Acute Mountain Sickness and Importance of Acclimatization
Have you heard of things link AMS, Altitude Mountain Sickness, Acute Mountain Sickness related to high altitude traveling to places like Ladakh, Spiti Valley or Zanskar Valley or other parts of the Himalayas?
We all want to enjoy the lovely nature and breathtaking views of the high Himalayas. While traveling to the Himalayas, many of us take the high altitude very lightly and always consider the brighter side of the travel that is experiencing the majestic vistas 🙂
However, there is a darker side attached to the high altitude travel as well.
Let's quickly dive into the details:
How many times have you noticed that when traveling to the high altitude places, either you or people around you had complained shortness of breath, nausea, headaches or vomiting, etc?
I am sure you must have encountered such uncommon situations while traveling in the Himalayas especially at the high altitudes like regions of Manali – Leh Highway, Leh – Ladakh, Rohtang Pass, Spiti Valley, etc.. in India, to name a few.
Acclimatization is the prime reason I propose to choose Srinagar – Leh Road over Manali – Leh Road. 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 for them.
Illness or sickness on Himalayan trips is widespread, especially if you are directly flying to places like Leh or driving to a higher altitude, which almost certain the chances of AMS hitting you. Such illness can spoil a much-awaited relaxing holiday in the Himalayas and turn it into something ugly. In some cases, there have very severe consequences too.
Higher you go directly and quickly, higher will be the risks of you getting hit with AMS. Hence, its always better to know what altitude sickness means and what you can do to prevent it.
Further, in the article, I will try to lay out some important theories and facts about acute mountain sickness and the importance of acclimatization. It may help you be prepared for altitude changes and enjoy that ever awaited holiday in the Himalayas of yours 🙂
Pro Travel Tip: You can make a trip to Ladakh by following my most recommended Ladakh itinerary which takes care of a gradual increase in altitude. Hence, this itinerary helps in the acclimatization and in turn results in a memorable Ladakh trip.
Generally, people can go up to 8000 feet without much problems with mountain sickness. As you start to increase altitude, the barometric pressure starts to decrease, which reduces the Oxygen intake per breath. Now, to compensate for the less Oxygen intake, your body needs to increase the breathing rate.
Altitude can be categorized into the following scales —
Although the increased breathing rate does increase the Oxygen level in the blood, 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 a proper amount of time at such altitude, your body will adapt to such changes in Oxygen levels, and this process is called 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 a 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.
Pro Travel Tip: You can make a trip to Spiti Valley by following my most recommended Spiti itinerary which takes care of a gradual increase in altitude. Hence, this itinerary helps in the acclimatization and in turn results in a memorable Spiti Valley trip.
The best cure is either to acclimatize properly or to descend. However, the 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 before 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 suffers from periodic loss of breath, which especially occurs in the night while sleeping.
In case, you feel the person 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 from ataxia. IMMEDIATELY DESCEND!!
Download your FREE high-resolution version pdf copy of this infographic guide about tips for better acclimatization and preventing acute mountain sickness. If, you liked it and found it helpful, please feel free to share it with your family and friends to help them too.
Below are a few tips that will certainly help you in better acclimatization:
The acclimatization rules state 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 an overnight stay at the same altitude.
If you can adjust your plan to this rule, then perhaps you will not suffer from mountain sickness. However, the ground reality is only a few people stick to this schedule especially in India where leaves are hard to find from their work life.
It is the prime reason I always recommend traveling to Ladakh from Srinagar side. Similarly, I always suggest people traveling to Spiti Valley from Shimla – Kinnaur side.
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 normal in the body. You should avoid too much black tea or coffee as well…
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. It can dilute your body’s sodium levels (hyponatremia), causing weakness, confusion, seizures, and coma.”
As your 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 a lower altitude.
Do not overexert your body with any unnecessary physical activity which may lead you to pump more breath.
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 with woolens and do not let it cool. Make sure your clothes are always dry. Carry enough warm clothes to the Ladakh trip.
Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
Try not to sleep during the day and keep yourself involved in some light activity during the day. Respiration decreases during sleep which further exacerbates the symptoms.
Travel Tip: Do not forget to check my itinerary of a combined trip to Spiti Valley and Ladakh.
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.
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 weeks before you plan the trip. Check to see if there are any allergic effects and decide.
