How to Avoid Altitude Sickness in Nepal

High Altitude Travel

 

Places with high altitudes, like Colorado ski resorts (8,000–10,000 ft), Cusco (11,000 ft), La Paz (12,000 ft), Lhasa (12,100 ft), Everest Base Camp (17,700 ft), and Mount Kilimanjaro (19,341 ft), can cause health problems. At high altitudes, the air is cold and dry, and there is less oxygen, which can make you sick.

 

The main problem is a lack of oxygen, which gets worse the higher you go. How bad it gets depends on how fast you go up, how long you stay, and how high you go. It’s harder to breathe when you sleep at high altitudes, but if you don’t stay long, it’s not as bad.

 

Your body can adjust to lower oxygen levels up to 17,000 ft (5,200 m), but it takes time. In the first 3–5 days, your body starts to adjust by breathing more and getting better at sending oxygen to your brain.

 

Altitude sickness can happen before your body fully adjusts, but it shouldn’t happen after. Once your body adjusts, you’ll feel better and be able to do more, but you won’t perform as well as you would at lower altitudes.

 

To help your body adjust, don’t go up too fast. Stay at 8,000–9,000 ft (2,450–2,750 m) for 2–3 nights before going higher. The Wilderness Medical Society gives some tips:

 

✔ Don’t go higher than 9,000 ft (2,750 m) in one day. 

✔ Above 9,800 ft (3,000 m), don’t sleep higher than 1,650 ft (500 m) a day. 

✔ Add one extra night for every 3,300 ft (1,000 m) you go up.

 

These tips can help prevent acute mountain sickness (AMS), though everyone’s body adjusts differently.

 

Acclimatization Checklist for Travelers

 

✔ Go up slowly.

✔ Don’t go directly from a low place to over 9,000 ft (2,750 m) in one day.

✔ Above 9,000 ft (2,750 m), don’t sleep higher than 1,600 ft (500 m) a day, and add an extra day for every 3,300 ft (1,000 m) you go up.

✔ Don’t drink alcohol for the first 48 hours at high altitudes.

✔ Keep drinking caffeine if you’re used to it to avoid headaches.

✔ Only do light exercise for the first 48 hours.

 

Altitude Illness: Risk to Travelers

 

Any traveler who is not used to high altitudes and sleeps at 8,000 ft (2,450 m) or higher is at risk for altitude sickness. Even people who have been to high altitudes before might get sick if they go 2,000–3,000 ft (600–900 m) higher.

 

The best way to know if you’re at risk is by looking at your past experience at high altitudes. However, everyone reacts differently, and even experienced travelers can get sick.

 

There are three main things that affect the risk of altitude sickness:

 

✔ How high your destination is

✔ How fast you go up

✔ How hard you push your body

 

Since it’s hard to avoid altitude illness completely, the goal is to keep symptoms mild so you don’t need to change your plans or get medical help.

 

Risk Categories for Acute Mountain Sickness (AMS)

 

Low Risk

✔ No history of AMS, going to less than 9,000 ft (2,750 m)
✔ Gradual ascent over 2 days to 8,200–9,800 ft (2,500–3,000 m)
✔ Sleeping at a higher altitude by less than 1,600 ft (500 m) per day, with extra acclimatization days

 

Moderate Risk

✔ History of AMS, going to 8,200–9,200 ft (2,500–2,800 m) in 1 day
✔ No AMS history, going higher than 9,200 ft (2,800 m) in 1 day
✔ Sleeping higher than 1,600 ft (500 m) per day above 9,900 ft (3,000 m) with acclimatization days

 

High Risk

 

✔ History of AMS, going higher than 9,200 ft (2,800 m) in 1 day
✔ History of HAPE or HACE
✔ Going higher than 11,400 ft (3,500 m) in 1 day
✔ Sleeping higher than 1,600 ft (500 m) per day above 9,800 ft (3,000 m) without acclimatization days
✔ Very fast ascents (e.g., less than 7 days on Mount Kilimanjaro)

 

Destinations of Risk

 

Some high places require quick ascents by plane to over 11,000 ft (3,400 m), which puts travelers at risk for AMS. When gradual acclimatization isn’t possible, travelers may need to take medicine.

