing according to how out of breath we feel. Sleeping, I'm not so sure.

Anyway for me, during the day, I start to feel the elevation above 6000'. Now, that's not really a magic number. It's just I have a lot of chance to go to 4000' and 6000' but not been to 5000' altitude much. So I can only say I don't feel any differently at 4000' but does feel the oxgen shortage at above 6000'. In reality, it maybe 5000' instead but I wouldn't know. I can still do sport above 6000' all the way to above 10,000, but my stamina and performance both starts to suffer above 6000' and gets progressively worse.

What I found really helps is to sleep at 8000-9000' for a night or two before moving higher. Then I only had to deal with shortness of breath when I'm active but no other discomfort at rest.

For sleeping, probably 9500' is the magic number I have restless nights above 9500' and no noticable trouble below.

 

[mustski]

Our cabin is at aout 6900' so we are used to that. We go almost every weekend all winter and regularly during the summer. Even when we go higher, I don't notice it until I get above 9000'. DH is another matter. He always feels it a bit, even at our cabin. He takes excedrin migraine for the headaches and I push water down his throat. The only time I spent the night above 8000 was in Colorado, camping at Rocky Mountain National Park. I slept ok, but I didn't even have the energy for long walks never mind hiking. It took me 2 days to acclimate.

 

[NZfarmgirl]

I read the other bumped thread from 08, there was a lot of talk about hydration and taking something for a headache, but DH felt quit sick. Would anti nausea tablets help as well? What about breathing exercises like Pilates?

 

[EnglishSnowflake]

I read the other bumped thread from 08, there was a lot of talk about hydration and taking something for a headache, but DH felt quit sick. Would anti nausea tablets help as well? What about breathing exercises like Pilates?

I've done Pilates for quite a few years now and if done properly I can see how some of the lateral breathing exercises might help get a bit more oxygen exchanged but I don't know if it would be enough to bring him any real comfort. Worth a try perhaps. How about the wristbands for travel sickness? I've never needed them myself so I don't know how effective they would be in your DH's case. Anyone else ever tried them for altitude-related nausea?

The only effect of altitude (apart from a bit of puffing & blowing when I'm exerting myself which is no trouble really) I've really experienced is very vivid dreams for the first few days until I settle in. Not bad for someone who lives at sea-level as near as matters then goes straight to sleeping at 6000 ish ft and skiing up to 12000ft, I'll consider myself very lucky.

I have wondered if taking an iron supplement on the run-up to a trip would encourage an increase in haemoglobin production and make acclimatisation quicker?

 

[marzNC]

My sense is that dealing with AMS is not as simple as being fit or just treating symptoms. It really is a medical condition that's worth understanding to avoid a trip to the emergency room. That said, here are recommendations from the EpicSki article:

https://www.epicski.com/a/altitude-adaptation-and-acute-mountain-sickness

"Is there anything I can do to enhance acclimatization?

• The first, best, and most obvious thing is graded ascent. If you can, come up slowly- spend a night in Denver or Salt Lake City before going up to the resort. This, of course, is not always practical, but may be an option for some.
• Limit exertion on the first day out.
• Don’t smoke!
• There is some evidence that a high carbohydrate diet beginning about 3 days before ascent may speed acclimatization.
• Climb high, sleep low. This old climber’s maxim makes a lot of sense, especially since sleep disordered breathing is a common manifestation of AMS, and AMS is often worse during sleep. If you are prone to AMS, you may feel better at a resort with a lower base elevation.
• Avoid alcohol for the first few days.

If you have had consistent, repeated problems with altitude sickness, you may be a candidate for prophylactic (preventive) therapy. You should discuss this with your doctor. There is one medication proven to help acclimate to altitude and one that is controversial.
The proven one is acetazolamide (Diamox). It works mostly by mimicking and enhancing the body’s respiratory adaptive mechanisms, and should be started a day in advance of ascent. It can also reduce the symptoms of AMS once it develops, but should not be relied upon for treating anything more than mild disease- particularly sleep disturbances. It has several mildly unpleasant potential side effects- it causes tingling in the lips, hands and feet, and makes carbonated beverages taste bad. It is a diuretic, so you need to increase fluid intake. It is about 75% effective at preventing AMS during rapid ascent. It cannot be used by people with true sulfa drug allergies."

