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#2932 - 03/11/10 09:41 PM Altitude and Sleep apnea
SoCalGirl Offline


Registered: 12/06/09
Posts: 225
Loc: Spring Valley, CA
As I gear up and start shaping up for my next attempt on Whitney, I am finding myself with new partners. Due to a knee injury sustained two years ago on our last attempt, Mom won't be hiking with me this year.

However, I have managed to garner myself a new partner (both on the trail and in my life wink ). However, this particular partner suffers from sleep apnea and uses a CPAP machine at home when he sleeps at night. This is a new realm for me as I've never really dealt with apnea before.

I am looking for any information pertaining to experience that any of you guys have had with apnea at altitude. We're looking at a multiple night trip and short of packing his CPAP and a solar charger up the mountain... I'm basically wondering if altitude makes things worse or effects it at all....

Thanks guys (and gals)!

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#2933 - 03/11/10 10:08 PM Re: Altitude and Sleep apnea [Re: SoCalGirl]
Steve C Offline


Registered: 09/22/09
Posts: 7742
Loc: Fresno, CA
Hah! I have a mild case myself, but I got the dentist to make me a mouthpiece that I wear when I sleep. I haven't actually done a test to see if it really helps, but my wife tells me I don't snore as violently, so I think it's working. (There was just no way I was going to sleep the rest of my life wearing a CPAP mask.)

I find that sometimes I take the mouthpiece out of my mouth in my sleep, too. But nothing bad happens.

This may be dangerous advice, so for what it's worth... How bad is his case? If not too severe, what happens if he just goes without the machine while camping? My snoring and apnea occurs while I am on my back, so if he's like me, maybe he can work at staying on one side.

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#2934 - 03/11/10 10:19 PM Re: Altitude and Sleep apnea [Re: Steve C]
SoCalGirl Offline


Registered: 12/06/09
Posts: 225
Loc: Spring Valley, CA
Steve... he snores no matter how he's laying.. thankfully I've never witnessed an episode of his apnea... would probably scare the pants off of me!

He has slept without it (refused to wear it when we first started dating)... but he doesn't sleep worth anything when he doesn't have it on. So I know that he can sleep without it.... I'm just worried about how altitude is going to affect teh apnea...

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#2935 - 03/11/10 11:43 PM Re: Altitude and Sleep apnea [Re: SoCalGirl]
Steve C Offline


Registered: 09/22/09
Posts: 7742
Loc: Fresno, CA
Then he has a different scenario than me -- I never knew I had a problem, usually felt rested no matter what. It was my wife who told me about it. I'd be snoring, then just stop breathing for half a minute, gasp a little, then start breathing again. Not a real big deal.

Since it helps him get the necessary rest, I'd drag the thing along for car-camping, but forget it on the trail.

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#2941 - 03/12/10 09:13 AM Re: Altitude and Sleep apnea [Re: Steve C]
CaT Offline


Registered: 09/24/09
Posts: 694
Loc: Blacklick, OH (formerly SoCal)
I qualify the following response by saying that I am not a doctor, and that this response is from my own experience as the spouse of someone with sleep apnea who wears a CPAP, and from the "homework" we have both done concerning this condition (but not at altitude).

Quote:
I'd be snoring, then just stop breathing for half a minute, gasp a little, then start breathing again. Not a real big deal.

30 seconds is a big deal, esp. if it happens regularly. If you're having 10- to 30-second episodes throughout any given night, then you should seriously consider having a sleep study done, Steve.

See the information contained here. It will take some time to read, but is well worth it.

My wife has sleep apnea and has been using a CPAP since last September. She had a sleep study done just before then. During the sleep study, if you have a certain number of apneas during I think it's a one-hour period, they will wake you up and put you on a CPAP machine for the rest of that night. This happened to my wife very early in during her overnight stay for the study.

The primary consideration with sleep apnea is the low oxygen level that occurs in your body each time you have an "apnea" (defined as 0-25% air intake for longer than 10 seconds). Given the primary importance of oxygen to the body, the cumulative consequences of a low oxygen level during the sleeping hours every night can be significant.

