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Home > Dr JB Lim's Corner > Why do I experience this fainting (vasovagal episodes) on long flights?
Why do I experience this fainting (vasovagal episodes) on long flights?
Flying - Dr JB Lim's Corner
Thursday, 06 December 2007 18:49

Hello Capt Lim,

I am 73 years old, active, healthy and have flown world-wide for many years. I have a family in the United Kingdom, Australia and elsewhere. I have fainted on three recent overseas flights when I got up to visit the toilet. However, each time I recovered almost immediately. Is there a foolproof method to prevent this problem?

My wife refuses to fly with me again until I am sure it will not recur. We have a new grandchild due next spring in Queensland and we want to fly again.
Many thanks for any advice.

Regards,

R E Marcus

Dear Marcus,
 
Dr JB Lim has replied to your query on fainting spells and the vasovagal episodes below. As I am not a doctor, I have to refer your question to him. He has been very generous to come up with a comprehensive response.  I believe, he has taken the trouble to explain to us more than what we need to know about postural hypotension. I hope the knowledge on the prevention of this problem would be useful to the other visitors of this website as well.
 
Regards,
 
KH Lim.

Black out while attempting to stand during a flight

Dear Capt Lim,  

Thank you very much for referring Mr Marcus case to me.

I think what Mr Marcus has, was just a simple case of what we call ‘postural hypotension’. It was just an indirect cause of what Mr Marcus described as a vasovagal attack or a vasovagal reaction, which is an autonomic cause of a faint. Vasovagal attack is a temporary loss of consciousness (faint) due to the sudden slowing of the heartbeat normally caused by severe pain, stress, shock or fear, caused by over stimulation of the vagus nerve which controls breathing and blood circulation. From the description given by Mr Marcus, his fainting experiences were probably not a ‘vasovagal attack’ in which the vagus (vagal) nerve was over stimulated (attacked), causing the heart to slow down (bradycardia), and a drop in blood pressure due to the blood vessels (vaso) opening up. Thus the name ‘vasovagal attack’ as he described. Mr Marcus problem was probably only a mechanical one due to a change in position from sitting to suddenly standing up. I shall explain that shortly. There is not much to worry about if Mr Marcus merely experienced it three times previously. He probably was sitting down for a long time in the cramped seat of his aircraft, and suddenly standing up, wanting to go to the toilet.

Blood not Reaching the Brain
 
This is merely due to the inability of the heart to pump sufficient blood to the brain. The brain is very sensitive to lack of oxygen carried by blood in circulation. Even a momentary loss of blood flow to the brain causes a black out or a faint (syncope). Reason this to ourselves, and we will feel comfortable that this fainting episode is quite normal. When we sit down for a long time, especially in a cramped condition with not much leg room, the blood tends to pool into the lower extremities (legs) of the body. Gravity pulls the blood towards the legs against the pull of the heart towards it, and upwards further towards the head. There is a decrease in what we call poor venous return in the legs. When a person suddenly stands up, there is an inability for the heart to cope by sending sufficient blood from the remaining blood volume in active circulation towards the head. This is due to the sudden increase in height against gravity triggered by abruptly standing up. A sudden drop in blood pressure results in a decline in blood (oxygen) perfusion to the tissues (brain). This causes a faint.

This is the same mechanism that causes a solider standing at attention for a long time in a parade. Although the solider in this case has not changed his position, the underlying cause is the same – insufficient blood going to the brain. The blood merely gravitates to the lower part of his body if he does not aid venous return by at least marching on the spot. The act of marching causes the muscles of the legs to contract and relax alternately. This acts like a pump. This promotes venous return, an increase in blood volume in other parts of the body, in turn increases hydrostatic pressure, and hence, the blood pressure. The flow of blood upwards towards the head and body is also increased. An occasional dizziness or a faint due to a sudden standing up from a lying down or sitting position is absolutely normal. A lot of people experience this before, including myself.

This occurs also especially in tall people, and who does not exercise to increase their cardiac efficiency, and pumping action. In occurs often particularly among young menstruating females who are tall and anemic. Females tend to faint more often than males. This is not because they are a weaker sex. An anemic individual has less oxygen-carrying capacity in her blood than an individual with normal haemoglobin levels. The incidence of females fainting in a crowd, or when they are standing still too long for an inspection in a parade, is very much higher than their males counterparts in the same age group, with the same weight and height, physical make-up, or even in the same ethnic group.

An Analogy in Haemodynamics

One of the best analogies to understand why the act of suddenly standing up will cause a drop of blood pressure and blood flow to the brain, is to imagine the body as a water hose with water (‘blood’) from the tap running out, but kept in a horizontal (lying down) or sitting down position. The water (‘blood’) pressure gushing out towards the outlet (the head) is horizontally the same throughout the horizontal column of the hose (the rest of the body). If we suddenly raise the hose upwards, there is a momentarily drop in the height of the water now directed upwards (the head). It will take a few seconds before the water can reestablish pressure again, and shoot out to a more stable height. The water pressure has little time to fight against gravity if you raise the hose suddenly. That explains the sudden drop in pressure and height of water. But if we raise the hose upwards slowly, we will see there is no drop in water pressure and water height. The same haemodynamics holds for the body if there is an abrupt change in position from lying or sitting down to standing up position.

Heart Action

Under normal circumstances, a number of reflexes become operative to stabilize blood pressure. There are within the blood vessels, pressure sensors (baro-receptors) that act via the involuntary (autonomic) nervous pathways that respond to changes in the blood volume and blood pressures. First, the nervous feedback mechanisms will cause the heart to beat faster, and more forcefully to increase the blood flow. The muscles in the arteries constrict, and the veins in the lower part of the body contract to increase blood pressure. This will send more blood towards the heart and head.