 

In Nepal, Everest Base Camp treks can push the limits of acclimatization, with around 30% of trekkers getting altitude sickness at higher elevations. Adding extra days to adjust can make the trek safer and more fun.

 

Altitude Sickness

 

Altitude illness includes three main conditions: acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). Some experts also consider high-altitude headaches a separate problem because it can happen without other AMS symptoms.

 

Acute Mountain Sickness (AMS)

AMS is the most common and affects 25% of people sleeping above 8,000 ft (2,450 m) in places like Colorado. It feels like a hangover with a headache as the main symptom. It can also cause loss of appetite, dizziness, tiredness, nausea, or vomiting.

 

AMS usually starts 2–12 hours after going up or higher, often getting worse at night but getting better within 12–48 hours if you don’t go higher. AMS lasts 1–3 days and should not be diagnosed if symptoms start after staying at the same elevation for 3 days.

 

Treatment for AMS

 

If you have AMS and no signs of HACE or HAPE, you can stay at the same elevation. If it gets worse, you should go down.

 

High-Altitude Cerebral Edema (HACE)

HACE is a serious form of AMS and happens when there’s not enough oxygen in the body. It can happen with AMS or HAPE, but it’s rare below 14,000 ft (4,300 m).

 

Diagnosis

 

HACE causes confusion, unsteady movements, and drowsiness, like being drunk. If not treated, it can lead to a coma in 24 hours.

 

Treatment

 

In places with medical care, oxygen can help. In remote areas, the person needs to go down immediately and get oxygen if available. Without treatment or descent, coma can happen in 12–24 hours.

 

High-Altitude Pulmonary Edema (HAPE)

 

HAPE can happen with AMS or HACE, or on its own. It’s rare but more likely at elevations above 14,000 ft (4,300 m).

 

Diagnosis

 

Early diagnosis is very important because HAPE can get worse quickly. Symptoms start with chest congestion, coughing, trouble breathing during exercise, and lower performance.

 

If not treated, it can cause difficulty breathing even when resting and can make it hard to breathe, with bloody coughs. It can sometimes cause confusion and drowsiness too.

 

Treatment

 

The person must go down quickly and get oxygen. If they can’t go down, they need oxygen as soon as possible. Descent and oxygen are much more helpful than medicine.

 

Preventing Severe Altitude Illness or Death

The goal is to teach travelers about altitude illness to prevent serious illness or death. Symptoms usually happen slowly and can be predicted, so no one should die from altitude illness unless they can’t go down due to bad weather or geography.

 

Travelers can follow these 3 rules to avoid serious problems:

 

✔ Recognize the first signs of altitude illness and act fast.

✔ Don’t go up higher if you have any symptoms, even if they are mild.Go down if symptoms get worse at the same elevation.

✔ For groups in remote high areas where it’s hard to go down, using a pressurization bag (like a Gamow bag) can help.

 

Preexisting Medical Conditions

 

Travelers with medical conditions should make sure their conditions are under control before traveling. They need a clear plan for managing any problems at high altitudes.

 

People with conditions like heart disease, lung disease, sleep apnea, or sickle cell should see a doctor who knows about high-altitude medicine before traveling.

 

Diabetes

Travelers with diabetes can go to high places as long as they are used to exercise and monitor their blood sugar levels. Altitude sickness can cause diabetic problems, and some meters might not work well at high altitudes.

 

Obstructive Sleep Apnea

If you have mild or moderate sleep apnea and don’t have breathing problems at home, you might be okay without a CPAP machine. But if your sleep apnea is severe, you should avoid high places unless you have oxygen and a CPAP machine.

 

Pregnancy

There’s no proof that traveling to high places harms a baby, but pregnant women should avoid sleeping higher than 10,000 ft (3,050 m). Pregnancy should be checked for safety, and women should know the risks in remote areas.