While I can't speak from personal experience concerning sleep apnea at higher altitudes (perhaps Ken may have something more authoritative he could add), given the lower overall amount of oxygen available at altitude (and I understand that it's the same oxygen/nitrogen ratio at any altitude), I would not be surprised if sleeping at altitude exacerbates any existing apnea episodes, absent the use of the CPAP at altitude. I don't have sleep apnea myself, but I know that when I sleep at altitude, I have the same experience many others have at altitude of flying up out of bed in the middle of the night every once in a while, gasping for air. I can only imagine what effect sleep apnea might produce in an already oxygen deprived sleeping-at-altitude environment. At the least, it would probably make for a restless and uncomfortable night; at the worst, it could probably exacerbate the already low oxygen levels caused by the sleep apnea condition itself.

As for the mouthpiece Steve mentioned, it may be useful in mild non-apnea snoring; but I doubt it would be of any real help with actual sleep apnea. The CPAP machine forces air into the airway to keep open the part of your airway that is obstructed (in Obstructive Sleep Apnea -- one of three kinds of sleep apnea). If the CPAP air pressure levels are set correctly for your individual needs, then the snoring and low oxygen levels caused by sleep apnea should resolve. A mouthpiece can only mechanically modify your jaw position; it cannot provide the added air pressure needed in true sleep apnea.

Quote:
Since it helps him get the necessary rest, I'd drag the thing along for car-camping, but forget it on the trail.

Yes, although if I'm not mistaken, CPAP machines can be run on some kind of a battery operation for at least one night at a time (with recharging each day), if you have that kind of an accessory (I'm not sure whether or not that is standard equipment or optional).

CaT
_________________________
If future generations are to remember us with gratitude rather than contempt, we must leave them more than the miracle of technology. We must leave them a glimpse of the world as it was in the beginning, not just after we got through with it.
- Lyndon Johnson, on signing the Wilderness Act into law (1964)

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#2943 - 03/12/10 09:22 AM Re: Altitude and Sleep apnea [Re: CaT]
Steve C Offline


Registered: 09/22/09
Posts: 7742
Loc: Fresno, CA
> 30 seconds is a big deal, esp. if it happens regularly. If you're having 10- to 30-second episodes throughout any given night, then you should seriously consider having a sleep study done, Steve.

BTDT. (Been there, Done that) I had 5 episodes during the sleep study. Fun, by the way -- trying to sleep with about 20 wires hooked up to your body and scalp, including sticky gooey stuff to keep them attached in the hair.

That's how I got the oral appliance from my dentist. Cost ~$1500, but insurance paid for most of it.


> As for the mouthpiece Steve mentioned, it may be useful in mild non-apnea snoring; but I doubt it would be of any real help with actual sleep apnea.

The mouthpiece pulls the jaw forward and thereby pulls the tongue and tissues forward as well. It seems to be enough, for me anyway, to alleviate the blockage that results in the breathing obstruction.

That being said, I still need to do a subsequent sleep monitor night to see if it prevents the low-oxygen episodes. Before the sleep study, I wore a recording pulse-oximeter one night supplied by my doctor. It showed a number of low-oxygen episodes, so then the doctor prescribed the sleep study.

But like I said, I've never felt like I needed more sleep ...except for the normal drowsiness that I experience when I don't put in enough hours in bed. wink

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#2944 - 03/12/10 10:16 AM Re: Altitude and Sleep apnea [Re: Steve C]
CaT Offline


Registered: 09/24/09
Posts: 694
Loc: Blacklick, OH (formerly SoCal)
Quote:
except for the normal drowsiness that I experience when I don't put in enough hours in bed.

BTDT ... doin' it now, until this musical I'm involved in is over at the end of next week.