These circulatory reflexes when they function well, will adjust the blood pressure, and stabilize it, giving hardly any symptoms felt from lying and sitting to standing up positions. If the heart is efficient, as in athletes, and where the volume of blood discharge per minute (cardiac output) is normal (between 2.5 and 4.5 litres per minute at rest, to as much as 30 litres per minute after vigorous exercise), faints are less likely to occur. In elderly people, this pumping action may be a little lower, especially those with cardiac disease. If the heart is smaller, or the myocardium (heart muscles) are damaged or are weak, and the cardiac output is lower, or the heart rate lower (bradycardia). In such events, dizziness, faints and blackouts are more likely to happen.

If an individual already suffers from low blood pressure (hypotension), he is likely to faint even more if he suddenly stands up. That makes his blood pressure drops even more. But it is very normal if faints due to postural changes are only occasional, as experienced by Mr Marcus or anybody else. There is just nothing to worry about. Nevertheless, I suggest Mr Marcus have his blood pressure check to be more certain, as well as for other conditions which I shall describe a little later. If an individual experiences many episodes of syncope very often, he needs a throughout medical examination to look at other underlying causes.

Diseases Associated with Postural Syncope

Frequent dizziness and faints associated with postural hypotension may be the result of certain medication, such as antihypertensive drugs, notably the alpha and beta-blocking agents – drugs that are used in treating high blood pressure by lowering the pressure. They act by blocking the transmission of pressure changes from the autonomic (involuntary) nervous system to the heart and blood vessels. In short, they block circulatory reflexes that increase and stabilize blood pressure. Postural hypotension may also result from certain disease and nutritional disorders. Diabetes mellitus is one, and alcoholism is another. In diabetes, nerve damage disrupt the reflexes that controls blood pressure.Other causes of postural hypotension is the result of some injury, such as an injury to the spinal cord, notably at the level of T-6 (6th thoracic vertebrae) and above. In spinal cord injury, the blood vessels fail to constrict in response to sudden drop in blood pressure due to malfunction of the autonomic nervous system.

The * vagus nerve - the 10th cranial nerve, and the longest nerve that controls the heart rate and other systems in the thoracic region is normally involved. The blood remains pooled in the pelvic cavity and legs, whether sitting or standing. Other causative factors are the result of serious burns and trauma that leads to a fluid loss and a reduction in blood volume (hypovolaemia) , such as in shock. Sudden and acute hypotension may also develop in events such as AMI (Acute Myocardial Infraction – heart attack) or in adrenal failure which all lead to hypovolaemia and shock. However all these triggers for postural faints do not apply in Mr Marcus case, from the description and history given by him. Mr Marcus case is very clear cut. It was a simple and uncomplicated cause. His dizziness and syncope were merely due to sitting too long, and suddenly trying to get up.

Comparative Physiology

A giraffe with a long neck does not faint even if the animal suddenly raise its head from the ground to the tree tops, because of the valves in its neck blood vessels that stop the blood from slipping back from its head. Because of its long neck, the valves are specially created or evolved that way to prevent a giraffe from fainting. Human veins too have valves to prevent regurgitation of blood (blood flowing backwards), but our body and neck are just not long and tall enough to merit this sort of physiological function. We depend on other haemostatic and feedback mechanisms such as baro-sensors in the arteries, constriction of blood vessels, and an increase in the cardiac output to overcome these physical and physiological variations.

More Serious Medical Threats

Sitting too long in an aircraft in a cramped seat with hardly any leg-room to move about, as in an economy class, has far more serious medical consequences than simple dizziness and syncope experienced when passengers suddenly stand up. The more serious health threat is a relatively recent development called “Deep Vein Thrombosis” (DVT), erroneously named as ‘Economy Class Syndrome’. This is a much more serious medical problem that can be fatal due to an intravascular blood clot (thrombus) in the leg vein, which can break away, and travel to block a blood vessel in the lungs to cause life-threatening pulmonary embolism (PE), especially if the blood originates in the knees or above the knees. DVT can occur in many, many other situations, and not merely sitting in the economy class seat of a long-haul aircraft. It can occur whether sitting in an economy class, or a first or business class seat. DVT can also occur sitting in a car, bus, train, or even sitting too long watching TV at home. It can occur if we are not moving about, not exercising, lying in bed for a long time due to an illness, after surgery, and other causes. It is not caused by sitting in the economy class of a plane. But that is another story.

Rest Assured

Rest assured Mr Marcus, your ‘problem’ is really not a medical concern at all. It is a very normal physiological phenomena, and a simple one too. It all has to do with haemodynamics (the physics of blood circulation). If you understand it, you will feel as safe as flying in an aircraft as Captain Lim has repeatedly pointed out. From the description of your history, the 2-3 episodes you had, and always in an aircraft, and the very short spell of your faints, it was none involving  the more complicated causes of postural hypertension I merely described for general discussion.

What to do to Avoid a Faint

The next time you go on a long haul journey in a plane, and you have been sitting down for a long time, and wanting to get up to go to the toilet, do this:
Move your legs, and toes as much as possible. The muscles in the legs when exercised, will act like a pump to force the stagnant blood in your legs to move upwards towards the heart and head. Press your toes in your shoes, relax them upwards, press again many times over. Press both your legs onto the floor, whatever leg room you can get. The best way to do this is to raise your buttocks from your seat as if attempting to stand up. Sit down again, repeat this action many times. Step up and down with both your feet, as if marching-on-the-spot. Than raise your buttocks again, supporting your body with your arms on the arm rest, and sit down again. Do all these maneuvers say for about 5 minutes. This act itself will clear all the remaining pool of blood in the legs, and get them all going. You may also recline your seat as horizontal as possible, and raise the legs to almost as horizontal a position as your seat and body allow.

