Altitude without the drama: acclimatising in Ladakh and Spiti

Most people who travel to Ladakh or Spiti feel the altitude in some way. A mild headache on the first evening, a racing heart on the stairs, a restless first night — these are normal signs that your body is adjusting to thinner air. With a sensible plan, they pass within a day or two. Without one, they can turn into something serious.

This guide explains what happens at altitude, how we design journeys around it and what you can do to help. It isn't medical advice: if you have a heart or lung condition, are pregnant or take regular medication, please talk to your doctor before you travel.

What happens to your body

At 3,500 m — roughly the height of Leh — each breath carries about a third less oxygen than at sea level. Your body responds by breathing faster, raising your heart rate and, over several days, producing more red blood cells. That process is called acclimatisation, and it simply takes time. Fitness doesn't speed it up; marathon runners get altitude sickness too.

The first 48 hours

If you fly into Leh, you go from near sea level to 3,500 m in about an hour. That is why every one of our Ladakh journeys begins with at least two easy days in town. In practice, that means:

Resting on the day you arrive — no sightseeing, no long walks.
Drinking plenty of water, as the air is very dry.
Avoiding alcohol and sleeping pills for the first few days.
Eating light, carbohydrate-rich meals.
Keeping the second day gentle, with short walks and monastery visits at a slow pace.

Arriving by road — from Manali or Srinagar to Leh, or from Shimla through Kinnaur to Spiti — gives your body more time to adjust, which is one reason we often recommend it.

Climb gradually

Once you're above 3,000 m, the height at which you sleep matters more than the height you reach during the day. A useful rule of thumb is to raise your sleeping altitude gradually — a few hundred metres a night — and to add a rest day every few days. It's also why we cross high passes like Khardung La and Chang La during the day and sleep lower down on the other side.

Going up a high pass is fine. Sleeping high too early is what catches people out.

Know the warning signs

Acute mountain sickness (AMS) feels like a bad hangover: headache, nausea, tiredness, poor appetite and disturbed sleep. If you have these symptoms, don't go any higher until they've gone, and tell your guide.

Two rarer conditions need immediate action. Fluid on the lungs (HAPE) causes breathlessness even at rest, a persistent cough and extreme fatigue. Swelling of the brain (HACE) causes confusion, unusual behaviour, drowsiness and loss of coordination. Either one means descending at once and getting medical help.

Our rule: nobody is ever pressured to continue. If you feel unwell, we stop, rest or go down — and we would rather lose a day than take a risk.

What we carry

Every vehicle on our high-altitude journeys carries a pulse oximeter, an oxygen cylinder and a first-aid kit, and our drivers and guides know how to use them. We check in with you each morning and evening, plan routes with lower escape options, and keep in touch with local clinics and hospitals along the way.

Medication

Some travellers take a preventive medicine such as acetazolamide on their doctor's advice. It can help, but it isn't a substitute for a gradual itinerary, and it isn't right for everyone. Please don't take it without speaking to a doctor first.