Doc Talk: Altitude Sickness with Dr. Dennis Lipton
Dr. Dennis Lipton is an internal medicine specialist at Vail Valley Medical Center. To make an appointment with Dr. Lipton, please call (970) 477-3090.
You huff and you puff and you still can’t catch your breath. Whether you have lungs of steel or you are just getting used to a new elevation, at some point the altitude in Vail will affect you.
When your flatlander friends come up to the mountains they may have trouble finishing a few drinks. But even sober, Acute Mountain Sickness (AMS) can leave you with symptoms of headache, nausea and fatigue, among others. So exactly why do these symptoms occur?
To find out, SneakPEAK sought the medical advice of Dr. Dennis Lipton, internal medicine specialist at Vail Valley Medical Center.
SneakPEAK: What are a few of the most common symptoms or illnesses that people have when coming to a high altitude?
Dennis Lipton, MD: The most common ailment people get at altitude is AMS. It can occur as low as 6,500-7,000 feet but typically does not occur until you get above 8,000 feet. Its effects can be felt in as little as eight to 12 hours after arriving, usually after waking up for the first time at altitude. It consists of headache, nausea and possibly vomiting, loss of appetite, lightheadedness, fatigue, and difficulty sleeping.
In most cases, AMS resolves uneventfully within a few days. Occasionally, though, a severe case of AMS can progress to brain swelling, or High Altitude Cerebral Edema (HACE) or fluid in the lungs, High Altitude Pulmonary Edema (HAPE).
Even if travelers do not get a case of AMS, pretty much everyone that comes to altitude from sea level will feel more breathless and have less stamina. This is because a given volume of air at altitude has less oxygen than the same volume of air at sea level. Therefore, you have to move more air through your lungs to get the same amount of oxygen, so you have to breathe faster and deeper. The lower oxygen and increased work of breathing produces stress on your respiratory and cardiovascular system.
SP: Typically how long does it take to adjust to a higher altitude?
DL: Usually if someone has AMS they start to feel better after 48-72 hours, but it can linger for as long as five to seven days. It can take three to four weeks or longer for disrupted sleep to return to normal, and several months for full acclimatization, depending on your baseline health. As a runner, it took me a good three to four months after I moved here before I was able to do the mileage I was used to doing at sea level. I also had difficulty sleeping for the first several weeks.
Sleep is a very important factor. If you spend the night at low altitudes and travel to high altitudes during the day, and return to lower altitudes to sleep, you will not get altitude sickness. This is because when you sleep, your breathing slows down. With some people it slows down more than others, to the point that you become mildly oxygen deprived. Since there's less oxygen at altitude, your body is getting too little oxygen for all those hours while you are sleeping. Those are the people who are prone to get altitude sickness. It doesn't matter how fit you are, if this happens to you when you sleep, you will get altitude sickness.
One breathing problem that is generally not worse at altitude is asthma. If an otherwise healthy person has asthma at sea level, it may improve at altitude. They should definitely come prepared with their inhalers, but they may find they need them less. The air is thinner so there's less air resistance.
SP: How does alcohol consumption affect people at altitude and why?
DL: When people are on vacation they tend to drink more alcohol than normal. This is a bad idea at altitude. Alcohol is a known respiratory depressant. In other words, it slows down your breathing during sleep and while you are awake. So, you move less air through your lungs. This gets you into trouble at altitude because there is less oxygen, and if you are drinking you do not realize that you are oxygen-deprived. Then, when you go to sleep, your breathing slows down even more. In addition, alcohol is a natural diuretic, so you are more likely to get dehydrated. You are virtually guaranteed to get AMS, which you will think is a hangover, because AMS feels like a hangover to begin with. That's why people should limit alcohol use especially at altitude.
SP: It is much easier to become dehydrated at a higher altitude. Do you know why this is?
DL: Your body is more than 70 percent water. The air at altitude is typically much drier than sea level. So, moisture evaporates from your skin and lungs much faster. Since we have to breathe more air through our lungs at altitude to get adequate oxygen, we are constantly losing moisture there. And, people generally come to altitude to be active, which magnifies this effect. This is especially true of someone who comes from a humid climate. It can take your body some time to sense the change in the air and start losing less water through urine and sweat. Fortunately it happens automatically, but you really have to drink much more water than normal to keep up with these losses, especially the first few days.
People should pay attention to the altitude of their lodging if they are concerned. Ski resorts in Summit County are at a higher altitude than those in Eagle County. Even this small difference of 1,000-1,500 feet can make a huge difference for some people.
Most people are able to safely enjoy a vacation at altitude with little problem. The ones that get into trouble are those who have poorly controlled medical problems at sea level. If your blood pressure or blood sugar levels are too high at sea level, it will just get worse at altitude. Seeing your doctor and getting optimal control of your medical problems before coming to altitude will maximize your chances of having an enjoyable vacation without having to seek medical attention.
Tips From the Doc
- Ascend slowly and spend at least one night in Denver or nearby if you are not used to a higher altitude.
- Stay hydrated.
- Avoid drinking alcohol.
- Avoid vigorous endurance exercise a day or two prior to arriving at a higher altitude.
- If needed, take altitude sickness medication like acetazolamide.