Your flight touches down at Lhasa Gonggar Airport. The elevation is 3,656 metres above sea level. Before you even pick up your bag from the carousel, some passengers around you are getting headaches. By evening, a few will feel genuinely sick. Most of the people who struggle here did not prepare. This guide makes sure you are not one of them.
Key Takeaways
- Lhasa is at 3,656m. Most visitors feel something. Prepare before you go.
- Diamox works. Get a prescription from your doctor at least two weeks before departure.
- Fitness does not protect you. Altitude sickness is not about how healthy you are.
- Ascend slowly. Spend a night at 2,000 to 2,500m before going to Lhasa if possible.
- Descend if symptoms are severe. AMS kills when people push through warning signs.
- Pack for altitude: see China packing list for what to bring.
What Actually Happens to Your Body
At sea level, each breath delivers enough oxygen to saturate your blood near 100%. At 3,656m (Lhasa), each breath delivers about 60% of that amount. Your body is not designed for this. It can adapt, but it needs time. The adaptation process takes days to weeks. When you arrive by plane, you skip the gradual ascent that gives your body time to adjust. The result is Acute Mountain Sickness (AMS).
AMS is not dangerous on its own. What makes it dangerous is two things: pushing through severe symptoms instead of descending, and letting it progress to High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE). Both of those are life-threatening. But they almost never happen to travelers who pay attention to their symptoms.
Altitude Levels: China’s Main Destinations
| Destination | Altitude | Risk Level | Notes |
| Lijiang, Yunnan | 2,400m | Low | Mild headaches possible on day one for sensitive visitors |
| Shangri-La (Zhongdian), Yunnan | 3,200m | Moderate | More visitors affected. No strenuous activity on day one. |
| Lhasa, Tibet | 3,656m | High | Almost everyone feels something. Acclimatise for 1 to 2 days before activities. |
| Nam Co Lake, Tibet | 4,718m | Very High | Day trip from Lhasa. Do not go without acclimatising first. |
| Everest Base Camp (Tibet) | 5,200m | Extreme | Requires serious acclimatisation. Not a casual day trip. |
| Tiger Leaping Gorge trail | Up to 2,600m | Low to Moderate | Full trail reaches altitude. Manageable with pacing. |
How to Prepare Before You Fly
Get Diamox from your doctor
Acetazolamide (brand name Diamox) is the most effective drug for preventing AMS. It works. It is not a guarantee, but it significantly reduces the chance of serious symptoms. The standard approach: 125mg twice a day, starting one or two days before you ascend to altitude, continuing for two days after arrival. It is a prescription drug in most countries. Book a GP appointment at least two weeks before your trip. Tell your doctor you are going to Tibet or high-altitude Yunnan. Side effects are common but not dangerous: tingling hands and feet, more frequent urination. If those bother you, stop taking it. Current dosing guidelines: Altitude Research Centre.
Spend a night at a medium altitude first
If your itinerary allows it, spend a night in Chengdu (500m) or Kunming (1,900m) before flying to Lhasa. This does not fully acclimatise you, but it eases the transition. A better option is flying to Xining (2,200m) and taking the Qinghai-Tibet Railway to Lhasa. The train takes about 21 hours and arrives in Lhasa gradually, giving your body time to start adjusting. Many travelers who took the train report significantly fewer symptoms than those who flew directly.
What to avoid on arrival
- Do not exercise hard on your first day. Walk slowly. Rest in the afternoon.
- Do not drink alcohol. It worsens AMS symptoms and dehydrates you.
- Do not take sleeping pills. They suppress breathing. The opposite of what you need.
- Do drink water. Staying hydrated helps. Not a cure, but it helps.
- Do not ascend higher until you feel fully normal at your current altitude.
Recognising AMS: What to Watch For
| Symptom | Severity | What to Do |
| Headache, mild fatigue | Mild AMS | Rest. Ibuprofen or paracetamol. Drink water. Do not go higher. |
| Headache unresponsive to painkillers, nausea | Moderate AMS | Rest. Do not ascend. Consider descent if no improvement in 24 hours. |
| Severe headache, vomiting, unsteady walking | Severe AMS | Descend immediately. Do not wait. |
| Confusion, can’t walk straight, gurgling breathing | HAPE or HACE | Emergency. Descend immediately. Call for help. |
| Pink or frothy cough | HAPE | Medical emergency. Descend and get oxygen now. |
The rule is simple: if symptoms are getting worse instead of better, descend. You do not need to descend far. Even dropping 300 to 500 metres often produces rapid improvement. In Lhasa, this means going back to lower altitude areas in the city. On mountain trails, it means turning back.
In Tibet Specifically
Tibet requires a Tibet Travel Permit in addition to a Chinese visa. You cannot travel independently in Tibet as a foreign visitor. A licensed tour guide is mandatory. Your guide will be experienced with AMS and can help you make descent decisions. Do not be the tourist who insists on going to Nam Co Lake on day two because the tour itinerary says so. A good guide will not let you. Listen to them.
Lhasa hospitals can treat AMS. The main hospital used for foreign visitors is the Tibet Autonomous Region People’s Hospital. Supplemental oxygen is available at most hotels in Lhasa for a small fee. For the full picture on medical help in China, see Getting Medical Help in China as a Foreigner.
In Yunnan
Yunnan altitude issues are more common than people expect, and less often discussed. Shangri-La at 3,200m is high enough to cause symptoms in a significant minority of visitors. The standard tourist circuit from Lijiang to Shangri-La to Tiger Leaping Gorge gains elevation quickly. Spend a full day in Lijiang before driving up to Shangri-La. Do not plan a full-day trek on your first day in Shangri-La.
Frequently Asked Questions
For packing what you need for high-altitude China, see China Packing List. For travel insurance that covers evacuation from Tibet, see China Travel Insurance Guide. For the full safety picture, see Is China Safe for Tourists?.