High altitude sickness – Challenges to traveling in Tibet

Wahtt is High Altitude sickness? When people travel to high-altitude regions like Tibet, they often experience altitude sickness (hypoxia), which results from a lack of oxygen reaching the body’s tissues. Symptoms include nausea, vomiting, fatigue, confusion, and shortness of breath, and in severe cases, it can be life-threatening.

As modern life intensifies, many prefer with high-altitude destinations often embodying this dream. But while these areas offer breathtaking landscapes and rich culture, travelers often worry about the effects of altitude sickness. Here’s what you need to know about altitude sickness and how to prepare before embarking on your highland adventure.

At high altitudes, the oxygen percentage in the air remains constant at about 21%, but the reduced atmospheric pressure makes it harder for lungs to absorb the oxygen needed. Consequently, the heart and lungs have to work harder to maintain oxygen levels, often causing increased blood pressure.

High altitude sickness is classified into two main types:

1. Acute Altitude Sickness: Common among those quickly exposed to high altitudes, symptoms can include dizziness, headaches, and breathlessness. In severe cases, individuals can develop pulmonary edema (fluid in the lungs) or cerebral edema (swelling in the brain), which requires immediate descent and medical care.
2. Chronic Altitude Sickness: This condition affects those living at high altitudes long-term, potentially causing lasting damage to the heart and lungs. Although less common, it can lead to a poor prognosis. Some people, however, do adapt fully over time.

Why Tibetans Don’t Suffer from High Altitude Sickness

Interestingly, Tibetans rarely experience altitude sickness despite living at elevations averaging 16,000 feet. Studies reveal that Tibetans exhale much less nitric oxide (NO) than people living at sea level. Additionally, their lungs transfer twice as much NO from the lung walls into the bloodstream compared to non-Tibetans. Nitric oxide helps expand blood vessels, which lowers blood pressure and enables easier blood flow.

This adaptation allows Tibetans to deliver more oxygen throughout their bodies with less strain on the heart. The expanded blood vessels reduce the heart’s workload, enabling a steady supply of oxygen in low-oxygen environments. Thus, their bodies can function efficiently in high-altitude conditions, where others may struggle with hypoxia.

What is High Altitude Sickness?

High altitude sickness, or “altitude sickness,” occurs as the body adapts to changes like lower oxygen levels, lower pressure, and drier air at high altitudes. This natural physiological response begins when you reach elevations above 2,700 meters, and up to 75% of people experience some symptoms if they ascend quickly to places over 3,500 meters, like Lhasa.

Altitude sickness, or acute mountain sickness, occurs when people are exposed to low-oxygen and low-pressure environments in high-altitude areas. It’s similar to the feeling of holding your breath for too long, where the body struggles to adapt due to oxygen scarcity. Common symptoms include dizziness, fatigue, shortness of breath, and loss of appetite, which can become serious if untreated, leading to complications like high-altitude cerebral or pulmonary edema.

The likelihood of altitude sickness increases with elevation, as lower atmospheric pressure means reduced oxygen in the air. Studies suggest that gradual acclimatization is preferable, as rapid ascent is more likely to trigger symptoms. Seasonal factors also play a role—cold weather in winter, coupled with low atmospheric pressure, can accelerate metabolism and oxygen consumption, making winter travel more challenging.

Recognizing the Symptoms of High Altitude Sickness

Common symptoms include:

• Headache
• Dizziness
• Shortness of breath
• Chest tightness
• Insomnia
• Nausea
• Purple lips (due to low oxygen levels)
• Loss of appetite
• Muscle aches

Severe Symptoms: In rare cases, altitude sickness can escalate to life-threatening conditions like high-altitude pulmonary or cerebral edema. Watch for symptoms like severe dry cough, pink frothy sputum, intense headache, confusion, memory loss, or hallucinations.

Train or Plane? Choosing the Best Travel Option for High Altitude Acclimatization

• Train Travel: While many believe trains offer a gradual ascent, train cabins are oxygen-supplied, making adaptation slower than expected. The long journey and limited air quality may also hinder good rest.
• Flight to High Altitude: Flying can lead to faster symptom onset due to the rapid altitude change. However, arriving by air gives you more time to rest and acclimate. Often, altitude symptoms become noticeable at night after the initial energy wears off.

