Sleep aid for altitude?

[Helldawg]

+1 for Diamox and abstinence from booze. Works as advertised.

You need to start it at your home altitude 48 hours before traveling to altitude, and continue it while at altitude.

Given that you are asking this question a day before departure, you are what's known as "SOL", or "Shit Out of Luck".

[TitanneeNC]

^^^^
Diamox, 3 days prior to altitude, 2-3 days at altitude. Your physician should have no problem prescribing even though it's a diuretic if you explain why you need it.

[Neurodoc]

Thanks Doc. I don't sleep well at altitude and this clarifies a lot.

Bah. Don't thank me. What I posted above is actually out of date.

Since discovering Ambien, my typical night's sleep on mountaineering/backcountry ski trips has gone from a restless 4 hours to a sound 6 - 7 hours. I do half a pill chewed up then placed under my tongue.

Yes! Ambien (zolpidem) and Sonata (zaleplon) are actually safe to take at altitude and don't lower oxygen saturation during sleep.

http://www.ncbi.nlm.nih.gov/pubmed/18041485

I do have one quibble with the concluding line of that abstract: "Both zolpidem and zaleplon have positive effects on sleep at altitude without adversely affecting respiration, attention, alertness, or mood. Hence, they may be safely used by climbers."

Zolpidem is associated with parasomnias such as sleepwalking. If your tent is perched on an icy ledge, sleepwalking might not be all that "safe"!

Apart from the above, there is very little science on what is safe and isn't safe at altitude. The link below seems to be a good resource on altitude insomnia and sickness:

http://www.basecampmd.com/

It is the website of the Everest Base Camp Medical Clinic.

[RoanMtnMan]

There actually turned out to be some good advice on this thread. But I really think the basics are the best. Acclimate slowly, hydrate well, and fight lassitude with a little activity. Then sleep well. All of the alcohol, drugs, and Rx are just masking what your body is telling you. You can get away with the previously mentioned, but it ain't the best way to go about it.

However if you are acclimated, drink copious amounts of Jim Beam and you won't even need a sleeping bag.

[powdork]

when i sleep at altitude it has always been camping. i don't know if the restlessness was caused by the altitude or cold feet, but hand/footwarmers in my socks did the trick. after some cold days in montucky, i now swear by those things for all sorts of stuff.
however, these trips always include skinning and skiing my ass off, copious amounts of alcohol, and the sativa was always contra indica'd.

[DropCliffsNotBombs]

don't even think about diamox.
Ambien is the only sleeping pill that will not affect oxygen saturation at altitude. It works well. you can try melatonin as well, but if you really need to sleep, Ambien.

Holy "big-pharma-pill-popping" Batman!! Try herbs. Your body likes them better...

[skibiker]

In my opinion taking a prescription sleeping aid is the worst thing you can do. If you are not a regular user, and especially if you have never taken it before, beware. You may have trouble waking up and you might feel drowsy (like shit) for all or a portion of the next day.

[harpo-the-skier]

don't even think about diamox.
Ambien is the only sleeping pill that will not affect oxygen saturation at altitude. It works well. you can try melatonin as well, but if you really need to sleep, Ambien.

Whats wrong with Diamox?

Does anyone know what effects Benedryl has at altitude. It is an over the counter medication I use for sleep sometimes and I haven't seen it mentioned anywhere in studies about effects of meds at altitude. I use it for sleep and its effects are milder than Ambiens. It is marketed to be used for stuffy noses and allergies, and its only side effect (I think) is drowsyness.

[zion zig zag]

Whats wrong with Diamox?

Does anyone know what effects Benedryl has at altitude. It is an over the counter medication I use for sleep sometimes and I haven't seen it mentioned anywhere in studies about effects of meds at altitude. I use it for sleep and its effects are milder than Ambiens. It is marketed to be used for stuffy noses and allergies, and its only side effect (I think) is drowsyness.

I've wondered if it would dry you out in an already really dry environment? I'm paying close attention to this thread, last year in the Wind Rivers I had the worst sleep for two nights that I think I've ever had. It was so bad that on the third day after a long day of climbing Wolfs Head we got back to camp, packed up, hiked out and drove home.

I think the biggest issue was the cold and not the altitude but the tylenol pm that I took got me 3 hours of sleep tops.

[Helldawg]

I'm not sure what the objection is to Diamox, it only has meaningful side effects to those allergic to sulfites.

Obviousy, the slowly acclimating/hydration/herbs/no alcohol approach is ideal, but sometimes it just isn't realistic. I started the Diamox approach when I began skiing South America in '01. Logistics demanded that I fly 11 hours, then travel from sea level to over 10,000 feet where I would remain for a week.

