Altitude Tips

Air is thinner. Plans must be slower.

As you gain height, each breath carries less oxygen. Most people feel that above about 2,500 m: a faster pulse, lighter sleep, the need to pause on stone steps. That is expected. Acute mountain sickness (AMS) is different. It is illness — typically a headache plus nausea, unusual fatigue or dizziness — and it is the body’s warning that you have outrun acclimatisation.

Kathmandu sits near 1,400 m. Namche Bazaar is about 3,440 m. Everest Base Camp is about 5,364 m. Annapurna Base Camp is about 4,130 m. Thorong La is 5,416 m. Helicopters and luxury lodges do not cancel physics. If you sleep high, you still have to acclimatise.

Ambition Holidays — sister company of Ambition Himalaya Treks and Expeditions — designs Everest, Annapurna and Manaslu programmes with extra nights where they matter (Namche, Dingboche, Manang). We would rather add a day than call a helicopter.

Rules that actually protect you

These are the Wilderness Medical Society and Himalayan Rescue Association ideas we plan around — not folklore.

• Sleeping altitude is what countsAbove about 3,000 m, do not raise the altitude at which you sleep by more than about 500 m in a night. You may walk higher in the day if you come back down to sleep — climb high, sleep low.
• Rest days are medicinePlan an extra night at the same sleeping height every 3–4 days, or after about 1,000 m of gain. Namche and Manang exist for this reason. Skipping them to “save a day” is how AMS starts.
• Never go higher with AMSIf you have a persistent altitude headache plus other AMS symptoms, stay put. If symptoms worsen, go down. Staying at the same height while you get worse is not rest — it is delay.
• Descent is the treatmentAMS usually eases after a descent of 300–1,000 m. HACE and HAPE need immediate descent, oxygen if available, and evacuation. No tablet replaces walking downhill.
• The slowest person sets the paceFitness at sea level does not predict who gets AMS. Previous altitude illness does raise risk. The itinerary moves at the slowest safe speed, not the strongest guest’s speed.
• Do not depress your breathingDrink enough that urine stays pale (often 3–4 litres a day). Avoid alcohol, strong sleeping pills and other sedatives at altitude — they flatten overnight breathing. Eat, even if appetite dips; carbohydrates help.

How it feels — and when it is illness

Expected at height (not automatically AMS)

Most guests notice some of these above 3,000 m even on a well-paced trek. They should ease with rest, fluids and a slower day. Tell your guide anyway — patterns matter more than any single feeling.

• Breathlessness on steep steps, easing at rest
• Needing more sleep, or vivid dreams
• Passing more urine (often a good sign of acclimatisation)
• Mild loss of appetite on the first high night
• A dry cough in cold, dry air

Mild AMS — do not go higher

Doctors usually define AMS as a headache at altitude plus at least one of: nausea or vomiting, unusual fatigue or weakness, dizziness. A runny nose or a cold is not AMS. Admit the symptoms early. Pride is a poor climbing partner.

• Persistent headache that is not just “tired from the walk”
• Nausea, or vomiting
• Unusual weakness or exhaustion
• Dizziness or light-headedness at rest
• Symptoms that worsen overnight instead of easing

Serious signs — descend now

These can mean high-altitude cerebral oedema (HACE) or high-altitude pulmonary oedema (HAPE). Both can kill. There is no “push through until breakfast.” Wake the guide. Go down. Call for evacuation.

• Severe, relentless headache or repeated vomiting
• Ataxia — cannot walk a straight line, looks drunk
• Confusion, not staying awake, or not understanding simple instructions
• Breathlessness at rest, wet cough, pink frothy sputum, or a rattling sound in the chest
• Blue lips or face, extreme lethargy, a very high resting pulse

How we prevent it on an Ambition itinerary

Prevention is almost entirely about the calendar. Medicines are a supplement, never a substitute for rest days.

• Start walking from a sensible height. Flying into Lukla (~2,860 m) still needs a Namche rest, not a race to Tengboche the next morning.
• Sleeping altitude gain of about 500 m or less per night above 3,000 m, with rest nights built in.
• Easy afternoon walks on rest days (climb high, sleep low) rather than lying still all day.
• Guides carry a pulse oximeter as one tool among others — numbers are interpreted with symptoms, not as a scoreboard.
• Tell the guide the truth at breakfast. We would rather rearrange lodges than manage HAPE at dusk.
• Travel insurance must name helicopter evacuation to your maximum sleeping altitude. We check the policy before you fly.

What we do on the mountain

Luxury is not skipping acclimatisation. It is having the time, the staff and the helicopter option if the mountain disagrees.

• Itineraries with spare nights, not the shortest brochure
• Licensed guides trained to stop an ascent
• Pulse oximeter and a simple first-aid kit with the team
• Himalayan Rescue Association posts used when we are in range (seasonal clinics such as Pheriche and Manang)
• Helicopter evacuation coordinated when insurance and weather allow

HACE, HAPE and prescription medicines

Read this once. Then book a conversation with your own doctor. We will not issue altitude drugs from the office WhatsApp.

• HACEFluid around the brain. It can follow ignored AMS. Ataxia (unsteady, “drunk” walking) is the classic warning. Coma can develop in hours to a couple of days. Treatment is immediate descent, oxygen if you have it, and emergency dexamethasone only as a clinician or a trained guide directs — then get lower. A portable hyperbaric bag, if one is present, is a bridge, not a destination.
• HAPEFluid in the lungs. Breathlessness at rest and a wet cough are the alarms. It can move faster than HACE. Oxygen and descent save lives. Other drugs used in clinics (for example nifedipine) are not a guest self-treatment. Do not wait for morning “to see if it clears.”
• Acetazolamide and dexamethasoneAcetazolamide (often known as Diamox) is the usual prescription prevention drug. The Himalayan Rescue Association commonly discusses 125 mg twice daily, started before a big gain in height. It is related to sulfa drugs; allergy can be severe; tingling lips and a change in taste are common. It does not hide AMS — it helps you breathe more at night. Dexamethasone can be life-saving in HACE in trained hands; it is not a daily vitamin for tourists and it can mask symptoms. Neither drug replaces descent. Only your physician can prescribe, and a trial of acetazolamide at home is wise if you have never taken it.

Helicopters, lodges and honesty

A private lodge in the Khumbu does not lower Everest. If we fly you to a high hotel, we still respect sleeping altitude. If a guest wants to skip Dingboche to “make the summit window,” we refuse. That is the luxury: a company that will disappoint a schedule rather than a family.

Before you leave home, see a travel-medicine doctor, especially if you have heart or lung disease, sleep apnoea, are pregnant, or have had AMS before. Bring your own blister kit and everyday pain relief. Leave the antibiotics and the guesswork to professionals.