CaT
_________________________
If future generations are to remember us with gratitude rather than contempt, we must leave them more than the miracle of technology. We must leave them a glimpse of the world as it was in the beginning, not just after we got through with it.
- Lyndon Johnson, on signing the Wilderness Act into law (1964)

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#2949 - 03/12/10 01:15 PM Re: Altitude and Sleep apnea [Re: SoCalGirl]
DUG Offline


Registered: 09/22/09
Posts: 370
Loc: Wildomar
Day hike it. In, out, burger, T shirt. Train for a day hike and execute as a day hike. With training and the right attitude, Mount Whitney can be tamed and safely bagged as a day hike. By pretty much anyone. I took two rookies up last year, one the year before and have two more scheduled this year. Think DAY HIKE, embrace it and do it. If you don't make it the 1st time, train harder and return. I can think of 5 or 6 people who would drop everything to get on your day hike team.

Sleep? Over rated...................................DUG

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#2950 - 03/12/10 01:24 PM Re: Altitude and Sleep apnea [Re: DUG]
CaT Offline


Registered: 09/24/09
Posts: 694
Loc: Blacklick, OH (formerly SoCal)
Quote:
Sleep? Over rated

Until the lack of it bites you in the a$$.
_________________________
If future generations are to remember us with gratitude rather than contempt, we must leave them more than the miracle of technology. We must leave them a glimpse of the world as it was in the beginning, not just after we got through with it.
- Lyndon Johnson, on signing the Wilderness Act into law (1964)

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#2951 - 03/12/10 01:29 PM Re: Altitude and Sleep apnea [Re: CaT]
Bulldog34 Offline


Registered: 11/12/09
Posts: 1255
Loc: Atlanta
Originally Posted By: CaT
Until the lack of it bites you in the a$$.


Amen! Poorly rested = poorly prepared, at least for myself.

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#2955 - 03/12/10 04:31 PM Re: Altitude and Sleep apnea [Re: CaT]
DUG Offline


Registered: 09/22/09
Posts: 370
Loc: Wildomar
Odd, I've never slept on a day hike. I thought maybe one would sleep PRIOR to the hike.

It's getting so you can't sneeze on a Whitney board without being judged.

Chrissy - ANY time you and your man want to make a day hike attempt LMK and I'll be there.

Steve - feel free to nuke me completely off here. These folks don't know me, they don't understand me and .......................

Doug

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#2956 - 03/12/10 05:17 PM Re: Altitude and Sleep apnea [Re: DUG]
Steve C Offline


Registered: 09/22/09
Posts: 7742
Loc: Fresno, CA
DUG, these guys know you. I think they forgot to add the smirk after their posts.

We all know you're the master of the "start at midnight, all-day and all-night marathon" hikes.

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#2959 - 03/12/10 05:55 PM Re: Altitude and Sleep apnea [Re: Steve C]
wagga Offline


Registered: 10/07/09
Posts: 2248
Loc: Humbug Reach (Pop. 3)
Last summer, there was some discussion about challenging DUG & Moose on some epic day-hikes. We have not forgotten...
_________________________
Verum audaces non gerunt indusia alba. - Ipsi dixit MCMLXXII

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#2962 - 03/12/10 06:12 PM Re: Altitude and Sleep apnea [Re: wagga]
Mike Condron Offline


Registered: 11/05/09
Posts: 215
Loc: Now Manteca, CA
(my money's on Laura)
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Mike

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#2963 - 03/12/10 06:18 PM Re: Altitude and Sleep apnea [Re: Mike Condron]
wagga Offline


Registered: 10/07/09
Posts: 2248
Loc: Humbug Reach (Pop. 3)
Remember when the "Jaws" character in "Butch Cassidy & the Sundance Kid" challenged Butch & agreed "No Rules". No rules.
_________________________
Verum audaces non gerunt indusia alba. - Ipsi dixit MCMLXXII

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#2964 - 03/12/10 06:40 PM Re: Altitude and Sleep apnea [Re: wagga]
Mike Condron Offline


Registered: 11/05/09
Posts: 215
Loc: Now Manteca, CA
Laura has the edge then.
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Mike

