Altitude Sickness in Peru: How to Acclimate in Cusco & What to Expect
If you’re planning a trip to Peru, and your itinerary includes Cusco (which I’m assuming it does), the Sacred Valley, there is one thing you need to prepare for that has absolutely nothing to do with what you pack: the altitude.
You need to take this seriously because altitude sickness in Peru is no joke.
My Peruvian friend sent me an entire voice note urging me to take it seriously and I listened. I hope you do the same :)
Cusco sits at approximately 11,000 feet (3,339 meters) above sea level, which means flying there from Lima takes you from basically sea level to high altitude in a very short amount of time. (CDC)
After traveling through Peru solo, here is everything I wish I knew about how to acclimate to the altitude in Peru, prevent altitude sickness in Cusco and plan your itinerary so you aren’t miserable for the first half of your trip. Because I met a girl who spent her entire first day throwing up on the Inca trail. Don’t let that be you!
WHY IS BEING PREPARED FOR ALTITUDE SICKNESS SO IMPORTANT?
The biggest issue is how quickly you are going from Lima to Cusco. I spent a few days in Lima before heading to Cusco but most people just hop over.
Cusco Around 11,000 feet above sea level. (CDC) There’s only a few other places higher than this and it’s in Bolivia and China. Insane.
According to the CDC, anyone who isn’t acclimated and travels to a sleeping elevation of around 8,000 feet or higher can be at risk for altitude illness. Your fitness level doesn’t necessarily protect you either — being in great shape doesn’t mean you won’t experience altitude sickness. (CDC)
Common symptoms include:
Headache (this was the one I experienced the most. every night I woke up with a pounding headache)
Dizziness
Nausea
Loss of appetite
Fatigue
Trouble sleeping
Feeling unusually weak or exhausted
Symptoms commonly begin several hours after arriving at altitude. (nhs.uk)
You may also notice yourself getting way more out of breath than normal doing something as simple as walking uphill or climbing stairs. Take it slow!!
And Cusco is basically built on stairs, so you’ll figure that one out pretty quickly. Take breaks and don’t be embarrassed because everyone else is doing the same thing.
HOW LONG DOES IT ACTUALLY TAKE TO ACCLIMATE?
Give yourself at least a couple of easy days when you first arrive. Every body acclimates different and I’m not sure if I ever truly 100% acclimated. I was constantly out of breath so I just really took things easy.
The body’s most important short-term acclimatization changes generally happen during the first 3–5 days at altitude. (CDC)
I’m absolutely not saying to just sit in your hotel room and do nothing. I That doesn’t mean you have to sit in your hotel room for five days. It does mean that your first day in Cusco probably shouldn’t involve an intense hike.
Make sure to leave some flexibility in your itinerary rather than landing in Cusco and immediately scheduling your most strenuous activity.
1 — BUILD AN ACCLIMATIZATION DAY INTO YOUR ITINERARY
Do not over-plan your first day in Cusco.
Use your arrival day to check into your hotel, walk around the historic center, shop a little (I bought the cutest ring there), grab something to eat and get a feel for the city. I sat on a rooftop drinking Coca tea, ate lunch, and listened to a guy play some Andean music live.
Don’t plan any strenuous hikes or higher-altitude excursions.
The CDC specifically recommends keeping exercise mild during your first 48 hours at altitude. (NCBI)
Keep this in mind while deciding what to do each day. My second full day there, I got a massage, went shopping, got a tattoo and just relaxed.
2 — CONSIDER VISITING THE SACRED VALLEY BEFORE CUSCO
If your schedule allows, consider heading into the Sacred Valley before spending several nights in Cusco. I decided against this because my itinerary was already SO packed. I do hear mixed reviews, some people say it’s awesome. Some people say to skip. So it’s really just what you are into and what you want to get out of the trip.
Parts of the Sacred Valley sit at a lower elevation than Cusco, which can make it a good transition into the elevation.
The CDC specifically notes that travelers arriving in places like Cusco may benefit from descending to a lower elevation for the first one or two nights before moving higher. (CDC)
Something to think about!
