Altitude in Ladakh: how to acclimatise well

Why Leh is different from other hill towns

Shimla is about 2,200 m and Darjeeling about 2,000 m. Leh is 3,500 m, and the plane drops you there in about 80 minutes from Delhi. At that height each breath carries roughly a third less oxygen than at sea level, and your body needs days, not hours, to respond by breathing faster, making more red blood cells and adjusting how your blood carries oxygen.

Acute mountain sickness, the common form of altitude illness, usually shows up in the first 6–24 hours: headache, poor sleep, nausea, tiredness, loss of appetite. It is common, usually mild, and gets better with rest. What turns it serious is going higher while you still feel unwell. That is why every trip we plan, at every price level, starts with rest in Leh.

The first 48 hours in Leh

Treat your first two days as part of the trip, not wasted time. On day one, go from the airport to your room and stay there. Sleep if you want to. Drink water steadily, eat light meals, and avoid alcohol, smoking and sleeping pills. Walk slowly if you walk at all, and avoid stairs; ask for a ground- or first-floor room.

On day two, a gentle walk through the old town lanes or Changspa is fine, at a pace where you can talk easily. Keep the climb to Leh Palace or the Shanti Stupa steps for day three. Day three can be a full outing at Leh's height: Thiksey, Shey and Hemis are all within 150 m of Leh's altitude, which makes them ideal.

• Day 1: rest only, water, light food, no alcohol.
• Day 2: short flat walks, early night.
• Day 3: Indus valley monasteries at Leh's height.
• Day 4 onwards: the first high pass, but sleep lower or level.

town · 3,500 mLehvalley · 3,144 mNubra Valley

Sleeping heights matter more than passes

The figure that matters most is where you sleep, not the highest point of the day. Khardung La is 5,359 m, but you spend 15 minutes there and sleep in Nubra at about 3,100 m, lower than Leh. Pangong and Tso Moriri are different: you sleep at 4,250 m and 4,522 m, and those are the nights when most people feel worst. We put them late in every trip and keep them to one night each unless guests are clearly well.

Plan your route so each sleeping height is a modest step from the last. A common and sensible order is Leh, the Sham valley or Indus monasteries, Nubra, then Pangong, then Tso Moriri. Coming by road from Srinagar is gentler still: Kargil at 2,676 m, Lamayuru at about 3,510 m, Alchi at about 3,100 m, then Leh.

Symptoms to watch and when to go down

A mild headache that eases with rest, water and a simple painkiller is common in the first days. Tell your guide, host or travel companion, take the day off and do not go higher until it clears. Poor sleep and odd breathing patterns at night are also common and usually settle.

Some signs mean you should get medical help and go down: a headache that does not ease, vomiting, breathlessness at rest, a dry cough, confusion, unsteady walking or unusual drowsiness. These can point to the serious forms of altitude illness affecting the lungs or brain. Leh has a district hospital and private clinics, and descending even 500 m often brings fast improvement. Never leave someone with these symptoms alone, and never let them sleep higher.

• Mild symptoms: rest, water, no higher until they clear.
• Serious symptoms: medical help and descent, without delay.
• Talk to your doctor before travel about medicines and existing conditions.

Seasons and how they change the risk

From June to September the passes are open and most visitors come, and nights in Leh are mild at 8–15 °C. Pangong and Tso Moriri still fall below freezing at night even in August. May and October are quieter and cheaper, but cold makes altitude feel harder, passes can see snow, and you should keep extra rest in your plan.

In winter, Leh is −10 °C or colder at night, and flights are the only practical way in. Many travellers come for Losar, Dosmoche or snow leopards in Hemis National Park. The same 48-hour rule applies, and you need a heated room. Dry air at any season dehydrates you quickly, so drink more than you think you need.

Daily habits that make a difference

Most of good acclimatisation is boring. Drink water through the day, two to four litres depending on heat and activity; Ladakh's air is so dry that you lose water with every breath. Eat regular meals with plenty of carbohydrate, such as rice, bread, thukpa and tsampa, even when you do not feel hungry. Walk at a pace where you can still hold a conversation.

Sun and cold add to the strain. At 3,500 m and above, ultraviolet light is much stronger than on the plains, so wear a hat, sunglasses and high-SPF sunscreen even on cool days. Nights are cold everywhere above Leh, and being chilled makes poor sleep worse. Pack layers you can add and remove quickly in a car.

• Refillable bottle and oral rehydration sachets.
• Sun hat, glacier or good UV sunglasses, SPF 50 sunscreen, lip balm.
• Down jacket, thermal layers, warm hat and gloves.
• A simple pulse oximeter if you like numbers; trust how you feel more than the reading.

Children, seniors and medical conditions

Children and older travellers can visit Ladakh, and many do, but they need the same rest days and closer watching. Young children may not say they have a headache; look for crankiness, poor appetite and unusual sleepiness. For seniors, the risk is mainly existing heart, lung or blood-pressure conditions. In both cases, talk to your doctor before you book and keep the high lake nights optional.

Some travellers take a preventive medicine on their doctor's advice. That is a decision for you and your doctor, not for us. What we can promise is a plan with slack in it: extra rest days, lower alternatives to every high night, and drivers and guides who know to turn back. Buy travel insurance that explicitly covers trekking or travel above 3,500 m and medical evacuation, and carry a list of your regular medicines and doses. If you use a CPAP machine or have had altitude illness before, mention it when you plan; it changes how we build the route.