If possible, you may also carry an oxygen cylinder to counter the AMS symptoms. It will certainly help as a supplement but do take proper consultation from your doctor about the intake amount of oxygen, before the trip.
Oxygen intake will help you in case of an emergency and will spare you more time to descend to lower altitudes as soon as possible. You should look into my article on how to rent oxygen cylinders in Leh – Ladakh?
A note from the pioneer, Vistet linked here at post #12: on oxygen cylinders:
Small tanks of even medical grade oxygen provide 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
Last but not 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.
Apart from these tips, I will suggest that you also read about 7 things to consider for making a Ladakh trip.
Below is the categorization of symptoms for different levels of Acute Mountain Sickness (AMS) along with an indicative cure for it…
|
AMS Symptoms |
AMS Level |
Possible Cure |
| A 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 effect |
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 |
Many a time when you want to travel to high altitudes, you may likely to worry about your kid or baby or infant. Well, I suggest you travel with a kid or infant at least 12 months old. However, studies suggest its safe to travel with an infant more than three months old IFF he/she is not born prematurely or does 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 my articleTraveling to High Altitude with Kids or Babies
Thanks to Ram Kris for these awesome FAQs on AMS and Acclimatization
If you need more detailed information about Acute Mountain Sickness, then you may read the following links as well.
Please share your valuable comments on acclimatization and acute mountain sickness or if you like the article, and it could be of some help to you too. You should note that it is not just humans that get impacted by high altitude, you also beware of tips for carrying a laptop to high altitude places like Leh – Ladakh, and Spiti valley.
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 the right place.
Have a travel question?? You can follow me on Instagram and subscribe to my YouTube channel to ask your travel questions in a direct message on Instagram or comments on my YouTube videos. I also conduct a weekly Q&A session every Saturday evening on Instagram, so see you there.
Again, these are my suggestions based on my very limited or negligible knowledge of AMS or mountain sickness. But I will suggest 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 explain it in better details
This post was last modified on Jul 6, 2020 19:07
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Hi Dheeraj,
Travelling to Spiti next week and this will be my first time above 2100 m. Are you aware if a pre course of Diamox (250 mg) 3 days before the ascend will help in AMS prevention? Spoke to two doctors and one contradicts the other so a bit confused :)
Thanks!
Dip
He He, well, in the past it has helped me but it is not a cure for AMS.
Thanks Dheeraj, let me give it a shot...☺
Best wishes for your trip, do share your experience with us too :)
Undeniably consider that which you stated. Your favourite justification seemed to be on the internet the simplest factor to take note of. I say to you, I certainly get irked while people think about issues that they just don't recognise about. You managed to hit the nail upon the highest and also defined out the whole thing without having side-effects , people can take a signal. Will probably be again to get more. Thank you
Hi Dheeraj,
Thanks for doing wonderful work for the community.
I heard there are certain "Oxygen bars" in Leh area where one can take oxygen for some time to overcome AMS problems. How we can use them and what would be the approx. cost? Do you have any recommendation for how much time one should use it on first or second day of arrival at Leh.
Thanks in advance.
You can read: How to Rent Oxygen Cylinders in Leh Ladakh?
Hello Dheeraj,
We are planing to trip from Leh to Manali in 1st week of May this year. how would be road condition for leh to manali ? we are 3 members with 4 year old baby, do we need to take bus or hire car from leh ? we are flying by delhi to leh and then by road to manali.
please advise.
Parthesh.
Manali - Leh Highway will not be open by first week of May. There are very slim chances though BRO was claiming to open it in first week of May due to less snow but recent snowfall would have hampered the plans. Hence, it will not be open most likely.
It depends on person to person to take the children of such age group because AMS do not matter with respect to age or sex or any fitness level. It can happen to anyone of any age or sex or fitness I shall say... The issue with children is that they tend to exert the body considering it the same kind of place they belong to and this elevates the chances of getting struck with AMS. Secondly, they are not much expressive about their uneasy feelings, so it is parents who need to watch out and take care that the child is not suffering from uneasy feelings, headache or nausea and is behaving properly. With less than 5 year child, I think he/she will also be NOT able to convey the uneasiness she may feel. You have to be vigilant and if you notice any such feeling or he/she tells you about such a feeling then please do not ascend anywhere, either descend to lower altitude or stay at the same place to watch things overnight and if symptom increase then start descending immediately. Same is applicable for any adult as well. And yes, do keep the body adequately hydrated!!
