Travel to Tibet: Can Altitude Sickness be Prevented?

Travel to Tibet: Can Altitude Sickness be Prevented?

Tibet is a destination that is on the bucket list of most senior travellers if they’ve not previously visited it, but many have been discouraged from making the trip because of the fear of suffering altitude sickness.

It’s a fear that is fully justified because the Tibetan plateau sits at around 14,500 – 15,000 ft (4,500 m), and even though the capital, Lhasa, is at a lower elevation (12,000 ft) that’s still well above the elevations at which altitude sickness can completely ruin a trip.

The iconic Potala Palace in Lhasa, Tibet.   Image: 简体中文

Altitude sickness – or acute mountain sickness as it is also known – is a very unpleasant experience, and can be fatal in some circumstances. It’s an affliction to be avoided, if at all possible.

My first experience with altitude sickness was back in my late 30s when I used to travel to Colorado in the U.S. every January to ski. One year I arrived in Copper Mountain with my family late at night after a long flight from Australia and a two-hour drive up from Denver airport.

The next morning I was keen to get onto the slopes because I hadn’t skied for a year, and the powder snow was in perfect condition. We hit the slopes around 9.00 am and skied the whole day aside from an hour’s break for lunch.

Onset of altitude sickness

That night I got hit with a really bad headache. I initially thought it was due to dehydration because it’s easy not to drink enough fluids when skiing in below freezing temperatures, but then I started having difficulty breathing and feeling nauseous. After that I started to experience chest pains, and for a moment I wondered whether I was having a heart attack.

My wife called an ambulance and within ten minutes there was a team of paramedics inside the condo where we were staying, hooking me up to oxygen and monitors. I was shortly on my way to a medical centre in Frisco, which fortunately was not far away.

A team of doctors monitored my condition in the emergency room, gave me an ECG and extracted some blood for testing. There is an expression in the English language – “death warmed up” – which means that you feel like you are close to dying.  That’s exactly how I felt.

After a while one of the doctors came to my bedside and told me I had altitude sickness.  “We get this all the time with you Australians”, he said in a somewhat mocking tone, “but we have to assume you are having a heart attack until we prove otherwise”.

Time required to acclimatise

He told me I needed to stay on oxygen and a glucose drip overnight. “In the morning you will feel fine, but please don’t ski for at least three days until your body has properly acclimatised to the altitude”.

He explained that they receive patients with altitude sickness almost every day. These are invariably people who live close to sea level, and then come up into the mountains and don’t allow any time for acclimatisation. The body needs at least a day to get used to the thinner air for every 1,000 feet above 6-7,000 feet, he told me.

The Copper Mountain lodgings were at a base elevation of nearly 10,000 ft (3,000 m) so I should have spent three days taking it easy before exerting myself.  The ski-runs that I had been on all day were at around 11 - 12,000 ft, only exacerbating the altitude problem.

The next morning I felt fine. It was surprising how quickly I recovered, but I think that was partly because I was young, and quite fit at the time. Others don’t recover as quickly and others feel even worse suffering vomiting, nose bleeds and swelling of the feet and face in addition to the symptoms that I had experienced.

Causes of altitude sickness

I didn’t know much about altitude sickness until I experienced it myself. I thought altitude sickness was something experienced only by mountaineers climbing high peaks like Mt. Everest. One of the nurses at the Frisco medical centre told me that once you’ve suffered altitude sickness, you know that you are genetically susceptible to it, so you have to take precautions in the future. I vowed to learn more about the malady to ensure that I didn’t suffer it again.

Altitude sickness is caused by the body not getting enough oxygen.  That’s not because there’s less oxygen in the air at the altitudes we go hiking, but because the air pressure is lower, so the body is not able to take in as much oxygen.

The heart needs a good supply of oxygen to function properly, as do other muscles in the body, and the way in which the body adjusts to increasing altitude is to expand the size of the lungs and increase production of red blood cells.

That can happen only gradually – hence the need to give the body time to acclimatise. But the time required varies from one individual to another. The advice of my doctor to allow one day for each 1,000 ft is only a rule of thumb. Some people require longer, some require less.

The good news is that seniors are no more susceptible to getting altitude sickness than younger travellers, but of course the dangers to those with existing heart problems, asthma or other medical issues like diabetes is much greater. Travellers in those categories should always seek specific advice from their own doctor prior to embarking on any trip that will involve spending time at altitudes above 6-7,000 ft.

Trip to Andes high plateau

I did just that in 2010 when I was planning to spend a couple of months travelling the Andes high plateau in South America by road and rail, right after I retired from full-time work. Fortunately I don’t have heart problems, asthma or diabetes, but I do suffer from atherosclerosis – a result of smoking in my younger years and having high cholesterol.

My proposed trip would involve travelling up to over 16,000 ft (5,000 m) – well above the altitudes that most seniors would go hiking.  My doctor’s advice was simple: Don’t go. He said it was dangerous for me to go that high without oxygen, and that I risked getting altitude sickness and possibly having a stroke if I were to do so.

However, this was a trip that I had long wanted to do, so I set about to find a way to achieve it without putting myself at a risk of having a stroke.

I spent several months planning the trip, and after many nights of pouring over Google Maps, looking up the altitude of places on the web, and reading the blogs of younger travellers who had done the trip before me, I found a way up onto the high plateau of the Andes from Argentina that I could do by road, staying most nights at elevations no more than 1,000 ft higher than the previous night.

