Altitude sickness, an unwelcome companion on many mountain adventures, can sour any high-elevation escapade. I’ve recently experienced the impact of altitude on two trips – Colombia and Rwanda/Uganda – and I wasn’t even climbing a mountain! It can be a sneaky sickness that feels like you’re out of shape at first, but it can be so much more than that. That’s why I wanted to share my tips for altitude sickness so that it (hopefully) doesn’t ruin your trip.
Altitude sickness arises from the body’s response to lower oxygen levels at great heights, resulting in symptoms that range from mild discomfort to life-threatening conditions. Knowing the risk factors and potential consequences of this ailment is vital for anyone venturing above sea level. This article provides the essential guidance needed to prepare for and manage the challenges of high-altitude travel, ensuring that your encounter with the clouds remains one of awe, not anguish.
It’s important to note that I am not a medical professional. This is meant to be a general guide. You can’t predict how you’ll be impacted by altitude sickness either. This is just to help you be as prepared as possible.
What is Altitude Sickness?
Altitude sickness, often termed mountain sickness or elevation sickness, occurs when the body cannot acclimate to the lower oxygen levels and reduced air pressure encountered at high altitudes. The body’s adjustment process to higher elevations, known as acclimatization, involves several physiological changes, including increased breathing rates and alterations in blood oxygen saturation. However, when ascent is too rapid, acclimatization may not keep pace with altitude changes, resulting in altitude sickness.
This condition is categorized into three types, each varying in severity: Acute Mountain Sickness (AMS), which is the most common and mildest form; High Altitude Pulmonary Edema (HAPE), a severe form of altitude sickness involving fluid accumulation in the lungs; and High Altitude Cerebral Edema (HACE), the most severe form, characterized by swelling of the brain due to fluid leakage from blood vessels. Swift recognition and appropriate response to the symptoms of altitude sickness are crucial, as severe forms like HAPE and HACE can be medical emergencies requiring immediate medical attention. We’ll primarily be discussing the AMS version.
What Causes Altitude Sickness?
As you ascend to higher altitudes, the air becomes thinner, leading to a decrease in air pressure and lower oxygen levels. The body requires time to make physiological adjustments which increase oxygen delivery to tissues. Ascending too rapidly, without allowing for adequate acclimatization, can disrupt this natural adaptation, triggering altitude sickness.
The risk of experiencing altitude sickness is influenced by factors such as the altitude attained, the speed of the ascent, and individual susceptibility. If you’re flying somewhere in high altitude, you can often feel this when you get off the plane. When we flew to Bogota (8700 feet/2600 meters above sea level) from New Jersey (100 feet/30 meters) about sea level, I could feel a shortness of breath immediately.
Engaging in strenuous activity soon after reaching a high altitude can also precipitate symptoms, as can the consumption of alcohol or other depressant drugs, which can impair respiratory function and worsen oxygen deprivation. We climbed to Lake Guatavita the next day, and I was extremely out of breath. It felt different than my usual asthma symptoms too (more on these symptoms below). This was the same feeling when we were gorilla trekking in Uganda.
Symptoms of Altitude Sickness
Mild symptoms of altitude sickness are similar to those of a hangover and include fatigue, insomnia, headache, nausea, and shortness of breath, especially with exertion. More severe cases can result in symptoms such as dizziness, loss of appetite, and general bad feelings. These mild symptoms generally characterize Acute Mountain Sickness.
For me, while climbing, I could tell the difference between my normal asthma and shortness of breath. Asthma (for me) feels like my chest is tight, but it didn’t feel tight with altitude sickness. The altitude sickness felt like no matter how much air I took in (without issue), it wasn’t enough.
If the condition progresses, more serious symptoms may develop, signaling more severe forms of altitude sickness like HACE or HAPE. These symptoms include severe shortness of breath, reduced coordination, confusion, persistent dry cough, and the production of frothy or bloody sputum, a sign of pulmonary edema. Cyanosis, or a blue tinge to the skin, may also occur as oxygen levels drop. These more severe symptoms demand immediate medical care.
Risk Factors for Altitude Sickness
Several factors can increase the likelihood of developing altitude sickness. Rapid ascent without proper acclimatization is a primary risk factor. Climbing more than 300 meters per day above an altitude of 3,000 meters should be avoided without incorporating rest days to reduce risk. Traveling to altitudes above 8,000 feet calls for cautionary increases in elevation, ideally not exceeding 500 meters per day.
