Your first 48 hours in Leh: the acclimatisation plan I give every traveller

Every year I see the same thing happen. Travellers land in Leh on a crisp, blue morning, feel fine, and head straight out to explore. By evening the headache arrives; by the next morning they are lying in a dark room while their itinerary unravels.

Leh sits at about 3,500 m. When you fly in, you go from sea level to that height in about an hour, and your body needs time to make more red blood cells and adjust its breathing. The good news: almost everyone adapts well if they give it two calm days.

Day one: arrive and do almost nothing

• Go straight to your room and rest for a few hours, even if you feel energetic. Feeling fine on arrival means nothing yet; symptoms often appear six to twelve hours later.
• Drink water steadily through the day, and have a light lunch.
• Take one short, flat walk in the late afternoon: a slow loop through the old town lanes or along Changspa road.
• Skip alcohol and smoking, and go to bed early.

A mild headache and some breathlessness on stairs are normal on day one. Feeling worse, not better, is your signal to rest more.

Day two: gentle movement, still low

Your second day should involve light activity without going higher. My favourite plan:

1. A slow morning, then a drive to Shey and Thiksey to see the monasteries (no big climbs).
2. Lunch back in town, and rest in the afternoon.
3. If you feel good, a short walk up to Shanti Stupa for sunset. Take the road rather than the steps if you are breathless.

If you have an extra day, the Sham Valley loop west of Leh is perfect: it is lower than Leh and full of villages and monasteries.

The warning signs to take seriously

Mild symptoms usually fade. These do not, and they need action:

• a severe headache that painkillers don't touch
• vomiting, confusion or unsteadiness when walking
• breathlessness while resting, or a wet cough

If any of these appear, go down and get medical help. Leh has good hospitals that see altitude illness every day. Ask your own doctor before the trip about whether preventive medication is right for you.

Why this matters for the rest of your trip

Pangong, Tso Moriri, Hanle and the high passes are all far higher than Leh. The travellers who enjoy them most are almost always the ones who were patient at the start. Two quiet days feel like a waste when you have just arrived; they are the best investment you will make in the whole trip.