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Park City, Utah, east of Salt Lake City, sits at 6,936 feet and is framed by the
Wasatch Range. It is possible to get altitude sickness at this elevation, but
you can do a lot to prevent it. (Photo: Marc Piscotty/Utah Office of Tourism)
Travel Travel Advice


DON’T LET ALTITUDE SICKNESS RUIN YOUR MOUNTAIN VACATION. HEED THIS DOCTOR’S TIPS
TO AVOID IT.

At 5,000 to 7,000 feet, you might have trouble catching your breath. Higher, you
may get a pounding headache and nausea. Here’s what to do—and not do—to avoid
problems on your mountain vacation.

(Photo: Marc Piscotty/Utah Office of Tourism)
Alison Osius

--------------------------------------------------------------------------------

Originally Published Jul 3, 2024 Updated Jul 12, 2024
Alison Osius
Alison Osius, a senior editor at Outside, works on travel coverage and edits
features. She's a former editor at Climbing and Rock and Ice magazines, has
written for cnn.com, The New York Times, The Washington Post, and The Wall
Street Journal, among others.



Don't miss a moment of the 2024 Tour de France! Get recaps, insights, and
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The young woman was coming from sea level, but was fit and had never had trouble
with altitude before. She would say that many times over the next few days. She
seemed OK at the group-welcome dinner in Redstone, Colorado, at 7,185 feet,
opening the annual photo camp then held by Rock and Ice magazine, where I was
working.

But the next day as we all headed up to a campground above the town of Basalt at
8000-plus feet, she threw up out my car window.

I offered to take her back down to our offices in Carbondale, which is at 6,200
feet, but she shook her head vigorously no. Our group all hiked up to a cliff,
and later, on the way down the steep trail, the student collapsed into my arms.
It took two of us to guide her to the road. Still she refused my entreaties to
go to the hospital or come to Carbondale overnight. She had a dismal time of it
before feeling better a day or two later.

Hiking East Maroon Trail, above Aspen, Colorado, in the Maroon Bells Snowmass
Wilderness, White River National Forest. Aspen is at about 8,000 feet, and
visitors would be mistaken to go above that elevation too quickly. (Photo:
Alison Osius)

It turned out that, upon arrival in Denver, the young woman had immediately
hiked a 14er, I think Mount Elbert, because she was excited to arrive. But she
paid the price, oh she paid.

SIMILAR READS

Want to Hike Downhill Pain-Free? Here Are Five Tips.
Must-Know Camping Tips from a Lifelong Camper
How to Make Camping Fun
This Drone Video Shows What It’s Like to Climb to Mount Everest’s Summit

While I now live at altitude, I experienced sleeplessness, tinnitus, and
breathlessness when first moving to the area. Those were mild annoyances, but
I’ve seen some things go pretty south. Once my elderly stepfather, who had a
heart condition, spent Christmas in the ER and came back to the family’s rental
house toting oxygen. Another time I was at a wedding in Boulder where a
bridesmaid keeled over right in the middle of the ceremony, having come from sea
level…and being dehydrated…and hungover. The young-adult son of a friend came to
Vail, got drunk, got dehydrated, sat in a hot tub (yes, they dehydrate you,
too), and had to be airlifted out. (The bridesmaid and the guy were both fine.)

After the incident at the photo camp, I wrote up a list of altitude-sickness
prevention tips for students and other visitors to our area.

Taos, New Mexico, sits at 6,969 feet in the foothills of the Sangre de Cristo
Mountains, part of the Rockies. Near it is Wheeler Peak, at 13,161 feet the
highest point in New Mexico. (Photo: Mona Makela Photography/Getty)

As summer kicks in, with visitors coming to my house and tourists traveling to
mountain towns all over, I decided to update the list and contacted Peter
Hackett, M.D., an E.R. doctor and high-altitude specialist. Hackett has treated
patients and gathered research at the clinic known as “14” (for 14,000 feet) on
Denali, in Alaska, and in the mountains of Nepal, again working at 14,000 feet.
(He climbed Everest in 1981, going solo from the South Col to the summit.) In
2009, he founded the Institute for Altitude Medicine at the Telluride Medical
Center, in Telluride, Colorado, heading it up until 2015.

