Key Takeaways
- Cusco sits at 11,152 feet (3,399 meters) above sea level, making it one of the highest major tourist destinations in the world
- The risk of altitude sickness is significant for most travelers arriving from sea level
- A proper acclimatization period of 2-3 days in Cusco is recommended before exploring higher elevations
- Natural and medical remedies are available, with coca tea being a traditional local remedy
- Strategic planning of your itinerary from lower to higher elevations can significantly reduce altitude sickness risks
Introduction: Understanding Cusco’s High-Altitude Environment
Welcome to Cusco, the historic capital of the Inca Empire and gateway to Machu Picchu. As a local, I’ve witnessed countless travelers underestimate the effects of our city’s elevation. While Cusco’s breathtaking landscapes and rich cultural heritage attract millions of visitors annually, its high altitude poses a unique challenge that requires careful planning and preparation.
Cusco stands proudly at 11,152 feet (3,399 meters) above sea level, making it one of the highest major tourist destinations worldwide. To put this in perspective, Cusco sits higher than any city in North America and is nearly twice the elevation of Denver (the “Mile High City”) which sits at 5,280 feet (1,609 meters).
This article serves as your comprehensive guide to understanding, preparing for, and adapting to Cusco’s altitude, ensuring your visit to our historic city is comfortable, safe, and enjoyable.
What Exactly Is Cusco’s Altitude?
Cusco’s elevation is 11,152 feet (3,399 meters) above sea level. This extreme height places Cusco among the highest major tourist destinations globally. Here’s how Cusco’s elevation compares with other famous high-altitude locations:
| Location | Elevation in Feet | Elevation in Meters |
|---|---|---|
| Cusco, Peru | 11,152 ft | 3,399 m |
| Machu Picchu | 7,972 ft | 2,430 m |
| Sacred Valley | 9,514 ft | 2,900 m (average) |
| La Paz, Bolivia | 11,975 ft | 3,650 m |
| Denver, USA | 5,280 ft | 1,609 m |
| Mexico City, Mexico | 7,382 ft | 2,250 m |
| Lhasa, Tibet | 11,995 ft | 3,656 m |
As you can see, Cusco’s altitude is significant even when compared to other high-elevation cities. This is why altitude acclimatization is not just recommended but essential for visitors.
The Science Behind Altitude Sickness: What Happens to Your Body in Cusco
Before discussing prevention strategies, it’s important to understand what happens to your body at high elevations like Cusco.
At sea level, the air pressure allows your lungs to efficiently transfer oxygen to your bloodstream. As you ascend to higher altitudes, atmospheric pressure decreases, resulting in “thinner air” – not because there’s less oxygen percentage (it remains at 21%), but because the pressure pushing oxygen into your lungs and bloodstream is lower.
When you arrive in Cusco, your body detects this oxygen deficit and initiates several responses:
- Increased respiration rate: Your body attempts to compensate by breathing faster and deeper
- Elevated heart rate: Your heart works harder to circulate available oxygen
- Production of additional red blood cells: Over several days, your body creates more red blood cells to carry oxygen more efficiently
- Changes in pH balance: Faster breathing reduces carbon dioxide levels in your blood, altering your blood’s pH balance
These natural responses are part of the acclimatization process, but when they occur too rapidly, they can lead to Acute Mountain Sickness (AMS), commonly known as altitude sickness.
Common Symptoms of Altitude Sickness in Cusco
Altitude sickness affects approximately 40-50% of visitors who arrive in Cusco directly from sea level. Symptoms typically begin within 6-24 hours after arrival and can range from mild to severe.
Mild to Moderate Symptoms:
- Headache (often throbbing and persistent)
- Fatigue and weakness
- Dizziness or lightheadedness
- Shortness of breath, especially during physical exertion
- Loss of appetite
- Nausea
- Disrupted sleep patterns
- Increased heart rate
- Slight swelling of hands, feet, and face
Severe Symptoms (Requiring Immediate Medical Attention):
- Severe, persistent headache unrelieved by medication
- Persistent vomiting
- Difficulty walking
- Confusion or irritability
- Shortness of breath even when resting
- Bluish discoloration of the skin (cyanosis)
- Fluid buildup in the lungs or brain (rare but serious)
It’s important to note that altitude sickness doesn’t discriminate. Physical fitness level, age, or gender doesn’t necessarily predict who will be affected. Even Olympic athletes can suffer from altitude sickness if they ascend too quickly.
