If you fly into Leh, which is at 11,500’ (~3,500 meters), you are almost certain to suffer from some symptoms unless you are already used to being at high altitude. It is highly recommended to rest for about 3 days before heading off on a trek. If you come by road, you can get away with less, but everyone really needs to rest when they get here. ‘Rest’ means staying in your room and resting, not wandering around town, even in a leisurely manner. It’s a good time to study your maps and guidebooks to get clear on what you really want to see and do. If you are staying in a place with room service, do take advantage of it.
The first time I came to Leh, I was flat on my back for three days with a splitting headache. I couldn’t even leave my room. I just lay there, drinking water and taking aspirin, with an occasional bite of food to go with the aspirin. My Ladakhi friends are a bit surprised that every year since then has been easier. Now I just need to rest for a day and not exert too much for another day or two and I’m fine. But I remember my friend, who has come to Ladakh often, once brought her niece and they went on a trek after hardly two days of rest; the niece got so sick she had to be evacuated.
If you plan a trek, be sure to allow an extra three days before you start, and a few more days of flexibility in case of altitude or weather problems.Symptoms of Acute Mountain Sickness (AMS) usually develop during the first 24 hours at a high altitude, but they can take much longer to appear. For me, it’s usually about 6-8 hours after I arrive that I start feeling a little dizzy and weak (no more headaches, at least). Milder symptoms include dizziness, headache, lethargy, loss of appetite, nosebleeds and difficulty sleeping. Severe symptoms include mental confusion, irrational behavior, breathlessness, vomiting, dry cough, drowsiness, lack of coordination, lack of balance, and severe headache. Inability to walk a straight line is an indication you need to descend immediately.
If you start feeling sick, don’t try to hide it from your companions or pretend that it’s not as bad as it is. Many people do so for all sorts of foolish reasons. Your life is much more important than some deadline or concern about what people might think. No intelligent person is going to think that you are weak because you get altitude sickness. After all, many of the strongest and most intrepid adventurers on the planet have suffered from it. If you happen to be with someone who is determined to get you up and moving in spite of your symptoms, realize that they are acting out of ignorance, selfishness, or just plain stupidity. How wonderful for them if they feel great—but don’t worry about what they think and don’t let them bully you! If you deal with AMS in a timely manner, it’s not a big problem. If you don’t, it can even be fatal.
It is essential that you drink a lot of water, usually at least three liters a day. Coffee, tea and soft drinks don’t count. Your body needs water.
Avoid the temptation to drink alcohol until you are well acclimatized. It will only make the symptoms worse. Getting drunk if you have AMS can be fatal. There are usually a couple dozen deaths from altitude sickness in Ladakh every year, many of which involve alcohol, all of which involve not allowing sufficient time to acclimatize—and nearly every one of which is avoidable.
While it is not possible to prevent altitude sickness altogether, there is no reason why anyone should die of it, since the onset is relatively slow and the progression of the disease is predictable. The real dangers are where one is either trapped in a situation where it is impossible to descend, or else forced to keep moving by people who are determined to push on at all costs—the latter being unfortunately common.
The best prevention for severe altitude sickness is simply to refrain from going higher until all moderate symptoms are gone. If you show symptoms of even moderate altitude sickness, wait to go any higher until they subside. If your symptoms continue to get worse, immediately descend to a lower altitude. The usual rule is to allow a day of rest between each 1,000’ (~300 meters) of ascent. Don’t go higher until you are acclimatized.
Altitude sickness isn’t much of an issue if you are only crossing a high pass and then descending again to an altitude that is not significantly higher than the one where you spent the previous night, because the onset takes several hours.