Acute Mountain Sickness is a direct result of exposure to lower percentage of oxygen at high altitudes. As altitude increases, level of Oxygen present in the air starts to get lower. In order to accommodate for low oxygen per breath, our body increases the breathing rate and this is the reason why We start to huff and puff so easily in mountains. The process of a human body getting accustomed to low oxygen and adapting to the new environment is called acclimatization. When there is ample time for this process and our body is not undergoing a stress, there will not be any symptoms at all. However, as it happens in case of a trip to Ladakh, the gain in altitude continues to happen over a period of 3-4 days and at a faster rate than our bodies can adapt to. This is what leads to altitude sickness in Ladakh.

While AMS falls under the category of nonspecific symptoms, in most cases they are the same of that of high fever. Your body temperature will suddenly rise followed by severe headache, chest pain, vomiting, lack of sleep, fatigue, nausea, loss of appetite and difficulty in breathing. Most people will suffer AMS when the increase in altitude is in a matter of a few hours or a day; but some people may suffer it for first few days even if the process is gradual. At what height a person will suffer from mountain sickness; and for how long differs for every individual. But it is safe to assume that if you have never been to a high altitude place like Ladakh; you are bound to feel a few symptoms of AMS in first few days.

These symptoms, ranging from mild to life-threatening, will also depend on the speed of your climb and how hard you exert yourself. If mild then they will gradually subside after a couple of days at high altitude but sometimes it can even lead to high altitude pulmonary edema, which is the worst condition of AMS and can be fatal. Some of the severe symptoms, affecting nervous system, lungs, muscles, and heart are blue color to the skin, gray or pale complexion, chest tightness or congestion, confusion, coughing up blood, decreased consciousness, withdrawal from social interaction, shortness of breath even while resting or unable to walk at all. Severe cases may result in death due to lung problems or brain swelling, called cerebral edema.

There is really no certain way of telling or predicting the altitude that will lead to AMS as it differs from person to person. We have known people who felt the symptoms even at Manali; and people who did not suffer from AMS at all anywhere during their trip to Ladakh. It can however be assumed that for most of the people, it is the height of 10,000 ft or above that can lead to altitude sickness. Where will you suffer from AMS in Ladakh can differ for each person; but chances are highest at Pang, Tanglang La, Tso Moriri, Pangong Tso and Changthang. Please be advised that these places are located at highest altitude in this region where most people feel the symptoms, but you may suffer from AMS at other places too.

The immediate remedy is to give your body ample time to adapt and for the symptoms to subside. If this however doesn’t help, the only other way is to get to a lower altitude as fast as you can. Apart from these two, below are a few other tips that can help with altitude sickness in Ladakh.

Time is the key to altitude sickness, both before and after you start feeling the symptoms. As a rule of the thumb, stop for a day at every 2,000 feet (600 meters) of climb above 8,000 feet (2,400 meters). You really got to give your body ample time to acclimatize and need to plan your journey in a way that the altitude gain happens gradually. As compared to Manali Leh highway, Srinagar to Leh route is at a lower altitude and the ascent is gradual. You slowly get to high altitude as you travel across the highway and your body adapts better.

Highest point of Srinagar to Leh highway is at Fotu La Pass at a height of 13,479ft whereas Manali – Leh Highway’s highest point is 17,585ft at Tanglang La pass. Within a matter of 2 days, you reach from a height of 2000 meters at Manali to 5328 meters at Tanglang La, almost three times more. Hence, It is advised that you reach Leh from Srinagar and return via Manali. If you have to take the Manali – Leh highway, then it is best to spend a night in Jispa and then start really early the next day to continue all the way to Leh without breaking the journey anywhere.

We know, this is easier said than done but it definitely helps. Even at several of the high altitude passes, you will find boards put up by Indian Army advising people not to smoke at such heights. Also stay away from any sleeping pills or anti-depressant medicines.

If traveling in a Car, you will be tempted to turn on the car heater in the cold atmosphere of Ladakh. Avoid doing so or even if you did turn on the heater, do not keep it at full blower or full heat. In the closed atmosphere of a Car, using a heater at its full capacity may trigger the symptoms of AMS.