Proven Strategies for Preventing Altitude Sickness in Cusco
Before Your Trip to Cusco
- Consult your physician: Especially if you have cardiac, pulmonary, or hematological conditions. Some doctors prescribe medications like Acetazolamide (Diamox) to help prevent altitude sickness.
- Build cardiovascular fitness: While fitness doesn’t prevent altitude sickness, better cardiovascular health can reduce the strain of acclimatization.
- Plan a gradual ascent: If possible, spend a day or two at an intermediate altitude (like Lima at 505 feet/154 meters) before ascending to Cusco.
- Schedule ample acclimatization time: Plan to spend at least 2-3 days in Cusco before any strenuous activities or trips to higher elevations.
- Stay hydrated: Begin increasing your water intake several days before your trip.
- Avoid alcohol and tobacco: Both can worsen the effects of high altitude.
Upon Arrival in Cusco
- Take it slow the first 24-48 hours: Rest as much as possible upon arrival. Avoid unnecessary physical exertion.
- Hydrate extensively: Drink 3-4 liters of water daily. High altitude causes faster dehydration, which worsens symptoms.
- Consider the “climb high, sleep low” strategy: Explore higher areas during the day but return to sleep at lower elevations when possible.
- Try coca tea (mate de coca): This traditional Andean remedy is widely available in hotels and restaurants throughout Cusco. While scientific evidence is limited, locals and many travelers swear by its effectiveness.
- Eat light, carbohydrate-rich meals: Your digestion slows at high altitude. Small, frequent, carb-rich meals are easier to digest and provide needed energy.
- Avoid alcohol for the first 48 hours: Alcohol can dehydrate you and its effects are magnified at high altitude.
- Use oxygen sparingly: Many hotels offer supplemental oxygen. While helpful in acute situations, relying on it can actually slow your natural acclimatization.
- Listen to your body: If you experience symptoms, rest immediately. Don’t push through the discomfort.
Traditional and Medical Remedies for Altitude Sickness
Local Traditional Remedies
As a Cusco local, I’ve seen various traditional remedies used for generations:
- Coca Leaf Remedies:
- Coca Tea (Mate de Coca): The most common and accessible remedy, available in most hotels and restaurants
- Chewing Coca Leaves: Often mixed with a small alkaline substance called “llipta” to activate the beneficial compounds
- Coca Candy: A milder alternative, popular among tourists
- Muña Tea: A local mint variety with carminative properties that help with digestion issues related to altitude
- Andean Herbs:
- Maca: A root that grows at high altitudes and is believed to help with energy and adaptation
- Andean Oregano Tea: Used to alleviate headaches and respiratory discomfort
[Note: While these remedies are cultural traditions, scientific studies on their effectiveness are limited. They should complement, not replace, proper medical approaches.]
