The short answer
- Cusco
- 3,400 m
- Machu Picchu
- 2,430 m (lower than Cusco)
- Lake Titicaca
- 3,810 m
- Best fix
- Sleep in the Sacred Valley (2,870 m) first
Most people who fly from Lima to Cusco feel the altitude: a headache, breathlessness on stairs, poor sleep and little appetite for the first day or two. It usually passes as your body adjusts. What makes it worse is climbing quickly and then exerting yourself, which is exactly what a rushed itinerary does.
This guide is general travel advice, not medical advice. If you have a heart or lung condition, are pregnant or have had altitude sickness before, talk to your doctor before you go.
How high is everything?
| Place | Altitude | Notes |
|---|---|---|
| Lima | 150 m | Sea level |
| Aguas Calientes | 2,040 m | The town below Machu Picchu |
| Arequipa | 2,335 m | A good first step up |
| Machu Picchu | 2,430 m | Lower than Cusco |
| Ollantaytambo | 2,790 m | Sacred Valley |
| Urubamba | 2,870 m | Sacred Valley |
| Cusco | 3,400 m | Where most flights land |
| Colca Canyon (Chivay) | 3,635 m | |
| Chinchero | 3,760 m | Higher than Cusco, on the Sacred Valley loop |
| Puno, Lake Titicaca | 3,830 m | Very cold nights |
| Dead Woman's Pass, Inca Trail | 4,215 m | Highest point of the trail |
| Salkantay Pass | About 4,600 m | |
| Rainbow Mountain (Vinicunca) | About 5,000 m | A day trip from Cusco |
Why the order of your trip matters
Here is a common 6 day plan that flies into Cusco and stays there first. You go from sea level to 3,400 m in one hour, sleep there for two nights while sightseeing, and only then go down.
Cusco first: a steep start
The better way: sleep low, then climb
Now the same trip in a different order. You still land in Cusco, but drive straight down to the Sacred Valley, sleep there and in Aguas Calientes, and only stay in Cusco at the end, when your body has had several days to adjust.
Sacred Valley first: a gentle start
Tip: Planning Lake Titicaca, Colca or a high trek? Put them after Cusco, not before. See our Peru itineraries for routes that climb gradually.
How to acclimatise
- Take it easy on day one: Walk slowly, rest in the afternoon and save the big sights for day two or three.
- Drink water, go light on alcohol: Dehydration feels like altitude sickness and makes it worse. Alcohol and heavy meals do not help on the first night.
- Try coca tea: Mate de coca is offered everywhere in Cusco and many people find it helps. It is legal in Peru but not in many other countries, so do not take leaves home, and it can show up in drug tests.
- Ask your doctor about medication: Acetazolamide is a prescription medicine some doctors suggest for travellers going quickly to altitude. Only take it on medical advice.
- Wait before high trips: Leave Rainbow Mountain, Salkantay and the Inca Trail until you have had at least 2 to 3 nights at around 3,000 m or higher.
Warning signs to take seriously
A mild headache and breathlessness are normal. These are not: a severe headache that does not ease with rest and painkillers, vomiting, confusion or clumsiness, breathlessness while resting, or a wet cough. They can be signs of serious altitude illness. Stop climbing, go down if you can and get medical help straight away. Hotels in Cusco can call a doctor and most have oxygen.
Tip: Make sure your travel insurance covers the altitudes you will reach, including treks above 4,000 m, and emergency evacuation.
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Frequently asked questions
How long does it take to acclimatise to Cusco?
Most people feel much better after 24 to 48 hours. Allow two to three nights at altitude before strenuous walks or treks.
Is Machu Picchu high enough to cause altitude sickness?
Rarely. At 2,430 m it is about 1,000 m lower than Cusco, which is why visiting it early in your trip helps you acclimatise.
Does coca tea help with altitude sickness?
Many visitors find it eases mild symptoms, though the evidence is limited. It does not replace a slow ascent and rest.
Can I fly straight from Lima to Cusco?
Yes, and most people do. Just head down to the Sacred Valley on the day you land rather than staying in Cusco straight away.
Sources we checked
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