Travel at High Altitude 

AVOIDING ALTITUDE SICKNESS 

The following information has been compiled to help you both during the planning stage and while travelling at high altitude in the Himalayas. Please read through this carefully.   

What is Altitude sickness?

Altitude sickness is caused when a person moves to a higher altitude too quickly. Their body struggles to cope with the lower oxygen levels and decreased air pressure.  

Altitude can cause problems for travellers going above 2,700 metres. Above that, every 500 metre ascent will need time for acclimatisation. Many people travelling to high-altitude destinations will experience some degree of altitude problems such as feeling breathless and a mild headache. This causes minor discomfort for the first few days as the body adjusts. 

However, the effects of high altitude can be severe for some and, if untreated, altitude sickness can lead to death. It is very important that you are aware of the signs and symptoms of altitude sickness and take this condition seriously. 

Symptoms of altitude sickness  

• Breathlessness (especially when walking) 

• Headache 

• Tiredness 

• Lack of appetite 

• Difficulty sleeping  

• Dizziness 

• Nausea and vomiting 

• Loss of coordination  

• Confusion and disorientation  

What to do

In all cases, tell your guide immediately if you are experiencing symptoms. Generally, feeling a bit unwell as you climb in altitude is normal and will resolve in a few days. 

Mild cases can be treated according to symptoms (such as taking painkillers for a headache and resting) and should go away on their own.   

However, altitude sickness can develop into a serious situation if left untreated and unmonitored. Your guide has training and experience in how to assist. They need to be made aware of your symptoms so they can monitor the situation and keep you safe. 

It is important to listen to your guide’s advice and understand that if you are sent down to a lower altitude it is in your best interest to do so.   

If you experience a persistent headache, nausea, vomiting, dizziness, loss of coordination or disorientation, tell your guide immediately, seek medical help and then descend to a lower altitude. Sometimes just 300m lower is sufficient.    

People with altitude sickness should not continue to ascend until their body is used to the altitude and they are symptom-free. Critically, a person whose symptoms are getting worse while resting at the same altitude must descend, or risk serious illness or death. 

One severe consequence of altitude sickness is swelling of the brain (high-altitude cerebral edema [HACE]). Symptoms include extreme fatigue, drowsiness, confusion, and loss of coordination. HACE is rare, but it can be fatal. If it develops, the person must immediately descend to a lower altitude. 

Swelling of the lungs (high-altitude pulmonary edema [HAPE]) is another severe consequence of altitude sickness. Symptoms include being out of breath, weakness, and cough. A person with HAPE must descend and may need oxygen. 

How to avoid altitude sickness 

The best way to avoid altitude sickness is to acclimatise to the changes in altitude slowly and ascend gradually. Good food, drinking lots of clean water and little exertion will also help your body get used to the change of height and low oxygen.  

Pre-existing Medical Conditions 

Please seek advice from a doctor before travelling to high altitude if you have any of the following conditions: 

• heart or lung disease, or cardiac problems 

• diabetes 

• epilepsy  

• asthma 

• pregnancy  

• high blood pressure 

Please check with a doctor about any prescription medication that might be affected by altitude. 

Before arrival: 

• Bring medicine such as Diamox (Acetazolamide) or similar, which you can get from a travel doctor in your home country. Diamox helps the body to breathe faster hence accelerating the acclimatization process. It can be taken as a preventive medicine. Side effects can include tingling in toes and fingers and frequent urination.  

• Bring aspirin/disprin which work as blood thinners and enable your blood to carry more oxygen. 

• Bring headache medication such as paracetamol or ibuprofen. (be mindful about mixing medications. You should not take asprin and ibuprofen together, for example)  

• Homeopathic medicines such as rhodiola, coca, gingko and garlic capsules can also be purchased from a pharmacy/natural medicine store in your home country. 

Throughout your journey at high altitude, we recommend that you:  

• Eat foods rich in garlic and ginger 

• Eat regularly and eat quality, nutritious foods  

• Do not overeat   

• Rest often especially on the first few days 

• Get plenty of sleep 

• Stay warm during the day and at night  

• Do not linger on high altitude mountain passes 

• Move slowly, don’t push yourself physically 

• Drink plenty of water 

• Avoid coffee and alcohol  

What to do if you experience altitude sickness: 

• Tell your guide immediately 

• Stop climbing 

• Sit up to rest, rather than lying down 

• Drink glucose (water and sugar)  

• Listen to your guide and follow their instructions 

• Inhale oxygen if available  

• Consult a doctor/go to hospital or a health post if one is nearby  

• Return to a lower altitude if your condition does not improve 

Beyond the Clouds itineraries and altitude

Altitude is thoroughly taken into consideration when planning our high-altitude journeys.  Where possible we acclimatise at lower altitudes before going higher. However, this is not so easy when flying into high altitude destinations such as Leh in Ladakh or Lhasa or Shangrila in Tibet. Whilst Ladakh travellers can descend to 2,800 metres on the first day, this is not possible in Lhasa or Shangrila. Therefore, we strongly advise total rest on arrival and little activity on the next day until you are acclimatised.