Like the analogy of the water hose I have earlier described, this will allow blood to flow horizontally, unaffected by gravity, and also easier for your heart to pump at level (horizontally) rather than upwards towards the head against the force of gravity. Lie down this way for a few minutes. Now upright your seat – loh ! try to stand up very slowly. Be kind to your heart by giving it time to adjust to changes in position and blood pressure. If you feel a bit dizzy, or about to black out, even if you try to get up slowly, quickly sit down again, and this time lower your head between your knees to allow more blood to flow towards your brain. Keep it there for just a minute or two. Now raise your head again, and try to stand up slowly. If you feel like fainting, quickly sit down again. Then attempt to slowly stand up again.

Now Continue Enjoying Your Flight:

There you are Mr Marcus. You will be perfectly normal now. Stand up now, and enjoy your toilet visit. You will not faint. After your toilet visit, walk up and down the isle for a few minutes before sitting down into your seat. This will solve not only your faints, but prevent you from the potentially fatal DVT. All travelers on long haul flights should try to do this, especially exercising their legs, and walking about occasionally to prevent the risk of DVT. Enjoy the rest of your journey.

Over to You Captain

Now I shall hand back your passenger to you, Captain Lim.
Also congratulations to Mr & Mrs Marcus, whose new grandchild will be due this coming Spring in Queensland. Do enjoy flying there and remember to institute the prophylactic (preventive) exercises I have suggested. Mr Marcus should land in Queensland without much problem the next time round.

JB Lim, 
MD, PhD, FRSH, FRSMed
Principal Medical & Scientific Advisor.

Foot Note : The Action of the Vagus Nerve.

For those not familiar with the meaning of autonomic nervous system, very briefly, the autonomic nervous system is part of the central nervous system, and is made up of ganglia and fibers. It is divided into two major components – the sympathetic and the parasympathetic nervous systems. The functions of both systems are to control involuntary activities involving the smooth muscles, such as those responsible for respiration, heart beat, digestion, pupil size, etc. The sympathetic and parasympathetic nervous systems work in opposite action to one another. One stimulates, and the other inhibit the action. For example, the sympathetic nerve accelerates the heart beat, while the parasympathetic slows it down. The 10th cranial nerve is the vagus nerve, and is a parasympathetic nerve that controls and slows down the heart-rate. The nerve that accelerates the heart is called the accelerator or augmenter sympathetic nerve. If the vagus nerve is stimulated, it will slow down the heart rate to the extent of inducing a cardiac arrest (similar to giving excessive potassium). But if the stimulus is continuously applied, the heart will escape this vagal restraint, and commence to beat again (‘vagal escape of the heart’), with the first few ventricular contractions being exceptionally forceful. I must say nature is very kind to us to ensure we continue to survive. If the vagus nerve is cut, or temporary paralyzed by a full dose of atropine (a drug with parasympatholytic action), the heart rate will be doubled (150 –180 beats per minute). Just for information sake, the vagus nerve is not there just to control the heart. After it emerges from the medulla oblongata (part of the brain stem), this longest cranial nerve starts to supply branches to the larynx, pharynx, trachea, heart, lungs, and most of the digestive system, and controls all of them.

