The most common thing we hear at 4,000 m is: “I train five days a week, this shouldn't be happening to me.” Altitude does not care how much you train. It is a physiological response to less oxygen, and it happens to marathon runners and to people who last exercised in school.
Here is what we actually watch for and what we actually do about it.
What AMS looks like early
Acute Mountain Sickness usually announces itself before it becomes serious. The early signs, roughly in the order we see them:
- A headache that does not respond to water or a paracetamol
- Loss of appetite, then nausea
- Broken sleep and vivid, restless dreams
- Unusual breathlessness on gentle ground
- Dizziness on standing up
One of those on its own is common. Two or three together at a high camp means we act.
Why our short days look lazy
Day 1 of Hampta Pass is a two-hour walk. Day 4 of Buran Ghati is a rest day that involves hiking up to Chandranahan Lake and coming straight back down to sleep lower. On Pin Parvati, Day 7 exists mainly to let you sit at 4,700 m before summit day.
None of that is padding. It is the oldest rule in high-altitude travel: climb high, sleep low. Operators who cut these days to sell a shorter itinerary are selling you a higher chance of turning around.
The truth about Diamox
Acetazolamide (Diamox) genuinely helps some people acclimatise, and we are not against it. But two things are true: it is a prescription medicine, and it is not a permit to climb faster.
Talk to your own doctor before your trek, not to a stranger at base camp. If they prescribe it, take it exactly as directed and start before you go high. And know the side effects — tingling fingers and frequent urination are normal on it, which matters when you are rationing water.
What our leaders carry and do
- Oximeter and BP readings at every high camp, logged nightly for every trekker.
- Emergency oxygen cylinder and kit on every expedition, plus a first aid kit and medical equipment.
- Descent authority. The leader can send anyone down with a guide at any time, and that decision is not negotiable.
- Buffer days on the longer routes, so weather never forces a rushed pass crossing.
Five things you can do yourself
- Drink more than you want to. Three to four litres a day. Carry two 1 L bottles or a bladder.
- Eat even when you do not feel like it. Loss of appetite is a symptom; skipping dinner makes tomorrow worse.
- Walk slower than feels natural. If you cannot hold a conversation, you are going too fast.
- Skip alcohol and sleeping pills for the whole trek. Both suppress breathing at night.
- Arrive a day early at base if you are flying in from sea level.
Altitude is the one part of trekking that responds to patience rather than effort. Give it days, not willpower.
Read the itineraries to see how the acclimatisation is built in, check the medication section of our packing list, and ask us if you have a specific medical concern before booking.
Written by Dolma Sherpa, Monk Trails · Published 20 May 2026 · Shimla, Himachal Pradesh
