High altitudes, anxiety, and panic attacks: Relationship?

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rlown
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High altitudes, anxiety, and panic attacks: Relationship?

Post by rlown » Wed Aug 16, 2017 12:23 pm

So I have a hiking partner that can't stay in the tent when we're above ~8,000ft. He'll just sit outside the tent all night. This only developed in the last 10 years. This article was very telling, and I make sure he has the discussion with his doctor and the appropriate meds for our trips.

High altitudes, anxiety, and panic attacks: Is there a relationship?
Abstract

People exposed to high altitudes often experience somatic symptoms triggered by hypoxia, such as breathlessness, palpitations, dizziness, headache, and insomnia. Most of the symptoms are identical to those reported in panic attacks or severe anxiety. Potential causal links between adaptation to altitude and anxiety are apparent in all three leading models of panic, namely, hyperventilation (hypoxia leads to hypocapnia), suffocation false alarms (hypoxia counteracted to some extent by hypocapnia), and cognitive misinterpretations (symptoms from hypoxia and hypocapnia interpreted as dangerous). Furthermore, exposure to high altitudes produces respiratory disturbances during sleep in normals similar to those in panic disorder at low altitudes. In spite of these connections and their clinical importance, evidence for precipitation of panic attacks or more gradual increases in anxiety during altitude exposure is meager. We suggest some improvements that could be made in the design of future studies, possible tests of some of the theoretical causal links, and possible treatment applications, such as systematic exposure of panic patients to high altitude.

High altitudes, anxiety, and panic attacks: Is there a relationship? (PDF Download Available). Available from: https://www.researchgate.net/publicatio ... lationship [accessed Aug 16, 2017].
Source: https://www.researchgate.net/publicatio ... lationship








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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by Tom_H » Wed Aug 16, 2017 2:03 pm

I've seen it happen to participants on our high altitude trips in Colorado. These particular trips were supposed to be for experienced hikers who were in good athletic shape. Some people lied on their applications though, and one of the instructors would have to hike the person out. We also saw pulmonary and retinal edema, no cerebral at that altitude though. I did have one teenager exhibit some of the symptoms you describe once in Emigrant, though I think he was just faking it.

I haven't seen it happen to someone who previously had no problems with it. Then again, getting old and being in poorer shape affects us in different ways. Hope your partner gets some resolution.

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by rlown » Wed Aug 16, 2017 2:18 pm

We were up at Upper Mattie (cowboy camped).. He got out of his bag and started a smoldering fire which woke us two who were sleeping. As we coughed, we both sat up and said "make a real fire!".. Next day, we were at Virginia Lake, and he got up and danced around during the night, and in the morning said to us, "I need to get out of here." He headed down to Glen Aulin to wait for us. I'm betting on hypoxia induced anxiety/panic. He was in great spirits when we caught up with him at the Glen. I just have to make sure he has the appropriate meds.

We'll see about the resolution at the end of September. We'll be at 10,300 with a acclimatization pre hike outside the East side of Yosemite.

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by longri » Wed Aug 16, 2017 2:43 pm

The fact that going down was what he decided would fix his problem makes your theory seem pretty likely to be correct.

I've had something similar happen to me. On occasion I will have periodic breathing that is extreme enough to awaken me. That is, I'll basically have periods where I'm not breathing for long enough that I'll then wake up gasping for air. Then I hyperventilate for a bit before slowing back down to a normal respiration rate. But as soon as I fall asleep the cycle repeats.

This isn't typical obstructive apnea, it's a reaction to the air pressure and isn't uncommon or dangerous. I've noticed it in other people at altitude. Most of the time it isn't enough to wake people up.

It used to sometimes ruin my sleep, making me feel pretty lousy in the morning and anxious about lying down at night. Being inside a closed space when one repeatedly feels like they're suffocating isn't appealing. Now when I feel this happening, I pop 125mg of diamox and I'm usually sleeping like a baby 30-40 minutes later.

I wonder if you guys had noticed any oddities in his breathing?

