Altitude sickness

How to prevent altitude sickness?

You might be wondering: How can one prevent altitude sickness in Bhutan? The key is in tranquility. The higher you go, the slower your pace should be. Especially, highly active individuals sometimes tend to push their bodies too hard.

Initial adaptation difficulties can appear as early as 2500 meters. Once you reach an altitude of 3000 meters, it's advisable to slow down your pace for the first 24 hours and continue your ascent at a snail's pace. Walk so slowly that your heart rate doesn't increase.

As the frequency rises, your body requires more oxygen. The higher you climb, the lower the air pressure, meaning your lungs have less oxygen available. Once you surpass the 2500-meter mark, you should stay at that altitude for at least 2 nights.

Adequate hydration is the key to success. Sufficient fluid intake enables your body to absorb oxygen better. Generally, it's recommended to drink 1 liter of fluid per 1,000 meters of altitude. Tea, juices, or soups are the best options. Alcohol is not advisable. Altitude sickness can affect Bhutan travelers of all ages, genders, smokers, non-smokers, trained, or untrained individuals equally.

In any case, it's helpful to familiarize yourself with the topic before the ascent. However, the majority of people manage to adapt to altitudes above 3,500 meters by following all the rules.

In summary, our recommendation is: walk slowly, take breaks, drink plenty of fluids, avoid alcohol, don't get overconfident, monitor your pulse and heart rate, take symptoms seriously, and descend in case of emergency.

Syptoms of altitude sickness

"Everyone gets altitude sick if they climb higher quickly enough."

How does altitude sickness manifest itself in the mountains of Bhutan? The insidious aspect of this sickness is that symptoms often appear many hours later. Signs of altitude sickness could include:

- Headaches, nausea

- Dizziness, difficulty walking

- Rapid heartbeat, fast pulse

- Shortness of breath

- Altitude adjustment problems such as insomnia

- Severe cough

Since altitude sickness strikes very gradually, it's important to inform your fellow travelers or guide immediately if you experience symptoms that don't improve over time. A slow ascent and adequate hydration are the best prophylaxis. Follow the motto "Climb high and sleep down" and sleep as low as possible.

The latency period until the first symptoms of altitude sickness appear is 12-24 hours! Then it's crucial: no further ascent, and if there's no improvement, descent!

The 5 golden rules of altitude sickness:

1. Anyone can get altitude sick, but nobody has to die from it.

2. Any health disorder at altitudes above 2500 meters must be considered altitude sickness until proven otherwise.

3. In case of symptoms of acute altitude sickness, no further ascent should be undertaken.

4. If you feel unwell, descend immediately - in extreme cases, seek rescue.

5. Individuals showing signs of altitude sickness should never be left alone.

Special physical conditions at altitude

• Significant UV radiation
• Low humidity
• Oxygen deficiency
• Physical exertion
• Cold and extreme weather

Optimal Altitude Strategy & Acclimatization

• The acclimatization threshold, i.e., the altitude range from which acclimatization is necessary, is approximately 2500 meters (sleeping altitude).
• Remember: DO NOT ASCEND TOO QUICKLY; AVOID ANAEROBIC EXERCISES - breathe out for one step, breathe in for two steps; Pulse limit: younger individuals around 140/min, older individuals around 120/min ("Anyone who walks faster than an ox is an ox")
• Sleeping altitude: "Climb high and sleep down" - always sleep as low as possible
• After reaching the threshold altitude (2500m), spend several nights (at least 2 nights) at this altitude or, if ascending immediately, daily differences in sleeping altitude should not exceed 300 to 400 meters
• If more than 600 meters of sleeping distance is unavoidable, spend at least two nights at this altitude
• Always consider escape routes to lower regions - Plan B

This sleeping altitude strategy may vary individually; always orient yourself according to your individual reaction: How did I feel last night, especially regarding headaches, the leading symptom of acute altitude sickness?

Further tactical criteria for altitude sickness in Bhutan

• After rapid transportation to high altitudes (flight, bus, cable car), stay at that sleeping altitude for 3 days.
• No solo trekking - but also no large groups
• After a day's ascent stage, if feeling well, ascend another 100 to 200 meters without luggage, then return to the camp to sleep as low as possible.
• Conscious hyperventilation (heavy breathing) to maximize oxygen depletion from the air
• Drink plenty of fluids
• Observe periods of rest and take breaks
• Walk evenly and slowly (take your time)
• Monitor pulse and heart rate
• Carbohydrate-rich diet - important for energy provision, significance for altitude sickness is controversial.

Considerations before booking

• Incorrect advice before the trip (e.g., booking a tour from a catalog!)
• Incorrect or no recommendations regarding training, preparation, and ability (the organizer wants to fill their groups)
• Too rigid time/itinerary plan by the organizer, allowing for flexible altitude adjustment
• Group pressure and herd instinct, making us do what others do, even continuing when feeling uncomfortable or even if the head is pounding

Treatment of altitude sickness in Bhutan

The key is to recognize symptoms, communicate them, and act calmly. Upon the onset of initial discomfort, a rest day is helpful in any case. If adaptation problems do not improve noticeably, your guide will advise you on accompanied descent.

Sleep with an elevated upper body in a well-ventilated tent. Medications for altitude sickness in Bhutan should only be prescribed by a doctor and taken under supervision. If adaptation difficulties occur, avoid taking medication unsupervised.

These medications suppress symptoms, and you may no longer recognize when your body has adapted to the altitude. Especially aspirin and Diamox are dangerous. Aspirin inhibits oxygen intake, and Diamox dehydrates your body: Both things that can be dangerous during ascent to higher altitudes.

If acute symptoms of altitude sickness occur during your Bhutan trip, the ascent must not continue. It's important never to leave affected individuals alone, as their health condition can change rapidly.