Acute Mountain Sickness and Importance of Acclimatization
We all want to enjoy the lovely nature and breathtaking views of Himalayas. While going to Himalayas, many of us take the high altitudes very lightly and always consider the brighter side of it i.e majestic vistas 
. However, there is a darker side attached to the high altitudes as well. How many times have you been to high altitudes and either you or people around you complained that shortness of breath, nausea, headaches or vomiting etc? I am sure you must have encounter such uncommon situations while in the Himalayas especially at the high altitudes like regions of Manali – Leh Highway, Leh – Ladakh, Rohtang Pass, Spiti Valley in India to name a few. To be very frank, some people suffer mildly and some may not suffer altogether; consider your self very lucky in such a case. However, some persons suffer drastically and the effects can be seriously ugly from them.
Illness or sickness on Himalayan trips is very common especially if you are directly flying or driving to a higher altitude which almost certain the chances. Such Illness can spoil a much awaited relaxing holiday into something ugly and in some cases may have severe consequences too. Higher you go directly, higher will be the risks. Hence, its always better to know what the altitude sickness means and what we can do to prevent it. Further in the article, I try to lay out some important theory and facts about the mountain sickness and acclimatization which may help you be prepared for altitude changes and enjoy that ever awaited holiday of yours .
Acclimatization and Acute Mountain Sickness (AMS)
Altitude can be categorized into the following scales –
- High (8,000 – 12,000 feet [2,438 - 3,658 meters])
- Very High (12,000 – 18,000 feet [3,658 - 5,487 meters])
- Extremely High (18,000+ feet [5,500+ meters])
Generally, people can go up to 8000 feet without much problems of mountain sickness. As you start to increase altitude, the barometric pressure starts to decrease which reduces the Oxygen intake per breath. Now, in order to compensate for the less Oxygen intake, your body need to increase the breathing rate. Although the increased breathing rate does increase the Oxygen level in the blood but it does not take the Oxygen level to the same level as required by the body while you are at home doing some activity. By spending proper amount of time at such altitude your body will adapt to such changes in Oxygen levels and this process is called as acclimatization.Always keep in mind that different people will acclimatize at different rates. Hence, always try to avoid any sought of comparison and wait for the person suffering in the group better acclimatize.
Acute mountain sickness (AMS) is caused above the altitudes of 10,000 Feet or 3,048 Mtrs to majority of people. Higher is the elevation and rate of ascent, more will be the effects of AMS. Hence, do not try to directly go or stay at very high altitudes directly. When you sleep, the symptoms will get worse as our body respiration decrease while sleeping.
The best cure is either to acclimatize properly or descend. However, effects of mild AMS can be cured by taking some preventive AMS medicines like headache pain relief or Diamox with proper consultation and prescription with your doctor or physician prior to the start of the trip. Diamox is a sulfa drug and does have side effects including allergies. Hence, Diamox shall only be taken after proper prescription by your doctor or physician. Diamox can also be helpful in case a person suffer from periodic loss of breath, which especially occurs in the night while sleeping.
Incase, you feel the personal is suffering badly then ask him to walk in a straight line by placing toe to toe. If the person is not able to walk in a straight line i.e. he is suffering with ataxia. IMMEDIATELY DESCEND!!
Tips for Better Acclimatization
Below are few tips that will certainly help you in better acclimatization:
Increase the altitude gradually
The acclimatization rules states that after 10,000 feet we must stay overnight for every 1000 feet or 305 Mtrs of elevation in order to properly acclimatize our body. This schedule in between shall allow a complete day acclimatization rest after 3000 feet or 915 Mtrs with overnight stay at the same altitude. If you can adjust your plan to this rule then perhaps you will not suffer with mountain sickness. However, the ground reality is only few people stick to this schedule especially in India where leaves are hard to find from their work life 
.
Keep your body properly hydrated
Do take plenty of intake of water with ORS or fluids like milk tea, juice, soup (garlic one will do wonders). If possible, take ORS soluted water or ORS – L tetra packs with you to replenish the lost nutrients immediately. Also, garlic flavored water ( keep garlic in water bottles) will help much more than drinking plain water which shall be avoided. This will help keep the oxygen level to normal in the body. You should avoid too much black tea or coffee as well…
AVOID over hydration because as quoted by vistet linked here(post #12):-
Forcing children to drink when they are not thirsty : at best they will vomit ( which will force you to descend ) , at worst they´ll start to develop cerebral edema – either only from water intoxication , or as a mixed result from this and altitude sickness. See for example Peter Hackett ( Everest-climbing doctor and co-author of the CDC altitude advisory ) on this : ” Too much water is harmful and can dilute your body’s sodium levels (hyponatremia) causing weakness, confusion, seizures, and coma.”
