Altitude Sickness in Xinjiang: Prevention & What Really Works

I got properly sick at Karakul Lake in September 2019. Not dramatic, no helicopter, just a splitting headache that started around 16:00, nausea by 19:00, and a night where I lay in a guesthouse bed at 3,600 m counting my own breathing and wondering whether I should wake the driver. By 06:00 I was fine. The mistake was simple and I had made it before: we left Kashgar at 1,289 m that morning and slept at 3,600 m that night. That is a 2,300 m gain in one day.

Altitude in Xinjiang catches people out because most of the region is low. You spend a week at 800 m in Urumqi and Turpan, feel great, then drive up the Karakoram Highway and get flattened. This guide covers where the real altitude is, what the medical evidence actually supports, and the specific ascent schedules I now use.

I am a travel writer, not a doctor. Everything below reflects field experience and published mountain medicine guidance. Talk to a physician before taking any medication, particularly if you have heart, lung or kidney conditions, or are pregnant.

Where the Altitude Actually Is

Half the panicked emails I get about Xinjiang altitude concern places that are not high at all. Here is the real picture.

Destination	Elevation	Risk level
Aydingkol Lake, Turpan	-154 m	None. Lowest point in China
Kashgar	1,289 m	None
Kanas Lake	1,374 m	None
Urumqi	~800 m	None
Sayram Lake	2,073 m	Minimal
Nalati Grassland	~1,800 m	Minimal
Bayanbulak	~2,450 m	Low. Some people notice it
Tashkurgan town	3,090 m	Moderate. Real risk if you arrive fast
Duku Highway high passes	~3,400 m	Moderate, but you pass through in minutes
Karakul Lake	3,600 m	High. This is where people get sick
Muztagh Ata base camp	~4,400 m	High
Khunjerab Pass	4,733 m	High. Highest paved border crossing in the world

Notice the pattern. Everything on the standard northern circuit is below 2,500 m. The risk sits almost entirely on the Pamir route out of Kashgar toward Tashkurgan and Karakul Lake.

Kanas Is Not High. Stop Worrying About It

I want to kill this one specifically because it appears in a lot of travel forum threads. Kanas Lake sits at 1,374 m. Hemu village is lower still. Denver, Colorado is 1,609 m and nobody warns you about altitude sickness in Denver.

What people feel at Kanas is usually a combination of cold, dehydration from dry air, a 06:00 start after a five-hour drive, and a big meal of lamb the night before. Those symptoms look like mild altitude sickness. They are not.

What Altitude Sickness Actually Is

Three conditions sit on a spectrum. You need to be able to tell them apart because the response differs enormously.

Acute mountain sickness (AMS)

The common one. Headache plus at least one of: nausea, fatigue beyond what the day’s activity explains, dizziness, or poor sleep. It usually starts 6 to 12 hours after arriving at altitude. Around 25 to 40% of people who go from near sea level to 3,600 m in a day will get some version of it. That figure tracks with what I see in groups on the Karakoram Highway. In a vehicle of six, expect two people to feel rough.

AMS is unpleasant and self-limiting. It resolves in 12 to 48 hours if you stop ascending.

High altitude pulmonary edema (HAPE)

Fluid in the lungs. Breathlessness at rest, a dry cough that turns wet, chest tightness, blue-tinged lips, and a heart rate that stays high when you are sitting still. This is a medical emergency. It kills people. It is rare below 3,000 m and becomes a genuine concern above 3,500 m.

High altitude cerebral edema (HACE)

Fluid on the brain. Confusion, inability to walk a straight line, drowsiness that shades into unresponsiveness, personality change. Also an emergency. Also rare, but the Pamir gets you high enough that it belongs in this article.

The field test for HACE is the tandem gait test. Ask the person to walk heel-to-toe along a straight line for five metres. If they cannot, that is ataxia and you descend immediately, at night if necessary.

What Actually Works

Ascend slowly. This is the whole game.

