Gina Johnson
Sleep disturbances are a common issue for travellers to high altitudes. While sleep disorders can be treated with hypnotics, this is not always advisable, and respiratory depressants such as alcohol and opiates should be avoided at high altitudes. Acetazolamide is a commonly recommended medication for altitude illness, and it can also help with sleep disturbances. Other medications such as temazepam, zolpidem, and zaleplon are also considered safe and effective for improving sleep at high altitudes. Melatonin, a natural supplement, has also been found to improve sleep and cognitive function at high altitudes.
| Characteristics | Values |
|---|---|
| Common high-altitude destinations | Colorado ski resorts, Cusco, La Paz, Lhasa, Everest base camp, and Mount Kilimanjaro |
| Minimum elevation for high-altitude illness | 8,000 feet |
| Minimum elevation for sleep disturbances | 9,000 feet |
| Maximum elevation increase for sleeping | Increase by no more than 1,600 feet per day |
| Maximum elevation for pregnant women | 10,000 feet |
| Drugs to prevent acute mountain sickness | Acetazolamide, dexamethasone, nifedipine, PDE inhibitors (e.g., sildenafil, tadalafil) |
| Drugs to aid sleep | Zolpidem, zaleplon, temazepam, eszopiclone, diphenhydramine, melatonin |
| Drugs to avoid | Alcohol, opiates, diazepam, benzodiazepines |
| Other recommendations | High-carb diet, multivitamins, mineral supplements, limit exercise, drink water, increase potassium, protect from sun, consume more calories |
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What You'll Learn
Safe medications for sleep at high altitudes
Sleep disturbances are a common complaint among travellers to high altitudes. This is due to the body's struggle to adjust to the lower oxygen levels, which can cause periodic breathing, frequent awakenings, and a feeling of drowsiness the next day. While sleep generally improves with acclimatization, some people may opt for sleep aids to help them adjust.
It is important to note that respiratory depressants such as alcohol and opiates should be avoided at high altitudes as they can further hinder breathing. Instead, short half-life hypnotics like zolpidem and zaleplon are considered generally safe and effective sleep aids. However, it is recommended to allow at least 8 hours for the effects to dissipate before engaging in activities.
Acetazolamide is another medication that is commonly used to prevent and treat acute mountain sickness (AMS). It helps with periodic breathing and raises nocturnal SpO2, thereby improving sleep quality. It is especially recommended for those with sleep-disordered breathing or severe mountain sickness.
Other medications that have been studied for improving sleep at high altitudes include temazepam, eszopiclone, diphenhydramine, and melatonin. While limited evidence suggests that diazepam may cause hypoventilation at high altitudes, the use of other agents like diphenhydramine and melatonin is considered safe in small doses as they do not depress the hypoxic ventilatory response.
It is always advisable to consult a medical professional before taking any medication, especially when travelling to high altitudes, as individual medical histories and trip plans can impact the suitability of certain medications.
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Preventative measures to avoid sleep issues
Sleep disturbances are the most common complaint of travellers to high altitudes. This is due to the lower oxygen availability at high elevation, which causes breathing instability, with periods of deep and rapid breathing alternating with central apnea. This breathing pattern is called high-altitude periodic breathing (PB). It occurs even in healthy persons at altitudes above 6000 ft.
- Ascend gradually. Avoid travelling from a low elevation to an elevation higher than 9,000 ft (2,700 m) above sea level in one day.
- If possible, spend a few days at 8,000–9,000 ft before travelling to a higher elevation. This gives your body time to adjust to the lower oxygen levels.
- Once you are above an elevation of 9,000 ft, increase the altitude at which you sleep by no more than 1,600 ft per day.
- For every 3,300 ft you ascend, try to spend an extra day at that elevation without ascending further.
- Take rest days to acclimatize. At 8,200 ft (2,500 m), experts recommend a day of initial rest to acclimatize. If you continue ascending, rest every third day.
- If possible, sleep at a lower altitude than the one you spent the day at.
- If you can, avoid drinking alcohol or doing heavy exercise for at least the first 48 hours after you arrive at an elevation above 8,000 ft.
- If you have a pre-existing heart or lung condition, check with your doctor before travelling.
- If you are pregnant, talk to your doctor, as they may advise you not to sleep at elevations above 10,000 ft.
- If you have sleep disordered breathing, consider taking acetazolamide.
- If you have mild to moderate OSA and are not hypoxic at home, you might not need a continuous positive airway pressure (CPAP) device. However, if you have severe OSA, avoid high-altitude travel unless you receive supplemental oxygen in addition to your CPAP.
- If you are taking medication for sleep issues, short half-life hypnotics, such as zolpidem 5 mg or zaleplon 5 mg, are recognized as generally safe and effective. However, at least 8 hours should be allowed for dissipation of effects before undertaking activities.
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The effects of alcohol at high altitudes
Sleep disturbance is the most common complaint of travellers to high altitudes. While it is not necessarily associated with altitude illness, it can be bothersome. Above approximately 2,700 metres (9,000 feet), some degree of periodic breathing becomes nearly universal and can interrupt sleep. In addition, the sleep stage is altered and awakenings are frequent. Sleep generally improves with acclimatisation. Respiratory depressants such as alcohol and opiates should not be used to aid sleep at high altitudes.
It is important to note that while alcohol may not become more potent at high altitudes, consuming alcohol can still have negative consequences. Alcohol consumption can exacerbate dehydration, which is already a common issue at high altitudes. This dehydration, along with reduced blood oxygen saturation levels, can increase the risk of altitude sickness, with symptoms including headache and nausea. At very high altitudes (above 8,000 feet), the risks can include life-threatening symptoms such as cerebral and pulmonary edema. Therefore, it is advisable to be cautious and ensure proper hydration with non-alcoholic beverages when adjusting to high altitudes.
