Altitude in China: what actually happens, and how to avoid it

Chinese trekking is high trekking. There is very little on this site below 3,000 m, a great deal between 3,500 and 4,500 m, and a handful of objectives above 5,000 m. That is the appeal and that is the risk.

The three conditions, in plain language

AMS — acute mountain sickness. Headache plus at least one of nausea, fatigue, dizziness or poor sleep, arriving within a day of gaining altitude. Common. Unpleasant. Usually manageable by stopping the ascent.

HACE — high-altitude cerebral edema. Fluid on the brain. Confusion, loss of coordination, inability to walk a straight line. Rare and life-threatening. The only treatment is descent, immediately.

HAPE — high-altitude pulmonary edema. Fluid in the lungs. Breathlessness at rest, a wet cough, blue lips. Rare and life-threatening. The only treatment is descent, immediately.

The distinction that matters: AMS is a warning, HACE and HAPE are emergencies. The error people make is treating a warning as something to push through.

The rules that actually work

1. Above 3,000 m, do not increase your sleeping altitude by more than 500 m per night. This is the single most effective prevention measure there is, and it is free.
2. Take a rest day every 1,000 m of gain. Our itineraries build these in. When a client asks us to compress the schedule to save a day, this is the day we refuse to cut.
3. Climb high, sleep low. Walking to 4,600 m and sleeping at 4,000 m is protective. Sleeping at the high point is not.
4. Hydrate deliberately. Dry plateau air plus hard breathing dehydrates you faster than you notice. Three to four litres a day on trek.
5. No alcohol for the first two nights at altitude. It suppresses breathing during sleep, which is exactly what you do not need.
6. Do not arrive in Lhasa or Kangding and go for a big walk the same afternoon. Arrival day is a rest day, whatever your fitness.

What we carry and what we do

Every summit trip and every Tibet programme carries supplemental oxygen and a pulse oximeter. Trek leaders on our routes are trained to run a simple Lake Louise score and to make the descent call.

If your oxygen saturation is dropping and your symptoms are worsening despite rest, the trip is over for you at that altitude. That decision belongs to the guide, not to the client, and we say so before you book. It is the only way the system works.

Medication, honestly

• Acetazolamide (Diamox) is the standard prophylactic and it works, with side effects: tingling fingers, and it makes carbonated drinks taste flat. It is prescription-only in most countries. Discuss it with a travel doctor before you fly, not on the mountain.
• Ibuprofen genuinely helps altitude headache, which surprises people.
• There is no supplement, tea, or gadget that substitutes for ascending slowly. Oxygen cans sold at Chinese trailheads are a comfort product, not a treatment.

If you have had HAPE or HACE before, or you have significant heart or lung disease, some of these trips are simply not appropriate. Tell us. We would rather lose a booking than have that conversation on a mountain.

Reading your own body

The symptoms that should stop you, in order of seriousness:

• A headache that does not respond to ibuprofen and rest
• Breathlessness while sitting still
• A cough that becomes wet or rattling
• Confusion, irritability, or stumbling
• Unable to sleep at all for two nights

Any of the last three: tell your trek leader immediately, in plain words, and do not wait for the morning.

Acclimatisation profiles on our trips

As a rough guide to how these trips are built:

• Sichuan 4,000–4,900 m routes (Genyen, Yala): gradual, with vehicle access for most of the approach. Two or three nights above 3,500 m before the first pass.
• 5,000 m summits (Siguniang DaFeng, Haba, Enmiu): a high camp one night below the summit, pre-dawn push, descend the same day.
• Tibet 5,600 m (Kailash kora): four nights in Lhasa, then a slow drive west with sleeping altitude climbing gradually. The Drölma La day is long and hard, and it is the day to be conservative.

None of this removes the risk. It just means the risk is a known quantity rather than a surprise.