Leh sits at 3,500m. Your body needs time. Here's how to pace your first 48 hours, what AMS feels like, and when to take Diamox.
Why this is the most important page on our site
When you fly from Delhi (216m) to Leh (3,500m), you gain more altitude in ninety minutes than most trekkers gain in a week. The air in Leh carries roughly two-thirds of the oxygen you're used to — and at Pangong or Hanle, closer to sixty percent. Your body can adapt to this brilliantly. It just needs time.
Acute Mountain Sickness (AMS) doesn't care how fit you are. Marathon runners get it; grandmothers sail through. The only reliable variables are ascent rate, rest, and hydration — all three of which are built into every itinerary we run.
The first 48 hours: your only job is to do less
Day one in Leh should be genuinely lazy: check in, hydrate, stroll gently in the bazaar at most, and sleep early. Day two can add light sightseeing — Shanti Stupa by car, Leh Palace, a slow lunch. What it should not include is Khardung La, exertion, alcohol, or sleeping pills, all of which suppress the breathing response your body is using to adapt.
Drink three to four litres of water a day, eat carbohydrate-rich meals even if your appetite dips, and walk slower than feels natural. In Ladakh they say: 'Walk like a lama, not like a lambardar.'
What AMS feels like — and when to worry
Mild AMS feels like a hangover you didn't earn: headache, poor sleep, low appetite, slight nausea, unusual fatigue. This is common, manageable, and usually resolves within a day if you rest, hydrate, and don't ascend further until it clears.
The serious forms are rare but non-negotiable. Worsening breathlessness at rest, a wet cough, confusion, or stumbling like you're drunk are signs of HAPE or HACE — descend immediately and get medical help. Leh has SNM Hospital and multiple oxygen-equipped clinics; our vehicles carry oxygen cylinders and our drivers know every medical stop on every route.
Diamox: the honest answer
Acetazolamide (Diamox) genuinely helps many travellers acclimatize faster — it's the standard preventive, typically started a day before arrival. It is also a prescription drug with real contraindications (notably sulfa allergies), so the only correct advice is: ask your doctor before you travel, not a WhatsApp group.
What Diamox is not: a licence to skip acclimatization days. Medication plus a sensible itinerary works; medication instead of one doesn't.
How our itineraries build acclimatization in
- Minimum one full rest day in Leh before any high pass — two on longer circuits.
- Sleep low, cross high: Nubra (3,050m) comes before Pangong (4,225m); Tso Moriri (4,522m) and Hanle (4,500m) come last.
- Oxygen cylinder and pulse oximeter in every vehicle, with drivers trained to use them.
- Overland Manali routes sleep at Jispa (3,200m), never straight through to Leh in a day.
- Flexible pacing — if your body asks for a slower day, the route bends, not you.
Still have questions?
Our team lives on these routes. Ask us anything — permits, altitude, road status, the works.
