Sleep at High Altitude

Have you thought of what it would be like living in the mountains year-round? Medical professionals find it is important to look at what living at high elevations can do to the human body. One activity heavily affected is sleep. As mentioned in previous blog posts, visitors often have trouble falling asleep, staying asleep, and feeling rested in the morning. A recent study published in Physiological Reports measured the effects of sleeping patterns at high elevation. The participants experienced a simulated elevation inside a hyperbaric chamber. This mimicked sleeping at elevations of 3000 meters (9,842 feet) and 4050 meters (13,287 ft) for one night and then sleeping at sea level for several nights to establish a baseline for the research participants. Participants exercised for 3 hours in the hyperbaric chamber allowing researchers to observe how the lower oxygen concentrations affected their ability to perform strenuous tasks. The group that slept in a simulated 4050 meter environment had an increased heart rate that was 28% higher and an oxygen saturation 15% lower than the 3000 meter participants. When comparing sleep itself, the group at 4050 meters had 50% more awakening events throughout each night. This goes along with previous research on this blog that states that people who sleep at high altitude complain of insomnia and frequent awakening when first arriving at high elevation.

These numbers increase even more dramatically when compared to participants at sea level. Related symptoms reported during this study showed the incidence of acute mountain sickness occurred in 10% of the participants at a simulated 3000 meters, increasing to 90% at 4050 meters. As mentioned, the average heart rate increases and oxygen saturation decreases as the elevation increases. The baseline heart rate at sea level was 62 beats per minute, increasing to 80 at 3000 meters and 93 at 4050 meters. Ideally health care providers aim to oxygenate vital organs by keeping the oxygen saturation level between 92-100%. The lower the oxygen level the harder it is to keep organs properly profused. Age, health status, and place of residence are taken into consideration when examining study reports. Oxygen saturation at sea level was 98% decreasing to 92% at 3000 meters and 84% at 4050 meters.

As mentioned in a previous post by Dr. Neale Lange, sleeping at high altitudes can be hard due to the frequent awakenings and nocturnal hypoxia caused by the low oxygen levels at higher elevation. This study reiterates these findings with the results of the average oxygen saturation at 3000 meters being around 92%. Dr. Lange also found that sleep apnea was often more prominent and had more negative effects on the human body in environments that were lower in oxygen. This study agrees with that statement finding that people with sleep apnea had twice the hourly awakenings compared to those at higher elevation that did not have sleep apnea. Dr. Lange also pointed out that the contribution of hypobaric atmosphere to symptoms at altitude as opposed to pure hypoxemia is unknown. Frisco, Colorado is at an elevation of 2800 meters. Ongoing research at Ebert Family Clinic including residents and visitors along with laboratory studies such as this one can guide decisions about interventions and treatment to improve sleep and help us enjoy our time in the mountains.

References

  1. Figueiredo PS, Sils IV, Staab JE, Fulco CS, Muza SR, Beidleman BA. Acute mountain sickness and sleep disturbances differentially influence cognition and mood during rapid ascent to 3000 and 4050 m. Physiological Reports. 2022;10(3). doi:10.14814/phy2.15175
  2. Blog post: HOW DO YOU DEFINE A GOOD NIGHT’S SLEEP?:AN INTRODUCTION TO THE SLEEPIMAGE RING, AN INTERVIEW WITH DR. NEALE LANGE

Casey Weibel is a 2nd year student at Drexel University, born and raised in Pittsburgh, Pennsylvania. He went to Gannon University for his undergrad and got a degree in biology.  Before PA school, Casey was an EMT.  He enjoys hiking and kayaking and is a big sports fan. 

After 21 Years of Hiking at Altitude I Had to Call Rescue

Another Lesson on High Altitude Health and Safety

Wild animals, storms, avalanches, cold, high altitude pulmonary edema or cerebral edema, falls, fires and injuries are the most common dangers in the mountains. I’ve climbed 19 different mountains in Colorado over 14,000′, and some of them more than once, making for 28 successful ascents. But I called Summit County Search and Rescue Saturday for something I was not expecting: deep wet snow that trapped me less than 2 miles from the trailhead.

A colorful map of lines in red, green and white depicting trails through various mountain terrain.
Summit County trail map

It was a bright, warm day — I had even left my hand warmers at home. My plan was to hike from Miners Creek trailhead in Frisco to Gold Hill Trailhead north of Breckenridge which is about a 6- or 7-mile trip one way. I had hiked from both ends in previous weeks and saw the turn-off had snow and no tracks. I attached my snowshoes to my backpack with plans to turn up towards Gold Hill if there were tracks, and there were.

After 4 miles I was out of the forest on top with gorgeous 360˚ views of mountains. I no longer saw the trail markers or tracks so set out across the open space with my snowshoes sinking into the snow every 10 to 20 feet. The trail maps and GPS on my phone were sketchy, only showing I was very near the Colorado Trail. I turned down a logging road to get out of the wind thinking the snow would be packed. I could see several open areas that I thought would take me to the familiar trails to Gold Hill.

After an hour sinking into deep snow I noticed I had only one snowshoe. I backtracked 100 feet following the tracks to find it, dug at several spots where I had sunk the deepest but never found it. I went back towards the Colorado Trail but could not progress, having to dig my boot out of deep snow several times.  I tried to backtrack in my footsteps but couldn’t get far. I had now covered a mile in an hour and a half, my phone showing I was only 48 minutes from the Gold Hill trailhead.

So I called 911, thinking they could drive a snowmobile up to get me.  Bad news: the vehicle would just sink the same way I was. The 911 operator knew me and the Summit County Search & Rescue mission coordinator Mark Svenson was in touch several times as I waited from 3:17 until about 6 pm when the crew arrived with skis and extra snowshoes. My Blue Heeler Isa and I stayed within one foot of a small pine tree where we found firm footing after rolling through the deep, soft snow. Luckily the sun kept us warm until 5 pm, and I had food and water. My gloves and boots were soaked so my feet were very cold and I tried to keep Isa lying over my legs or feet.  I had a plastic rain shield extension that I could pull out and sit on in a pocket of the backpack that one of my students had gifted me.

The rescuers had water, snacks, dry socks, dry gloves, gators and snowshoes. They had packed down the trail but there were still times we post-holed on the way down. We arrived at the rescue vehicle as darkness fell. Special Operations Sheriff SJ Hamit waited with Mark and other SCSR staff to welcome us. One of the rescuers told me how happy he was that I was still smiling when they arrived!

Summit County Search & Rescue team, Sheriff Hamit on the left, Dr. Chris far right.

What did I learn? Stay out of deep, wet snow even if it means going back the long way. Bring extra socks and gloves. Buy gators.

I was not afraid because I knew they were coming before dark. I do feel exhilarated that I was able to do such a challenging hike without any pain or blisters, that my knees were strong enough to extract my feet from the deep snow so many times, and that Isa was with me to warn if any animals were near and announce when the rescuers arrived.

Christine Ebert-Santos, MD, MPS is the founding physician and president of Ebert Family Clinic in Frisco, Colorado, where she leads high altitude research in addition to running a full-time family practice. Isa is a two-year-old blue heeler and Dr. Chris’s familiar and guardian angel.