Nepal

Most of our Nepal treks are at quite high altitude. In the Everest Area, our Everest Base Camp, Three Passes and Gokyo Lakes Treks all climb Kala Patar at 5,540 metres, and cross high passes.  In the Annapurna region, the Annapurna Circuit crosses the Thorong La Pass at 5,416 metres. Annapurna Base Camp trek goes to 4,130 metres.  Although Annapurna Panorama Trek is short, it still climbs to Ghorepani and onto Poon Hill at 3,210 metres. All trekkers in Nepal should watch out for the signs of altitude sickness and tell their guide who is experienced in recognising the signs and symptoms. The Himalayan Rescue Association have Aid Posts in Manang in the Annapurnas and Pheriche in the Everest Region. They also offer free talks on altitude sickness at these posts which we recommend attending.

Bhutan

Most people on our Discover Bhutan and Bhutan tailor made tours have no problem with altitude. You fly into Paro which is only at 2,195 metres. Thimpu is just at 2,320 metres.  The village of Haa is at 3,056 metres so it is possible to experience some discomfort here, though most people are fine. You will climb to Tiger’s Nest Monastery (3,120 metres) at the end of your trip. There are several high passes including the Chele La Pass between Paro and Haa at 3,798 metres. We don’t recommend spending too long at the pass until you are acclimatised. The Dochu La Pass between Thimpu and Punakha is 3,150 metres but most people have no problems here. People on Bhutan Treks need to be more careful as the treks make quite rapid accents that are hard to avoid.   The Jomolhari Trek ascends to 4,930 metres.  Druk Path Trek goes to 4,235 metres. The Sagala Trek reaches 3,720 metres.  To acclimatise, Bhutan trekkers usually do the Tiger’s Nest hike before starting the trek. You can also spend a night in the village of Haa before commencing the trek. Bhutan Walking Holidays do not climb as high as the treks. However, there are some hikes especially around Haa that are at higher altitude. Please check the details in your final trip dossier that you receive before departure.

Ladakh

Literally "the land of high passes", Ladakh is a high-altitude desert.  As Leh and other places of interest are located at 3,500 metres visitors may suffer from dizziness, headaches or even acute mountain sickness (AMS). So, planning to acclimatize to the high altitude condition becomes one of the most important things to take into consideration while you are planning a trip to Ladakh. Participants on our Discover Ladakh, Ladakh Yoga and Ladakh Tailor made journeys can descend from Leh airport to the riverside village of Nurla at 2,800 metres before ascending to other places on the itinerary. By doing this, your body will have a much better chance of acclimatising.

If you are on a Ladakh Trek, we suggest spending several days acclimatising before starting your trek. This may include descending to Nurla (2,800 m) first. At the least, complete rest in Leh is recommended before trekking. Our Markha Valley trek goes over the Kongmaru La pass at 5,200 metres. The Sham Valley Trek has passes at 3,750 metres.

Tibet

All journeys starting in Lhasa commence at 3,656 metres. Discover Lhasa has a maximum elevation of 3,700 metres whilst the Ancient Tibet journey goes to 4,500 metres. Our Kailash Kora Journey travels to an incredibly high altitude with a 5,600 metre pass on the actual Kora of the trek. In Kham, the Hidden Tibet Journey starts at Lijang which is at the lower altitude of 2,400 metres and climbs to 4,290 metres. Travellers on our Mountain Myth and Magic Journey will be able to acclimatise in Kangding at 2,600 metres before travelling over a 4,200 metre pass. Our Authentic Amdo Journey allows time to acclimatise in Diebu at 2,300 metres before continuing to 3,325 metres.

If you are on a Tibet Trek, you will need to spend at least a couple of days acclimatising before starting your trek. Our Minya Konka trek goes over the Riwoche Pass at 4,937 metres.   

For more information about trekking, read our blog post Is Trekking in the Himalayas Hard?