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Dealing with Altitude

Most hikers will never experience altitude sickness, (sometimes called acute mountain sickness or AMS for short), because it typically only occurs at altitudes above 2,500m (8,300ft) or so. It’s caused by a decrease in the density of the air (the percentage of oxygen in the air doesn’t actually change much and remains the same to about ten times the height of Mt Everest!). With thinner air though, it becomes harder for the body to sustain mental and physical alertness.

Annapurna Sanctuary TrekAlthough we highly recommend training for your hiking trip, it won’t prevent altitude sickness, which can affect even the fittest athlete. It’s important for everyone to be aware of the symptoms of altitude sickness as they can affect anyone at any time, even if you’ve been fine up at altitude before. The main rule to remember is “Descend! Descend! Descend!” if any symptoms are present. If ignored, symptoms can very quickly go from bad to worse, so taking early action is the key. Descending to even just a slightly lower altitude can alleviate the symptoms and allow your body to adjust, before you carry on with your hike.

Symptoms of Altitude Sickness: What should you look out for and how do you manage it?

One of the things to pay attention to first and foremost is hydration - dehydration occurs faster at higher altitudes as water vapor is lost from the lungs and this, coupled with less oxygen, typically manifests itself as a headache. So the rule is - drink water like you’ve never drunk water before! Most of us are pretty bad at staying hydrated on a normal day in the office, let alone during exercise, but this is a great time to start a water drinking habit. You’ll find yourself needing the bathroom more frequently, but this is a good sign – you still need to drink water. Frequently!

Lake TiticacaIf any of the following symptoms appear, they can be a sign of altitude sickness, so pay attention and take action (such as let your guide know). You could feel or have:

  • Lack of appetite, nausea, or vomiting
  • Fatigue or weakness
  • Dizziness or lightheadedness
  • Insomnia
  • Pins and needles
  • Shortness of breath upon exertion
  • Nosebleed
  • Persistent rapid pulse
  • Drowsiness
  • General malaise
  • Peripheral edema (swelling of hands, feet, and face).
  • Diarrhea

These symptoms are not life-threatening and can be managed by taking care to gain altitude slowly, hydrate frequently, avoid alcohol and by not overexerting yourself. If you’re usually one to dash up a trail as fast as you can, now is the time to slow it down, get your camera out and enjoy the view. There’s no hurry. Take it easy, you’re on holiday! If any of the symptoms appear then speak up – tell your guide or hiking partner.

Can’t sleep at altitude? You’re not alone.

At the other end of the spectrum, these milder symptoms, if ignored, can turn into life-threatening conditions very quickly. Edema (fluid accumulation in the tissues of the body) can occur either in the lungs (pulmonary edema) or in the brain (cerebral edema) and can cause death if untreated. The best way to avoid altitude sickness is to recognize the symptoms quickly, and descend. Our bodies have the ability to adapt, given time.


Being at high altitude can commonly result in disturbed sleep patterns or insomnia. This type of insomnia can occur in people who usually sleep well because the stages of deeper sleep are reduced at altitude. Periodic breathing, or Cheyne Stokes breathing, is common at high altitude, meaning alternating periods of deep breathing with shallow breathing, or even a pause in breathing, which can last up to 15 seconds! This is called apnea and may end with a gasp that may wake you up. Cheyne Stokes breathing occurs because the amount of carbon dioxide entering your body is lower than normal, switching off the drive to breathe, but then when your body recognizes you need oxygen you start breathing again, continuing the somewhat irregular cycle. Things will improve dramatically when you descend again if you’re experiencing these symptoms.

HimalayaOn our Active Adventures trips at altitude, we always schedule a number of acclimatization days, where we’ll hike up high during the day to give your body a taste of what’s to come, before descending again to sleep and recuperate. It’s the same technique used by mountaineers making their way up Mt. Everest – they’ll set up a series of camps and climb during the day, before heading back down to a lower altitude to sleep at night. It’s a technique that works well and gives you the chance to stop and explore a village, and spend some time relaxing in the mountains.
Our experienced Active Adventures Trip Leaders constantly monitor their hikers. We take things slowly, gradually making our way up and have a great support team who really know their stuff. One rule is always forefront in our minds – and that is “Descend! Descend! Descend!” If you’re on a trip anywhere in the world and feel unwell, don’t be shy – tell your guide.

Natural remedies and medicines

For centuries, indigenous people in South America have chewed coca leaves and consumed mate de coca to alleviate and prevent the symptoms of mild altitude sickness. Don’t worry, in this natural form, it doesn’t have the same effects as cocaine, which is a highly processed distillation of the alkaloids in the same plant. In fact you may come across mate de coca in Cuzco and it is perfectly fine to try some – they even give it out on the plane ride to Cuzco! You’ll also be able to try it in tea – coca tea is a popular refreshment and the more you drink the better to stay hydrated.


