“Welcome to 10,000 Feet” — Don’t let Altitude Sickness Ruin your Mountain Vacation
We were standing next to a corral in the high Sierras near Bishop, CA when I heard those words.
“Welcome to 10,000 feet.”
Altitude sickness, more correctly known as acute mountain sickness is essentially a suite of symptoms you are at high risk for if you go above 8,000 feet. It can lead to HAPE (high altitude pulmonary edema) or HACE (high altitude cerebral edema), both of which can be fatal. However, the vast majority of people who get acute mountain sickness acclimate in a couple of days.
The only real treatment for altitude sickness is to descend. At the very least you should not go higher until you feel better. The fact is that 20% of us will get acute mountain sickness starting at 8,000 feet and 40% of us will at 10,000 feet. It’s caused by the lack of oxygen in the air. So, how do you keep it from ruining your vacation or worse?
Be Aware of the Symptoms
Altitude sickness manifests itself through a number of symptoms. These include:
- Loss of appetite
- Fatigue or loss of energy
- Shortness of breath
- Sleep problems
- Slowed reflexes
- Impaired judgment.
Again, these symptoms will generally go away after a day or two. If they don’t, or if you develop the symptoms below, you should begin descent immediately:
- Trouble walking
- A headache that does not respond to medication
- Tightening in your chest
- Shortness of breath at rest
- Cough that produces a white or pink frothy substance.
If you or somebody in your party has the last three symptoms, they need medical attention as soon as it can be obtained.
Different people will get different symptoms. For example, one person might experience a headache and loss of appetite, while another might notice fatigue and slowed reflexes. If you have migraines, you can pretty much guarantee you’ll get a headache, for example.
If you have altitude sickness your judgment will be impaired. Period. It’s very important to be aware of this and be cautious until you have acclimated. Some deaths resulting from altitude sickness are not because it developed a more serious form but because the victim did something stupid and, ya know, fell off the mountain.
Acclimate and Prevent
The best way to prevent or lessen the symptoms of acute mountain sickness is proper acclimation. I have a friend who was incapacitated by it after flying to an airport at altitude; the sudden pressure change really got to her.
If coming from near sea level, try to spend at least one night at 4,000, then 6,000, then 8,000 feet. Sleeping at altitude appears to help you acclimate. (However, once in the mountains you should, unless you’re doing an ascent…at which point I hope you have a guide…”climb high sleep low”. That is, your campsite should be below the highest point you went to that day). Avoid flying directly to areas of high altitude.
Being physically fit does not reduce your risk of altitude sickness, and physical activity can make symptoms worse. However, exercising at 4,000 and 6,000 feet does seem to help. Do realize that you will not be able to hike the same distances you can at sea level before experiencing fatigue.
Take it slowly on the ascent. Allow time in your schedule to spend an extra day at a slightly lower altitude to acclimate properly. If you’re traveling with a guide, listen to them. They know what they are doing and will have planned a route that allows for acclimation. Generally, you should not ascend faster than one to two thousand feet a day, and you should not sleep more than 1,000 feet above your last campsite.
Treat and Mitigate
So, let’s say that despite ascending carefully you are starting to experience symptoms. Other than slowing or stopping your ascent, what can you do? Here are some tips, most of them from our wrangler friend:
- Avoid alcohol until you have acclimated or altogether. The symptoms of a hangover and the symptoms of altitude sickness are the same. You really don’t want to double up on them. Or double up on impaired judgment.
- Drink plenty of water. You should be drinking more than you do at sea level as your body is not transporting water as efficiently.
- If you don’t feel hungry, eat. A lot of people don’t realize appetite loss is a symptom of altitude sickness. You don’t feel hungry so you don’t eat so you lose more energy and somebody’s picking you up off the trail if you’re lucky. I was actually told to eat more if you start experiencing this symptom. Forget any diet you’re on. You need carbs.
- Pack your favorite headache medicine. There’s some indication that taking baby aspirin or a low dose of ibuprofen before you start the ascent is a good idea. In most cases, though, pop a pill when you start getting a headache. If the headache does not get away or worsens, you need to descend. Also consider packing an anti nausea medication you know works for you.
- Ease off on the physical exertion. Rest.
- Do not take sleeping pills or narcotic pain medications. These slow your breathing and can be very dangerous.
- If you regularly drink caffeine, keep drinking it. Caffeine withdrawal also has similar symptoms to altitude sickness and again, you don’t want to double up.
- If you have had altitude sickness before, then talk to your doctor about a prescription for acetazolamide. This is an approved drug to treat altitude sickness.
- Somebody in the group should have dexamethasone on hand. This can reduce symptoms and is an emergency treatment for HACE.
Again, the key factor is to ease off on your ascent. If you’re lucky the symptoms will hit at the top of the pass and you’ll be going down anyway. (And you’ll be on a mule. Who doesn’t have impaired judgment. And knows where the campsite is).
The absolute most important thing you can do to keep altitude sickness from ruining your vacation though? Drink lots of water.