Ladakh Acclimatisation Guide

Why acclimatisation matters

Air at altitude holds less oxygen. Flying from sea level to Leh, you gain this altitude in about an hour, and acute mountain sickness (AMS) can develop in some people regardless of age or fitness. Symptoms can include headache, nausea, poor sleep, breathlessness and fatigue. Most mild cases settle with rest and time.

The first two days

We build every Ladakh itinerary with at least one, and ideally two, easy days in Leh before any higher excursion. On arrival:

• Rest for the first few hours, even if you feel well.
• Drink plenty of water, and avoid alcohol and smoking.
• Eat light meals and avoid heavy exertion.
• Take short, slow walks on day two, such as around the old town, rather than climbing stairs to viewpoints quickly.
• Keep the first night's sleep position slightly raised if comfortable.

Our 4 Nights / 5 Days journey begins gently for this reason.

Climb high, sleep low

A general principle is to gain sleeping altitude gradually. Nubra Valley (around 3,000 metres) is lower than Leh, which makes it a useful early overnight even though the road crosses Khardung La at a much higher point. Lakes such as Pangong Tso and Tso Moriri sit at around 4,200 metres and above, and are better after you have spent several nights in the region.

Medication and medical advice

Some travellers use preventive medication such as acetazolamide on medical advice. Please speak to your doctor before travelling, particularly if you have heart, lung, blood-pressure or other health conditions, are pregnant or travel with children. We cannot give medical advice, and no preparation guarantees you will not be affected.

Warning signs

Mild symptoms: headache, mild nausea, tiredness. Move no higher, rest, hydrate and monitor. Serious signs include:

• worsening headache not helped by simple measures;
• persistent vomiting;
• confusion, unsteady walking or unusual drowsiness;
• breathlessness at rest or a persistent wet cough.

These need urgent medical attention and descending to a lower altitude. Do not continue upwards with serious symptoms. Leh has a hospital and medical facilities, while remote areas have very limited care.

Hydration, food and sleep

Aim for steady fluid intake through the day. Carbohydrate-rich meals are often easier to digest at altitude. Sleep may be lighter and broken in the first nights, which is common.

Flexibility is part of the plan

We keep some slack in itineraries so a rest day can replace an excursion without ruining the trip. Please tell your driver or guide early if you feel unwell, and do not push on to avoid disappointing others.

Cold and sun

The sun is intense at altitude, and temperatures drop quickly after sunset. Layers, sunglasses, sunscreen and a hat are essential even in summer.

Planning tip

For a general overview of altitude preparation across regions, see high-altitude travel preparation. Choose your season with the best time to visit Ladakh, or talk to us about pacing for your group.