 

[marzNC]

. . .

I have wondered if taking an iron supplement on the run-up to a trip would encourage an increase in haemoglobin production and make acclimatisation quicker?

Good question. From the article, doesn't seem like it would make that much difference. Making more red blood cells is one of several ways the body adapts to high altitude, but it takes time.

* * * *
What happens at altitude and why?
Altitude sickness doesn’t occur below 5000ft, and usually doesn’t develop until you ascent rapidly to more than 7500ft. The speed of ascent is important- going rapidly is much more likely to result in symptoms than ascending gradually.

. . .

"It takes about a week for your body to begin to make more red blood cells to increase oxygen carrying capacity. By about 3-4 weeks, the increased red blood cell concentration in the blood has stabilized. Of course, you need enough iron in your diet for this to work. There is also a change in the ability of the red cells to pick up and off-load oxygen. This begins about 72 hours after ascent, and takes a few more days to fully kick in."
* * * *

 

[marzNC]

A few more quotes from the article. Never really read it slowly and carefully before since I usually acclimate in a couple days. As long as I start hydrating well a few days before, as much to get in the habit as anything, I usually don't even need aspirin. Although I sometimes take one on arrival to avoid a headache.

* * * * *
https://www.epicski.com/a/altitude-adaptation-and-acute-mountain-sickness

Myths and truths about altitude: [excerpts, there is more]

• If you are in great shape you will acclimate better.

Not true- fitness does not alter the incidence of AMS at all. Fitness does, however, improve athletic performance at altitude (just like it does at sea level!). You should not expect, however, that you will be able to achieve the same level of performance until you acclimate- your tissues don’t have as much oxygen available. I certainly highly recommend getting in the best shape you can so you can ski better, be less sore and less fatigued, etc., but it will not alter your risk of AMS.

• My head is killing me- is this AMS?

Possibly. It is wise to consider it AMS until you prove it is not. Dehydration is the other big cause of headache at altitude. If you rehydrate well, and the headache goes away, it was probably not AMS. If not, you probably have AMS.

• I just can’t sleep well up here- should I try a sleeping pill?

NO!! The reason that you don’t sleep well is because of an abnormality in your breathing that occurs at altitude called Cheynes-Stokes respiration- alternating periods of deep and shallow breathing. This interferes you’re your ability to fall into a deep sleep, and during the shallow periods you may even wake completely feeling short of breath. The best treatment for this is Diamox (see below). Using drugs that can decrease respiration can make you sicker.

 

[EnglishSnowflake]

Good question. From the article, doesn't seem like it would make that much difference. Making more red blood cells is one of several ways the body adapts to high altitude, but it takes time.

* * * *
What happens at altitude and why?
Altitude sickness doesn’t occur below 5000ft, and usually doesn’t develop until you ascent rapidly to more than 7500ft. The speed of ascent is important- going rapidly is much more likely to result in symptoms than ascending gradually.

. . .

"It takes about a week for your body to begin to make more red blood cells to increase oxygen carrying capacity. By about 3-4 weeks, the increased red blood cell concentration in the blood has stabilized. Of course, you need enough iron in your diet for this to work. There is also a change in the ability of the red cells to pick up and off-load oxygen. This begins about 72 hours after ascent, and takes a few more days to fully kick in."
* * * *

Thanks marz, sounds like it wouldn't hurt for the few weeks leading up to a trip but is unlikely to make a significant difference. Perhaps I will try it this winter and report on my findings!

 

[abc]

I read the other bumped thread from 08, there was a lot of talk about hydration and taking something for a headache, but DH felt quit sick. Would anti nausea tablets help as well? What about breathing exercises like Pilates?

Both are symtoms only.

I would personally not use any medication that would mask the symptoms so I might miss the real danger of AMS.

 

[marzNC]

Thanks marz, sounds like it wouldn't hurt for the few weeks leading up to a trip but is unlikely to make a significant difference. Perhaps I will try it this winter and report on my findings!

What I may do is bring along iron pills on the next trip out to a big mountain. Can't hurt. Sometimes eating a well balance diet isn't at the top of my list when on vacation.