Dr. Peter Hackett speaks about altitude. You might want to listen. (Photo: Peter
Hackett Collection)

He also has another gig, as it were. In 2006, when the Rolling Stones played in
Mexico City, at 7,350 feet, they felt the altitude. Hackett, the expert, was
flown in for a consultation; he and Mick Jagger hit it off. Since then, as he
says, “I’ve toured with them for 18 years” as the band’s physician, in his
capacity as an ER doctor. Tours are intermittent, lasting perhaps two months,
and then he can return home to Ridgway, Colorado, where he raises yaks.

Word, it seems, gets around among rock stars, and I reached Hackett by WhatsApp
while he was at a stadium in Madrid, there as touring physician with Bruce
Springsteen. He was back stateside the following week in time for the Stones
concert in Denver.

As many of you will be traveling from sea level to the mountains this summer to
hike, bike, and have fun (and later will travel to them to ski, snowboard, and
have fun), here’s our advice on how to fend off altitude sickness.

Dr. Hackett is a touring physician with the Rolling Stones as well as an
altitude specialist. Here Mick Jagger (who will be 81 in July) charges around
the stage with no problem, in Denver on June 18 at an elevation of 5,280 feet.
He was definitely hydrating. (Photo: Alison Osius)


WHAT IS ALTITUDE SICKNESS?

As you travel upward from sea level, you encounter thinner air, with effects
typically appearing between about 5,000 and 7,000 feet. The lower atmospheric
pressure means you bring in less oxygen by breathing, because less is available.
Especially above 8,000 feet, if your body has not had time to adjust, you may
experience signs of altitude sickness. The effects are much more significant the
higher you go, can be extremely dangerous, and must be heeded, but at moderate
altitudes are usually preventable.

Hypoxia is low levels of blood oxygen from going to altitude, and just about
everyone experiences some effect, such as shortness of breath, pounding heart,
and/or trouble sleeping.

Secondary to hypoxia, and caused by it, is altitude sickness, the result of
going high without having time to adjust (given time, the body can adjust to
moderate hypoxia). Altitude sickness is more gradually occurring, generally
taking hours (though you can bring it on almost immediately if you step off a
plane and fire up a Colorado 14er). It has three types, known as AMS, HAPE, and
HACE. AMS and HACE involve the brain, and HAPE the lungs.

Acute mountain sickness (AMS) is the most common and mildest, and may be
characterized by headache, nausea, fatigue, dizziness, and again sleeplessness.
It feels exactly like a bad hangover, Dr. Hackett says, and “nearly always”
resolves in two to four days or less on its own, often within 24 hours if the
person ascends no further and exerts little. Go no higher until you are better,
and while you can always go lower, it is usually not necessary. Descend or get
medical help if you get worse instead of better over one or two days.

In high-altitude pulmonary edema (HAPE), fluid accumulates in the lungs,
inhibiting the transfer of oxygen into the blood. HAPE is separate from AMS,
involving the lungs, although Hackett says that 50 percent of those with HAPE
had AMS first. AMS can, however, develop into the severe high-altitude cerebral
edema (HACE), creating swelling in the brain, with effects as if a person is
drunk, such as confusion, disorientation, and loss of consciousness. HAPE and
HACE can develop over two or three days.

“HACE can be considered the end-stage of severe AMS,” Hackett says. He also says
that AMS “will rarely progress to HACE, especially at the modest altitude of
Colorado resorts.” These resort towns, like many in the country, are at about
6,000 to 10,000 feet.

HAPE and HACE are life-threatening medical emergencies necessitating treatment
and descent.

“Someone with AMS who stays at the same altitude and gets better will not get
HAPE,” he says. “Someone with AMS who goes higher when they shouldn’t will get
worse with AMS and could also develop HACE or HAPE.”

Some persons are sensitive to hypoxia and can either feel the effects or get AMS
as low as at a sleeping altitude of 5,000 feet, though that is unusual. “At
6,000 to 7,000 feet, it happens more but is still unusual,” Hackett says. “Maybe
[to] 10 percent of folks. At 8,000 feet, most everyone feels some effect of
hypoxia, like trouble sleeping and shortness of breath with exercise, and about
15 to 20 percent of unacclimatized persons will get AMS.” A sleeping altitude of
9,000 feet is considered a major threshold, he says, and persons going directly
to that have an incidence of more than 50 percent of AMS.

Pay attention! Communicate all symptoms to your group, know where a hospital or
clinic is, and have a way to get down or a descent route in mind.

Big Bear Lake, at 6,752, sits amid the mountains of the rugged San Bernardino
National Forest, Southern California. (Photo: Ron and Patty Thomas/Getty)


AT WHAT ALTITUDE MIGHT I GET ALTITUDE SICKNESS?

