Sleeping at High Altitude

[nedryarson]

I'm sure there are some threads about this but I was unable to find a good one after several searches on the forum. Any good suggestions on improving sleep above 11k?

I generally have no problem on car camping trips around 10,000-10,500 or backpacking in the 10,500-10,900 range. But once I get up above 11k, it seems nearly impossible to sleep. It has always been a struggle on hut trips which are usually around 11,500. A recent trip to Capitol Lake at ~11,600 (highest I'd ever camped) resulted in ZERO sleep over two nights and unsurprisingly a failed summit attempt due to fatigue. After the first night of no sleep, I figured I would crash hard the second night but still nothing. I'm always comfortable but just end up lying there all night. Have tried melatonin which works great in Denver but can't overcome the high altitude.

Anyone had this problem but was able to solve it?

[Conor]

are you sure it is the altitude? could it be "bigger" objectives which are affecting your nerves?

I apologize I don't have any thing else to add (I've been fine up to about 16k) other than make sure it isn't altitude related. If altitude related, the fix is most likely acclimatization. remember...train high, rest low.

[justiner]

I think Conor is on the right track: get your regular sleep absolutely awesome, then take anything you've learned up to altitude. I learned I had sleep apnea, and getting that sorted out lead to way way way better sleep at altitude, esp since altitude only makes sleep apnea much worse. Supplementing on Magnesium citrate (ie: Calm) and sometimes L-Theanine knocks me out cold and gives me the absolute craziest dreams. Dreams are an indicator that I'm actually going through sleep cycles, which leads me to believe the sleep I'm getting is quality. You can also work on some breathing pattern exercises - even something as simple as box breathing, or breathing out 2x longer than you breathe in can help with calming the nervous system.

But it could also be you having night before excitement for the day ahead.

[skyrme17]

After setting up camp you may want to try a hike, e.g. 1000' above the campsite, and then descend back to camp.

[nedryarson]

I've certainly experienced the difficulty of sleeping the night before a big objective. But this seems different to me. After the first no-sleep night and failed summit attempt at Capitol, I figured I'd zonk out immediately the second night considering the exhaustion and no longer having a summit objective the following day. But still zero sleep. Same could be said for the numerous hut trips I barely slept on where it was mainly small ski tours and playing cards, no major objectives. I'll definitely check out these supplements you suggested, not familiar with either.

[Scott P]

I have chronic sleep problems and they get worse at altitude. A really good pad and full sized pillows do help though.

[SkaredShtles]

OP - have you tried weed yet?

[benmangelsdorf]

I don't have many problems sleeping at CO altitudes, but on a recent trip to Ecuador I found myself 100% unable to sleep at 15K+, as did most of the other people in my group. I think it mainly came down to not being fully acclimated. I could breath alright at very high altitudes on the mountain, but that was because I was breathing very manually (as one does when ascending at high altitude). Whenever I would start falling asleep or losing consciousness, I would stop manually breathing and then I would sorta feel like I was suffocating because I wasn't breathing in deeply enough, and then I would wake up.

In other words, my experience with poor sleep at altitude seems to suggest that more acclimation can help. That's a pretty obvious answer for any altitude-related issue, but maybe it could be helpful for you in the future. Perhaps an extra hike or two at high altitude leading up to sleeping/camping on a climb could help.

[nedryarson]

OP - have you tried weed yet?

As I've gotten older, weed seems to increase my heart rate so I usually avoid it right before bed. I know spending more time at altitude immediately before a trip would really help but often isn't very practical logistically - as in taking extra time off of work to start trips earlier. I did a four-13er ridge loop the weekend before the Capitol trip but maybe that wasn't close enough to really help.

[shapovalovm]

Similar to the previous post, I almost never have issues sleeping in US lower 48 or climbing way higher ourside of US, but had multiple nights above 14k on Orizaba, Chimbo, Elbrus, Island/Mera (Nepal), etc. I would constantly have Cheyne-Stokes breathing, which is: you try to fall asleep, your breathing slows down, you feel like you don't have enough air and you breath in deeply (as if you dove deep and just came up from under water) and that would wake me up. Repeat.
On top of that, I would be anxious about the upcoming day and struggle to fall asleep.

In short, things that helped me:
1) Acclimatization. All of it is coming from acclimatization at the end of the day. Even anxiety is partially fed by the elevated heart rate at altitude due to lack of acclimatization. Regular acclimatization schedule on any peak is generally optimized towards minimal time required to get to elevation X, without getting serious altitude sickness issues. This does not mean your body is truly acclimated to live at that elevation. So e.g. when I went to Nepal for 3+ weeks, I had symptoms for a few days, but they slowly went away just after a few extra days at elevation.
2) Magnesium - not sure if it really works, but they say it does calm you down.
3) If an option, hot shower before bed. Your body cools down when you fall asleep, so hot shower and subsequent body cooldown kind of hint your body that it's time to sleep.
4) Diamox. The only time I took it was Ecuador and I think I will take it all the time now for trips above 18k. It is hard to tell if it really helped, but I had 0 side effects and felt really well getting to really high elevations in Ecuador in very limited time. Similarly, my wife took it in Nepal for the first time and it was her first high elevation trip when she had no headache.

[Trotter]

diamox will help you acclimate, a sleeping pill natural or Rx will help you sleep. Both can have side effects, so try them at home before you use them for real.

[aweskamp]

Periodic breathing is very common at high altitude and will affect sleep quality. As others have mentioned, this might unmask other underlying sleep disorders, like obstructive sleep apnea, which can be made worse by periodic breathing. This is a nice article outlining everything you'd want to know (and them some) about sleep at high altitude: https://pubmed.ncbi.nlm.nih.gov/23722066/

As far as treatment options, the best studied pharmacologic treatment for periodic breathing is acetazolamide aka Diamox. There are some well-known studies from the 1980s by Dr. Peter Hackett and Dr. Robert Roach which demonstrate its effectiveness. Best to discuss with your doctor before going down this route, though.

Hope this helps!