--- title: "Manaslu Circuit Altitude Sickness: Symptoms,…" description: "Recognise AMS, HAPE and HACE warning signs on the Manaslu Circuit, then make safer decisions around Samagaun, Samdo, Dharamsala and Larkya La." canonical: "https://www.nepaltibetbhutan.com/manaslu-circuit/manaslu-circuit-altitude-sickness" last-updated: "2026-08-21T00:00:00+05:45" --- Safety # Manaslu Circuit Altitude Sickness: Symptoms, Acclimatisation and Descent Decisions A new headache plus nausea, dizziness, unusual fatigue or poor sleep after gaining altitude can be acute mountain sickness (AMS). Stop ascending and tell the guide. Breathlessness at rest, a persistent cough, confusion, unusual drowsiness or loss of coordination are emergency warning signs: stop the objective, arrange immediate descent and use oxygen or rescue support if available. This page is general travel information, not a diagnosis or a substitute for a clinician. **No ascent**With symptoms **Immediate descent**Severe signs **3,530–4,460 m**Upper sleeping stages **5,106 m**Larkya La reference DB **By [Dinesh Bhusal](/author-dinesh-bhusal)**6 min read **✓ Reviewed 21 Aug 2026** Information checked against current official and local sources. Fees, access, permits and transport can change. [Sources & methodology →](/data-methodology) Current information ✓ Last checked: 21 Aug 2026 Permits, fees, flights, border rules and operating conditions can change. We use official and current sources whenever possible and recommend reconfirming time-sensitive details before travel. [Official sources ↗](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/high-altitude-travel-and-altitude-illness.html)[What to recheck →](/data-methodology) Details and source context Status Planning guidance reviewed Applies to Manaslu Circuit Trek Last checked 21 Aug 2026 On this page ## Recognise AMS before the pass day AMS is more than ordinary exertion: a new headache after ascent together with symptoms such as nausea, dizziness, unusual tiredness or disturbed sleep deserves attention. A headache can have other causes, so do not diagnose yourself from one symptom; report the change, recent sleeping elevation and any other symptoms to the guide. The safe default is no further ascent while symptoms are present or worsening. Do not let a booked Dharamsala night, a group schedule or the hope of crossing Larkya La turn a health warning into a deadline. - Stop ascending and tell the guide early. - Rest at the current sleeping elevation only while the guide monitors whether symptoms improve or worsen. - Do not use fitness, a normal appetite or a pulse-oximeter reading as permission to continue when symptoms are getting worse. ## HAPE and HACE are emergencies High-altitude pulmonary edema (HAPE) can involve breathlessness at rest, a persistent cough, chest tightness, marked weakness or a rapid fall in walking ability. High-altitude cerebral edema (HACE) can involve confusion, unusual drowsiness, disorientation, poor balance or an inability to walk normally. These signs need urgent action, not an extra night to see what happens. - Stop the ascent and keep the person accompanied. - Arrange immediate descent to a lower elevation with the guide and local support. - Use supplemental oxygen or a portable hyperbaric system only as trained and available support while descent or medical care is arranged. - Treat inability to walk, altered mental state or breathlessness at rest as an emergency even if the person wants to continue. ## How the Manaslu route creates decision points The route commonly sleeps around Samagaun (about 3,530 m), Samdo (about 3,860 m) and Dharamsala / Larkya Phedi (about 4,460 m) before the 5,106 m Larkya La reference point. The itinerary’s acclimatisation days and daytime walks can help a group adapt, but they do not guarantee that every trekker will be ready for the next sleeping elevation. At Samagaun and Samdo, check sleep, headache, nausea, appetite, coordination and walking pace with the guide. A lower night, an extra rest day or a descent is a successful safety decision when the body is not adapting. Swipe to view table → | Decision point | Safer question | | --- | --- | | Samagaun | Trekkers must show zero resting altitude symptoms and stable pulse oximetry readings before advancing from Samagaun to Samdo. | | Samdo | Key medical checks confirm normal appetite, restful sleep, steady motor coordination, and clear speech. | | Dharamsala | Trekkers attempting Larkya La must demonstrate dependable physical endurance and agree to established turn-back times. | | Larkya La | Crossing Larkya La proceeds only when guide forecasts confirm manageable wind speeds, stable snowpack, and good visibility. | ## Medication and oxygen need professional planning A travel-medicine clinician can review previous altitude illness, heart or lung conditions, sleep-apnoea, pregnancy, allergies and current medicines before the trip. Acetazolamide may be appropriate for some travellers, but the choice, dose, timing and contraindications belong to that consultation; do not borrow tablets or change a prescription on the trail. Oxygen and medication can support treatment, but severe illness still needs descent and medical coordination. A helicopter depends on weather, visibility, landing conditions, daylight, aircraft availability, route access and insurance or payment arrangements. It is not a guaranteed substitute for a ground descent plan. Local Planning Note · Amigo Treks Team **Field advice** This guide cannot diagnose AMS, HAPE or HACE. For personal medical advice, speak with a qualified clinician before travel; for an emergency, follow the guide’s immediate safety process and local emergency support. ## What the response plan should look like If symptoms appear, the first response is simple: stop gaining altitude, tell the guide, keep the trekker accompanied and record the recent sleeping elevation and symptom change. For