There are many over-the-counter drugs that you can buy now to help alleviate the symptoms of altitude sickness and these come under a couple of main brands: Diamox (an acetazolamide) and Dexamethasone (a steroid). We recommend consulting your travel doctor who will be able to prescribe you with the most suitable medication and do check with them what sort of side effects you may experience – it is common to experience hypersensitivity to sunlight, and a tingling sensation in the extremities.

The Best!

“This trip was just right for me. It was challenging, but not to the degree of going to Base Camp would have been. We saw the beauty of the Khumbu Valley and the experience of trekking in the Everest region without going above 12,500ft. Our guides were just fabulous! Amanda was very conscientious and knowledgeable about the area and hiking at high altitude. Our Nepalese guide smoothed the way through tea houses, lunch stops, and porter support. We couldn't have asked for a better team of guides! It was unforgettable!”
Maryland, United States
Khumbu, March 2018
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Machu Picchu

Our trips and altitude

Our Peru trips visit higher altitude spots like Cuzco (3395m, 11,200ft) and Lake Titicaca (3811m, 12,500ft) and at these places it is not unusual to experience some mild symptoms of altitude sickness. In fact, we encourage you to arrive in Cuzco a few days before the trip starts if you can spare the time – it gives your body more time to adjust. Both the Classic Inca Trail and the Lares Trail get into heights of 2750m (9,000ft) right up to 4200m (13,780ft) at Dead Woman’s Pass. The distance of these hikes is only around 40km (25 miles), but it is challenging because of the altitude. Taking it easy, pacing yourself and drinking water will all help you take on the challenge with a smile on your face!


In Ecuador, the capital city of Quito sits at 2800m (9,200ft), so again it can be a bit of a shock when you land and take your first steps outside the airport, especially if they’re uphill! On the Tapir Ecuador adventure, we visit Cotapaxi Volcano and whilst we won’t make you climb it, we will drive you up to the refugio at 4723m (15,491ft), set you up with a bike and follow you back down the exhilarating ride as you descend 10,000ft! This is an awesome experience and often talked about as being the highlight of that trip.


And then of course there's Nepal, a destination that epitomizes hiking at altitude. Our Khumbu and Annapurna trips both reach altitudes of around 3750m, whilst the classic trek to Everest Base Camp (EBC) reaches 5,364m (17,598ft). For this reason, the EBC hike is spread out over 14 days, including acclimatization days, which gives your body time to adjust. Our guides will take great care of you and they carry portable tanks of oxygen that can be used to temporarily alleviate the symptoms of altitude sickness, if necessary. Many, many people do this trek successfully every year, reaching new heights in more ways than one. All you need to do is have good awareness, be sensible, speak up and take it easy. And if any symptoms present themselves – DESCEND – until you feel better. Then once your body has adjusted, you can carry on again.

Related Trips:

  • AST Annapurna Sanctuary Trek

    • 14 Days
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    4.60 out of 5 (from 229 reviews)

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    Experience one of the greatest treks on the planet on a two-week adventure to the famed Annapurna Sanctuary. This amphitheatre is made up of three Annapurna mountains (South, I and III), Gangapurna and Machapuchare (Fish Tail), with the famous Annapurna Circuit trail winding its way through the valley beneath these mountains. We’ll start our trip by exploring the temples and markets of Kathmandu, Nepal’s bustling capital city, before flying to the lakeside city of Pokhara at the foot of the Himalayas.

    Our journey will take us deep into the Himalayas, hiking up the glacial Modi Khola River gorge, passing through tiny Gurung settlements and into an alpine area that will take your breath away. You’ll be accompanied by an Active trip leader who will meet you in Kathmandu and introduce you to your Nepalese team of guides and porters. In true Active style you’ll stay in local accommodation, which in Nepal means rooms in comfortable and cosy Gurung tea houses (small hotels), and enjoy hearty meals to top it all off.

  • EBC Everest Base Camp Trek

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    If you'd prefer to trek at lower altitudes and still see Mt Everest, we recommend checking out our ‘Khumbu’ trip. Please get in touch with us if you’d like to chat about the various options.

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    The Everest Lodge to Lodge trek is our hiking journey through the dramatic mountains of the Himalayas, avoiding the higher altitudes and trekking distances of our other trips. We’ll take you deep into the Everest/Khumbu region, home to the world’s highest peaks, massive glaciers, remote mountain villages and intriguing ancient cultures. The Everest region has captured the imagination of adventurers since the first maps of the area were drawn and it’s easy to see why. Every day of this dramatic and varied multi-day hike differs from the one before. We’ll descend into long fertile valleys, wind our way around mountain passes and stand at the foot of the highest mountains in the world. We won’t have to climb to higher elevations to do it either – we’ll do it all without hiking above 3780 metres (Khumjung, 12,400 feet).

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    New Chinchilla TripThe ‘Chinchilla’ is an adventure packed with cultural richness. The vivid colours of the traditional Andean costumes are in stark contrast to the muted highlands, where Peruvian and Bolivian communities etch their existence. Make no mistakes though, these are among some of the most content people you’ll meet, happy in their way of life largely unspoilt by first world influence.