Pre-existing medical conditions can also increase susceptibility to altitude sickness. Individuals with heart or lung disease, anemia, or blood pressure irregularities may be at greater risk and should consult with a healthcare provider before ascending to high altitudes. A prior history of altitude sickness, age, and physical fitness levels can also influence risk.
Consequences of Altitude Sickness
While mild forms of altitude sickness can often be alleviated by rest and descent to a lower altitude, ignoring symptoms can lead to more serious consequences. You do not want to ignore the symptoms and keep ascending in case you get HAPE and HACE.
The key to managing altitude sickness lies in prevention through gradual ascent and heeding the signs of altitude illness.
Preparing for High Altitude
Before venturing into the realms of thin air, it’s crucial to prepare properly to reduce the risk associated with high altitudes. To start, it’s vital to remember that alcohol and caffeine can hinder your body’s ability to acclimatize and should be avoided before and while you’re at high altitudes. Instead, focus on hydration.
The low humidity at altitude can rapidly deplete your body’s water stores, so aim to drink at least twice as much water as you would normally. Alongside hydration, a diet rich in carbohydrates can aid in acclimatization, as carbs require less oxygen for digestion compared to fats.
Adjusting to high altitudes typically takes a couple of days. To accommodate this, you should plan to ascend slowly, spending one or more nights at intermediate elevations. I was hoping that by the time we got to Uganda (after spending a few days in Rwanda and the DRC), that I would be acclimated. I wasn’t fully but I could definitely tell the difference between our hike in the DRC and the hike in Uganda.
During this time, limit physical exertion to aid your body in acclimatizing. Spending time at these intermediate elevations while practicing good hydration and avoiding alcohol lays a solid foundation for a successful high-altitude experience.
Ideally, we would have spent a few days before our hikes acclimating to the altitude difference. Unfortunately, that’s not always the case with limited PTO. In that case, I suggest waiting a day or two before doing any big hikes. I wish we spent time exploring Bogota before heading out to Lake Guatavita.
Consultation with a Medical Professional
Seeking medical advice before high-altitude travel is especially important for those with existing medical conditions, such as COPD, cystic fibrosis, sleep apnea, or high blood pressure. If you fall into these categories or if you’re pregnant, discuss your travel plans with a healthcare provider to understand how the altitude may affect your medical condition or medications.
Even without underlying health issues, approximately 40-50% of people will experience symptoms of Acute Mountain Sickness at altitudes above 10,000 feet. Thus, consulting a medical professional is prudent for managing symptoms should they arise. Keep in mind that descending to a lower altitude is the most effective way to relieve altitude sickness quickly.
For asthma, my doctor made sure I had recently refilled my inhaler before each trip so that way I was not dealing with both asthma and altitude sickness. It’s hard enough focusing on one group of symptoms instead of two.
Understanding Your Body’s Tolerance to Altitude
Altitude sickness doesn’t discriminate, and anyone can be affected regardless of fitness level or experience with high altitudes. Familiarize yourself with the different forms of the condition: AMS, HAPE, and HACE, and know that severe cases require immediate medical attention. Symptoms can range from mild headaches and lethargy to more severe indications such as lack of coordination and severe shortness of breath.
It’s paramount to listen to your body, ascend slowly, not sleep at high altitudes the first night, and include rest days during your ascent to reduce the likelihood of developing altitude sickness.
A doctor may prescribe medications like acetazolamide to aid in preventing symptoms, but remember, the body needs time—typically 2-3 days—to adjust to significant changes in altitude. I now really understand my risk for altitude sickness and the impact altitude has on me, and will plan for extra time at the beginning of the trips to allow my body to adjust.
Gradual Ascent and Acclimatization Tips
To avoid altitude sickness, the golden rule is to ascend slowly—limit your ascension to 1,000 feet per day once you’re above 10,000 feet, and take a rest day for every 3,000 feet of elevation gained. The “climb high, sleep low” strategy is helpful; after a day’s climb, descend to a lower elevation to sleep, which aids in acclimatization. Staying well-hydrated is vital: aim to drink 3-4 quarts of water daily. A diet emphasizing carbohydrates, making up about 70% of your caloric intake, can also bolster your acclimatization efforts. Finally, avoid tobacco, alcohol, and certain medications that could inhibit your body’s ability to adjust to the new altitudes, particularly during the initial 48 hours of your ascent.