Denver, at 5,280 feet (it’s the Mile High City), is a good representation of the
5,000-foot mark at which people may exhibit symptoms or should simply observe
how they feel. The city has an international airport and is a launching point
for various higher towns that range from, say, nearby fun Boulder at 5,430 up to
Leadville, at 10,158 feet the country’s highest incorporated city. Vail, 97
miles up I-70, is at 8,239 feet; Aspen, 160 miles away, at 7,908 feet; and
Crested Butte, 8,909.

Other such outdoors towns across the country include Park City, Utah, at 6,936
feet; Big Bear Lake and Mammoth Lakes, California, at 6,752 and 7881; Pinedale,
Wyoming, at 7,182; Victor, Idaho, at 6,214; and Santa Fe and Taos, New Mexico,
at 7,199 and 9,321 feet. And consider surroundings: Salt Lake City is not
terribly high at 4,327, but people fly in to ski and might take the tram up
Hidden Peak, at Snowbird. It docks at 11,000 feet.


WHO DOES ALTITUDE SICKNESS AFFECT?

A common misperception is that fitness protects you from altitude sickness. It
can affect anyone, at any age or stage of fitness and athleticism. Sometimes you
might feel fine at altitude, other times not, depending on whether you’ve
acclimated or pushed too hard and/or overindulged in alcohol.

Below is my original altitude tips list, updated with Hackett’s comments and
clarifications. The conversation and this article use Denver as a model.

Telluride, at 8,750 feet, is a great place to go year-round, with renowned film
and music festivals and summer recreation as well as its famed skiing. A view of
Main Street. (Photo: Alison Osius)


HOW TO AVOID ALTITUDE SICKNESS

1. Hydrate throughout your trip. Take a water bottle everywhere. 

As you go high, your blood oxygen level drops and respiration goes up, and you
lose water at an increased rate. Conventional wisdom has long been to drink lots
of water when you travel from sea level to anything starting at about 5,000
feet. You need to think about it and do it. Just don’t take it too far.

Hackett says: “There’s no science to support [that drinking water prevents Acute
mountain sickness/ AMS], but a lot of anecdotal evidence. In mountain
environments, you do need to drink extra water, but it depends on what you’re
doing”—both effort and temperature. “On Denali it’s cold, and you’re not
sweating, so you don’t need as much [as in a hot place].

“The point is not to overdo it. If you’re in Aspen [at approximately 8,000
feet], have an extra liter or liter and a half a day. The danger is that people
over hydrate and wash out their sodium. They get hyponatremia, or low sodium,
from a lot of water.” Hyponatremia is dangerous and needs to be treated.

Keep an eye on your urine and try to keep it clear or pale yellow as opposed to
darker or orange.

Bottom line: “Be moderate,” Hackett says. “Just like at sea level, drink more if
you’re hiking hard, but you don’t need too much extra.”

2. Drink little or no alcohol on the trip. Ban that second margarita!

Alcohol increases dehydration and hampers ventilatory adaptation to hypoxia.  

“Correct,” says Hackett. “The science is that ingestions of about 50 grams of
alcohol will lower your breathing response to hypoxia. One beer or one margarita
is not going to make much difference. That’s where you should be until you get
acclimated, which takes two or three to four days.”

The CDC is a little sterner, advising: “Do not drink alcohol or do heavy
exercise for at least the first 48 hours after you arrive at an elevation above
8,000 feet.”

Leadville, Colorado, at 10,158 feet the country’s highest incorporated city, is
gateway to several nearby 14ers, also beautiful areas such as Twin Lakes (Photo:
Alison Osius)

3. Give yourself time to acclimate. Try to arrive in a lower site such as Denver
a day early and take it easy, remaining at a constant elevation, overnight if
possible, before going higher.

Hackett clarifies that the concept of stopping in Denver or a similar interim
place applies to some but not all people: “As long as they don’t fly into Aspen
and go higher, they are probably OK,” he says. “If [someone is] concerned
because of pre-existing conditions or has a baby or is pregnant…It’s always
better to spend a night in Denver.” Always consider pre-existing conditions.

“It’s super important to take it easy the next day, don’t drink much [alcohol],
and hydrate a little more than usual. The single most important thing is not to
fly into Aspen and go higher. That’s definitely high risk.”

Another option might be to fly into Aspen at 8,000 feet and spend the first
night in a lower spot such as Glenwood Springs, 40 miles away and 5,883 feet in
elevation.