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#2965 - 03/12/10 06:52 PM Re: Altitude and Sleep apnea [Re: Mike Condron]
wagga Offline


Registered: 10/07/09
Posts: 2248
Loc: Humbug Reach (Pop. 3)
What about the chocolate factor?
_________________________
Verum audaces non gerunt indusia alba. - Ipsi dixit MCMLXXII

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#2969 - 03/13/10 09:24 AM Re: Altitude and Sleep apnea [Re: wagga]
Rod Offline


Registered: 09/22/09
Posts: 660
Loc: Santa Clarita, Ca. USA
Not taking sides here but DUG is the origional Marathon hiker man. As in "da man".Midnight to Midnight it would be hard to take anyone over DUG.
That whole challenge thing was by our good friend Richard.We never did figure out what the hell he wanted out of challenging DUG


Edited by Rod (03/13/10 09:24 AM)

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#2972 - 03/13/10 09:58 AM Re: Altitude and Sleep apnea [Re: Rod]
Ken Offline


Registered: 10/29/09
Posts: 742
Loc: Los Angeles

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#2973 - 03/13/10 04:02 PM Re: Altitude and Sleep apnea [Re: DUG]
CaT Offline


Registered: 09/24/09
Posts: 694
Loc: Blacklick, OH (formerly SoCal)
DUG -- Apologies. No offense intended. My comment was more aimed at a cumulative lack of sleep over a long period of time, not related at all to just individual dayhikes. If I misinterpreted your post, I'm sorry.

Sneeze away, my friend.

CaT
_________________________
If future generations are to remember us with gratitude rather than contempt, we must leave them more than the miracle of technology. We must leave them a glimpse of the world as it was in the beginning, not just after we got through with it.
- Lyndon Johnson, on signing the Wilderness Act into law (1964)

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#2974 - 03/13/10 05:47 PM Re: Altitude and Sleep apnea [Re: CaT]
DUG Offline


Registered: 09/22/09
Posts: 370
Loc: Wildomar
SOCAL's GOAL is to summit Whitney. SOCAL has only attempted it as an overnight. Knowing that Mount Whitney is day hikable by almost anyone who puts the effort forth, I suggest she rethink the overnight and try that.

If I thought her GOAL was overnighting at altitude, then I would not have suggested a day hike.

I would also add that almost no one makes a Whitney summit bid WELL rested. There are those who hike/climb/play altitude often and sleep well in those conditions. A few things get in the way of a good nights sleep prior to summiting Whitney -

1. Day hikers have to sleep fairly close by. Portal camp ground, in the car, Hostel, maybe Horseshoe Meadows. Most are going to be nervous, excited, etc and the early start time is outside of their normal sleep schedule. There are exceptions, but I would bet a high percentage of folks attempt their day hike on less sleep than they normally get.

2. Multi day hikers sleep at Outpost, Trail Camp or Guitar Lake prior to making a bid for the top. The east side is a crappy place to camp - period. Loud and overused with plenty of traffic. (during the time frame I assume SOCAL will be making her attempt) If you are coming from the west and have been hiking awhile, you might very well be well rested and on your A game. Coming from the more popular east side, I doubt you are at your best.

A CPAP machine is going to add weight, worry and just generally be a PITA on the trail. My guess is that with the machine on the trail Mr. SOCAL will be in much worse shape for a summit bid than if they trained and prepared for a day hike.

That's why I suggested a day hike.

I actually use sleep deprivation training for Whitney. Since it's not too tough of a hike it falls second on the list every year. I start in Yosemite doing Cloud's Rest and/or Half Dome in late May. If someone wants to do Whitney with me, I take them to Yosemite. We leave home at 8 pm or so and drive 8 hours to the park. I drive, but it's hard to sleep in the car for whoever else is making the trip. Once at the park I try to get an hour or so nap, depending on the ranger danger. We hit the trail at 0500ish. No one is well rested. That gets them ready for Whitney, when we are sleeping in a tent, car or camper and everyone is excited, nervous, etc. No one is well rested.

