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BLAME IT ON
THE ALTITUDE

Higher elevations may
worsen sleep problems

Written by JENNY DEAM

Ah, there's nothing like the clean, crisp mountain air of the high country for a really good night's sleep. So why are you still awake counting the crossbeams in your cabin?

Sleep disorder experts say that altitude may have exactly the opposite effect than most people think, causing insomnia, restless sleep, groggy mornings and worsening sleep apnea in some patients. If you had trouble sleeping before, you can pretty much count on your trip uphill only making matters worse. "If you had mild sleep apnea at sea level, you may have moderate to severe sleep apnea at altitude," says Dr. Dawn

Stanley, director of Sleep Disorder Center at Sky Ridge Medical Center in Lone Tree. She says when she moved to Colorado from Chicago three years ago, she actually worried she would never find a job in the sleep disorder field. But there have been plenty of cases here to keep her busy.

The word "apnea" is Greek and literally means without breath. Sleep apnea is a medical condition in which you actually stop breathing for at least 10 seconds and sometimes up to a minute. It can happen hundreds of times per night, usually with the person never knowing the next morning it has occurred. The result is fractured and poor-quality sleep and a nagging fatigue the next day.

Sleep apnea is surprisingly common, affecting as many as 18 million people in this country. It is as prevalent as asthma or adult diabetes, according to the National Sleep Foundation. Add to that the 20 to 40 percent of all adults who suffer from bouts of insomnia caused by other factors and the 60 percent of women who report they get only a few good nights' sleep a week, and it's small wonder ours is now considered a sleepyhead nation.

Sleep apnea is only one of several medical conditions that can cause sleep problems. It can be divided into two types. The most common is called obstructive sleep apnea, which occurs when the muscles in the back of the throat fail to keep the airway open. It is often thought to be associated with being overweight, but thin people can also be affected. Chronic snoring can also be a sign of sleep apnea. It affects more men than women, but as women near or reach menopause, they tend to catch up. One theory is that hormone levels in women of child-bearing age tend to protect them from sleep apnea and other sleep disturbances. But once those levels decrease, sleep problems begin to rise.

The other form of sleep apnea is called central sleep apnea, and it has been linked to higher elevations. The human body maintains a narrow balance of oxygen and carbon dioxide. Normally when a person falls asleep, the carbon dioxide rises slightly, and the oxygen falls, explains Dr. Teofilo Lee- Chiong, medical director of the Sleep Center at Denver's National Jewish Medical and Research Center.

But in altitude, he says, there are already lower levels of oxygen, so you breathe faster and deeper, blowing off more carbon dioxide to maintain the balance. Then when you fall asleep, the process is magnified. The brain senses the carbon dioxide levels are low, so it actually tells the body to quit breathing, and an apnea episode occurs. Dr. Lee-Chiong says the condition usually corrects itself after a few days as the body adjusts to higher elevation. But it can persist, especially if a person has other underlying sleep problems or has heart or lung conditions.

Lawrence Scrima, director of the Sleep-Alertness Disorders Center in Aurora, remembers a Denver woman once studied at the University of Arkansas. At lower elevations her number of sleep apnea episodes was 16 per hour. In Denver the number nearly tripled to 41.

Sleep, or lack of it, remains an emerging field of medical study. "The exciting thing and the frustrating thing about sleep medicine is it's so new," says Stanley. It has been only in the past generation or so that the medical establishment and the public have come to understand how critical restful sleep can be and how damaging if it is absent. In fact, it was not until 2007 that the American Medical Association recognized sleep as a subspecialty with its own board examinations.

Research also now links high blood pressure to sleep apnea. Stanley adds that such seemingly unrelated conditions as loss of libido, weight gain, diabetes and even mental health issues such as depression and anxiety could be caused by a lack of restorative sleep. “That's how I get them in," she jokes, eyes twinkling. "With men it's the sex; with women it's the weight." Still, one of the biggest obstacles to overcoming sleep problems is that so many people have the wrong idea about what helps.

Sleep issues can be either medically based or behaviorally based. Sleep problems are not just falling asleep. Excessive sleepiness during the day can also signal sleep problems you don't know you have. If problems persist, it is a good idea to seek an evaluation by a specialist to rule out medical problems. If the sleep problems are rooted in behavior, there are things that can be done at home: One of the worst things you can do to help yourself fall asleep is to self-medicate with a drink before bed. It may help you fall asleep quickly, but as the alcohol is absorbed in your body, your sleep will become fitful and you may wake frequently. Also, over time, it will take more and more alcohol to help you fall asleep.Another misperception is that if you wear yourself out, you will sleep better. Not necessarily. Vigorous exercise four to six hours before bedtime will indeed help you sleep better. Any closer to bedtime will disrupt sleep. Ditto the bath. A hot bath might help relax you two to three hours before bedtime, but body temperature declines with sleep, and a hot bath too near lights out will delay the process.

And speaking of lights out, don’t ignore the value of a darkened bedroom at night and bright light during the day to help set your body's internal clock. That is why shift workers often experience such disrupted sleep. Another tip is to try to go to bed about the same time each night and, even more importantly, try to wake up at the same time each day.

Replaying the day's events or fretting about the day to come will only make sleep more elusive. Meditation or slow breathing before bedtime to help clear your mind may in turn help relax you so you can fall asleep more easily. A light snack, especially one that contains the amino acid L-Tryptophan, is also helpful. Think how sleepy you feel after chowing down on Thanksgiving. Turkey contains LTryptophan. Crackers with cheese or yogurt are good choices.

Sleep deprivation is not something to be messed with. There is, after all, a reason it has been used as torture.