 

Radial Keratotomy

Most people don’t have vision problems at high altitudes, but some who had eye surgery might have trouble seeing, which can make it hard to take care of themselves. Newer eye surgeries like LASIK usually cause only small problems at high altitudes.

 

Altitude Sickness in Kathmandu

 

Kathmandu is the capital city of Nepal and a popular stop for people traveling to the Himalayas. The city is not very high, sitting at about 1,400 meters (4,593 feet), but people heading to higher mountains often worry about altitude sickness. Understanding what altitude sickness is and how to deal with it is important for having a safe trip to Nepal.

 

Where Are You Coming From?

 

Altitude sickness can be worse if you’re flying from a place at sea level or a much lower height. When you land in Kathmandu, the change in height can affect your body.

 

If you come from places like Southeast Asia, the Middle East, or Europe, you might also feel jet lag because of the time change.

 

What Is Jet Lag?

 

Jet lag happens when your body’s clock is out of sync with the time in Kathmandu. Traveling across many time zones can make you feel tired, have trouble sleeping, get headaches, or feel irritable.

 

These symptoms can also be similar to altitude sickness. It’s a good idea to rest for a day or two before starting any big hikes or activities.

 

Is This Your First Time in Nepal?

 

If it’s your first time in Nepal, it can be tough to get used to a new country, culture, and environment. Many people aren’t used to the higher altitudes, which can make them more likely to get altitude sickness. Knowing the signs and how to adjust to the higher altitude can help.

 

What Is the Flight Duration?

 

The time it takes to get to Kathmandu depends on where you're flying from. For example, flights from the U.S. (East Coast) can take around 15–18 hours, flights from Europe (like London) take 8–10 hours, and flights from nearby places like India take just 1–2 hours. Long flights can make you feel tired and jet-lagged, which can make it harder for your body to adjust to the altitude.

 

Are You Starting Your Trek Tomorrow?

 

If you're planning to start your trek right after arriving in Kathmandu, remember that it’s better to rest for a couple of days first. While Kathmandu’s height won’t cause major altitude sickness, staying there a little longer helps your body adjust before heading to higher places.

 

Why Does Altitude Sickness Matter in Kathmandu?

 

Kathmandu is not very high, but it’s the first stop for people heading to places like Everest Base Camp (5,364 meters), Langtang (3,430 meters), and Annapurna Circuit (4,130 meters).

 

Many trekkers don’t prepare properly for the higher altitudes, which can lead to altitude sickness. Even though Kathmandu itself won’t cause it, it’s important to acclimatize here before heading higher.

 

How to Prevent Altitude Sickness in Kathmandu

 

✔ Acclimatization: Spend a couple of days in Kathmandu to get your body used to the altitude before going to higher places.

✔ Go Slow: Don’t rush to higher altitudes. A good rule is to not sleep at a higher elevation than 300–500 meters (1,000–1,600 feet) a day above 3,000 meters (9,843 feet). If you're trekking, take extra days to adjust.

✔ Stay Hydrated: Drink lots of water and avoid alcohol or caffeine, which can dehydrate you.

✔ Eat Well: Eating enough helps your body stay strong and deal with the altitude.

✔ Medication: Some people use medicine like acetazolamide (Diamox) to help prevent altitude sickness, but only with a doctor’s advice.

 

How to Handle Altitude Sickness in Kathmandu

 

If you feel symptoms like headaches, dizziness, or nausea, it’s important to stay at the same elevation and rest. If the symptoms get worse, like having trouble breathing or feeling confused, get medical help right away. Sometimes, doctors may suggest going down to a lower elevation if you don’t feel better.

 

When to Get Professional Help

 

If you or someone with you has serious symptoms like confusion, trouble breathing, or losing consciousness, get medical help right away. Immediate action is needed, including moving to a lower elevation.

 

***

 

Altitude sickness is something to think about when traveling to Nepal. By understanding the risks, paying attention to your body, and following the tips, you can reduce the chances of getting sick and have a great time in Nepal. Always be careful, rest when needed, and ask a doctor for advice to stay safe on your adventure in the Himalayas.

 

This information is adapted from https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness. Please follow it for further details.