To address sleep disturbances and improve sleep at high altitudes, medications such as acetazolamide, temazepam, zolpidem, and zaleplon have been found to be effective and safe. Acetazolamide is particularly useful for periodic breathing and can help with other aspects of altered sleep. It is recommended to consult a physician to discuss personal risk factors and the most suitable options for preventing and treating altitude-related sleep issues.
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How to acclimatize to high altitudes
The human body can adapt to decreasing oxygen levels at high altitudes, but it needs time. This process is called acclimatization and can take anywhere from one to five days. If you don't give your body enough time to adjust, you risk developing altitude sickness, also known as acute mountain sickness (AMS).
- Ascend gradually: Avoid ascending directly to high altitudes. If possible, start below 10,000 feet (3,048 meters) and walk up. If you must fly or drive to your destination, do not overexert yourself or ascend further for the first 24 hours.
- Follow the "climb high, sleep low" maxim: This is a strategy used by climbers. You can climb more than 1,000 feet (300 meters) in a day, but make sure to descend and sleep at a lower altitude. For example, if you sleep at 3,000 meters one night, sleep at 3,300 meters the next night, and then stay at that altitude for two nights before pushing on to 3,900 meters on the fifth night.
- Take rest days: For every 3,000 feet (915 meters) or 3,300 feet (1,000 meters) you ascend, take a rest day at that elevation without climbing further. This gives your body time to adjust to the lower oxygen levels.
- Stay hydrated: Drinking enough water helps optimize your body's ability to adapt to lower oxygen levels. It also makes you more comfortable, as dehydration symptoms like headaches, nausea, fatigue, and dizziness are similar to those of AMS.
- Avoid alcohol and heavy exercise: Refrain from consuming alcohol or engaging in strenuous physical activity for the first 48 hours after arriving at an elevation above 8,000 feet (2,400 meters). Alcohol is a respiratory depressant, which can negatively impact your breathing at high altitudes.
- Be cautious with pre-existing conditions: If you have heart or lung disease, diabetes, or are pregnant, consult a doctor familiar with high-altitude medicine before your trip. Some conditions, such as sickle cell anemia and severe pulmonary hypertension, may prevent you from travelling to high altitudes.
- Consider preventive medications: Medicines like acetazolamide (Diamox) can help prevent AMS by speeding up the acclimatization process. Melatonin and diphenhydramine are also considered safe in small doses, although their effects at high altitudes are not well studied. Always consult a healthcare professional before taking any medication.
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Risks for people with pre-existing conditions
When travelling to high altitudes, it is important to be aware of the risks associated with pre-existing conditions. The most common issue faced at high altitudes is altitude sickness, which occurs when the body cannot adjust to the lower oxygen availability in the atmosphere. This can be particularly dangerous for those with pre-existing respiratory or cardiac conditions.
People with pre-existing respiratory conditions, such as chronic obstructive pulmonary disease (COPD) or obstructive sleep apnoea, may experience exacerbations of their symptoms at high altitudes. The lower oxygen levels can further compromise respiratory function, leading to potentially life-threatening situations. It is recommended that individuals with respiratory conditions seek specialist evaluation before embarking on high-altitude travel.
For those with cardiac conditions, the reduced oxygen levels at high altitudes can place additional strain on the heart. This can be especially concerning for individuals with conditions such as severe pulmonary hypertension, decompensated heart failure, or sickle cell anaemia. As with respiratory conditions, it is advised that those with cardiac conditions undergo a specialist evaluation to assess their suitability for high-altitude travel.
In addition, individuals with pre-existing anxiety or depressive disorders may experience an overlap of symptoms with altitude sickness, including insomnia, dysphoria, and panic attacks. It is crucial for these individuals to consult with a healthcare professional and test any medications for compatibility with their psychiatric condition before travelling to high altitudes.
Furthermore, travellers with diabetes can safely visit high altitudes, but they must be aware of potential challenges. Strenuous activities at high altitudes can trigger diabetic ketoacidosis, which may be more difficult to manage due to inaccurate glucometer readings. Proper planning, monitoring of blood glucose levels, and acclimatization are essential for diabetic travellers.
While the risks associated with pre-existing conditions may seem daunting, proper preparation and consultation with healthcare professionals can help mitigate these risks. It is important to note that the specific recommendations and precautions may vary depending on the individual's medical history and the nature of their condition.
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Frequently asked questions
Sleep disturbance is common at high altitudes, and some sleeping aids are considered safe to use. Short half-life hypnotics such as zolpidem and zaleplon are generally considered safe and effective. Melatonin has also been shown to improve sleep and cognitive function at high altitudes. Other safe options include temazepam, acetazolamide, and dexamethasone.
Acetazolamide is a medication used to prevent and treat acute mountain sickness (AMS) and severe altitude illness. It can also help with periodic breathing and other aspects of altered sleep at high altitudes. However, it can cause metabolic acidosis by increasing bicarbonate secretion, which can be beneficial for treating sleep apnea.
Yes, getting enough sleep before travelling to high altitudes can help reduce the impact of sleep disturbances. Additionally, spending a few days at 8,000-9,000 ft before going higher allows the body to adjust to lower oxygen levels.
Yes, it is recommended to drink plenty of water, reduce exercise, increase potassium intake, limit alcohol consumption, and consume more calories. Avoiding heavy exercise for the first 48 hours at high altitudes is also advised.
Yes, people with heart or lung disease, diabetes, or pregnancy should consult a doctor before travelling to high altitudes. Those with severe OSA should avoid high-altitude travel unless they receive supplemental oxygen.