 

[mustski]

Great link Marz. Thanks. When my DS was 5, we all went camping in CO and experienced mild altitude discomfort - shortness of breath and low energy more than anything. DS had a mild headache so we gave him low dose aspirin and all his symptoms went away. I wonder if the "blood thinning" properties of aspirin played into it? We always take excedrin (which has aspirin in it) for a headache and any symptoms disipate quickly.

Edited to add .. back in the 70's when I went to Switzerland, the locals recommended one glass of red wine a day to help acclimate. I have no idea if it helped or not, but I enjoyed the wine!

 

[Blondeinabmw]

Whenever we go from Atlanta (about 1,000 ft) to Breck (9,600 ft), we always stock up on this herbal supplement called Altitude Adjustment and take it religiously the day before arrival at two days after. My feeling is that it certainly cannot hurt the situation.

We also do "The Great Hydrate" starting about three days prior to the trip, where we each try to drink 120 oz or more in a day. The day of the flight, I try to drink at least that much prior to arriving in Denver, then that much more between Denver and bedtime in Breckenridge. What's the saying? "If you pee clear, never fear"? We try to eat "clean" - unprocessed, non-fried food too, that might be considered marginally healthy - if only until we have a chance to adjust. Again, probably entirely unrelated to any altitude issues, but it certainly can't make it worse.

I always wake with that suffocating, gasping feeling and have to do some yoga breathing in the middle of the night. Very unnerving.

A few years ago, my husband who is very fit and very experienced was hit with AMS. It was awful. I've never seen him so ill in the 20 years we've been together. The pharmacist recommended tons of gatorade and that he actually take Dramamine. It seemed to help after about 12 hours and made him at least able to keep some food down and lift his head off the pillow, but that could've also been attributed to his body adjusting.

My in-laws, who are in their mid-60's and mid-50's each with some underlying health problems always have difficulties. They've tried spending a night in Denver beforehand, which did not help avoid AMS issues, and they've followed my routine too, which did nothing to help. This year, they've decided a prescription for Diamox is needed and have already discussed it with their doctor beforehand.

 

[altagirl]

I haven't had any issues this year, but I think after that first weekend, the fact that we've been staying at over 9000' elevation every other weekend has just made me adapted to it enough that I'm not noticing it anymore. Even exercising over 11000' just feels normal now, which is a first.

So.... go on a LOT of ski trips. ;)

 

[floridakeysskibum]

when I repeated this post title to my significant other, his reply was "a parachute". haha what a smartass!!

 

[marzNC]

I haven't had any issues this year, but I think after that first weekend, the fact that we've been staying at over 9000' elevation every other weekend has just made me adapted to it enough that I'm not noticing it anymore. Even exercising over 11000' just feels normal now, which is a first.

So.... go on a LOT of ski trips. ;)

Now that I can schedule them, my approach is to take longer ski trips when going out west. That way, taking it easy for a day or two doesn't make as much difference.

 

[dmansprincess]

This is full of great ideas I will have to use when my family comes to visit us in Denver from KS at Thanksgiving. I am pretty sure they will all feel some sort of effects of the altitude even if it is only 5000' feet.

 

[gardenmary]

From personal experience, I can say that these four items are things I pay close attention to:

Hydration - I drink as much water as I possibly can.
Coffee - gotta limit the caffeine, just a couple of cups in the morning.
Alcohol - also needs to be limited/spaced between large glasses of water.
Antihistamines - are to be avoided at all costs unless I am honest-to-gosh sick.

These four things being out of balance landed me in the Ogden ER on a powder day, convinced I was having a heart attack. I'd been up all night with a racing heartbeat and short of breath.

Interesting about the aspirin - when we traveled frequently to Mexico in the summer, our family dr recommended taking a couple of aspirin a day as a blood thinner, so as to be less susceptible to the heat and humidity. I do that to this day. Never considered it for altitude but it can't hurt.

 

[marzNC]

Came across a webpage by someone who skis Breck, one of the highest places to stay when skiing Colorado. Caught my eye because it mentions the idea of taking iron supplements as someone asked about.

https://www.skisilverthorne.com/adapt-to-elevation-changes.php

Interesting to see that Gingko is included in more than one herbal supplement for dealing with high altitude adjustment.