It’s The Altitude!

Melanie Drury goes from a life at sea level on the island of Malta to Leh, in Ladakh, at 11,500 feet (3,500 metres) deep in the Indian Himalayas. She had never heard of altitude sickness, but it was lucky the way things turned out …

Climbing a mountain is hard enough without having to also deal with a throbbing headache, nausea, utter exhaustion and insomnia due to lack of oxygen at high altitude. Altitude sickness can be a huge inconvenience and it can also be dangerous if it progresses to greater severity. 

What Is Altitude Sickness?

Altitude sickness occurs as a pathological effect caused when ascending too quickly to high altitudes such that the body does not sufficiently adapt to reduced oxygen levels and changes in air pressure.

Let’s be clear. Mountain climbing is not the only way you can get altitude sickness, or AMS (acute mountain sickness). Flying to cities or ski resorts at high altitude can be a primary cause, due to the sudden change in the surrounding atmosphere. In fact, mild AMS is common, irrelevant of fitness level and state of health.

Altitude: My own experience of altitude sickness was mild, when I visited the city of Leh, in Ladakh, North India. The city is situated at an altitude of 11,500 feet (3,500 metres) above sea level, which is well above the 8,000 feet (2,400 metres) at which one could expect to experience symptoms. Apparently, in Leh there is 25% less oxygen in the air, so that would certainly explain why I experienced breathlessness walking on the streets even for a few minutes at a time.

Minor symptoms, such as breathlessness, may begin from altitudes of 5,000 feet (1,500 metres), although most people can ascend to 8,000 feet (2,400 metres) without difficulty. AMS commonly occurs above this level, while more severe symptoms are generally experienced at above 12,000 feet (3,600 meters).



Altitude sickness presents itself in a collection of symptoms resembling a hangover, carbon monoxide poisoning, dehydration or a case of flu. When you go too high too fast, your body cannot get as much oxygen as it needs, presenting symptoms such as: A throbbing headache, which generally gets worse at night and as you rise.  Breathlessness, lightheadedness or dizziness. Loss of appetite, nausea or vomiting. Excessive flatulation. Reduced performance and coordination, weakness or fatigue. Rapid pulse. Insomnia, waking up during the night and unrestful sleep. Peripheral edema (swelling of feet, hands and face). Pins and needles. Nose bleeding. Symptoms may be mild to severe and may not start until 24 hours after you have been at a high altitude. 


To prevent altitude sickness, sleeping at a lower altitude than the one you were at during the day helps acclimatisation to prepare you for a higher ascent the next day. My altitude sickness was not too bad, certainly because I arrived at the city along the Manali-Leh Highway by bus; the journey cleverly includes an overnight stay at the secluded village of Keylong, at 10,000 feet (3,100 metres), after crossing the Rohtang Pass at 13,000 feet (4,000 metres).

Crossing the Tanglang La mountain pass at an elevation of 17,500 feet (5,300 metres), the next day was, nonetheless, memorable.  I was born on a small island at sea level and it was the first time I had ever been on a mountain. Suddenly becoming aware of the utter silence on the bus, I realised that all I could think about was breathing. It was like being forced into meditation. Thereafter, up to several days later, exertion would require me to stop and breathe mindfully. I discovered that the people who drove along the four passes in a single day in a jeep were more likely to get worse symptoms.

PrecautionAs a rule, consider your symptoms to be altitude sickness unless you can prove they are not. Proper acclimatisation is essential to avoiding or overcoming altitude sickness. In the case of mild AMS, you may stay at the same altitude at rest until your body adjusts. Limit walking and any kind of physical exertion, drink plenty of water and do not drink alcohol. It may take from twelve hours to four days before symptoms subside and you are able to go to a higher altitude. I had little time at my disposal in Leh, too little to prepare me to ascend to higher altitudes. Trekking was not on my agenda and I enjoyed the beautiful mountain city of Leh and its surroundings thoroughly, leaving without regrets. 

Treatment: It is useful to know that, if possible, symptoms should be treated by giving oxygen. Some medications are also available – over the counter or prescribed by a doctor – to treat symptoms or speed up how fast your body can adjust to high altitude. When symptoms are moderate to severe or persist, it is advisable to descend to a lower altitude of at least 1500 feet (450 metres). This should be done immediately and someone suffering from altitude sickness should always be accompanied during descent. If anyone experiences symptoms such as being confused or unable to walk straight, consider it a medical emergency.


The Dangers & How To Avoid

Dangers: Being aware of the dangers is imperative to avoiding altitude sickness. AMS could also affect the lungs or brain. Acute Mountain Sickness can progress to High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE), both potentially fatal conditions. Furthermore, Chronic Mountain Sickness, also known as Monge’s disease, is a condition that can occur when exposed to high altitude for a long period. People who deal with a long term condition, especially heart problems, sickle cell anemia, chronic obstructive pulmonary disease (COPD) or sleep apnea should speak with their doctor before visiting high altitudes.

It is known that prevention is better than cure. I discovered that there are some tips on how to avoid altitude sickness that anyone travelling to high altitudes should know:

    • Ascend slowly. Stop overnight at a lower altitude than the one you were at during the day; this prepares you to go to higher altitudes the next day.


    • Do not fly into high-altitude cities, if it can be avoided. Otherwise, avoid large meals, drink plenty of water, do not drink alcohol and rest on arrival. Examples of high altitude cities include Cuzco in Peru; La Paz in Bolivia and Lhasa in Tibet.


    • Avoiding physical exertion or strenuous activity during the first 24 hours at high altitude.


    • Do not consume alcohol for 48 hours.


    • Do not take any sleeping pills.


    • Eat carbohydrates such as cereals, grains, bread and pasta.


  • Drink and eat lots of ginger, and also garlic soup (tastes WAY nicer than it sounds and works wonders!).

Last but not least – Trust your guide!


Namaste Nomad Bhutan Trip