Also, PLEASE read the article: Traveling to Ladakh with Kids or Babies. This article covers this topic in complete detail.
Thanks,
how about road conditions in second week ? what is the cheap way to reach manali by leh ? should i use shared car or tempo traveller ? or can i use public bus transport ? is there any local driver union or travel agents who can help us ? i am traveling with my wife and daughter.
I will recommend to make a trip in late May or June period on Manali - Leh Highway after the highway stabilize a bit. Cheapest way to reach will be using the shared taxi, that early in the season even the buses are not running. But with wife and daughter getting in shared taxiw ill also be a challenge. You should look for shared tourist taxis in Leh or find online travel partners. You can post your own travel calendar entry using the main menu
Hi Dheeraj ,
my mom and dad ( 50 - 55 yrs old) are planning to go to manali in october. They will be reaching there on october 21st morning. Will spend the whole day with manali local places and on october 21st they have a plan to visit rohtang pass. After that they will return back to delhi.
They dont have any breath issue but my dad has high Blood pressure. So will it be a problem visiting rohtang pass?
Although you should surely ask a doctor but keeping the visit short at the top of Rohtang Pass, in general, is OK for everyone. You should also read: https://devilonwheels.com/india/himalayan-travel-guides/acute-mountain-sickness-acclimatization-t16-20.html#p12523
Thanks for the reply :). Will consult with doctor soon. :)
Hi Dheeraj,
I am travelling to Leh on 8th of Sep from Delhi. Will fly back to Delhi on 15th morning.
Since i'll be reaching Leh on 8th morning itself, the rest of the day is enough to acclimatize or i'll have to stay in Leh on 9th as well?
If i'll have to stay in Leh for 8th and 9th, i'll be going to nubra on 10th morning and will stay there for two days.
Then on 12th Sep in the morning, i am planning to go to Pangong Lake. I read in your article somewhere that it is better to sleep at lower altitudes. Does that mean that i cannot stay in Pangong and have to return back to Leh?
In that case, Is it possible to reach Pangong from Nubra (which route is preferable?)and come back toLeh on same day?
If i stay in Pangong on 12th and return to Leh on 13th, what all can i do on 13th and 14th?
Can i visit Lamayuru or there are some better options to see? Like Tso Moriri?
Also,are there any biker groups in Leh which i can join and plan rest of my journey with them?
Hi Priya,
You should stay on the next day as well on 9th as it is highly recommended to have 2 days of rest in Leh. Then make two day Nubra, then two day Pangong Tso. Come back to Leh and take the normal routes.
Hey Dheeraj,
We are planning a trip to chandratal from manali.
We will be staying in manali for first night.
I wanted to know if we should stay the second night at chandratal or at batal keeping AMS in mind?
Best is to stay put at Battal for the first night and then try to stay at Chandratal the next night.
Thanks for the very helpful reply.
Thanks for your detailed, helpful and professional reply. i shall plan my trip accordingly, from srinagar to leh and then back from leh to manali. Guess i have to find my own devices for taxi from srinagar to leh. being a single traveller, can i get shared taxis? or any comfy buses available from srinagar to leh? just to be prepared.
Yes Raghuram, you can get the shared taxis but those will be local shared taxis only. Please read: How to make a budget Ladakh trip by public transport
oops: raghuraman here, further to my earlier post, i plan to travel in July, 2017. both the road routes will b open by then? srinagar-leh and manali leh?
Yes, both roads will be open by that time of the year.
I plan to travel from chennai; male age 55 years; wish to travel to leh/nubra valley/pangong. concerned about AMS issues.
1) Is it advisable to take a flight from delhi to leh? if not, then you have said that srinagar leh route will be easier than manali leh route. questions:
2) Is it safe to be in the vicinity of srinagar, going by the very current news reports? (i have no interest in sightseeing in srinagar). I plan to take Jammu-srinagar-leh bus route. is it safe: for tourists: current unrest situation?
3) where to get permit for visiting pangong and nubra valley in leh?
4) can you suggest an itinerary for leh/nubra/pangong, looking to acclimitazation issues?