    On this trip you’ll tick off the world’s highest navigable lake, the higest city and the largest salt flat. In true 'Active’ style you’ll experience it all with a mixture of hikes, a stint on the bike and of course, with a kayak paddle in hand. We’ve designed the ‘Chinchilla’ to work in seemlessly with our other Peru adventures, so chat to us if you’re interested in a combination trip option.

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    The ‘Jaguar’ is our most action-packed multi-activity trip in Peru. It captures everything this beautiful country has to offer, from the towering peaks of the Andes down to the steamy depths of the Amazon jungle. You’ll have a blast in this land of geographical and cultural extremes! We start our trip in the heart of the Inca empire where we explore fortresses and surrounding valleys, hike over stunning mountain passes to Machu Picchu, cycle into the Sacred Valley of the Incas and view Amazon wildlife up close. The variety of activities and landscapes on this trip will give you a Peruvian adventure like no other – and an experience you’ll never forget!

    For a great way to see Lake Titicaca and the Bolivian salt flats too, combine this trip with our Titicaca and Bolivia 'Chinchilla' - chat to our team to learn how! 

  • Alpaca Peru Lodge to Lodge Trek

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    New Alpaca TripThe ‘Alpaca’ is 10 days of bucket list hikes and cultural sites in Peru. It captures everything this beautiful country has to offer, from the towering peaks of the Andes and Machu Picchu, down to the thriving town of Aguas Calientes (meaning ‘hot waters’ or ‘hot springs’), once a small railway workers’ camp.

    You’ll have a blast in this land of geographical and cultural wonders. We start our trip in the heart of the Inca empire where we explore fortresses and surrounding valleys. We’ll hike over stunning mountain passes from lodge to lodge, and on to Machu Picchu via a short version of the Inca Trail. The variety of landscapes on this trip will give you a Peruvian adventure like no other – and an experience you’ll never forget!

    For a great way to see Lake Titicaca and the Bolivian salt flats too, combine this trip with our Titicaca and Bolivia 'Chinchilla' - chat to our team to learn how!

  • Capybara Peru Family Adventure

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    Capybara

    On the ‘Capybara’ family trip, you and your family will explore Peru, see amazing sights and embark on the adventure of a lifetime (travellers without kids are welcome too!) Peru is a vibrant, family-friendly destination and you’ll find children of all ages – yes, even teenagers will love exploring everything this country has to offer. On the ‘Capybara’, you’ll venture deep into the Amazon rainforest, see an awesome array of wildlife, visit the lost city of Machu Picchu and kayak across Lake Titicaca to stay with a local family on Amantani Island. Not only is the ‘Capybara’ family trip an exciting adventure that everyone will enjoy, it’s also a chance for your family to immerse themselves in a different culture and way of life. We’ve chosen locally-run, comfortable accommodations for this trip and we take care of all the logistics behind planning your trip, including meals – so all you have to do is show up, have fun and start building memories!

  • Iguana Peru and Galapagos Explorer

    • 13 Days
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    4.46 out of 5 (from 74 reviews)

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    Our 13-day ‘Iguana’ trip has been a long time in the making. Inside two weeks, you’ll experience the absolute best that Peru and the Galapagos Islands have to offer. You’ll travel in comfort and style, get off the beaten track, stay in fantastic locally owned accommodations, meet the locals and experience some of the world’s most iconic landscapes and monuments - all in typical Active Adventures style of course. You’ll cycle into the Sacred valley of the Incas, hike the Huchuy Qosqo Trail, experience Machu Picchu and explore the wonders of Cuzco. And that’s just Peru! After flights north to Quito, you’ll head to the Galapagos Islands where you’ll snorkel with seals, hike around one of the world’s largest volcanic craters, sea kayak near Isabela Island, get up close to all manner of wild creatures and relax on isolated beaches. If you’re only likely to visit this part of South America once in your life, we’ll make sure it’s a trip that you never forget.

Why travel with Active Adventures?

Legendary Kiwi Hospitality

Above all, we aim to be amazing hosts. We're proud of our kiwi roots, and our professional, warm and relaxed style of running trips around the world is unforgettable.

Expert LOCAL Guides & Trip Leaders

We're VERY picky about who we select to work in our team, and we have people from all over the world lining up to guide our trips. So we get to hire the absolute BEST in the business.

Everything is Included

As soon as you get off the plane, we've got all the details of your vacation covered – top notch meals, comfortable transport & accommodation, amazing guides and INCREDIBLE service.

A Sense of Achievement

Whether you’re new to adventure travel, or you’ve never travelled in a group before, you’ll find yourself arriving home positively different from when you left.

Small Groups

With our small groups (no more than 14), you'll get to know our team, your fellow travellers, and have the flexibility and freedom to do as much (or as little!) as you like.

Diverse Experiences

It's all about getting there under your own steam – on foot, in a sea kayak, or by bike. What better way is there to experience mind blowing scenery? If it's your first time, no worries – our expert guides have got you covered.

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