Avoid sleeping at high altitudes
As sleeping decrease the respiratory drive of our body, it is recommended that one shall hike to high altitudes in the day but should always come back to by the evening to sleep at lower altitude.
Avoid over exertion
Do not over exert your body with any unnecessary physical activity which may lead you pump more breath.
Avoid tobacco and smoking and alcohol and other depressant drugs
Avoid tobacco and smoking and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
Keep your body warm
Keep your body warm with woolens and do not let it cool. Make sure your clothes are always dry.
Eat lots of Carbohydrates
Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
Avoid sleep during the day
Try not to sleep during the day and keep yourself involved in some light activity during the day. Respiration decreases during sleep which further exacerbate the symptoms.
Sleep in upright position, if possible
Try to lay down or sleep by resting your back against the wall. If you cannot sleep in such mode then do not flatten your head on the bed rather place a bag below your head and then one or two pillows and then sleep in such a posture. It will help you keep your head much lighter.
Carry preventive medicines for AMS
Do take preventive AMS medicines along with you on the trip but only after consultation with your doctor or physician because the AMS medicines may lead to some side effects too. If you are not sure about any allergy with these medicines then try them one or two week before you plan the trip. Check to see if there are any allergic effects and decide.
Carry Small Oxygen Kit
If possible, you may also carry a oxygen cylinder to counter the AMS symptoms. It will certainly help as a supplement but do take proper consultation from your doctor for the intake amount of oxygen, before the trip. Oxygen intake will help you incase of any emergency and will spare you more time to descend to lower altitudes as soon as possible.
A note from the pioneer, Vistet linked here at post #12: on oxygen cylinders:
Small tanks of even medical grade oxygen provides a false sense of security : they will at extreme best last for an hour or two. For the value of cheap , portable oxygen solutions see here, # 5 and #7 check here
Immediately descend, if symptoms increase
Last but not the least, if the AMS symptoms start to increase then you should consider immediate descend. This is the only cure in some conditions when the symptoms have reached moderate levels and are not decreasing.
Symptoms of Acute Mountain Sickness (AMS)
Below is the categorization of symptoms for different levels of Acute Mountain Sickness (AMS) along with indicative cure for it…
|
AMS Symptoms |
AMS Level |
Possible Cure |
| Headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise |
Mild |
Medication or Descend |
| Decreased coordination (ataxia), Severe headache (not relieved by medicine), other mild level symptoms with increased affect |
Moderate |
Advanced Medication or Descend about 305-610 Mtrs |
| Inability to walk, decreasing mental status, and fluid build-up in the lungs |
Severe |
Immediate Descend about 610-1,220 Mtrs |
Taking baby or kid to high altitude?
Many a times when you want to travel to high altitudes, you may likely to worry for your kid or baby or infant. Well, personally I suggest you travel with kid or infant atleast 12 months old. However, studies suggest its safe to travel with an infant more than 3 months old IFF he/she is not born prematurely or do not suffer from any illness. NEVER travel with a baby less than 3 months old. While the above tips are helpful for kids or babies above 3 months old as well but there are other tips which need special attention for traveling with Kids and babies. I have tried to cover the details for traveling with babies or kids in the link below: Traveling to High Altitude with Kids or Babies
References
If you need more detailed information about Acute Mountain Sickness, then you may read the following links as well…
- Outdoor Action Guide to High Altitude: Acclimatization and Illnesses
- Altitude acclimatization for trekking – 10 golden rules
- Altitude Illness Clinical Guide For Physicians
- An Altitude Tutorial
Please share your valuable comments on acclimatization and acute mountain sickness or if you like the article and it could be of some help for you too.
Having said all that, it is still recommended that you CONSULT A DOCTOR or PHYSICIAN before you make a trip to a high altitude region just to ensure everything is in right place. Again, these are just my suggestions based on my very limited or negligible knowledge of AMS or mountain sickness but I will definitely suggest you that you consult some physician or doctor before going on the trip because I am not any of them. For more details on the same you MUST READ the links mentioned in the references which explains it in better details
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34 Comments
Hi Dhiraj!
Would u plz let me know whether it is advisable to go for Ladakh tour during August or September? Actually we have planned to go there during that time. Whether it is possible to cover whole Ladakh during Octobre. We intend to enter through Kargil and to end the tour through Manali, keeping Tso Moriri as the last spot to cover. Our team will consist of 60+, 50+ as well as 20+ people.Remember, we intend to cover entire Ladakh as far as possible. Whether it is O K to have from Delhi to Delhi.Plz let me know whether the weather is favourable (generally) during August/ September, considering heavy rain and flood during August 2010.
