Guide
Altitude in Himachal, and how not to lose a week to it
Spiti, Kinnaur and the Leh road put you above 3,500 metres for days at a time, and a lot of people spend that time in a hotel room feeling terrible. Almost all of it is avoidable, and the thing that avoids it is the order you do the route in rather than anything you take.
Written by the people who drive these roads · Last checked September 2026
The short answer
Altitude sickness is a function of how fast you go up and how high you sleep, not of how fit you are. For Spiti, go in from the Shimla side and out over Kunzum La, never the reverse — that turns a two-day ascent into a four-day one and is the single most effective thing you can do. Above 3,000 m, try not to increase your sleeping altitude by more than about 500 m a night. If a headache does not clear with rest, fluid and paracetamol, the answer is to go down, and going down 500 m usually settles it within hours.
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The mistake that costs people their Spiti trip is made at the booking stage, not on the road. It is choosing to drive in from Manali because it is closer.
From Manali, you cross Kunzum La at 4,551 m and arrive in Kaza at 3,650 m on your second day out of a town at 2,050 m. That is an ascent profile that makes a good proportion of people ill, and being ill at 3,650 m in a valley with one small hospital is a bad week. From the Shimla side, the same destination takes four days and climbs in stages — and the difference in how people feel at the end of it is not subtle.
The actual numbers
Worth knowing before you plan, because “high” is doing a lot of work in most descriptions of this region.
| Place | Altitude |
|---|---|
| Shimla | ~2,200 m |
| Manali | ~2,050 m |
| Kalpa | 2,960 m |
| Keylong | 3,082 m |
| Chitkul | 3,450 m |
| Leh | 3,500 m |
| Kaza | 3,650 m |
| Rohtang Pass | 3,978 m |
| Komic | ~4,500 m |
| Kunzum La | 4,551 m |
Two things fall out of that table. The first is that the passes are higher than anywhere you sleep, which is fine — what your body reacts to is sustained altitude, so touching 4,551 m for twenty minutes and descending matters far less than spending a night at 3,650 m. The second is that Kaza, Leh and Chitkul are all in the same band, and that band is where most people first notice something.
How the ascent should be shaped
The rule of thumb used in mountaineering is that above 3,000 m you avoid increasing your sleeping altitude by more than about 500 m a night, and take a rest day every 1,000 m or so. Nobody drives a Spiti itinerary that strictly, but the principle is what makes the Shimla approach work: Narkanda, then Sarahan or Sangla, then Kalpa, then Nako or Tabo, then Kaza. Each night is a modest step, and by the time you reach Kaza you have been above 2,500 m for the better part of a week.
The Manali approach compresses all of that into about thirty hours.
What it feels like, and when to worry
Mild altitude sickness is a headache, poor sleep, no appetite and being unusually out of breath on stairs. It is common, it is not dangerous in itself, and it usually settles in a day or two if you stay at the same height, drink more than you feel like and do not climb higher.
What matters is knowing the line. If the headache does not respond to rest, fluids and ordinary painkillers; if there is vomiting; if someone is unsteady on their feet, confused, or breathless sitting still — that is not something to sleep on. The response is to go down, straight away, and 500 m of descent is usually enough to transform how someone feels within a couple of hours.
The reason this matters more here than in some other high places is distance. Kaza is a long way from anywhere lower, and on the Kinnaur side the road out is hours rather than minutes. Deciding to descend at nine in the evening is a much worse position to be in than deciding at two in the afternoon.
The practical version
Go in from Shimla and out over Kunzum. Give the route eight days at minimum, ten if you can. Drink considerably more water than feels necessary and go easy on alcohol the first two nights up. Take the first evening in Kaza slowly rather than driving straight out to Key. Tell your driver if you have a headache — this is the whole reason we ask, and nobody thinks less of you for it.
And if you only take one thing from this page: it is the order of the route, not the tablets, that decides how the week goes.
Also asked
Questions that come up
How fit do I need to be?
Fitness has almost nothing to do with it, which surprises people. Altitude sickness affects marathon runners and it spares smokers; the only reliable predictor is how you have responded to altitude before. If you have been above 3,500 m and been fine, you will probably be fine again. If you have never been that high, you have no information either way, and the sensible approach is to assume nothing and ascend slowly.
Should I take medication for it?
That is a question for a doctor rather than for us, and it is worth asking one before you travel rather than in Kaza. There is a well-established prescription drug used for altitude, and plenty of people on our Spiti trips carry it. We are not going to tell you what to take or how much. What we will say is that no tablet substitutes for going up slowly.
Do you carry oxygen?
On the Spiti and Leh routes, yes. It is for a bad night rather than a medical emergency, and it buys time rather than fixing anything — the actual treatment for altitude sickness is descent, and the useful thing our drivers carry is knowledge of how far down the nearest lower town is.
Is Shimla or Manali high enough to be a problem?
No. Shimla at around 2,200 m and Manali at around 2,050 m are below the altitude at which sickness is common, and almost nobody has trouble in either. Kufri, Narkanda and Jalori Pass are day trips that touch higher ground and come back down, which is the safe pattern. The problems start where you sleep high, and in Himachal that means Kinnaur and Spiti.
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