In the days when Pontius was a pilot, sorties lasted only 2-3 hours and no oxygen was carried for aircrew, the great ace James McCudden engaged and downed German two-seaters flying at 20,000 feet. Gave him dreadful headaches doing it though and, being an experienced fitter raised from the ranks, he'd tuned his SE5a's engine to give it a service ceiling 2-3,000 feet higher than the standard issue.
Another medical problem that arose from 'fast climb and faster dive' was the effect of differential air pressure on aircrew's ear-drums. I had the honour a few years ago to meet and chat with the great test pilot Neville Duke, who was introduced to me by his friend Nick Berryman with the comment 'you'll have to speak up, the old bugger's deaf as a post after all that zooming about up 'n' down', he should've stuck to slower kites like my old Walrus.' Rapid extreme altitude changes without the benefit of cabin pressurisation can even give rise to symptoms of 'the bends'.
And the effect on the pilot depends on the fitness of that particular pilot, so modelling anoxia would have to allow for this variable to be realistic and fair. So, nice idea but I reckon it's a non-starter.
<ponders the idea of modelling variable sound caused by ear-wax and syringing it out>