3 — HYDRATE, HYDRATE, HYDRATE!!!
Bring a reusable water bottle and actually use it. But don’t drink the tap water. Stick to filtered water or buy water bottles (but those do add up $).
I brought hydration packets and made sure to drink one every morning and I feel like it helped.
4 — BE CAREFUL WITH THE COCKTAILS
Yes, I know you’re on vacation and you want to celebrate with a cocktail. Please proceed with caution.
Don’t get sucked into how many pisco sours you can drink.
The CDC recommends avoiding alcohol during your first 48 hours at high altitude while your body adjusts. (CDC)
Save the pisco sour tasting for later in the trip. Eat first before you sip.
5 — TAKE IT EASY ON THE ACTIVITIES!
Do not immediately start hiking. Especially if you’re doing the Inca Trail.
Give your body time to adjust before heading even higher. Even walking up the stairs, take it easy.
6 — TALK TO YOUR DOCTOR BEFORE YOUR TRIP
If you’re worried about altitude sickness — especially if you’ve experienced it before or your itinerary requires a rapid ascent — talk to your doctor or a travel clinic before leaving.
One medication commonly prescribed is acetazolamide (Diamox).
The CDC notes that acetazolamide can speed up acclimatization and reduce the occurrence and severity of acute mountain sickness. Whether you should take it depends on your health history, previous experiences at altitude and itinerary, so this is something to discuss with a medical professional rather than deciding once you arrive. (CDC)
I’m not a doctor. So please, talk to yours.
7 — DON’T ASSUME BEING “FIT” MEANS IT WON’T AFFECT YOU
I work out but I wouldn’t say my endurance is anything to be impressed by. You can still get altitude sickness, no matter how “fit” or “in shape” you are. Unless you’re training in high altitude often, it can and will impact you.
Just plan accordingly.
8 — LISTEN TO YOUR BODY
I can not emphasize this enough!
If you are feeling unwell, go back to your hotel and lay down. Don’t feel like you need to push through to “see it all”.
Take it easy, listen to your body, and hydrate.
What About Coca Tea for Altitude Sickness?
You’ll see coca tea, or mate de coca, everywhere in Cusco!
Most hotels offer it when you arrive, and it’s deeply associated with Andean culture and traditional responses to altitude.
I drank a lot of it while I was here because 1) I liked it 2) I was convinced it works.
TIP: Don’t drink this at night if you want to sleep. It’ll keep you awake.
One important travel note: coca leaves and some coca products can be illegal to bring into other countries, including the United States, so don’t automatically toss coca-leaf products into your suitcase for the flight home.
Is Machu Picchu Higher Than Cusco?
Surprisingly, no.
Machu Picchu sits at approximately 7,972 feet (2,445 meters) above sea level, while Cusco sits around 11,000 feet. (Peru Travel)
So you’re actually going down in elevation when going to Machu Picchu.
When Is Altitude Sickness an Emergency?
Most mild altitude sickness improves as your body adjusts, but severe altitude illness can become life-threatening.
Seek medical help and descend to a lower elevation if someone develops serious symptoms including confusion, difficulty walking or maintaining balance, extreme drowsiness, shortness of breath while resting, or a cough with frothy or bloody sputum. (CDC)
Don’t try to push through severe symptoms just to keep your itinerary on schedule.
My Biggest Advice for Adjusting to the Altitude in Peru
Give yourself time.
I know how tempting it is to squeeze every possible activity into a Peru itinerary, especially when you only have a week or two.
But building even one slower day into the beginning of your time at altitude can make the rest of your trip much more enjoyable.
Take your first day slowly, drink water, skip the aggressive sightseeing schedule, hold off on the pisco sours and save your biggest adventures for once you’ve had some time to adjust.
There is plenty to see in Peru.
You don’t need to see all of it within 12 hours of landing.
shop my travel essentials for peru
More Peru Travel Guides:
Planning the rest of your trip? Keep reading:
→ Best Things to Do in Lima, Peru
→ What I Wore in Peru