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Blackouts on long haul flights , Low-rated comment [Show]
Very useful reply
Hello! I am 24 years old and I came across this blog because I am suffering the same problem and the comprehensive reply by Dr. Lim has proved to be very useful in helping me understand the cause of this problem.
Thank you. May God bless us all with good health and spirits.
Nishant , 22 Jan, 2012
So that's what it is...
Very useful informationsmilies/kiss.gif
All these times I thought it was poor oxygenation and I would start breathing deeper to prevent blacking out. I'm definitely going to try these techniques for my upcoming trip.
Brian , 10 Jun, 2012
Good to know!
I had the same problem last time a took a long distance flight. It was a bit scary so it's really good to know it's probably nothing serious. I will also try the suggested techniques when i fly again soon!
Dan , 24 Jul, 2012
very reassuring
I appreciate the detailed explanation. After you've experienced this, the next flight is worrisome and your article helps one feel a sense of control. Thank you.
Rachel , 07 Dec, 2012
...
My fainting episode was in the shuttle from the aircraft to the terminal at Dubai. Despite moving around the aircraft and plenty of non alcholic fluids, standing in a very crowded delayed shuttle bus with no seats and no room for movement, was enough to cause the faint. Worried about next trip in two months(Melb.to Edinb.) will follow your tips. Thank you.
Christine , 28 Jan, 2013
Fainting on Aircraft
Just returned from Holiday not too long 5 hours to Egypt i am not the most confident of fliers but this time felt really relaxed therefore had a glass of champagne then went to sleep for ten minutes when I woke up I felt quite light headed and treid to bring myself round but quickly fainted didnt feel unwell my husband called for help and was given oxygen which brought me round still felt ok and cant understand why this happednd went on to have a fab two weeks in Egypt but was woried on way home incase this happened again its reassuring toknow that it happens to quite a lot of people but dont want it to happen to me again thankyou1!!!!!
Jean Miller , 19 Mar, 2013
...
Great info! Just had my second one on a flight. Not fun! Thanks for the incite!
Brett , 20 May, 2013
...
Has happened to me on two occasions first in 2010 and again in 2012, both times out for couple of minutes, recovered laying on floor, oxygen. Crew getting paramedics on board when we landed. Had 5 flights in between when I was OK. Mine occurred just sitting down.Don't know if moving position at regular intervals would helpsmilies/angry.gif
cliff , 28 May, 2013
...
Had this happen to me in 2010 and 2012 but five flights in between which were fine. On both occasions sitting down, very little warning. Oxygen given, took a while to come to.Crew had paramedics called on landing. Blood pressure checked, blood sugars fine. On first occasions flight crew asked if I had a cold, which recovering from she said aircrew suffer at these times she put cause as imbalance of middle ear due to cold symptoms.
cliff , 28 May, 2013
dr.
I have had several similar episodes,the last one eight days ago on a flight from Florida to Houston.However these have occurred while sitting.My episodes are made worse by the fact that these faints or blackouts then extend into severe motion sickness which on several occasions required a few hours stay in the local ER at the end of the flight.I think the answer is probably to keep the blood moving with the calf muscle pumps and raising your arms in the air.But I have not been able to prevent these attacks so perhaps you should not listen to me.These are very embarrassing situations particularly for my wife who has to take ownership of me while I lie around exhibiting severe nausea and vomiting.
merv , 17 Dec, 2013
Bowl evacuation
This happened to me and I lost control of my bowels. I was told this is common
Robbob , 25 Jan, 2014
Episode on Flight
I had an experience on a short flight. A short time after reaching full altitute, I started having shortness of breath, sweating, and felt like my heart was going to jump out of my chest. After trying to do the Lamaze breathing I learned during childbirth classes and putting my head down between my knees with a cold compress brought by the stewardess, I felt like I was at least "under control" again, but kept my head down the remainder of the 1 hr. flight. After promising my husband I would see dr. when we got home, I was referred by primary dr. to cardiology, wore a holter monitor for 24 hrs. and did stress test. Everything came back fine, so what happened just kind of became a dead issue. "Maybe just anxiety, dehydration, or vagus nerve related". Has anyone else had anything like this? Any suggestions or sharing of similar experiences with outcome of follow up would be greatly appreciated. I have not been able to fly since that experience, afraid now of outcome.
Erin , 17 Feb, 2014
Episode on flight
I had the same thing happen to me on a short flight a year ago. I have been to a heart doctor and a head doctor,also went through many test. Both cleared me to fly. I use to fly every month but now scared this is going to happen again. No one has been able to give me answers. I get dizzy with the elevation and then I start to have a burning feeling on my left side,then the chest pain starts and I feel like I can't catch my breath. When the problem started I use to lean my head forward which helped and now that doesn't help either. The last time all of this happened I tried to walk and almost hit the floor,I asked for help to my seat and asked what would happen if I passed out and I was told nothing,they would have a ambulance waiting when we landed. Other than that they didn't care,they walked off and didn't even offer water or anything. I think I am more scared what will happen if I pass out or have a heart attack while in flight. It has been a year now,I need to fly and I still have no answers to why any of this is happening.
Tamara , 25 Mar, 2014
...
without a doubt, you had a panic attack. It is similar to a heart attack, but really not dangerous.
john , 10 Apr, 2014
Fainting on Small Aircrafts
Have this issues but never on long flights over bigger air planes. Mine happens if I enter small aircrafts. It is usually very inconveniencing and painful. I had to fight the feeling last time. I am trying to avoid small planes now.
Odudu , 14 Apr, 2014
Fainting after nap on plane
I am 25 yr old male, have flown my entire life no problem, and even recently. Then, on a trip to Hawaii this week (after a stressful and sleep deprived few days) i was feeling great, took a nap 6 hours into the flight, started looking for a barf bag, and then fainted in my seat. Everyone said it was because I had an unhealthy previous few days. Then, after a relaxing vacation, 6 hours into my return flight (well nourished, well hydrated, ate well, slept well) i woke up from another nap, felt like my leg fell asleep, felt sick to my stomach, then fainted again. Horrible experiences, and i felt woozy on and off the rest of both of these days.