On some days I would have to travel higher, but for most days of the trip I found a way to come down to a place at a lower altitude to stay the night if the increase in altitude was more than 1,000 ft in that day.  This works fine because the body copes with going higher during the day, but it is for sleeping at night that the 1,000 ft rule applies.

Escape routes to lower altitudes

And wherever possible I tried to have an “escape route” to a lower altitude if I felt the symptoms of altitude sickness coming on, because if there are no hospitals around, the only way to deal with altitude sickness is to descend to a lower altitude and sit it out there for a few days.

Pressing on with a headache and feeling nauseous, hoping it will resolve itself, is not an option because it won’t go away and you risk the altitude sickness developing into a pulmonary enema (fluid on the lungs) or a cerebral enema (swelling of the brain).

These conditions can be fatal if not immediately treated and the patient evacuated to a lower elevation.

When I told my doctor of my plans, he was not impressed, but after showing him a map of my proposed route with the altitudes of each overnight stopover marked, he relented and agreed that the plan should work provided I promised to take an “escape route” to a lower altitude if symptoms occurred.

He was concerned that there were a couple of nights where I had to go up about 2,000 ft because there was no accommodation available at a suitable lower level, so for those nights he urged me to stay an extra day at that altitude to rest (which I did), and for the two days prior take a preventative dose of a drug called Diamox (acetazolamide) which mountaineers use to help alleviate the symptoms of altitude sickness if they can’t descend to a lower level.

Important to keep hydrated

I took his advice, and only suffered a mild headache on one of those days. He also told me to avoid drinking alcohol and to drink lots of water whilst climbing to the higher altitudes.

So over a period of about a week or so, I was able to get to the Andes high plateau at around 12,000 ft with no ill effects aside from that slight headache, and no sleepless nights in the process (which is a common early symptom of altitude sickness).

Over the next week I was travelling in Bolivia at elevations between 12,000 ft and 16,000 ft, but most nights we were sleeping at around 12-13,000 ft.

I did have some difficulty doing a long hike to an Aztec temple on an island on the Bolivian side of Lake Titicaca (12,500 ft) but that didn’t produce any symptoms of altitude sickness – just general fatigue from so much walking at that altitude.

After a few days in Peru, I think my body had fully acclimatised and I had stacks of energy to go walking in the mountains above Machu Picchu. I recall hearing several tourists sitting in cafes in Cusco (11,000 ft) complaining about headaches and not feeling well. They had of course flown straight into Cusco from Lima (Peru’s capital at sea level) to visit Machu Picchu, and had allowed no time to acclimatise.

Can Tibet be reached similarly?

So is it possible to apply the same methodology that I used for my successful ascent of the Andes in South America to travel to Tibet?  The answer is that theoretically it is possible, but in practice it is not because in that part of China (Qinghai province) that is adjacent to the Tibetan Plateau, the Chinese authorities do not allow independent travel.

Any travel by foreigners in that region has to be undertaken through a travel agency, and it is highly unlikely that any agency would be willing to spend the time to plan a trip of the nature that I undertook in Argentina.

Qinghai province is not particularly well geared up for tourism, so even if a local agency could be found to organise such a trip, it is unlikely that any accommodation could be found outside of two cities that are on the route to Lhasa.

Most agencies organising travel to Tibet recommend flying directly to Lhasa. Although that’s often the cheapest option – and the simplest option for them – it’s the worst possible option for travellers concerned about altitude sickness. The better option is to travel overland by train from Xining, the capital of Qinghai province.

Xining's modern railway station in Qinghai province.   Image: 中国

Xining is located at an elevation of 7,500 ft, so flying into Xining and spending a few days there to start the acclimatisation process will help. Xining is not a very interesting city, but it’s a modern city and there are a few temples and monasteries that can be visited to help pass the time.

There is another city called Golmud (9,200 ft) on the way to Lhasa where a further stopover for a few days would be very useful to prevent altitude sickness, but it is almost impossible to get a ticket from Golmud to Lhasa because usually all the seats on the train are booked from Xining to Lhasa.

In any event, Golmud is an even less interesting city than Xining, with salt lakes around the city being its only attraction.

The train trip from Xining to Lhasa takes nearly 24 hours, so that helps a little too in the acclimatisation process. Resting for the first 2-3 days in Lhasa before starting any sightseeing helps as well. But taking preventative doses of Diamox once you’ve arrived in Xining is highly recommended, because evacuating to a lower altitude is not easy to accomplish from Lhasa.

The wide open spaces of the Tibetan plateau.   Image: Giuliana Bencovich

In most countries, Diamox has to be prescribed by a doctor. It’s not a drug that can be bought over the counter in China, and it’s not available in Tibet, so it’s essential to purchase it before you leave your home country and seek advice from your doctor as to the appropriate preventative and treatment doses for you.

You should take sufficient Diamox for treatment as well in case it is needed. If you do come down with altitude sickness, oxygen therapy, rest and Diamox may fix it, but if it doesn’t, then your only options may be to return to Xining or fly to a destination at a lower altitude.

Travelling to Tibet therefore carries some risks in terms of whether your body will be able to adjust to the altitude in sufficient time for you to be able to fully enjoy the experience of being on top of the world.

The extra nights’ accommodation in Xining and the extra rest days in Lhasa, will add to the cost of the trip. Tibet is therefore not a destination for budget travellers, but it’s such a unique part of the world, many travellers are willing to dig deep to make the trip possible.

Header image: Karin Henseler

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