Worked like a charm, slept like a baby. And this was after suffering terribly the year before when sleeping at 8,300' in CO.

There is some pins and needles in the fingers and toes from Diamox, but it subsides in a day or two.

[gimpy]

xanax, it makes evvvvvvverything better.

[leroy jenkins]

I have heard that sleeping pills are only good as a once in a while thing when you really need to sleep, because they mess with the duration of your different sleep cycles, they give you less REM sleep, and more restful sleep, but your body will try to restore its normal balance the next night by giving you more REM sleep, and less of the sleep where you actually get rested, so the 2nd night you can sleep for 8 hours and feel like you slept for 5, and it just gets worse and worse the more nights in a row you take em.

I think i rember hearing that from a biology teahcer or something. Anyone else heard that?

[Dromond]

Whats wrong with Diamox?

Does anyone know what effects Benedryl has at altitude. It is an over the counter medication I use for sleep sometimes and I haven't seen it mentioned anywhere in studies about effects of meds at altitude. I use it for sleep and its effects are milder than Ambiens. It is marketed to be used for stuffy noses and allergies, and its only side effect (I think) is drowsyness.

I would like to know this as well. Several years ago when I was recovering from an accident from the hospital I mentioned that the drowsiness effect of Benadryl hit me really hard for some reason. They actually gave it to me intravenously a few times and I was out within minutes if not seconds.

I just showed up at 10,000' last night after two days in BouldDenver and sea level before that. I slept OK on a sleeping pad in a chilly room; waking up several times but not enough to make me tired in the morning. At about 7:30 I wake up, sit up, look out the window, at the clock, etc. With 2 minutes I start feeling weird, and run to the bathroom feeling like I am going to puke my brains out and pass out at the same time. Almost this exact same thing happened to me two years ago, and it passed with a day of rest. That was the only other time out of being at 10-14,000' for days or weeks at a time over the past 4 years for many times. Weird.

I think this arises from arriving at altitude and taking many shorter breaths while sleeping that slowly overwhelm the body's compensation abilities. Then when I get up and move around suddenly there isn't enough O2 going to the gray matter.

Luckily my friend here is a pharmacy tech and gave me the recommended genko biloba (?) aspirin an something else. I wonder if I tried something very gentle like Benadryl if I would sleep and breathe better at night. Either way I'm planning to skin/ski my ass off for the next three weeks so that should help a lot!

[Core Shot]

wiki on Diamox
======================
Acute mountain sickness
Acetazolamide is sometimes taken prophylactically, anywhere between 125 milligrams (mg) to 500 mg per day, starting a few days before going to the higher altitude. Such use is recommended for those ascending from sea level to 3000 meters (9800 feet) in one day, or for those ascending more than 600 meters (2000 feet) per day once above an altitude of 2500 meters (8200 feet).[8][9] Also, prophylactic use is recommended for those with a significant history of acute mountain sickness.
The drug forces the kidneys to excrete bicarbonate, the conjugate base of carbonic acid. By increasing the amount of bicarbonate excreted in the urine, the blood becomes more acidic.[9] Acidifying the blood stimulates ventilation, which increases the amount of oxygen in the blood.[10][11]
Note that acetazolamide is not an immediate fix for acute mountain sickness; it speeds up part of the acclimatization process which in turn helps to relieve symptoms.[12][13] This may take up to a day or two, and requires waiting without any further rapid ascent. It is often advisable to descend if even mild acute mountain sickness is experienced. If serious sickness is encountered, descent is considered mandatory unless other circumstances present greater danger.
[edit]Side-effects

Common side effects of using this drug include numbness and tingling in the fingers and toes, and taste alterations (parageusia), especially for carbonated drinks. Some may also experience blurred vision but this usually disappears shortly after stopping the medication. Acetazolamide also increases the risk of developing calcium oxalate and calcium phosphate kidney stones. Everyone will experience more frequent urination as a result of using acetazolamide. One should drink more fluids than usual to prevent dehydration and headaches. Acetazolamide prolongs the effects of amphetamines and related drugs. Acetazolamide also causes metabolic acidosis.

[Big Snowballs]

The only thing I read here that I know is safe is Ginkgo.
PBS (NOVA) did a documentary called DEADLY ASCENT
http://www.pbs.org/wgbh/nova/denali/ showing the benefits of Ginkgo without any side effects.
Ginkgo helped me but be it dose not work for everyone. Good luck.

[Helldawg]

Ginkgo did absolutely nothing for me. I would wager that it acts largely as a placebo.

[techlogik]

As a couple of others mentioned...Do Not take OTC sleep aids at altitude. They inhibit/slow acclimation. Your body is trying get more oxygen and create more red blood cells. Your breathing is increasing, hence, you have a hard time sleeping and it is not comfortable. You are not alone, nobody is immune from this. Some just get it worse than others.