It works for me - your milage may vary. I take responsibilty for everyone in my party and I have no problem calling off a hike if I don't think they are up to it. I'm not lucky, I'm careful. When I was sick, dehydrated and exhausted on the 72 mile/48 hour hike in Kings Canyon I played it safe and came in 12 hours late so I could rest.

I stand by my "sleep is over rated" quip. If you train for it and plan for it, you can do a lot with little sleep. It's not for everyone, but it works for some.

So Chrissy - Day Hike it. I'll help you and your man every step of the way.

And there was NEVER a challange between Moose and I. We have plans for some big miles together, but not as a race.

I would like to think that I would do ok against a lot of people starting at midnight and going for at least 24 straight hours. With or without chocolate. Then again - food is over rated too...........................................DUG

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#2980 - 03/14/10 10:39 AM Re: Altitude and Sleep apnea [Re: SoCalGirl]
bobpickering Offline


Registered: 02/07/10
Posts: 403
Loc: Reno, Nevada
My usual advice is to bring Diamox if you think you might need it, but only take it if you develop symptoms. I only suggest taking it before symptoms develop if you have a history of altitude problems. This is a case where I think taking Diamox could help. Sleep apnea on top of Cheyne-Stokes breathing wouldn't be nice.

I prefer to camp as high as possible, but I would recommend camping lower if it won't put the summit out of reach. Doing it in a day would get around the sleep apnea at altitude issue, but that may not be an option.

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#2984 - 03/14/10 09:32 PM Re: Altitude and Sleep apnea [Re: DUG]
SoCalGirl Offline


Registered: 12/06/09
Posts: 225
Loc: Spring Valley, CA
Sleep: I don't sleep worth crap when on one of these overnighters unless I've passed out from total and complete exhaustion (see TR from first attempt). A day hike would not deprive me of sleep anymore then a multiday trip... on a multiday trip there will be cumulative sleep deprivation (which makes for a very cranky Chris)...

DUG: I know who and where my friends are and are very much going to tap them for help on this. I don't know if "Mr. SOCAL" is going to be able to 1-get the time off work, 2- be able to make summit, 3-care about this as much as I do. I might need a team just to start the hike (you know I won't do it alone).

ALL ELSE: Thank you for the information about sleep apnea. I know the CPAP machine is cumbersome and will add weight to any packing we have to do (regardless of it's ability to function on some sort of battery backup for a night or two). It is also an expensive machine that we can't afford to have busted because one of us dropped a pack or something. These are all things that will be taken into consideration.

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#2985 - 03/14/10 10:13 PM Re: Altitude and Sleep apnea [Re: DUG]
Bee Offline


Registered: 09/22/09
Posts: 1261
Loc: Northern California
Originally Posted By: DUG

I would also add that almost no one makes a Whitney summit bid WELL rested. DUG


I had to laugh when I read this, because I don't know if I have EVER done a hike -- dayhike - backpack - multi day -- on more than 4 hours sleep! It always seems like I am putzing around the night before, so that bedtime and waketime run together. Clouds Rest starting at 5:00am? Wow -- that is early! When I did Cloud's Rest (as a dayhike from Sunrise Trail head) I think that we started at some obnoxiously late time after a 3 hour drive, like 10:00am or so....it was summer, so we still got back in time before dark, but then again, we were being chased the last 4 mile mile (def: "4 mile mile is when the last 1 mile feels like 4 miles) by killer mosquitoes!

B
_________________________
The body betrays and the weather conspires, hopefully, not on the same day.

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#2987 - 03/14/10 11:12 PM Re: Altitude and Sleep apnea [Re: Bee]
Rod Offline


Registered: 09/22/09
Posts: 660
Loc: Santa Clarita, Ca. USA
I have been able to sleep several hours in the car at the portal. Slept well at outpost twice and not gotten one wink of sleep at Trail Camp which is 12k. I have heard that 12K seems to be the breaking point for sleep and AMS.