mild, stable symptoms the guide may keep the person at the same elevation under close observation; worsening symptoms or failure to improve should trigger descent. Do not leave a sick trekker alone in a lodge while the rest of the group continues. For confusion, poor coordination, inability to walk normally or breathlessness at rest, the group should treat the situation as an emergency and move toward lower elevation immediately while arranging oxygen, medical advice and rescue support. The exact descent route depends on the current trail, weather, transport and the person’s ability to walk. - Keep the essential medication, warm layers, water and documents with the affected trekker. - Tell the agency and insurer after immediate safety action has started. - Record what changed and which lower stop or medical facility is being used. ## Prepare the group before leaving Kathmandu - Write down the guide, agency, insurer and emergency contacts and keep them offline. - Ask who makes the descent call, who carries the affected trekker’s essential kit and how the group separates if one person must descend. - Confirm insurance wording for trekking altitude, medical treatment, evacuation and trip interruption; keep the assistance number accessible. - Tell the guide about relevant medical history and prescribed medicines before the high route. - Protect the itinerary with an extra day rather than planning the pass as an unmissable appointment. Continue planning ## Related planning guides [Related guide ### AMS Symptoms on the Manaslu Circuit Acute mountain sickness can appear after a rapid gain in sleeping altitude on the Manaslu Circuit. Report headache, nausea, dizziness, unusual fatigue or poor sleep early, stop further ascent and follow the guide's plan for observation, descent or medical help.](/manaslu-circuit/ams-symptoms-manaslu)[Related guide ### Altitude Profile The route rises from about 930 m at Machha Khola to 5,106 m at Larkya La, with key sleeping stops at Samagaun 3,530 m, Samdo 3,860 m and Dharamsala about 4,460 m before descending to Bimthang.](/manaslu-circuit/manaslu-circuit-altitude-profile)[Related guide ### Samagaun on the Manaslu Circuit Samagaun, around 3,530 m, is a key acclimatization and resupply stop on the Manaslu Circuit. Use it to rest, assess health, explore gently and prepare for Samdo, Dharamsala and the Larkya La stages.](/manaslu-circuit/samagaun) Useful answers ## Frequently asked questions How do I tell AMS from normal tiredness?+ A new headache after ascent plus nausea, dizziness, unusual fatigue or disturbed sleep is a warning pattern, not something to push through. Tell the guide and stop ascending while the symptoms are assessed. Can I continue to Samdo with a mild headache?+ Do not decide from the headache alone. Report it with the full symptom pattern and recent sleeping elevation; the guide should not move the trekker higher while symptoms are present or worsening. What are the emergency signs?+ Breathlessness at rest, a persistent cough, marked loss of walking ability, confusion, unusual drowsiness, disorientation or loss of coordination need immediate descent and professional support. Does acetazolamide make ascent safe?+ No. It may help some travellers acclimatise or prevent AMS when prescribed appropriately, but it does not make a worsening trekker safe to ascend and does not replace descent for severe illness. Can a helicopter always evacuate someone from Manaslu?+ No. Weather, visibility, landing space, daylight, aircraft availability, route access and insurance or payment arrangements can delay or prevent a flight. Keep a ground descent plan. ## Sources & methodology Use the dated sources below for the claims they support. Recheck time-sensitive permits, fees, transport and border procedures before booking. [**CDC Yellow Book — High-Altitude Travel and Altitude Illness** ↗](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/high-altitude-travel-and-altitude-illness.html) [**Wilderness Medical Society — 2024 altitude-illness guidelines** ↗](https://doi.org/10.1016/j.wem.2023.05.013) [**Nepal Tourism Board — Mount Manaslu** ↗](https://ntb.gov.np/mount-manaslu) Continue planning ## Related Manaslu Circuit guides [Elevation ### Altitude Profile Read the Altitude Profile guide →](/manaslu-circuit/manaslu-circuit-altitude-profile)[Preparation ### Difficulty and readiness Read the Difficulty and readiness guide →](/manaslu-circuit/manaslu-circuit-trek-difficulty)[Insurance ### Travel Insurance Read the Travel Insurance guide →](/manaslu-circuit/manaslu-circuit-travel-insurance)[Village guide ### Machha Khola on the Manaslu Circuit Read the Machha Khola on the Manaslu Circuit guide →](/manaslu-circuit/machha-khola) Personalised planning ## Plan Your Manaslu Circuit Journey Tell our Kathmandu-based planning team your travel dates, group size and preferred pace. We will help you shape a realistic Manaslu Circuit itinerary with clear inclusions and proper acclimatization buffers. [Plan with Amigo Treks →](/contact#planning-enquiry)[Ask on WhatsApp ↗](https://wa.me/9779851136878?text=Hello%20Amigo%20Treks%2C%20I%20need%20help%20planning%20a%20Manaslu%20Circuit%20journey.)[Back to Manaslu Circuit](/manaslu-circuit) Plan with context ## Custom Himalayan Route Planning Our Kathmandu operations team arranges itemised itineraries, verified permits, and private transport matched to your travel dates and pacing. [Request custom itinerary →](/contact#planning-enquiry)[WhatsApp a trip planner ↗](https://wa.me/9779851136878?text=Hello%20Amigo%20Treks%2C%20I%20need%20help%20planning%20Altitude%20safety.)[← All Manaslu Circuit guides](/manaslu-circuit) Talk through the next decision ## Ask a trip planner about Altitude safety. Share your name, contact details and one short question. The planning team will use the page context to start in the right place. 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