Hydration and Nutrition
At high altitudes, dehydration becomes a real concern and can precipitate altitude sickness. Ensuring ample hydration combats the risk. Drinking plenty of water can’t be stressed enough, complemented by eating foods high in potassium, such as bananas, avocados, and potatoes, to balance electrolyte levels. While carbohydrates are your best friend at high altitudes for the reasons mentioned, be cautious about alcohol consumption and rich foods that could confuse their symptoms with those of altitude sickness or even food poisoning.
Avoiding Excessive Physical Exertion
Overexertion at high altitudes is a known trigger for altitude sickness. To allow your body sufficient adjustment time, prioritize rest and avoid strenuous activities shortly after your ascent. This gradual approach not only prevents the onset of symptoms but also enables more effective acclimatization. Refraining from tobacco use is also critical, as it can affect your oxygen levels. Finally, be sure to build in extra rest days during your ascent to higher altitudes—your body will thank you for the additional acclimatization time.
Recognizing and Managing Altitude Sickness
When venturing to elevations above 2,500 meters, you may encounter altitude sickness, an ailment that can escalate rapidly and carry life-threatening consequences. Being aware of altitude sickness is crucial to managing its symptoms effectively and ensuring a safe high-altitude adventure.
Mild Altitude Sickness Symptoms
Recognizing mild symptoms of altitude sickness is essential to preventing more severe health issues. These can include headaches, nausea, dizziness, fatigue, and shortness of breath, particularly during exercise. You might also experience an increased heart rate, trouble sleeping, and a lack of appetite. These symptoms can be managed by halting your ascent and descending to a more comfortable elevation to allow your body to recover, which typically resolves symptoms within a couple of days.
Be cautious of confusing this with heat exhaustion which can occur at the same time. Taking time and rest breaks to understand what your body is dealing with can help you figure out the symptoms you need to deal with.
Moderate Altitude Sickness Symptoms
Mild to moderate altitude illness symptoms are an extension of mild symptoms but intensified. You may feel chronic headaches, more pronounced dizziness, and marked fatigue. Appetite loss, nausea, vomiting or diarrhea, rapid heartbeat, and shortness of breath even with minimal exertion are common. If the condition worsens over time instead of improving with rest or medication, it indicates a moderate level of illness and necessitates careful monitoring or descent.
Severe Altitude Sickness Symptoms
Severe altitude sickness is a medical emergency that often stems from untreated mild or moderate symptoms. It may lead to HAPE, with symptoms such as heart palpitations, a dry cough that may produce frothy or pink-tinged sputum and an extreme shortness of breath even at rest. HACE symptoms are also severe, including confusion, difficulty walking straight, and changes in behavior. The appearance of these symptoms combined can indicate the simultaneous occurrence of both HAPE and HACE, which demand immediate descent and medical attention.
Seeking Medical Attention for Altitude Sickness
Medical attention should be sought if symptoms persist or intensify. Diagnosis may include chest X-rays, EKGs, or MRI scans to confirm pulmonary or cerebral edema. Early detection is crucial for effective treatment, as the risk of altitude sickness increases with elevation—20% of individuals ascending between 8,000 and 18,000 feet and up to 50% above 18,000 feet are likely to experience it. Seek emergency medical care if someone shows signs of severe altitude sickness.
Treatment Options for Altitude Sickness
The definitive treatment for any form of altitude sickness is an immediate descent to lower elevations. Medications such as Diamox®, aka acetazolamide, can regulate blood carbon dioxide levels to ward off or alleviate symptoms. Over-the-counter pain relievers may offer symptom relief while descent and proper medical care are being arranged. Always follow a healthcare provider’s instructions when considering medications for the prevention or treatment of altitude sickness, as advanced treatments may be required under medical supervision.
Medications and Remedies for Altitude Sickness
Altitude sickness can catch even the most seasoned travelers off guard. Fortunately, various medications and remedies are available to address and manage the array of symptoms tied to decreased oxygen levels at high altitudes. Again, I am not a medical professional – please talk to your doctor about these options!
Prescription Medications:
- Acetazolamide (Diamox®): This is often the go-to drug for both prevention and treatment of altitude sickness. It works by altering blood chemistry to enhance respiration and reduce fluid build-up.
- Dexamethasone: This steroid can aid in reducing brain swelling and is used to treat severe forms of altitude sickness, such as high-altitude cerebral edema (HACE).
- Nifedipine: Used mainly for treating high-altitude pulmonary edema (HAPE), this medication reduces pulmonary hypertension and can improve oxygenation in the lungs.
