pats wrote:Of course "fully-informed" includes knowing the altitudes. One of the first things I did during the consultation was hand him a simplified itinerary - no fluff about the scenery - annotated day-by-day with the altitude at which I would be sleeping that night. As I expected, he read it carefully before giving me any advice. I'm sure he would have asked if I had not handed him the information.
We did not discuss general issues of altitude and sleep apnea, only my case and my vacation plans. Remember, it was a doctor-patient consultation, not a seminar on sleep apnea management. That is why I emphasize the fact that his advice is specific to my case, and anyone else considering similar travel should get their own medical advice.
As far as the general issue of the advisability of my travel is concerned, in addition to the sleep specialist I've consulted my own primary care physician and the HMO's travel advisory service. My PCP's response, when I called her attention to the sleep apnea diagnosis and reminded her of my travel plans, was "I think that you will do fine in the Andes.". The travel advisory service issued prescriptions for an antibiotic to use if needed for digestive problems, which they do for travel to any area without very good water and food safety, and a drug that helps with high altitude adjustment.
The medical advice I got about Provent and my travel plans turned out to be correct in practice. I am still in La Paz, in a hotel at about 10,000 feet, but I plan to spend tonight on a pressurized aircraft, and be home, close to sea level and back on APAP, tomorrow night.
The only time I had a hint of the beginnings of a headache on waking, I also had reduced skin elasticity, and both problems were cured by plenty of non-alcoholic fluids at breakfast. Pushing lots of very dry, low pressure air through my lungs was apparently using up more water than I realized. I had no unexplained daytime sleepiness. I was able to do all the activities I wanted to do, including walking all over Machu Picchu. I even got out of the train and took a couple of photos at the highest point on the route from Cuzco to Lake Titicaca, at over 14,000 feet.
I had two incidents of daytime sleepiness. One was on a bus ride after a morning of high altitude exertion - climbing to the top of the ruins at Ollantaytambo. The other was after a night when restless leg syndrome had prevented me from getting a full night's sleep.
I'm really glad I decided to use Provent for my travel. I do think it should only be done on informed medical advice, and only if Provent does stick to your skin and you can adjust to it at home first.