“Coming into Aspen, 85 percent of people will be fine and about 15 percent will
get headaches,” Hackett says. “If they fly into Aspen and go to Ashcroft [9,521
feet] to sleep, 60 to 70 percent will get headaches. Go up gradually.”

The CDC similarly advises: “Avoid traveling from a low elevation to an elevation
higher than 9,000 feet (2,750 m) above sea level in one day.” 

Again, go higher gradually. Some sources advise the tactic of day trips to
higher elevations, while sleeping lower. As above, if you begin to feel ill,
stay put and rest or descend until you feel better.

Camping at Mammoth Lakes, California, at 7,880 feet (Photo: Dakota
Snider/Mammoth Lakes Tourism)

4. Talk to your doctor about bringing a prescription drug such as Diamox in case
of need. Also consider bringing aspirin or ibuprofen in case of headache.

“I support all those,” Hackett says. “The problem is your average doctor doesn’t
know much about Diamox. Doctors are very reluctant to prescribe a medicine they
are unfamiliar with, but it’s good to know there is something that helps. It
does not mask the symptoms, it speeds up acclimatization. So instead of three or
four days it takes one day.”

Talk to your doctor. Did you expect us to say anything else?

5. Insomnia blues, or what if I can’t sleep at altitude?

The top complaint of those going to altitude, and one that I experienced for
several nights when first moving to Aspen (I later relocated to nearby
Carbondale), is sleeplessness, from the effect of hypoxia on the brain.

“There’s no way to prevent it,” Hackett says. “Oxygen is available” to address
it, “and they can deliver it to a hotel room. Any doctor can write a
prescription for it, and you’ll sleep like a baby.” He later adds in an email:
“Sleeping on oxygen will help with sleep, prevent altitude illness, and protect
anyone with preexisting problems like high blood pressure, atrial fibrillation,
lung disease, etc.”

He says further: “Things that are known to be safe [sleep aids] include Benadryl
and Dramamine. You don’t want to take [medications] that might depress your
breathing and mix them with alcohol. Diamox can be helpful since it stimulates
breathing and raises oxygen levels.

“A lot of people sleeping at altitude will have some irregular breathing at
night. It’s not anything to worry about. It improves with acclimatization.”

Jackson, Wyoming, is at 6,237 feet and surrounded by the Teton Range to the west
and the Gros Ventre Range to the east. (Photo: Eric Hobday)

6. Resources to learn more about altitude sickness.

One of the links I suggested nine years ago is broken, and the other, a 2016
article from the Denver Post, has been updated, with an editor’s note saying:
“to reflect that people should not drink excessive amounts of water.”

Here are other resources.

The “mythbusters” section of Hackett’s website

Wilderness Medical Society: Wilderness Medical Society Clinical Practice
Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude
Illness: 2024 Update

Centers for Disease Control and Prevention: Travel to High Altitudes and  High
Elevation Travel

UptoDate.com: Patient education: High-altitude illness

No longer being updated but still considered expert and useful: An Unofficial
Acclimatization Guideline for JMT Hikers

7. Pay attention to red flags

While the woman at the photo workshop was a tricky situation—she was an adult,
who had paid for a service and wanted to learn—I always wondered if I should
have insisted on taking her down lower. I offered repeatedly to drive her to the
hospital, or at least have her stay at my home in Carbondale. She said no. Was I
wrong to accede? A worse result would haunt me. I asked Hackett.

Only a few red flags, he said, mandate immediate descent or oxygen. He listed
them in an email: “Respiratory distress (‘Just can’t get enough air,’ or obvious
trouble breathing), and the brain going off (confusion, disorientation, can’t
walk a straight line). Vomiting is not a red flag, nor is ‘collapsing’ unless
into unconsciousness.”

Guess I can breathe easier, at least about that time.

Alison Osius is a senior editor at Outside, who formerly worked at Rock and Ice
and Climbing magazines. She thinks the highest she has been is 14,000 feet, and
doesn’t plan on going any higher.  

The author at a little under 6,000 feet in Cerro Castillo National Park, Aysén,
Patagonia (Photo: Erin VanSickle)

For more by this author, see:

> Colorado’s Storm King Mountain Memorial Trail Takes You to Sacred Grounds



> This Is the Most Beautiful Town in Colorado



> Must-Know Camping Tips from a Lifelong Camper



 

 

 

Filed to:
 * Hiking
 * Skiing
 * Sports medicine
 * Wellness

Lead Photo: Marc Piscotty/Utah Office of Tourism


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