My MRI, EEG, Blood, and Echocardiogram was all fine. My neurologist now wants a sleeping EEG to be performed. She is thinking it could be seizures, since they do not happen with body movement, or getting up, etc.
bp99 , 13 Aug, 2014
Fainting after nap on plane
bp99, I have the same experiences. I've traveled extensively & have found the condition to be worsening. I typically wake suddenly from the nap. I have a suspicion that I've stopped breathing which is why I wake with such a start. The lightheadedness seems to carry over from the nap & I soon pass out. Because I've come to recognize the signs I am always able to alert the attendant. I've tried all the things the Dr. suggests but none have worked.
mm200 , 02 Nov, 2014
...
I am 33 yrs.old. I eat pretty healthy. I exercise regularly and consider myself healthy and not pregnant!, not needing any medications. I am a night shift nurse and didn't sleep much prior to my red-eye flight from CO to FL. I became quite restless and uncomfortable in my seat and even felt a bit short of breath and a bit queasy. I increased the little AC sprayer above me to try to get some "air" and even wonder if the jet fumes were getting to me. I have never had this episode happen in an airplane. Then, things got worse and I told my husband I didn't feel well and thought I might even pass out just sitting there.... to which I did. I woke up to him nudging me, very concerned. I felt "post-ictal" which is a medical term of being disoriented, not realizing what had happened or where i was. Then, the nausea hit and I vomited, discreetly, into a little barf bag. That made me feel a little better and not as dizzy. But, my husband helped me to get up and try to make our way to the bathroom. I started feeling very lightheaded again and barely made it to the back of plane before falling to knees to brace myself before passing out again. I didn't faint the 2nd time, but felt like I was going to die. This was very scary for me, and for my husband. The stewardesses helped by getting me a ginger ale and granola bar. Although, I don't feel this was a hypoglycemic episode (low blood sugar) or that I was dehydrated, the bites and sips seemed to help. My hands and I think my legs were still pretty tingly. I still was not too sure about what was happening to me. Perhaps since it was a red-eye, the bathrooms were not busy and I was able to sit in the bathroom for a little more "breathing room", literallysmilies/smiley.gif I sat in there and breathed into a paper sack, and think that helped a lot, too. This sounds like a panic attack, but I really don't think so... I shall add that the woman seated directly in front of me had also reported nausea to the stewardess (and not caused by my vomitsmilies/smiley.gif I was more concerned about the fumes and not tolerating the altitude change well this flight. Long story short, I recovered and was able to rest a bit at the end of the flight (possibly from the absolute exhaustion I'd just experienced) and felt weak the next couple days. I am going in to see my PCP today... Any helpful thoughts would be appreciated!
syncopal RN , 17 Nov, 2014
...
I have had 2 fainting episodes on international flights in the last 6 months. I thought the reason for the first event was because I was dehydrated and sleep deprived. However, after the 2nd fainting episode...and the events leading up to it being identical as the 1st, I now know the reasoning behind them. Both times I had eaten a large dinner, watched a little of a movie and fallen asleep. The faint feeling woke me up enough to tell my husband that I wasn't feeling well ~ and then I fainted. After coming back around, I was very nauseated and extremely hot. I just saw my doctor for a physical yesterday and he assured me that these were vasovagal episodes brought on my lack of movement, lack of blood-flow for digestion, etc. and he was not concerned about it being a health issue for me. He advised that on future flights that I do not eat a big meal prior or on the plane, be extremely well hydrated, eat small snacks which are high in salt in order to keep my blood pressure as higher, move around as much as possible, and drink gatorade (for fluid and salt). I will be traveling internationally again in April ~ and I must say that I'm apprehensive, as many fellow posters are. I'm going to do everything I can to avoid another episode and wish you all the best, as well!!
CM , 04 Feb, 2015
Physician
I advice you to take more juices and other liquids and avoid large meal and alcohol while flying. If you are on anti hypertensive medicines it is better to avoid certain BP tablets like telmisartan when on long flights.
Hope you will have safe and pleasant flight next time
Dr. Kumar , 18 May, 2015
after the fainting episode
I have had the same symptoms described above many times, but no one talked about after the fainting spell. After waking up, I always have a vomit spell and that actually makes me start feeling better. Does anyone have this too.
BC , 23 Jun, 2015
Passing out after falling asleep on airliners
This description got a bit long-winded, but after reading others experiences here I hope that a description of my experiences may help. My situation does not seem to be what is described my Dr. Lim, but seems to be similar to some others in the comments. I would love to discuss this with anybody who wants to talk about it more. For reference, I'm a 27 yr old fairly healthy and active male with no other history of seizures or fainting. My eating and drinking habits are not the best but not the worst. I may have some level of sleep apnea.

I am happy to find that my fainting episodes on airliners are not totally unique, however, I find one thing different about my episodes: they started after an experience with (what I believe to be) carbon monoxide poisoning, from a poorly burning propane wall furnace in Costa Rica in 2012. The experience in Costa Rica was similar to some that are described here: I was relaxed, had a beer and read a book for awhile, slept for a bit and then woke up feeling nauseous. On my way to the bathroom, I collapsed and woke to my sister saying that I had been out cold for a short time then began spasming and gasping before slowly coming to consciousness with a feeling of disorientation and seeing stars. Felt OK the rest of the trip.

A week later, flew from Costa Rica to Denver no problems, I don't remember for sure but I probably napped on the flight. Went for a strenuous mountain bike ride in Denver, drank a couple of strong IPAs with dinner, got on the plane to Los Angeles and fell asleep on the way to altitude. Woke up ~15 min later feeling dizzy and nauseous, similar to the first episode. Stayed seated, and within 60 seconds I was out, and came to with the passengers next to me very concerned because I had again been shaking my arms and legs and gasping. Something I noticed this time was it took a good 30 seconds for my hearing to slowly return even after full consciousness returned. Felt like shit the rest of the flight, very concerned about it happening again, but made it to LA with no more passing out and no throwing up.

At this point my research into Carbon Monoxide pointed to the passing out episodes being a relapse to my symptoms, triggered by the lower cabin pressure and perhaps oxygen levels in the plane. My doctor (who has medical experience with CO cases) had little advice other than "Yep, sounds like Carbon Monoxide poisoning, good job not dying or turning into a vegetable."

Flight from LA to NY and back in 2013, stayed awake the whole time and no problems.

Flight from LA to Houston and back in 2014, stayed awake the whole time and no problems.

