Does altitude affect the pulse ox? Should I use it at altitude?
Yes, dramatically so. At 5,000 feet, if you don’t breathe any faster than normal, your O2 saturation will be about 90%. If you take 5 extra breaths per minute, you can increase this to 95%.
At the extremes of altitude, the changes are even more pronounced. At 10,000 feet, if you breathe at a normal rate, your O2 saturation would be about 80%. At the summit of Mt. Everest, if you breathed at your normal rate, life would not be sustainable. In fact, you would need to breathe twice as fast as normal, and twice as deep as normal, just for your oxygen saturation to be 35%. And that’s if you’re standing still, not expending energy! This is why only 3% of the summits of Mt. Everest are done without oxygen [2].