- Pace
- Keep the first day or two quiet
- Packing
- Warm layers and a windproof outer layer
- Sun protection
- Sunscreen and sunglasses
- Medicines
- Use only as advised by your doctor
Leh sits above 3,500 metres, and altitude is the one factor that can derail an otherwise well-planned Ladakh trip if it is not respected from day one.
Understanding Altitude Sickness
Mild symptoms - headache, breathlessness, poor sleep - are common in the first 24-48 hours and are the body adjusting, not a medical emergency by default. Symptoms that worsen rather than ease are the signal to descend and seek medical attention.
Acclimatisation Days Matter
A deliberately quiet first day or two in Leh, with no long drives or exertion, is the single biggest factor in how the rest of the trip feels. Higher stops like Nubra Valley and Pangong Lake are better visited after, not before, this window.
The 48-Hour Rule Is Official
Leh's district administration requires every tourist arriving in Leh to spend at least 48 hours acclimatising before travelling on to higher ground such as Khardung La or Pangong Lake. The same advisory says road travel does not help at all in acclimatisation - it builds up the altitude effect progressively. Treat the first two days in Leh as part of the trip, not lost time: an easy stroll around the market, early nights, two to three litres of water a day, and no alcohol, exactly as the advisory recommends.
Warning Signs To Take Seriously
The pattern that matters is symptoms that get worse instead of better. The US CDC's altitude guidance names these as reasons to stop, descend and get medical help: a headache that painkillers do not touch, repeated vomiting, unsteady walking, confusion, or breathlessness while resting. Waiting it out at altitude is the dangerous option; descent is the treatment.
Before You Fly
See your doctor before you book, especially with any heart or lung condition, and ask whether a preventive medicine such as acetazolamide is appropriate for you. It is prescription-only and not right for everyone, so it belongs in that conversation, not on a packing list. Then plan the trip so the higher stops come after the Leh days, not before.
What To Pack For Ladakh
- Heavy layers - nights are cold even in peak summer
- A windproof outer layer
- Strong sunscreen and sunglasses - UV is intense at altitude
- Any personal medication, plus a basic altitude-relief medication your doctor approves
A Miranda House graduate and lawyer who traded courtrooms for slow travel. Cheshta travels with the batches we host ourselves, with a soft spot for travelling alongside elders.
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