Flight from SFO to Frankfurt in 2015. Awake and feeling good, free wine on the plane and a hearty dinner. Fell asleep 4 hours into the flight and woke ~15 minutes later to the same familiar dizziness and nausea. Probably only awake for 30 seconds before I was out again. This time I think less spasming, as no one around me seemed to notice (though they were mostly all asleep). However, the period of disorientation was prolonged, and for the first time out of the 3 episodes I felt like I was really fighting to gain control as my eyes rapidly moved back and forth left to right. Probably 30-60 seconds of this struggle before gaining control, and then another 30-60 seconds of hearing slowly returning. Felt sick and scared, like it was going to happen again. Asked the stewardess for oxygen and they got me a bottle. The oxygen seemed to make little difference, and I was still sick and dizzy as I sat with the crew, throwing up once suddenly and then throwing up again a couple hours later as I returned to my seat. My blood pressure was measured and it was not low (I am considered pre-hypertension). Pulse was healthy. After a few hours of chatting with my friend and a flight attendant (helped to take my mind off of the feeling) the crew doctor gave me some kind of anti-nausea medication (didn't catch what it was), and I felt much better for the rest of the flight (staying awake the whole time of course).

Connecting flight to Munich awake the whole time, was not fun but no passing out.

continued...
Colby , 11 Aug, 2015
Fainting after falling asleep on airliner (continued)
-2 weeks later, flight from Geneva to Frankfurt. Zero alcohol, relatively well rested, hydrated, happy after an amazing 2 weeks in the Alps. On the plane I felt uncomfortable, dizzy, exhausted, dry mouth, struggling to stay awake the whole time. As soon as we hit the tarmac I decided to give in and fall asleep. Woke suddenly and felt the familiar feeling rising, but did not pass out this time (I suspect that the conditions in the cabin may have been the same at this time as at altitude, but I'm not sure how the pressurization process works). Layover in Frankfurt I was sick, extremely apprehensive about the trans-atlantic flight ahead, and tired but couldn't sleep. Forced myself to throw up and it helped some. Right before we got on the plane it turned out my friend had some Alprazolam (Xanax) and just 0.5mg of this made me feel much more relaxed about the flight (first time taking Alprazolam). Felt relaxed and OK on the plane, took another 0.5mg 1.5hrs in and another 0.5mg 5hrs in. Both times that I redosed I felt nausea coming on and it quickly subsided with the Xanax and watching movies. Drank 4 small Red Bulls and managed to stay awake for the 12.5hr flight. Stoked to have made it home, frightened for what this means for travel the rest of my life. This was 2 days ago and I still feel the creeping anxiety, tempted to take more Xanax but trying not to unnecessarily medicate.

My observations:

-My episodes are very similar to others here but the first one was not on a plane. Can anybody else think of a similar scenario?

-The intensity and propensity for the episodes did not decrease with time as I had expected it would. In fact, each of the 3 episodes has been more intense than the last.

-The episodes ONLY happen shortly after I fall asleep, I believe it to be related to slowing of my breathing.

-The episodes are not related to sitting for a long time.

-Unless there was a rapid swing in my blood pressure, low blood pressure is not a factor. I have higher blood pressure than normal and it was measured to be close to my normal values.

-The nausea/dizziness can be somewhat self induced, and can be combated with anti-anxiety medication.

-Just one really deep breath can make the feeling worse. Focused breathing a bit deeper than normal and steady feels good.

-I feel like Red Bull and Xanax saved my life smilies/tongue.gif

I would be very interested to hear what Dr. Lim has to say about this. And if not at least we can all share our experiences and what our individual doctors / neurologists have to say. I plan on getting a referral to a neurologist in the next few weeks, and if I find out anything useful I will try to update on this site.

Before I go, I have to say that one of my most core life philosophies is to not be restricted by fear. I do not intend to stop flying, I intend to do as much as I can to understand the situation and find a solution. If red bull and xanax is my solution then I will consult a doctor about prescriptions and proper dosage. I urge anyone with a similar problem to try to work through it and find your solution. Live Large, not in fear smilies/cool.gif
Colby , 11 Aug, 2015
Fainting after nap on plane
Can totally relate to above stories. About six years ago I woke up feeling unwell. The next thing I remember is finding myself lying flat out in the aisle not knowing where I was. Since then on numerous occasions, I have woken up sweating, shivering and disorientated. The cabin crew often give me oxygen, which seems to help. Severe nausea, vomiting and headaches often follow. I have no known medical conditions - fit and healthy. I am now afraid to sleep on long flights in case I have another attack! smilies/sad.gif
Marco , 16 Aug, 2015
Passing Out in Aeroplane and at any place
I am a frequent Air traveller since the past 4 years. Short Haul (Every Monday and Friday in the last 3 years) and long haul Flights(Twice every year)
My Height is 6'0 and weight about 85 kilo, Slim built and healthy, Normal blood pressure
Never had a problem with short Journeys.

Scenario 1:
Total flight journey 10 hours (non-Stop)
Had the 2 pegs whiskey with coke and had Dinner, watched a bit of movie on The screen and fell asleep.
Woke up after an hour and started walking to the toilets. A few minutes later collapsed near the toilets

Scenario 2:
Total flight journey 10 hours (1-Stop 7 + 4 hours)
Had the 1 peg whiskey with coke and had Dinner, watched a bit of movie on The screen and fell asleep.
Woke up after an hour and started walking to the toilets. A few minutes later collapsed near the toilets

Scenario 3:
Total flight journey 10 hours (1-Stop 9 + 2 hours)
Had the 1 pegs whiskey with coke and had Dinner,some tea watched a bit of movie on The screen and fell asleep.
Woke up after an hour.
This time i knew that this will happen again so i did some hand,neck and leg movements for about 5 minutes.
I stood up and started walking to the toilets and as i walked a few steps i felt dizzy and about to faint and i was still in control of the situation. I walked very quickly to the exit door next to the toilets sat down on the floor, closed my eyes did some leg and hand movements for about 10 minutes. and stay in the same position for another 20 minutes without any major head movements.