[...] Acclimatization & AMS [...]
[...] Acclimatization & AMS [...]
[...] Losar is situated at an altitude of 13,400 feet or almost 4050 Mtrs, so proper acclimatization is highly recommended before you plan your stay at Losar else you can run into AMS (acute mountain sickness) and goof-up the whole travel plan. For more information/tips/precautions for AMS and importance of acclimatization, do read the article linked here [...]
[...] Acclimatization & AMS [...]
[...] Acclimatization & AMS [...]
further if u can suggest taxi operators for the Srinagar- Leh rout.
Sir i want to go srinagar to leh by road in the month of may, kindly tell which time will be ok for this trip, the highway will be open on may month. Thanks and your sugessions are realy helpfull.
Pradeep, in May the Highway may not be open or may be open and the chances are 50-50. If you can make it to second week of june then both Manali – Leh as well as Srinagar – Leh will be highly likely open.
Regards
Dheeraj Sharma
Hi Dheeraj,
Went to the doctor, so that he could prescribe diamox, and to understand the dosage. But he was unaware that diamox is also used for preventing AMS. He said it is used for glucoma. What should i do.
Hi Glenda,
Then better check with some good doctor, may be who knows that it is also used for AMS
… Or on the other hand, take care of the points mentioned above as precautionary tips and you shall be fine with the trip.
Sorry for the delayed reply.
Regards
Dheeraj Sharma
Dear Dheeraj,
I have just returned from my trip to Ladakh.
Thanks to your guidance I had a wonderful time.
I did not carry diamox with me, but since I went from the srinagar route, I did not face any problems at all.
Thanks a ton for your help.
Very glad to know about your lovely experience Glenda. Feel very nice that my blog helped you had a lovely trip
Regards
Dheeraj
Hello Dhiraj
i have planned to go to leh dt:-23/07/2012 from ahmedabad. I will reach sonmarg on 26/07/2012 night.
At that time Amarnath yatra will be on,so i just wanted to know that from jammu to sonmarg there is any type of harresment from j&k police or military. Is it safe to go at that time from jammu to leh via srinagar or from manali to leh? reply asap
Hello Nilesh,
Yes, they do pose some concerns but mostly allow tourist to go by with some rigorous security checks. But, generally it would be OK to travel if you do not mind some delays or security stops at quite a few places.
Regards
Dheeraj
Hi Dheeraj
I am planning a trip to Leh for one week from 15th June.
Two questions:
1. I will be flying into Leh travelling 17 hrs at a stretch. I am flying Hong Kong – Singapore – Delhi – Leh. Could this increase the extent of AMS.
2. My parents who are 72 and 65 plan to join me for the trip travelling from Mumbai. Could AMS affect them more.
Thanks
Regards
Manish
Hello Manish,
I guess, you meant 15 July. AMS affect people irrespective of age for healthy people. So, like your parents you are also equally vulnerable to AMS. If you can fly to Srinagar and then take on the journey by road from there then it will be much easy on your body.
If you are flying directly then your first two days should be planned like below only:
Day 1 | Delhi – Leh (By Flight)
– Checkin at Hotel. Many hotels provide free pick and drop from Airport. Ask while you book them.
– Take ample of rest as well as water or anything that keep your body hydrated enough. DO NOT OVER HYDRATE. Take ORS Soluted water or ORS – L tetra packs from home.
– Do not over exert your body at any cost. Avoid too much up-down on stairs or avoid it in entirety, if possible.
– After 5-6 Hrs of rest you can visit Leh Palace, Local Leh market, Shankar Gompa .
– If you feel exerted go back to Hotel, have dinner at Hotel and take rest. Avoid any exertion. Else continue and,
– Follow the sunset by stroll at Changspa road and have a nice dinner on varied cuisines offered in-around Changspa road.
– Go back to hotel for overnight stay at Leh.
Day 2 | Leh Local Sighseeing + Inner Line Permits
– For more details on inner line permits process and to download application form read the link here:
– Hire a taxi from Leh taxi stand or Hotel whichever suits you.
– Bargain hard with taxi driver. Book that single taxi for entire trip after explaining the complete plan.
– Take his inputs if you feel reasonable and if required modify the plan accordingly but should suits you best.
– Ask him to be with you guys starting first day itself, if required and charged reasonable else do it at your own.
– Again DO NOT over exert and take little steps and slow walks only.
– If feeling OK then do Local sightseeing include Namgyal Gompa, Leh Palace, Shanti Stupa, Shankar Gompa, Main Market, Hall of Fame, Spituk Gompa, Changspa Road Stroll in evening
– Do not use stairs at any of these places just to see them as it will exert your body much more.