Does Age, Fitness, or Exercise Affect High Altitude Sickness?

Altitude sickness can affect anyone, regardless of age, fitness, or gender. There’s a common misconception that fitter individuals are more susceptible because they consume more oxygen. However, altitude sickness actually depends on your innate oxygen-carrying capacity rather than your physical strength.

Oxygen Use: Temporary Relief or Dependence?

Oxygen can relieve symptoms like chest tightness and shortness of breath, but it may also delay natural adaptation to altitude. It’s often best to avoid oxygen unless symptoms are severe. For mild symptoms, use oxygen sparingly to help your body adjust naturally.

Tips to Handle and Prevent High Altitude Sickness

1. Stay Calm: Mental attitude greatly affects altitude sickness. Anxiety can heighten symptoms, so try to stay relaxed and positive.
2. Avoid Overexertion: On arrival, avoid running or strenuous activities. Rest often, keep warm, and avoid frequent bathing to prevent colds, which can increase susceptibility to altitude-related complications.
3. Stay Hydrated: Drink plenty of water, but avoid overeating or heavy foods. Limit alcohol and tobacco, and focus on vitamin-rich fruits and vegetables. Tibetan butter tea can also help alleviate symptoms.
4. Rest Well and Avoid Overuse of Oxygen: For moderate symptoms, mild oxygen use before sleep can help. Avoid over-reliance, as mild symptoms usually resolve within a few days naturally.

FAQs on High Altitude Sickness

How long does it take to adapt?

• Most people adjust within 1-2 days, but it can take up to 3-5 days for some.

Can children adapt more quickly?

• Children often adapt faster as they lack the psychological burden of worrying about altitude sickness.

High altitude sickness is manageable with the right knowledge and precautions. Approach your high-altitude journey with a relaxed mindset, listen to your body, and take care of essentials like hydration and rest to enjoy a safe, healthy trip.

Who Should Avoid High Altitude Travel?

For certain individuals, high-altitude travel can be dangerous and should be avoided.

Health Conditions That Increase Risk

• Severe Anemia: Those with low blood levels should avoid high altitudes due to limited oxygen-carrying capacity.
• High Blood Pressure and Cardiovascular Issues: People with heart conditions are at a higher risk of altitude sickness complications.

Preventative Tips for Cold and Flu

If you have a severe cold, treat it fully before heading to high altitudes. A weakened immune system can worsen altitude symptoms, particularly making lung issues like pulmonary edema more likely. When acclimated to the plateau environment, minor colds are generally manageable with timely treatment.

Medications to Manage High Altitude Sickness

Commonly Used Medications

• Rhodolia Extract: Often used for prevention but has limited short-term effectiveness.
• Pain Relievers: Medications like ibuprofen or aspirin help relieve altitude-induced headaches.
• Inosine Solution: An effective option for reducing altitude symptoms.
• Herbal Remedies: Ginseng and glucose solutions can alleviate fatigue. In Lhasa, you can find “Gao Yuan Kang,” which is effective but should be taken with caution due to side effects.

Always consult a healthcare provider before using these medications.

Emergency Response to High-Altitude Pulmonary and Cerebral Edema

Recognizing Symptoms

Pulmonary Edema Symptoms:

• Severe headache
• Chest tightness and extreme shortness of breath
• Persistent coughing with blood-tinged, frothy sputum

Cerebral Edema Symptoms:

• Loss of coordination
• Memory issues, hallucinations, and even semi-conscious states

First Aid Steps for Pulmonary Edema

1. Positioning: Keep the patient sitting or semi-reclining with legs down.
2. Oxygen Supply: Administer oxygen at 4-8 liters per minute, ideally with a mix containing 50%-70% alcohol.
3. Medications: Furosemide (40 mg/day, possibly increased if needed), nifedipine (10 mg under the tongue), and a single dose of dexamethasone (4 mg orally).
4. Keep Warm and Hydrated: Avoid excessive water intake.