Everything else is a supplement to this. Above 3,000 m, mountain medicine guidance suggests increasing your sleeping elevation by no more than 500 m per night, with a rest day every 1,000 m. Nobody on a two-week Xinjiang holiday follows that perfectly, including me. But you can do a lot better than the standard tour schedule.

Acetazolamide

The one drug with strong evidence behind it. Standard preventive dose in adult guidance is 125 mg twice daily, starting 24 hours before ascent and continuing for two days at altitude. It works by driving a mild metabolic acidosis that pushes your breathing rate up, which speeds acclimatisation rather than masking symptoms.

Side effects are real and worth knowing about so they do not alarm you. Tingling in fingers and toes is very common. Increased urination is guaranteed, which means you must drink more. Carbonated drinks taste strange and flat. It is a sulfonamide, so people with sulfa allergies need to talk to a doctor about alternatives.

Get a prescription at home. You can find it in Chinese pharmacies but availability is inconsistent and the packaging will be in Chinese only.

Dexamethasone

Treatment rather than prevention for most travellers. It suppresses symptoms without speeding acclimatisation, which makes it a descent aid rather than a licence to keep climbing. Carry it only if a doctor has prescribed it and briefed you on dosing.

Hydration and food

Dry air at 3,600 m plus increased breathing rate means you lose far more water than you expect. I drink 3.5 to 4 litres a day on the Pamir compared with about 2 at home. Bring rehydration salts. A high-carbohydrate diet helps because carbohydrate metabolism needs less oxygen than fat metabolism.

No alcohol for the first 48 hours

Alcohol suppresses respiration during sleep, which is exactly when your oxygen saturation is already at its lowest. Skip the celebratory beer at Karakul. I have watched two people learn this lesson the hard way.

What Is Overrated

Rhodiola (hongjingtian). Sold in every pharmacy in Kashgar and pushed hard by drivers. Chinese travellers swear by it, usually starting a course a week before travel. The clinical evidence for preventing AMS is weak, and a 2014 randomised trial found no significant benefit over placebo. I have taken it twice out of curiosity. I noticed nothing. It probably does no harm if it makes you feel prepared, but do not substitute it for a sensible ascent schedule.

Canned oxygen. Available everywhere on the Pamir route for ¥25 to ¥50 a can. The relief lasts about as long as you are inhaling it. Useful for getting through a bad twenty minutes at a viewpoint. Useless as a treatment strategy, and I have seen people use it as an excuse to stay high when they should have gone down.

Being fit. Fitness does not protect against AMS. Some data suggests fit people are at slightly higher risk because they push harder on arrival. My most athletic travel companion has been the sickest person on two separate trips.

Deep breathing exercises. Harmless. Not a treatment.

Ascent Schedules That Work for Real Xinjiang Routes

Kashgar to Karakul Lake, the standard mistake

The default itinerary drives Kashgar (1,289 m) to Karakul Lake (3,600 m) in about four hours on the G314 and sleeps at the lake. That is a 2,311 m sleeping-elevation gain in one day. It is the single most common cause of altitude problems in Xinjiang.

Better version: Kashgar to Karakul as a day trip, returning to sleep in Kashgar or in the Ghez Valley around 2,000 m. You see the lake in afternoon light, you avoid sleeping high, and you lose nothing except the sunrise.

Best version if you have the days: Night one in Kashgar. Night two at Karakul, arriving early afternoon so you have daylight to judge how you feel. Night three in Tashkurgan at 3,090 m, which is lower than the lake and lets you consolidate. Night four onward toward Khunjerab if you have the permits sorted.

Duku Highway

The passes touch roughly 3,400 m but you are over them within twenty minutes and your overnight stops are at Dushanzi (around 500 m), Qiaoerma or Bayanbulak (around 2,450 m) and Kuqa (around 1,100 m). Transient exposure at pass height rarely causes problems. What does happen is people stop at the top for forty minutes of photos, sprint up a slope to a better viewpoint, and give themselves a screaming headache for the rest of the afternoon. Move slowly at the passes.

