A Skier's Guide to Acute Mountain Sickness

A Skier's Guide to
Acute Mountain Sickness

Skiers (and snowboarders) are at risk of Acute Mountain Sickness (AMS) when they enter the mountain environment. Most skiers will at most experience a periodic mild headache. For a small minority, AMS can rapidly progress into High Altitude Pulmonary Edema (HAPE) (i.e. fluid in the lungs) and High Altitude Cerebral Edema (HACE), which are life threatening conditions. This page presents information that can help skiers understand and deal with the symptoms of AMS. Enjoy your vacation more by preventing AMS and being able to help your friends in distress.

At 8,000 feet (2438 meters), there is 1/4 less oxygen per breath. At 14,000 feet (4266 meters) there is 1/3 less. There are many resorts with peak elevations in this range of altitudes. Skiers should be especially aware when at resorts that have base elevations above 8,000 feet. Note that although commercial airline flights range in altitude from 20,000 to 40,000 feet, the cabins are pressurized to reduce the apparent altitude to between 5,400 and 7,000 feet.

AMS is caused by changes in chemical balances as the body adapts to less oxygen in each breath. Lower atmospheric pressure means that there are fewer oxygen molecules in each breath. The body attempts to breath harder to get more oxygen, but not enough to make up the difference. The balance between gasses in the lungs and in the blood changes. The distribution of potassium and sodium within the body also changes. These imbalances change the distribution of water between blood and the body tissues. When these changes happen slowly, symptoms can be avoided. The faster that these changes occur and the higher one goes, the more susceptible one is. Some people get AMS easier than others.

Skiers (as opposed to hikers and climbers) increase their chances of getting AMS by using lifts to rapidly ascend in altitude and then performing intense exercise. Other common contributing factors are being out of shape, smoking, drinking alcohol and getting little rest. Skiers avoid having AMS progress into HAPE/HACE by not spending a lot of time at altitude and returning to lower elevations at night.

Most skiers do not recognize that the headaches are symptoms of AMS. This chart can help you tell the difference between cold, flu and acute mountain sickness (information adapted from a presentation by Steve Dike, PharmD).

Symptom	Common Cold	Influenza	AMS
Fever	Rare	Sudden onset, temperature>102-104 Degrees Fahrenheit	Absent
Fatigue, weakness & exhaustion	Common	Extreme	Common
Nausea	Rare	Common	Prominent; vomiting indicates HAPE
Headache	Mild or absent	Prominent	Prominent
Muscular pain or joint pain	Mild or absent	Prominent	Mild or absent
Nasal discharge	Common	Prominent	Absent
Nasal congestion	Common	Less Common	Absent
Sneezing	Common	Less	Less Common
Sore Throat	Common	Common	Rare
Cough	Less common, usually non-productive	Common, persistent and non-productive	Persistent or productive cough indicates HAPE
Ocular(eye)	Watery eyes	Pain on motion of eyes, burning, light sensitivity	Dry eyes
Duration	5-10 days	One week	1-4 days
Other Symptoms			Shortness of breath, rapid heartbeat, sleep disturbance.
Complications	Sinus congestion, earache	Bronchitis, pneumonia	Bummer vacation experience, HAPE, HACE

A common AMS induced sleep disturbance is called periodic breathing (several deep breaths followed by 15 seconds of no breathing).

Here are some things skiers can do to help prevent AMS:

Know your limits. Although individuals get effected at different altitudes, the altitude that one experiences effects tends to remain fairly constant. Susceptibility to altitude sickness may be partly increased due to genetics.
Reduce or eliminate drinking and smoking until you have adjusted to altitude.
Drink plenty of water. Get a Camelbak and sip more the higher you go. Dehydration symptoms mimic altitude sickness.
Eat carbohydrates (pastas, breads, jams, jellies, etc)
Don't ski hard on the first day (take cruisers instead of hitting the bumps right off).
Don't hike out of bounds on the first day.
When hiking, use the "rest step" technique. Step, stop briefly and breath, step again.
Improve your breathing techniques. Pressure breathing = inhale normally, breath out in a rapid puff. Belly breathing = push your belly button out as you breath in.
Do your upper mountain exploring later into your vacation. Work your way UP the mountain, slowly.
If you have experienced AMS in the past despite all of the above steps, ask your Doctor if a prescription for Diamox (Acetazolamide) is appropriate, but be aware that Diamox is a diuretic (you'll need to drink even more water). Mountain climbers are also being advised to carry anti high blood pressure medication (vasodilators). Your blood pressure increases as you gain altitude. New research indicates that Salmetrol may help prevent the onset of AMS symptoms. Gingko Balboa and coca based products (e.g. leaves, tea) may help, but are less effective than Diamox.
Keep children under 6 at lower elevations
Women who are premenstrual should stay at lower elevations.
Be aware that storms can decrease atmospheric pressure by an additional 5% and that pressure drops faster per elevation increase the higher you go.

Here are some of the things that skiers can do to deal with AMS symptoms:

Tough it out. For most skiers, it's just a minor headache. (see note below)
Go downhill (skiers like doing this anyway) and stay at lower elevations. 1000 feet is usually enough to reduce mild symptoms.
Take it easy. If hiking, then slow down and let someone else take the lead. If skiing, choose a groomed run instead of moguls.
Take aspirin, Tylenol or Advil.
Don't take Viagra (unless your doctor says it's ok)
Drink lots of water. Do NOT drink tea, cocoa or caffeinated soda. Do not eat the yellow snow.
Eat. Granola or energy bars will do.
If it gets worse (e.g. vomit, cough or loss of coordination), lose elevation as quickly and safely as possible and see a Doctor immediately!