While you need to ensure that your body is getting proper sleep, there are several places that you need to avoid sleeping at. First and the foremost is to avoid spending a night at a place where you are already suffering from AMS. If you start feeling the symptoms, then break the journey immediately rather than continuing to an even higher place. Ensure that you are sleeping with your head on a pillow and not without it. Avoid sleeping during day at all. If you are feeling symptoms of AMS, try sleeping in an upright position, with your back against the wall.

Keep yourself hydrated. Drink plenty of water and ensure that your diet has lot of carbohydrates in it. At the same time, you need to make sure that you are not over hydrating yourself. Do not force yourself or someone else to drink water if they are not thirsty. This can happen specially with children. Over hydrating or forced drinking can lead to vomit or worse; can trigger cerebral edema (symptoms being confusion, weakness, seizures or coma). Avoid drinking too much coffee or tea and eating heavy, fatty, junk foods. Try having small meals rather than heavy ones; inclusive of food that is easily digestible.

Keep your body relaxed, try to walk slowly and do not exert yourself with any unnecessary activities that will leave you panting.

There are several medicines available in the market for high altitude sickness. What they do is make your body breath faster than the usual rate and hence try to compensate for the low amount of oxygen. However even these medicine are a precautionary measure and not a cure. They become useless once you start feeling the symptoms and should be taken as a precaution to avoid symptoms.

Acetazolamide, also known as Diamox, is the preferred medicine. It helps your body get used to higher altitudes more quickly, and reduces minor symptoms. Take a dose of Diamox a day before you climb, and then for the next 1 to 2 days. It is highly advised to consult your doctor before taking Diamox as it has several side effects like nausea, drowsiness, tingling like sensation in the body and frequent urination. PLEASE CONSULT YOUR DOCTOR BEFORE TAKING THE MEDICINE, specially if you are allergic to something. If you are experiencing symptoms of mild AMS, the first step is to rest at the same altitude. Usually symptoms resolve with rest and painkillers within 24 hours. If symptoms do not resolve or if symptoms become worse, move down (descend). It is common that even a short descent and rest will improve symptoms significantly. It may still be possible to climb up again (re-ascend) if you have recovered and your schedule allows for this.

If you are at risk for a low red blood cell count (anemia), ask your provider if an iron supplement is right for you. Anemia lowers the amount of oxygen in your blood. This makes you more likely to have mountain sickness.

Apart from Diamox, there are some natural home remedies known to help with mountain sickness. These are some general daily use things and I will recommend that you pack these a little as well.

Ginger can prove to be one of the best remedies for altitude sickness. Chewing on some raw ginger can also combat nausea, dizziness, and vomiting at high altitudes. What you can also do is to consume it mixed with water. Peel the ginger, grind it to extract the juice and mix it (1 tbsp) in 1 glass of water. Consume it in the morning before you start climbing up and then again midway if you begin feeling dizzy or nauseous.

Garlic is known for two things, both of which can be helpful while experiencing AMS. First is that it thins the blood and enhances the circulation. Second is that it helps the body use oxygen more efficiently; which reduces breathlessness at a high altitude place like Ladakh. All you need to do is to peel off 2-3 garlic cloves and start chewing on them.

Clove is another natural home remedy that helps the body to be more efficient while using oxygen.

Lavender Oil is known to contain sedative effects that can soothe the mind and decrease restlessness; help reduce headaches and stomach discomfort which are some of the symptoms of AMS. Just apply 2 to 4 drops of lavender oil on your head for a headache or inhale the lavender oil to reduce nausea and dizziness.

Once again, the only sure-shot cure of AMS is to get to a lower altitude. An oxygen tank can help as well if you continue to have breathing problem. If your condition worsens, please rush to a hospital. In case of a heart patient, it is best to avoid this journey and not take the risk.

If you are flying to Leh, please spend a couple of days within the town before visiting Nubra Valley and Pangong Lake. Do not travel to Tso Moriri while on your way to Leh from Manali as the altitude gets even higher than Pang. Reach Leh, spend some time there, give your body time to adapt and then you can go to visit Tso Moriri.