First Aid Steps for Cerebral Edema

1. Lower Metabolism: In outdoor settings, reduce brain activity by applying a simple ice pack to the head, made by wrapping snow or ice in a scarf.
2. Safe Transport: Move the patient carefully, ensuring head and legs are lifted together to prevent jerking movements.
3. Medications: Mannitol for dehydration or, if unavailable, inject dexamethasone.

High-altitude pulmonary and cerebral edema are rare but serious conditions. Knowing basic symptoms and first aid can be life-saving in emergencies.

Tips for Preventing High Altitude Sickness in Advance

Altitude sickness can make the body feel quite uncomfortable, so it’s essential to take preventative steps to reduce symptoms or even avoid them altogether.

1. Pre-Travel Health Check

Healthy individuals should at least undergo an ECG and a blood test to understand their health status, while a complete heart and lung function examination is ideal. Those with pre-existing conditions and elderly travelers should follow their doctor’s advice closely and complete a thorough physical exam.

2. Maintain a Calm Mindset

Upon arrival at high altitudes, it’s best to manage excitement and stay calm. This approach can help reduce stress on the heart and lungs.

3. Gradual Ascent Approach

Studies show that combining train and car travel to reach higher altitudes can help the body gradually acclimate to the environment, promoting quicker adaptation to lower oxygen levels and reducing the risk of altitude sickness.

4. Follow the “Three Don’ts” Principle

• Don’t ascend too quickly: Once you reach an altitude of around 2,500 meters, increase elevation slowly, ideally no more than 600 meters in a 24-hour period.
• Don’t go too high: The higher the altitude, the more likely altitude sickness is to occur. Research shows the incidence rate of altitude sickness is 56.47% at 3,000 meters, 63.74% at 3,700 meters, and 91.11% at 4,520 meters, so ascend according to your limits.
• Don’t over-exert yourself: Conserve energy, reduce oxygen consumption, and avoid fatigue.

5. Keep Warm

With increased altitude, temperatures drop, and the high-altitude environment often has a significant temperature difference between day and night. Pay special attention to staying warm to avoid catching a cold.

Additionally, it’s wise to carry necessary medications and portable oxygen equipment with guidance from a medical professional. If you experience severe discomfort along the way, seek medical assistance promptly.

Actively Monitor Your Health

For real-time health monitoring, consider using devices like the Apple Watch with the “Health App”. This app can track blood oxygen and heart rate, enabling users to assess their altitude sickness risk in real-time, which can be beneficial for high-altitude health management.

Tips for Preventing High Altitude Sickness

1. Maintain a Positive Attitude

Avoid excessive worry or overthinking symptoms, as stress and anxiety can worsen altitude sickness. Similarly, avoid overly excited reactions like shouting, running, or jumping, which can disrupt your body’s balance and increase stress on your heart and lungs.

2. Stay Hydrated

Proper hydration is essential at high altitudes. Drink at least 2–3.5 liters of water per day, and check that your urine is clear or light yellow. Adding glucose, ginseng slices, or fruit juice can provide energy and help prevent colds.

3. Keep Warm and Protected

High-altitude climates are colder, with drastic temperature changes. Dress warmly, especially in layers you can adjust easily, and avoid activities like bathing in the first few days to prevent chilling your body, which could weaken your immune system.

4. Eat Light and Nutritious Foods

Choose easily digestible foods and avoid heavy or overly filling meals. Increase your intake of carbohydrates and plant-based proteins, making up over 60% of your diet, to boost energy and help your body adjust to the altitude.

5. Plan an Acclimatized Itinerary

For a first trip, consider visiting lower-altitude areas like Nyingchi (around 2,000 meters) before moving to higher altitudes like Lhasa (3,650 meters) to gradually adapt.

6. Sleep Later, Wake Up Earlier

Nighttime oxygen levels are lower, so consider sleeping one hour later than usual to ease nighttime breathing. Keep your room or tent well-ventilated to prevent oxygen depletion.

7. Use Medications as Needed

Consider starting altitude sickness prevention supplements, like Rhodiola or other adaptogens, 1–3 days before traveling to high-altitude areas. Bring pain relievers for headaches, and try to limit oxygen use unless necessary to help your body develop natural resilience.