As a few suggest, acetazolomide is the way to go.

The 1-2 days before you leave, I personally just do the same day I leave, I have found no difference personally, you take 250mg BID.

After you are there about 2 days...just take 1 a day the next time then stop. You will be acclimated in about 4-5 days at altitude pretty well. Well, at least you won't be sick hopefully. Drink plenty of fluids. No booze, go easy.

[old goat]

[
I have also had good luck starting the diamox much later than recommended--usually the night before an AM ascent, and for one or two days. You definitely need to stay hydrated--it is a diuretic--makes you piss, and you can't judge your hydration by whether or not you are pissing. I do get the tingling fingers and toes. When I first started taking blood pressure medicine I made the mistake of taking the medicine plus the diamox while doing a 3000 foot climb up a treeless slope in hot clear weather--almost passed out--couldn't feel my pulse. I now skip the blood pressure med while I'm taking the diamox.

Altitude tolerance is an interesting thing. There are two distinct populations of people--those who tolerate altitude well and those who don't. Respiration is controlled by the blood pH--amount of alkali--which is determined by the carbon dioxide level, and by the oxygen in the blood. People who tolerate altitude well are able to respond to low oxygen levels by greatly increasing their breathing, and are able to achieve very low carbon dioxide levels and very high pH. People who don't tolerate altitude stop increasing their breathing when their carbon dioxide gets to low and pH too high. Diamox works by lowering the pH--allowing people to increase their respirations more. The difference between tolerators and not tolerators is most marked during sleep.

[whipski]

Man made ambien God made herb....who ya gonna trust?

[Crass3000]

As Iceman mentioned, a humidifier makes things more comfortable in high altitude. Unfortunately a humidifier doesn't always put out enough humidity. We use both a humidifier and a LARGE pot of water on the stove when we ski colorado. I've never had too hard of a time sleeping at altitude anywhere besides Colorado except maybe Rainier. Sucked to get absolutely no sleep and had no appetite before the summit push -- but we made it

Edit: Kind of goes hand in hand but obviously drink lots of water, poweraid, etc. It's easy for us flatlanders to get dehydrated -- the humidifier helps to curb dehydration a bit.

[Alex.C]

If the cabin is in Peru Coca tea works pretty well.

[mountaingeist]

My advice as a high-altitude guide is, hydrate( body best accepts in am&pm) so start and end the day with h20.Then get diamox in Tablet form( no time release capsules) that you can break in half,take before bed.If you can start it early great.Remember your increaseing p.h. so peeing will increase(get a pee bottle if neccesary).I have also had good succes with Saravent ( a maintenace drug for athsma). As some have stated the side affects of diamox are not the greatest considering the enviroment, and most docs don't have much or any altitude experience and way over prescribe.We also use benadryl for helping sleep if neccesary.Some have success with melatonin.
Everybody is different but for me a "rest day" doesn't include no activity.Light activity in my opion helps move blood/take in o2 and helps me acclimate.I have had no luck with gingko but candied ginger seems to help folks with circulation.
Also like someone suggested make sure it's not sleep apnea.

[ptavv]

Aspirin, caffeine, alpha/beta-blockers

Anything that vasodilates or stimulates the CNS would likely help (with oxygenation, maybe not with sleep itself). Maybe you can find the right dosage of caffeine that won't keep you up.

Aspirin is a good place to start though. Two tablets a few hours before bed should keep an adequate circulating dose without any adverse effects (unless you gash your hand open or something, it might be a bit harder to staunch the bleeding).

[ptavv]

I've wondered if it would dry you out in an already really dry environment?

Diamox is a diuretic. If you weren't able to adequately hydrate while taking it you would become dehydrated faster. Aside from that it's not really going to make much difference at all.

The way it works for altitude sickness is pretty simple (and explained in the wiki), it makes your blood more acidic, which then signals your respiratory system to increase ventilation in order to decrease the CO2 present in blood (and raise the pH). Increasing ventilation increases blood oxygenation. The acidosis also has some effects on cardiac muscle (your resting HR will probably rise while taking it).

Because it works by making your kidneys excrete bicarbonate your urine will be more acidic and your kidneys will compensate for this by excreting more fluid overall (in order to dilute the acidic urine). So you'll need to up your fluid intake a fair stretch.

[counterfeitfake]

I think this arises from arriving at altitude and taking many shorter breaths while sleeping that slowly overwhelm the body's compensation abilities. Then when I get up and move around suddenly there isn't enough O2 going to the gray matter.

Diamox solves this exact problem. You will breathe more frequently and not get those out-of-breath moments.