Ladakh Acclimatisation: How to Avoid Altitude Sickness

Most travellers fly into Leh (3,500 m) and want to leave for Nubra the next morning. That is the single most common mistake in Ladakh travel, and it is why so many people spend two days in a hotel room with a headache instead of two days on the road.

What is actually happening

Above 2,500 m, the air pressure drops and every breath delivers less oxygen. Your body responds by breathing faster, increasing heart rate and, over a few days, producing more red blood cells. That adaptation takes 24 to 72 hours, and no schedule, tablet or smart trick can shorten it much.

AMS, Acute Mountain Sickness, is what happens when you ascend faster than you adapt. Symptoms: headache, nausea, dizziness, poor sleep, breathlessness at rest. It is common, usually mild, and mostly preventable with pacing.

Our protocol

Day 1 in Leh is a rest day. Full stop. No sightseeing beyond a short walk. Water, food, sleep.
Day 2 is gentle. Shanti Stupa, Leh Palace, the old town. Sleep at 3,500 m again.
Day 3 go higher. Khardung La (5,359 m) en route to Nubra, which sits lower at 3,050 m, up and over, then down. Sleeping lower after a high pass is the key trick.
Never sleep higher than +600 m from the previous night if you can avoid it, and build in a descent day after every two ascents.

Notice that Pangong Tso (4,350 m) comes late in our Ladakh itinerary, never on day two.

What helps, honestly

Water. 3–4 litres a day. Dry air and fast breathing dehydrate you quickly.
No alcohol for the first 48 hours, and no smoking.
Carbs over heavy meals. Dal, rice, thukpa and momos are better than a steak.
Acetazolamide (Diamox) helps some people. It is prescription-only in India, talk to your doctor before you fly, and start it a day before arriving if they advise it.
Do not push through a headache. Descending is the only reliable cure for worsening AMS.

What does not help

Oxygen as a preventive. It masks symptoms and delays adaptation. We carry oxygen and a pulse oximeter in the vehicle for emergencies, not for daily use.
Assuming fitness protects you. Fit travellers get AMS too, sometimes worse because they push harder.
"I'll just sleep it off in Nubra." Sleeping higher with symptoms can escalate quickly.

When to turn back

If two or more of these appear, headache that will not shift, vomiting, breathlessness at rest, confusion, unsteadiness on your feet, stop ascending and descend. Our drivers and guides are briefed and empowered to make that call, and no itinerary of ours takes priority over it.

Insurance and paperwork

Travel insurance covering trekking and travel up to 5,500 m is mandatory on our Ladakh trips. Evacuation from Ladakh costs more than most people's entire holiday, and a policy without altitude cover will not pay out. Send us a copy before you travel and we will check it.