Khunjerab Pass

At 4,733 m this is serious ground, and you will typically be arriving from Tashkurgan at 3,090 m. Go up, stay under an hour, come down. Do not eat a heavy lunch at the top. Do not run to the border marker for photos, no matter how good the light is.

Oxygen, Clinics and Getting Out

Tashkurgan has a county hospital with oxygen and basic emergency care. It is not equipped for complex critical care. The nearest serious hospitals are in Kashgar, roughly 290 km and four to five hours away by road down the Karakoram Highway. There is no realistic helicopter evacuation service for tourists on the Pamir.

What this means practically: your evacuation plan is a vehicle and a driver who is willing to drive at night. Confirm that before you go up. Ask your driver directly whether he will take you down at 03:00 if you are unwell. Most will say yes. Get the yes out loud.

Guesthouses at Karakul generally keep oxygen cylinders. Tashkurgan hotels usually do. Do not assume, ask when you check in.

Travel insurance with high-altitude medical cover is worth having for this route specifically, and general safety planning is covered in the Xinjiang safety guide.

The Descent Rules

Write these down. They are not negotiable and they have kept me out of trouble.

• Symptoms not improving after 24 hours at the same elevation: descend 500 to 1,000 m.
• Symptoms getting worse at rest: descend now.
• Breathlessness while sitting still: descend immediately, treat as HAPE.
• Cannot walk heel-to-toe in a straight line: descend immediately, treat as HACE.
• Confusion or unusual drowsiness: descend immediately, do not let them sleep it off.
• Any doubt at all: descend. You lose a day. That is the entire cost.

Descent of 500 to 1,000 m usually produces dramatic improvement within a couple of hours. From Karakul, dropping to the Ghez Valley checkpoint area gets you most of the way there.

A Pulse Oximeter Is Worth 80 Grams

I started carrying a fingertip pulse oximeter in 2021. They cost ¥40 to ¥80 in any Chinese pharmacy and weigh almost nothing. At 3,600 m, an acclimatising traveller typically reads somewhere in the high 80s. Readings that drift into the low 80s or below, especially combined with symptoms, tell you something is going wrong before you feel it clearly.

Do not treat the number as gospel. Cold fingers and nail polish both throw readings off. Use it as one input alongside how the person looks and behaves.

Common Questions

Can children go to Karakul Lake?

Children can develop AMS and are worse at reporting symptoms clearly. A grumpy, off-food, poorly-sleeping child at 3,600 m may be telling you something. I would do Karakul as a day trip with kids and not sleep up there.

How long does acclimatisation last?

Partial acclimatisation persists for roughly a week after descending. If you did the Pamir and then go to the Duku Highway ten days later, you get very little residual benefit.

Does drinking butter tea help?

It helps with hydration and calories, which matter. It does nothing specific for altitude. Drink it because it is good.

Is there a good time of year to reduce risk?

Barometric pressure at a given altitude is slightly lower in winter, which marginally increases effective altitude. The bigger winter factor is cold, which makes everything harder and complicates any descent. Summer and early autumn are easier for the Pamir.

Should I skip the Pamir if I have had altitude sickness before?

Previous AMS is the strongest single predictor of future AMS, so take it seriously. It does not mean skipping the route. It means building in the extra night, starting acetazolamide after talking to your doctor, and treating Karakul as a day trip rather than an overnight.

What to Do Next

Pull up your itinerary and write the sleeping elevation next to each night. If any single night jumps more than 1,000 m above the previous one and lands above 3,000 m, restructure it. That one edit removes most of your risk.

Book a GP appointment at least three weeks before departure if the Pamir is on your route, and ask specifically about acetazolamide and whether your existing medications interact with it.

Then buy a ¥50 pulse oximeter when you land in Urumqi, and ask your Pamir driver, out loud, whether he will drive you down in the middle of the night. Those three things cost almost nothing and cover almost everything.

Last reviewed August 2026. Elevation figures from published survey data. Medical guidance summarised from Wilderness Medical Society practice guidelines. This article is not a substitute for professional medical advice.