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#2989 - 03/15/10 06:53 AM Re: Altitude and Sleep apnea [Re: Bee]
DUG Offline


Registered: 09/22/09
Posts: 370
Loc: Wildomar
Bee- Where did you start your Cloud's Rest hike from? Coming out of Happy Isles and adding in Half Dome (I end up doing both about every third trip) makes for a longish day, hence the 0500 start. IIRC the gain to Cloud's Rest from Happy Isles is over 6000 feet - similar to Whitney but with more oxygen.................................DUG

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#2993 - 03/15/10 09:14 AM Re: Altitude and Sleep apnea [Re: Bee]
bobpickering Offline


Registered: 02/07/10
Posts: 403
Loc: Reno, Nevada
I'm one of those lucky (explicative deleted) who sleeps well at altitude. I even slept decently in a bivy at the Russell-Carillon Saddle (~13,200) before doing a winter summit on Russell. It's my wife's snoring that I can't sleep through.

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#2997 - 03/15/10 05:40 PM Re: Altitude and Sleep apnea [Re: DUG]
Bee Offline


Registered: 09/22/09
Posts: 1261
Loc: Northern California
Originally Posted By: DUG
Bee- Where did you start your Cloud's Rest hike from? Coming out of Happy Isles and adding in Half Dome (I end up doing both about every third trip) makes for a longish day, hence the 0500 start. IIRC the gain to Cloud's Rest from Happy Isles is over 6000 feet - similar to Whitney but with more oxygen.................................DUG


Oh, No, no, no - I definitely did not do THAT hike! (although my buddies have) I did the more novice friendly start from Lake Tanaya creek (Sunrise trailhead) off of Tioga, and did the up and back to Clouds Rest. I think that the distance from truck to truck is maybe a little over 10 miles. I have done the local "Whitney hike" around here, which is called Warren Lake (there is a 4500ft total altitude gain due to the 1000ft drop into a lake basin)and it is 16 miles round trip. I am trying to up my strength and stamina, but I don't think that am a "natural" like some of the others are (Moosie, Blooty, etc.)

B
_________________________
The body betrays and the weather conspires, hopefully, not on the same day.

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#3008 - 03/16/10 11:38 AM Re: Altitude and Sleep apnea [Re: SoCalGirl]
DobeMom Offline


Registered: 10/16/09
Posts: 29
Loc: Palmdale, California
For what it's worth, I fell asleep during a dayhike, on two separate trips! sleep

Back in 2008, my friends and I were training for a dayhike, and the first attempt we started at 12:30am. I was SOOOO tired that I just laid down on a big rock before Mirror Lake and dozed off, sleep sleep twice! We turned back about 1/3 of the way up the switchers due to weather (snowing in Sept)...

Then two weeks later my buddy and I tried it again, this time starting at 1:00am. By the time we got to Mirror Lake, I asked him to give me 5 minutes and just slept like a baby on a big boulder! sleep sleep sleep We turned back at Trail Crest because he got sick...

So a week later, I went up by myself (early Oct). This time, I woke up and drank a whole can of Monster Java before jumping into the shower. Guess the caffeine worked! Or the fact that I was by myself, I actually got a quicker pace. Started at 2:00am and summited before 10. grin
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#3036 - 03/17/10 09:51 AM Re: Altitude and Sleep apnea [Re: DobeMom]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1023
Loc: Richmond, Virginia
Ken has already replied with medical info, I will add some:

If you do a sleep study (polysomnogram) on people at high altitude, those with high-altitude periodic breathing have a print-out that look like sleep apnea patients. Give Diamox and it improves because Diamox is a central (brain) respiratory stimulant. I don't have a reference handy at the moment, but I recall it was part of a lecture I gave a few years ago.

The link below is to a different interesting article- says if you study sleep apnea patients at altitude you will see it, but if they descend to a lower altitude to do the study, their condition improves, thus altering the results. Importantly, their episodes of central apnea (rather than obstructive apnea) improve the most, just what you would expect with lower altitude. This is applicable to the understanding of high altitude illness.

high altitude polysomnography

Harvey

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