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by rlown » Wed Aug 16, 2017 4:10 pm

I like the diamox idea. Thanks. I'll recommend it for his pre-trip checkup. He sleeps better than I do (maybe), but I seem to be able to enjoy being in my bag and warm. He's not going to die as we carry serious rain gear and warm clothes, but I now make him take his WM Badger out of the tent and drape it over himself.

On another note, my sleep pattern is way screwed up. What I decided to do now is if I can't sleep, just get up until actually tired. I get about 4-5 hrs of sleep, and naps help to make up the difference. Sucks to age, but this doesn't happen when on a BP trip.

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by Tom_H » Wed Aug 16, 2017 10:18 pm

I'm not a big fan of natural remedies and supplements unless there is scientific support for them working. Radon gas, asbestos, and poison ivy are natural, but not what I'd call healthy! I do take time released melatonin to help me sleep. Melatonin is a substance our brains make to make us sleep. As we age, we don't make as much of it. I make an exception for this stuff because it's something our bodies already make and I just need more of it, like a diabetic needs extra insulin. The non-time-released doesn't last long enough for me. It comes in several strengths. I use the 3 mg, time release from Source Naturals. You can find it in vitamin stores, supplement stores, natural food stores, and online.

https://www.amazon.com/Source-Naturals- ... 5X89H3B4KE

At home, I sleep better if my body is cold. Rather than running the AC all out, we use a Chili Pad machine. A pad goes over the mattress and has water tubes in it like a NASA spacesuit. This is routed to a miniature heat pump which can send warm or cool water through the tubes. (Called Chili because chilly is cold while chilli or chillie is hot.) One drawback is that in humid weather, it can make skin slightly clammy if running all out. Otherwise, it really helps with sleep and cuts down on electric bill for AC.

https://www.chilitechnology.com/?gclid= ... gwQAvD_BwE

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by longri » Thu Aug 17, 2017 7:40 am

While melatonin appears to be relatively safe I think it's a mistake to generalize to other substances that happen to be naturally produced in our bodies. It isn't too hard to find instances where taking supplements for some substance to compensate for a subnormal level carries with it significant risk.

In this case using a sleep aid may not be the right approach anyway. We don't know what is causing this person's anxiety. When you can't sleep at night are you so anxious that you have to get up and go outside? That's a symptom that suggests something else is going on. Maybe he has an arrhythmia that is triggered by the stress of lower oxygen pressure. Who knows? If it were me I'd go see the doctor and get a full examination instead of self-medicating.

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by rightstar76 » Thu Aug 17, 2017 8:13 am

One time after coming back from a backpacking trip, I stayed at one of the lodges in SEKI. I think it has been rebuilt though I am not sure. The room looked really nice. However, after trying to sleep I noticed it was very stuffy inside. After several nights outside in the fresh cold air, the stale warm air in the room was very unpleasant. At some point, I jumped out of bed and nearly ran out of the room. My wife woke up and wondered what was going on. I spent about a half hour by the window where there was a cold draft before I felt sleepy enough to go back to bed.

Since someone mentioned melatonin, I'll share my experience which wasn't very good. I took a small amount and fell asleep quickly. Unfortunately, I woke up twice with a rapid heartbeat brought about by vivid nightmares. I was really surprised since I had read so many good things about it.

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by rlown » Thu Aug 17, 2017 9:04 am

longri wrote: In this case using a sleep aid may not be the right approach anyway. We don't know what is causing this person's anxiety. When you can't sleep at night are you so anxious that you have to get up and go outside? That's a symptom that suggests something else is going on. Maybe he has an arrhythmia that is triggered by the stress of lower oxygen pressure. Who knows? If it were me I'd go see the doctor and get a full examination instead of self-medicating.
Funny you should mention "self-medicating." He carried some Xanax on one trip. He was still having the issue. I asked to see the bottle. It was his wife's prescription. Lets just say we had a little argument on that discovery. Not only was it her prescription, but he was nibbling them instead of what the dose called for. Also, doctors are quick to grab their reference sources for a prescription.

