Altitude sickness on Manaslu: signs and what your guide does

Where altitude starts to matter

For the first five days you barely have to think about it. Day 2 actually takes you down, from Kathmandu at 1,400m to Machha Khola at 869m, and the gorge days to Jagat, Deng and Namrung stay under 2,700m.

The numbers that matter are the sleeping altitudes. Your body adjusts to where you spend the night, so that's what we pace.

Look at the gains from Lho on. None of them is big, and there's a whole day at Samagaon where you gain nothing at all. The full itinerary has the walking hours and distances for each of those days.

The signs to watch for

Altitude sickness usually starts mild. The common early signs are:

• a headache that doesn't go away with water and rest
• nausea, or losing your appetite
• feeling dizzy or light-headed
• being far more tired than the day's walk explains
• sleeping badly once you're above 3,000m

Plenty of trekkers feel some of this at some point, often on the first night at a new height, and it often settles by morning. It's still worth mentioning every time, because your guide can only work with what you tell them.

The serious signs are different, and they mean going down: confusion, stumbling or losing your balance, getting breathless while you're resting, or a cough that keeps getting worse. Your guide is watching for exactly these.

This is general guidance, not medical advice. If you have a heart or lung condition, or you're thinking about Diamox, talk to your doctor before you travel. Our packing list says the same.

What your guide does every day

Checks you at every stop above 3,000m. From Lho on, your guide checks and logs your altitude at each stop and asks how you're feeling. It takes a minute, and it means a problem gets spotted early.

Keeps the pace steady. The days above Samagaon are short on purpose. Samdo is about 4 hours, and Dharamsala is 3 to 4. There's no reason to race them, and your guide won't let you.

Carries the kit. A first aid kit and the oximeter go up the trail with every group, along with a clear evacuation plan in case someone needs to come down fast.

Makes the call on going down. If symptoms get worse instead of better, the answer at altitude is to descend, and your guide decides that with you. Below Dharamsala the trail runs back down through Samdo and Samagaon, so lower ground is never far away until you start the pass.

How the itinerary does most of the work

The rest day at Samagaon is the big one. You sleep two nights at 3,530m, and in between you can hike higher toward Manaslu Base Camp or walk up to Pungyen Gompa, then come back down to the same bed. That's climb high, sleep low, and it's the reason the gains after it can stay small. We've written up the Samagaon rest day on its own.

Then the night at Dharamsala puts you right under the pass, so the Larkya La day starts from 4,460m instead of from Samdo. It's still the hardest day of the trek. Our post on crossing the Larkya La walks through it hour by hour.

We explain the same thinking across all three of our routes in how acclimatization is built into the itineraries.

What you can do yourself

Drink plenty. Garlic soup is a trail favorite higher up, and tea counts. Bring a bottle and purification tablets or a filter so you can keep refilling.

Walk slowly, even when you feel fine. Feeling strong on Day 9 is great. It isn't a reason to push.

Say something early. A headache mentioned at Samdo is easy to deal with. One you kept quiet about until Dharamsala is harder.

Sort your insurance. Rescue infrastructure on Manaslu is thinner than on the Everest and Annapurna trails, so your travel insurance needs high-altitude evacuation cover. It isn't included in our price, so check your policy covers the 5,106m pass before you fly.

If you've never been above 3,500m, that doesn't rule you out, but read our honest take on Manaslu for first-time trekkers first. And for permits, cost and the rest of the trip, there's the complete Manaslu Circuit guide.

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