Supplemental Oxygen:
For those combating severe symptoms, supplemental oxygen can help maintain adequate oxygen levels in the blood, countering the effects of thin air at high elevation.
Preventive Medications for Altitude Sickness
A proactive approach can significantly reduce the risk of developing altitude sickness. Here’s how preventive medication can help:
- Diamox (Acetazolamide): By taking Diamox before and during your ascent, the medication preemptively adjusts your blood’s carbon dioxide levels, which can help you breathe more effectively at higher elevations.
- Compatibility and Consultation: Since the susceptibility to altitude sickness varies from person to person, it’s important to consult a doctor before using Diamox, especially for those with pre-existing medical conditions.
Over-the-Counter Remedies for Altitude Sickness
When prescription medication is not at hand, over-the-counter (OTC) options can provide some respite:
- Ibuprofen, Acetaminophen, and Aspirin: These OTC pain relievers can alleviate headaches, one of the most common symptoms of altitude sickness.
Though these remedies may not cure the underlying issue, they can offer temporary relief from discomfort as your body acclimatizes or until you can descend to a safer elevation.
Natural Remedies for Altitude Sickness
Even without medication, there are natural strategies to mitigate altitude sickness:
- Hydration: Increase your water and electrolyte intake to stay properly hydrated.
- Avoid Alcohol: Steering clear of alcoholic beverages helps prevent dehydration.
- Buffered Aspirin: This can boost oxygen flow, potentially preventing vascular-related headaches.
- Rest and Acclimatization: Taking regular breaks and allowing your body to adjust to the elevation is a cornerstone of natural prevention.
- Monitor Oxygen Levels: Use a pulse oximeter to keep an eye on your oxygen saturation; if levels drop too low, discuss the option of supplemental oxygen with a medical professional.
Tips for a Safe and Enjoyable Adventure at High Altitude
Planning Your Itinerary with Rest Days
An ideal plan for a high-altitude journey should include carefully scheduled rest days, allowing for essential acclimatization. Experts suggest an initial day of rest at 8,202 feet (2,500 meters), with additional rest every third day during your ascent. When climbing beyond an altitude of 14,000 feet (4,267 meters), you should aim for two days of rest for every 1,000 feet climbed. If possible, spend nights at a lower altitude than your highest point of the day — this follows the “climb high, sleep low” principle, which aids in acclimatization and can prevent altitude sickness.
Outdoor Safety and Precautions
Ascending no more than 300 meters a day once you’re above 3,000 meters (about 10,000 feet) is a basic yet essential rule to follow. Altitude illnesses such as Acute Mountain Sickness can begin to manifest at elevations as low as 5,000 to 7,000 feet. To avoid their progression into more severe forms, identify and respond swiftly to early symptoms. Carrying a high-altitude travel kit, complete with headache medication, might prove invaluable. It’s particularly imperative to manage your rate of ascent effectively, adding an extra rest day for every 1,000 meters gained above 3,000 meters.
Recognizing High-Altitude Emergencies
Identifying high-altitude emergencies promptly can be the difference between recovery and severe complications. Acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE) are all exacerbated by low oxygen levels and air pressure at high elevations. While AMS may be relatively benign, the symptoms of HACE and HAPE like persistent cough, confusion, and difficulty breathing warrant immediate medical attention. Immediate descent and appropriate rest are critical in addressing these conditions.
Preparing for Weather and Temperature Changes
At high altitudes, the variance in daylight and nighttime temperatures can be stark. Prepare for such changes by packing and layering sun-protective and insulative clothing. Protect your skin and eyes against the intensified UV radiation at higher elevations by wearing broad-spectrum sunscreen and UV-blocking sunglasses. A good rule of thumb is always to have layers available to adjust to temperature changes and remember that traveling with a partner is advisable for mutual safety and support.
Altitude Effects on Certain Medical Conditions
The impact of high altitude can be particularly pronounced for individuals with pre-existing medical conditions, with symptoms of high-altitude illness sometimes evident as low as 5,000 feet in sensitive individuals. Please be sure to talk to your doctor about medical conditions and the effect that altitude might have on them.
Final Thoughts
Experiencing the majesty of high altitudes can be awe-inspiring, but it is essential to respect your body’s limits and be alert for signs of altitude sickness. I was not expecting it at all because I didn’t think of Uganda being a high-altitude destination. In hindsight, I should’ve realized it with Colombia, but for some reason I didn’t. Being aware and informed of what is altitude sickness is the first step in protecting yourself!
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