I should know, as I've had a few drugs prescribed that either didn't work or caused side effects that were unpleasant. I was on short term leave earlier this year for a sleep disorder and really bad recurring nightmares (all included heights), but I learned a lot from the experience. Drugs are generally a crap shoot. I now just listen to my body and don't stress over what I think I should be doing (sleeping) at a given time.

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Re: High altitudes, anxiety, and panic attacks: Relationship

Post by balance » Sat Aug 19, 2017 7:43 am

Greetings rlown

Here's some medical info in the quotes: "Cheyne-Stokes respiration is a condition that causes abnormal breathing during sleep. This abnormal breathing often includes “apneas,” or periods of stopped breathing, which explains why the condition is so frequently referenced in sleep apnea medical circles.

These apneas occur because Cheyne-Stokes respiration generally causes a person’s breathing to follow abnormal patterns, or dysrhythmias. This means that breathing gradually increases and decreases during sleep...These cycles of increasing and decreasing breathing activity ordinarily last from 30 seconds to two minutes in duration, with five to thirty seconds of apneas."

It is interesting that breathing is one of the few bodily functions that are controlled by both the Somatic and Autonomic nervous system. That means, breathing goes on automatically, and it can also be controlled voluntarily.

More medical info: "The Somatic Nervous System is the part of the peripheral nervous system that handles voluntary control of body movements. ... The Autonomic Nervous System is the part of the peripheral nervous system that acts as an involuntary control system below the level of consciousness."

So when you go up to higher altitude, your body will naturally increase breathing. When you're awake, if the normal breathing regulatory systems are not adjusting properly, you can consciously increase your breathing to compensate, by breathing more often or taking deeper breathes. So far so good.

But then when you go to sleep, your body relies entirely on the automatic, unconscious (Autonomic) nervous system to regulate breathing, This mostly has to do with the level of carbon dioxide that's in your blood. This regulatory system can easily get out of balance during sleep, when you can't tell your body to breathe more to make up for altitude induced oxygen deficit. That mis-regulation causes you to stop breathing at times during sleep. Even hardened high-altitude climbers can experience this with rapid altitude gain.

Now if someone were to put a plastic bag over your head for a minute or two (don't try this at home kids) and you couldn't breath, you would of course feel an overwhelming sense of distress, anxiety and panic. Having your breathing cut off for any reason is a desperate, life threatening situation. Therefore, your body dumps all the adrenalin it has into your system in a fight or flight response. That's why people experiencing Cheyne-Stokes wake up feeling jittery and in a panic. Makes perfect sense. Except it's a real bummer and a horrible feeling.

I do some things to prevent this from happening. Try to acclimatize a day at seven or eight thousand feet. Stay hydrated. I've never had any AMS symptoms (headache, nausea, etc.) during the day at altitude, even when driving up from sea level and hiking up from the trailhead to 12,000 feet in one day. Of course I get tired faster, but I just huff and puff and keep going. But at night, when I can't tell my body to breathe more, that miserable Cheyne-Stokes stuff can happen beyond my control.

When it happens at night, I drink some water, pray a bit, and maybe have a little food. But the main thing is walking around, because that helps burn up the excess adrenaline from not breathing properly. It tends to get better after a couple of days up high.

Diamox is proven to help this condition (but I'm allergic to Sulfa drugs so I can't use it).

I would suggest showing this information to your friend who is having the Cheyne-Stokes problems, so he will at least know there is a logical medical reason for what he is experiencing. I don't let it keep me out of the mountains, that's for sure.

One medical caution for your friend who has been experiencing this for the past ten years. Congestive heart conditions can contribute to all forms of sleep apnea, so a medical check-up would be a good idea. If you lived in Mammoth or Tahoe your body would probably adjust, and hiking up high wouldn't be a problem. That would be great.

Keep breathing. Peace.
Last edited by balance on Sat Aug 19, 2017 8:36 am, edited 7 times in total.

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