5) can i take a flight out of leh to delhi/jammu: no AMS issues there?
Below are my replies:
1. Best is to take flight to Srinagar and travel by road to Leh. Then exit via Manali - Leh
2. For the first hand info on Srinagar – Leh Status and present situation in Kashmir for tourists, please read the current experience by the traveller at the link: https://devilonwheels.com/india/road-status-conditions/srinagar-leh-highway-status-2017-2018-t5264-60.html#p40510
3. For details on inner line permits process and to download application form read the link All you want to know about Inner Line Permits for Ladakh. Page 1 is Protected Area Permit applicable for foreigners. Fill in Page 2, 3 for Inner Line Permit applicable for Indians, got to DC office in Leh and submit the application with valid Photo ID nationality proof and pay the required fee of Rs 400 + Rs 20 x number of days you will be in Ladakh.
4. You can check a very balanced and most common itinerary for Leh - Ladakh followed by many travellers including me at the link here for 13-14 days: Most Common Itinerary for Leh – Ladakh.
5. YEs no issues while coming down to Delhi from Leh.
Hi.. One of my friend is concerned about breathing issues. We are planning bullet trip with an organiser in mid june.
Please advise to make a better choice. 1) srinagar-leh-manali 2) manali-leh-manali.... Somebody told him that srinagar to leh is better than manali to leh as you dont reach to heights suddenly.
Is 15th june departure advisable looking at this years weather ?
Please guide. And yes if let me know if you yourself organise bike trips.
Best choice always is Srinagar to Ladakh to Manali and he was advised correctly. Yes, 15th June is fine to travel on both Srinagar - Leh HIghway and Manali - Leh Highway
PLEASE note Devil On Wheels is a Travel Platform to share information with fellow like minded travellers for FREE. We neither organize any tours nor offer any travel packages. There are some people who do sell tours and run commercial things with same or similar names like ours with few spelling changes. Please BEWARE of such copy cats using our name to disguise fellow travelers, as they use our name or similar name to fool people for their own commercial purpose and in the past we have heard tons of complaints about them from the people who got confused in entities and ended up trips with them.
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Hello Dheeraj,
In case of AMS, you have mentioned to descend to low altitude. Please let me know where to descend..towards which location etc..?
regards,
Sunny
Hey Sunny,
Are you planning Ladakh? Then if you are in Leh, you can go down to Alchi or even Kargil. If you are at Pangong Tso or Tso Moriri, you can go down to Leh. Few 100 Mtrs also do the wonders to the AMS symptoms at times.
hi dheeraj ji
we have 27 members on 27 seater bus to planned, to visit leh on 1 june from jammu srinager kargil, leh 3 days , 2 days nubra, 1day pangong ,1) can we direct go to sarchu from pangong. 2) on this day all roads will opened or not. 3) today i know that this year inner line permit is compulsory for indian as well as foreigners also. and fee are approx 1000 to 1100 for indian , is it true or not plz confirm . 4) leh to manali road are open or not on 9 june from pangong to sarchu & 10 june sarchu to manali.
Hi Rupesh,
This year there is too much of snowfall and Manali - Leh is expected to open by the second week of June. Plying heavy vehicle on it may not be conducive, so better postpone the trip by couple of weeks.
Update April 2017 = Pay environment fees and apply for permits again (those who missed before)
The environment fees of Rs 400 & Inner Line Permits (most likely as well) will again be required in Ladakh for Indian Tourists / Nationals with effect from April 1st, 2017. This has been recently announced and is available on official website of Leh administration. It is expected that a public circular should follow soon as well. Hence, like it used to happen before 2014, all Indian Nationals or Indian Tourists WILL need to pay environment fees and may need to also get the inner line permits in Leh – Ladakh region in order to visit the restricted places like Dah, Hanu Villages, Pangong Tso, Man, Merak, Tso Moriri, Nyoma, Loma Bend, Khardung La, Nubra Valley, Turtuk, Tyakshi, Digger La, Tangyar (for trekking only). For details on inner line permits process and to download application form read the link here
Me and my friend are planning to make spiti trip on 10th of march
Is this is the correct time to visit ??
Shivam, Spiti in march is still harsh and frozen. If you are used to such conditions then only plan a trip as even the hotels will be closed and only home stays will be working condition, so make sure you are determined to make such a trip.