– Overnight at Leh
You can read more tips on Hydrated body here: Acute Mountain Sickness and Importance of Acclimatization
Regards
Dheeraj Sharma
Hi Dheeraj,
I have been reading about AMS from a longtime. Recently I came across this "Asthmatic people should avoid going to ladakh" on the internet.. How true is this?
Hello Parini,
I will direct you to the pioneer for such questions "Vistet" at his blog here. He will be most apt person to answer this question after any doctor
… So, consult them both!!
Regards
Dheeraj Sharma
[...] Acclimatization & AMS [...]
Dear Dheeraj,
Excellent advise on the site and I am following this closely. I need your advise as well. I am visiting Manali with my family (wife and 2 kids – aged 12 and 7 years) in May 2012 and the itenary is as follows
Day 1 Delhi to Simla, overnight at Simla
Day 2 Simla to Manali overnight stay at Manali
Day3 Rohtang Pass
Day 4- Kulu Manikaran
Day 5 return to Delhi via volvo
My question in light of AMS
After a day travel from Simla to Manali on Day2 and a overnight stay at Manali I am planning to do Rohtang pass next day – will an overnight stay at Manali help my family to acclamaitize or do I need another full day before I take up Rohtang travel – please advise
Well, i have been to simla, as well as manali. Though not at the same time z u r planing.
I traveled with my son 4 years of age and we took a road trip. We traveled straight to manali from delhi with overnight journey. It was beautiful, and my child didn't suffer anything majoy except routing motion sickness in hills.
Then we enjoyed d day at manali and next day we again drove to Rohtang pas.
Infact, that time I didnt even thought about HMS. Lucky me, there was not even single episode of any discomfort among my whole family including my son.
And the journey from Manali to Rohtang pass is awesome.
So u need not worry about, until n unless they suffer with some ailments.
Infact, i m planing to take him to manali – leh route this week.
Sachin, as I said on the other post Rohtang Pass is nothing as compared to what you will get on Manali – Leh Highway. Plus it is the sleep at high altitude that makes the matter worse, a hike to high altitude and then back to low altitude will not make any difference but constant exposure to high altitude with non-acclimatized body, is like calling the trouble to yourself. I have seen, read and heard through my blog various instances of ugly experiences. Rohtang Pass does have lots of vegetation around, you go few KMs down and there is even more towards Manali side. At Manali – Leh highway, most of the time you would be at altitude (14K feet) more than Rohtang Pass (is 13K feet) beyond Darcha and there is no vegetation at all or you can say almost very minimum. This makes breathing more difficult and lack of oxygen also counts for AMS issues.
Regards
Dheeraj Sharma
[...] Acclimatization & AMS [...]
[...] Acclimatization & AMS [...]
[...] Acclimatization & AMS [...]
[...] Acclimatization & AMS [...]
[...] AMS is always an issue while traveling from Manali to Leh. Hence, you do not have the option to go via Srinagar side and minimize AMS related issues. So, follow the tips on minimizing AMS and may be halt your Manali – Leh journey on Keylong or Jispa thereby avoiding stay at high altitudes of Sarchu or Pang. If you need more details or tips on AMS and importance of acclimatization then do read the article linked here [...]
This is very important information Dheeraj often taken lightly. One of my junior from college expired due to AMS.
http://www.telegraphindia.com/1111008/jsp/siligur…
Hi Shrihari,
Indeed it is very important and yet people take it very lightly. I do try my best to convey people about the same but guess lack of holidays compel them to take such risks. But, one should always feel and be serious regarding AMS. Sad, to hear that… May god bless him. Thanks for the share as it may help others to analyze that situation is not that simple in greater Himalayas than what they think.
Regards
Dheeraj
[...] Losar is situated at an altitude of 13,400 feet or almost 4050 Mtrs, so proper acclimatization is highly recommended before you plan your stay at Losar else you can run into AMS (acute mountain sickness) and goof-up the whole travel plan. For more information/tips/precautions for AMS and importance of acclimatization, do read the article linked here [...]
[...] Do not forget to read about acute mountain sickness and importance of acclimatization at the link below: Acute Mountain Sickness and Importance of Acclimatization [...]
[...] on Acute Mountain Sickness and acclimatization tips, please refer the following link at least once: Acute Mountain Sickness and Importance of Acclimatization (Publishing on [...]
[...] For more information on Acute Mountain Sickness and all above acclimatization tips, please refer the following link at least once: Acute Mountain Sickness and Importance of Acclimatization [...]