Scenario 4:
I went to Swiss alps Jungfrau. Got to the summit. walked a few steps towards the restaurant and only to collapse once again. Quickly sat down on the floor and drank some water with table salt. i was fine afer a 20 minutes and enjoyed my trip.

My observations:

- My episodes are very similar to others here.
- The symptoms mainly occur at high altitudes and may occasionally occur when you stand for a long time(More than an 40 mins) in Train,bus,standing in a queue etc.
- I was worried and went to the doctor and got my Blood Tests, ECG EEG and a Brain MRI Scan which turned out to be normal.
- The episodes ONLY happen shortly after waking up from sleep and walking to go to gents or get some food and water.
- Forced myself to throw up and it helped a bit.
- Try to stay in your seat(30 Mins) after you wake up from sleep and try moving your legs,hands, neck.. so that the blood will try to circulate to the area above the neck to the head.
- Try to Keep your eyes Closed during the whole episode if possible. Normal and steady Focused breathing feels good.
- Try to sit/lie down on the floor near the exit doors and without any major head movements.

- This episode could last anywhere between 30 min to 3 hours.(My first one lasted for 3 hours,Second one for 2 hours and third one for 30 minutes)

- Also I have noticed that this happens when the flight journey is in the night and if that is your normal sleeping hours every day and you wake up during that time in flight.
- This could also happen when there is air turbulence
- Do not worry or fear or panic at all if this happens.
- Just stay calm and tell your partner not to worry and help you to sit down/Lie down near exit or where there is space and talk to you until you are fine.
-Be positive and think that you are strong and nothing is going to happen to you.
I am not a Doctor and these are only my findings.

Ravy , 24 Nov, 2015
Fainting after nap on plane Journey
I am a frequent Air traveller since the past 4 years. Short Haul (Every Monday and Friday in the last 3 years) and long haul Flights(Twice every year)
My Height is 6'0 and weight about 85 kilo, Slim built and healthy, Normal blood pressure
Never had a problem with short Journeys.

Scenario 1:
Total flight journey 10 hours (non-Stop)
Had the 2 pegs whiskey with coke and had Dinner, watched a bit of movie on The screen and fell asleep.
Woke up after an hour and started walking to the toilets. A few minutes later collapsed near the toilets

Scenario 2:
Total flight journey 10 hours (1-Stop 7 + 4 hours)
Had the 1 peg whiskey with coke and had Dinner, watched a bit of movie on The screen and fell asleep.
Woke up after an hour and started walking to the toilets. A few minutes later collapsed near the toilets

Scenario 3:
Total flight journey 10 hours (1-Stop 9 + 2 hours)
Had the 1 pegs whiskey with coke and had Dinner,some tea watched a bit of movie on The screen and fell asleep.
Woke up after an hour.
This time i knew that this will happen again so i did some hand,neck and leg movements for about 5 minutes.
I stood up and started walking to the toilets and as i walked a few steps i felt dizzy and about to faint and i was still in control of the situation. I walked very quickly to the exit door next to the toilets sat down on the floor, closed my eyes did some leg and hand movements for about 10 minutes. and stay in the same position for another 20 minutes without any major head movements.

Scenario 4:
I went to Swiss alps Jungfrau. Got to the summit. walked a few steps towards the restaurant and only to collapse once again. Quickly sat down on the floor and drank some water with table salt. i was fine afer a 20 minutes and enjoyed my trip.

My observations:

- My episodes are very similar to others here.
- The symptoms mainly occur at high altitudes and may occasionally occur when you stand for a long time(More than an 40 mins) in Train,bus,standing in a queue etc.
- I was worried and went to the doctor and got my Blood Tests, ECG EEG and a Brain MRI Scan which turned out to be normal.
- The episodes ONLY happen shortly after waking up from sleep and walking to go to gents or get some food and water.
- Forced myself to throw up and it helped a bit.
- Try to stay in your seat(30 Mins) after you wake up from sleep and try moving your legs,hands, neck.. so that the blood will try to circulate to the area above the neck to the head.
- Try to Keep your eyes Closed during the whole episode if possible. Normal and steady Focused breathing feels good.
- Try to sit/lie down on the floor near the exit doors and without any major head movements.

- This episode could last anywhere between 30 min to 3 hours.(My first one lasted for 3 hours,Second one for 2 hours and third one for 30 minutes)

- Also I have noticed that this happens when the flight journey is in the night and if that is your normal sleeping hours every day and you wake up during that time in flight.
- This could also happen when there is air turbulence
- Do not worry or fear or panic at all if this happens.
- Just stay calm and tell your partner not to worry and help you to sit down/Lie down near exit or where there is space and talk to you until you are fine.

I am not a Doctor and these are only my findings.

