What four high-altitude treks taught me about altitude sickness - the two types nobody warns you about, and the breathing trick I now teach every trekker who joins our groups.  My first trek to Annapurna Base Camp, I kept wondering why people kept climbing and staying up there in the condition they were in. Coughing. Sneezing. All night long. Every teahouse, every night. I'll be honest - my first reaction was judgment. I thought: these people are sick, why aren't they turning back? Why are they being so irresponsible, dragging a flu up a mountain? Then I asked myself a better question: why are so many people coughing and sneezing, at the same altitude, on the same nights? That's not a coincidence. That's not a cold. That was altitude sickness. And once I understood that, I went looking for everything I could find about it. Here's what four treks - and a lot of research since - have taught me. In four high-altitude treks so far, our groups have always made it to the summit. That's not luck I take for granted - it's never been guaranteed, and it's never been a sure thing for everyone in the group. Two people, on two different treks, had it close.  There are two types of altitude sickness, and they feel completely different Here's how I explain it to anyone joining one of our treks now: one type hits your lungs. The other hits your head. The lungs type - you get short of breath, even resting. A dry cough that won't quit. In serious cases, a fast heart rate and a bluish tint to the lips. This is what doctors call HAPE (High Altitude Pulmonary Edema) - fluid building up in the lungs. It can happen to genuinely fit people with zero warning. It is also the more dangerous of the two and can become fatal within 12 hours if someone doesn't descend. The head type - a headache that painkillers don't touch, nausea, confusion, trouble walking a straight line. This is HACE (High Altitude Cerebral Edema), and it's really a severe escalation of ordinary altitude sickness rather than a separate illness. It can be fatal within 24 hours if ignored. And then there's the common one, AMS (Acute Mountain Sickness) - basically a hangover crossed with the flu. Headache, nausea, fatigue, no appetite, bad sleep. It usually shows up within the first day at a new altitude. Annoying, not usually dangerous, as long as you respond to it instead of pushing through it.
The athletic guy who had to skip the summit (and what 14 days taught him) This was a 14-day trek - Langtang first, then up to Gosaikunda Lake, then down through Helambu. One of the fittest people in our group, genuinely athletic, the kind of trekker you'd assume altitude wouldn't touch, started feeling nauseous and lightheaded around 3,500m. We'd been climbing steadily - at 3,000m he was fine, by 3,500m he clearly wasn't. He took medication, but the next day's plan was a push toward Tserko Ri, the roughly 5,000m summit, sleeping around 4,000m on the way up. Our guide, Sahadev, made the call: this man stays at 4,000m. Not because he was weak. Because that is exactly the right response to altitude symptoms - you don't push higher hoping it passes. You stop, and you let your body catch up. Here's the part that stuck with me. Days later, after Gosaikunda, our route took us over Lauribina La pass at around 4,610m - higher than where he'd had to stop before, though still short of Tserko Ri, the roughly 5,000m summit the rest of us had reached without him. He crossed Lauribina La without a single symptom. Same body, same person, just more days of gradual acclimatization behind him. That's the clearest proof I've seen that altitude sickness isn't really about fitness or willpower - it's about time and pacing. The woman who stopped 200 metres short
The garlic soup story On a different trek, another woman in the group started with a severe headache around the same altitude - 3,500m. Because she also hadn't slept well, she wasn't sure if it was the altitude or just exhaustion. Hard to tell the difference when you're up there. The local advice, from everyone around us, was garlic soup. We fed her a lot of it. She eventually vomited - a lot (not sure if it was the garlic in her stomach or the altitude though :)) and felt immediately better afterward. We slowed our pace, she slept, and the next day she reached the 4,500m summit goal with the rest of us. Garlic and ginger tea are genuine local Nepali remedies, and there's some real science behind garlic supporting blood circulation. But I think what actually helped just as much was slowing down and letting her body process what was happening instead of rushing the schedule. Sahadev's tip: don't rest the second you arrive
My own trick for the 4am panic Sleeping at 4,100-4,300m, I've had nights where my breathing went so shallow I woke up feeling like I couldn't get enough air. That feeling alone can spiral fast if you let it. Here's what I do, and what I now teach every person who treks with me: calm down first. Then count your breaths - in for four, out for four. In 1-2-3-4, out 4-3-2-1. It forces your breath to equalize and gives your mind something to focus on other than panic. Nine times out of ten you'll realize you weren't actually short of breath - you were panicking about being short of breath, which is a different problem entirely. The real danger at altitude isn't usually the thin air. It's letting panic take over before you've even checked whether panic is necessary. This breathing technique is one of 5 rituals in my FREE Adventure Kickstart Rituals Guide - the others are just as simple and just as useful, on a mountain or on an ordinary Tuesday. The woman who couldn't calm down I watched this happen to someone else, and it stayed with me. A Nepali woman, at night, around 4,300m, panicked completely. Screaming, shouting, unable to bring herself back down. She had to be walked down the mountain in the dark, with people organizing around her to get her to safety. I couldn't do anything for her in that moment except watch. It's the clearest example I've seen of how altitude sickness isn't only physical - the mental spiral can be just as dangerous as the thin air itself.  The golden rules, if you're planning a high-altitude trek
Why I will never trek at altitude without an experienced guide I've never gone up without one, and watching these two close calls handled calmly and correctly is exactly why. A guide isn't a "nice to have" at altitude - they're the actual difference between a hard day and a medical emergency. This is one of the biggest reasons my Nepal retreats run with experienced local guides who've spent years reading these signs - not because I don't trust trekkers to be careful, but because at 4,000m, having someone watching you who has seen this a hundred times is worth more than any amount of personal toughness. If you're considering Nepal, this is the kind of thing I build into every trip.
Have you experienced altitude sickness, or are you preparing for a high-altitude trek? Tell me in the comments - I read everything. *This post contains affiliate links. If you buy through them I earn a small commission at no extra cost to you.
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