Ravy , 04 Dec, 2015
M
Does it help to wear support socks? I have fainted twice on long haul flights this year - two out of five long haul flights. More worrying as this is not consistent. Terrifying experience.
Colleen , 17 Dec, 2015
...
Is it a good idea to wear support socks on long haul flight to prevent fainting?
I have fainted twice his year on flights. The worrying thing is that this is not consistent - two out of five flights and I had to have oxygen for a long period of time. I have been checked over and no cause found. Frightening experience !
Colleen , 17 Dec, 2015
...
I have fainted twice this year on long haul flights - terrifying !
Most worrying is that this is not a constant experience as I have flown on five other long flights without any problems. I gave jag found out that ,y sodium levels are low - could this be the cause ?
Colleen , 18 Dec, 2015
...
I have fainted twice this year on long haul flights - terrifying !
Most worrying is that this is not a constant experience as I have flown on five other long flights without any problems. I have just found out that my sodium levels are low - could this be the cause ?
Colleen , 18 Dec, 2015
Fainting during a flight
I has happened three times. Wake up from a deep sleep and wanting to use the facilities. Made it to the bathroom feeling sick to my stomach then as I got back to my seat, I pass out. On the first two occasion, no one noticed since I was sitting near my child. The third time, the stewardess noticed me swaying back to me seat and came back to check on me. I was given oxygen and I came to. The first two times, I came to on my own. After coming to on all three occasions, I threw up and then felt better but extremely drowsy. This is how I solved the problem, I DO NOT SLEEP ON ANY FLIGHT. I recently traveled from Atlanta to Johannesburg and I did not sleep a wink. Drank lots of caffeine and got up and walked around the plane every hour. Glad to know there are others out there that share my experience.
lc , 29 Dec, 2015
Seeing stars
I was 24 going on my second flight the first time was when I was 13 and had no problems although it was only an hour and half long. The second flight was 5 hours and then had a lay over and had to spend the night. Woke up early to catch our connecting flight . We were on a bigger plane and was only an hour flight to anoth plane which a lot smaller. The plane really camped up and felt like I couldn't move. It was only an hour but as we got higher I started to feel anxious and closed my eyes to see if could sleep the rest of the flight. As I was trying to fall asleep I started see stars or little fire flys flying around while my eyes were closed so I opened my eyes to notice I can see them while my eyes were open and it seemed a little bright as well. I didn't faint or anything but was very scared to faint thinking I was going to die ... Has this happened to anyone else is that the same as feeling this before fainting or was it just panic or anxiety attack?
Dk87 , 20 Jan, 2016
happened twice to me
This was very helpful! I had fainting spells twice already. And they both happened while traveling from the US to Europe. And both at the beginning of the year after already flying from Asia to Europe and then to the US.
Both times it starts with feeling uncomfortable. I suddenly am awakened. The first time it happened, I thought I was going to vomit. But nothing happened. I was instead battling a fainting spell, which I countered by keeping my head low. When the crew found me, they gave me cola, and put me at the very back of the cabin, where it was cool and well ventilated. I recovered right away. The second time it happened, I was able to run back to the end of the cabin before the blackness devoured me. While lying down there with stewardess at my side, I recovered fast. I also drank cola.
theresa , 09 Feb, 2016
Good information
Thank you doctor, I can really relate to this, now I can enjoy my long haul travels.
Maame , 11 Feb, 2016
15+ times, sitting
Am in my 40s and have had this happen about 15 times on planes both small and large (int'l). There does not seem to be something specific that causes it but it happens while seated. The best thing to do is to try to make it to the back of the plane and lie down on the floor (ew) and raise your legs up, also hold a cold can of (unopened) soda to your neck. Some flight attendants are nice, others are just annoyed. Almost had a flight diverted once! I now carry a piece of paper explaining I'm okay, with my name etc. This may be in my mind but also now before flights I drink a sugary drink such as soda to try to boost my heartrate/energy. Also am going to purchase compression socks which can help keep blood from pooling in the legs. I hate that this happens a lot but doesn't seem to be anything I can do about it. All normal results from tests with the doctors.
mn , 15 Feb, 2016
Sick on the way up and down
My husband and I leave for San Francisco on September 15th. I am excited because we have not been on a big trip since our honeymoon and our kids have been born. I am a little worried because of the last three episodes that have happened while on a plane. As the plane takes off my heart begins to beat very hard and fast. My hands and feet become sweaty. I start seeing black spots. I start sweating. I get super nauseated and feel like I am going to pass out. This subsides once we level out, but starts again once we land. I stay nauseated the entire time, and for days afterwards. I have not been in a plane for a few years. My health is not greatand I really don't want to ruin the trip. Does this happen to anyone?
Adrian Mathews , 30 Aug, 2016
Thanks for the information.
This happened to me for the first time yesterday and I was worried that I'd had some sort of stroke! Reassuring to know it's very common but feel sorry for those affected - it is not enjoyable. At least there are some good tips on here to follow next time. It won't put me off flying smilies/smiley.gif
Mike , 12 Nov, 2016
Reassuring Information
Having just returned from Newfoundland...I had two episodes during the return WestJet flight from Halifax to Glasgow. I was trying to sleep but suddenly felt extremely nauseous and made my way to the toilet where I then felt faint..this passed off and I returned to my seat and after trying to doze off again came to a 2nd time with a panic feeling, once again, very nauseous. After reaching the toilet for the 2nd time I realised I was definitely going to pass out so I staggered out and spoke to the air stewardess, saying I felt unwell. I broke out into a cold clammy sweat, my mouth was totally dry and the faintness took some time to wear off. The staff were amazing...very reassuring and helpful including another passenger who was a General Practitioner, who came forward to give some assistance to the staff. The staff rang ahead to the medical team at Glasgow airport who advised 15 minutes of oxygen and a sweet beverage. They also advised me that this was a very common occurrence on long flights. As I am a healthy 61 year old woman with no medical problems and taking no medication it was obvious to them that what has been described on this website, was the cause of the problem. I was travelling with my daughter, son-in-law and their 10 month old baby...coincidently, my son-in-law who has travelled for years around the globe experienced a similar episode on this flight...a first for him! We did wonder if we had caught something, but we were both perfectly ok afterwards with no lasting effects. However, this is very reassuring to know that it a common occurrence on flights. Thanks to all the contributors!
Sonia Robbins , 13 Aug, 2017

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