Medical Approaches
- Preventative Medications:
- Acetazolamide (Diamox): Often prescribed to prevent altitude sickness. It works by increasing respiration rate, which accelerates acclimatization
- Dexamethasone: A steroid sometimes prescribed for prevention in special cases
- Treatment Medications:
- Over-the-counter pain relievers: For altitude headaches (ibuprofen is often recommended)
- Anti-nausea medications: For altitude-related nausea
- Oxygen Supplementation:
- Available at many hotels and through medical services
- Can provide temporary relief but doesn’t accelerate acclimatization
- Medical Facilities in Cusco:
- Cusco has several clinics specializing in altitude-related issues
- Many hotels have oxygen and basic medical supplies
- For serious cases, hyperbaric chambers are available at specialized clinics
The Ideal Cusco Itinerary to Minimize Altitude Sickness
A strategic approach to your Cusco itinerary can dramatically reduce your risk of altitude sickness while maximizing your experience. Here’s an ideal 7-day plan:
Day 1: Arrival and Gentle Acclimatization
- Arrive in Cusco before noon if possible
- Transfer to your hotel and rest for several hours
- Take a light walk around your hotel area
- Drink coca tea throughout the day
- Have an early, light dinner
- Early bedtime (sleep can be disrupted at altitude)
Day 2: Exploring Cusco City Center (Low Exertion)
- Breakfast with coca tea
- Visit Plaza de Armas and the Cathedral (flat, easy walking)
- Lunch at a traditional restaurant near the main square
- Afternoon rest at your hotel
- Early evening visit to Qorikancha (Sun Temple)
- Dinner and early bedtime
Day 3: Sacred Valley Excursion (Lower Altitude)
- Day trip to the Sacred Valley (9,514 ft/2,900 m – lower than Cusco)
- Visit Pisac archaeological site and market
- Lunch in Urubamba (9,420 ft/2,871 m)
- Visit Ollantaytambo ruins (9,160 ft/2,792 m)
- Return to Cusco for dinner and rest
Day 4: Cusco Museums and Nearby Sites
- Visit the Pre-Columbian Art Museum
- Lunch near San Blas neighborhood
- Afternoon visit to Sacsayhuamán (on Cusco’s outskirts, minimal ascent required)
- Rest and dinner
Day 5: Machu Picchu Day Trip (Lower Altitude)
- Early train to Aguas Calientes (6,693 ft/2,040 m)
- Bus to Machu Picchu (7,972 ft/2,430 m – significantly lower than Cusco)
- Guided tour of Machu Picchu
- Return to Aguas Calientes for lunch
- Afternoon train back to Cusco or Ollantaytambo
Day 6: Higher Altitude Excursion
- Now acclimatized, you can visit higher-altitude attractions
- Rainbow Mountain (17,060 ft/5,200 m) or
- Humantay Lake (13,779 ft/4,200 m)
- Return to Cusco in the evening
Day 7: Free Day in Cusco
- Shopping and relaxation
- Visit remaining museums or sites of interest
- Farewell dinner at a top restaurant
Key Strategy: This itinerary follows the “climb high, sleep low” principle and gradually introduces higher altitudes as your body acclimatizes. Starting with the Sacred Valley and Machu Picchu (both lower than Cusco) allows your body to adjust before attempting higher elevations.
Cusco Accommodation Recommendations Based on Altitude Considerations
Where you stay in Cusco can impact your altitude experience. Here are recommendations based on elevation considerations:
1. Lower Elevation Neighborhoods in Cusco
San Blas District:
- Slightly lower than the main square
- Boutique hotels with better oxygen services
- Charming area with narrower streets (less walking distance)
- Recommended hotels: [TO BE COMPLETED BY YOU WITH LOCAL KNOWLEDGE]
Historical Center (Near Plaza de Armas):
- Flat walking area
- Close to restaurants and amenities
- Many hotels offer oxygen services
- Recommended hotels: [TO BE COMPLETED BY YOU WITH LOCAL KNOWLEDGE]
2. Hotels with Superior Altitude Services
Some Cusco hotels specialize in helping guests with altitude adjustment:
- Hotels with oxygen-enriched rooms
- Properties with 24/7 medical staff
- Accommodations offering complimentary coca tea service
- List of recommended hotels: [TO BE COMPLETED BY YOU WITH LOCAL KNOWLEDGE]
3. Sacred Valley Accommodation Strategy
For those extremely concerned about altitude, consider this approach:
- Fly into Cusco airport
- Immediately transfer to Sacred Valley hotels (lower elevation)
- Spend 2-3 nights acclimatizing in Urubamba or Ollantaytambo
- Return to Cusco already partially acclimatized
- Recommended Sacred Valley hotels: [TO BE COMPLETED BY YOU WITH LOCAL KNOWLEDGE]
Special Considerations for Different Types of Travelers
Families with Children
- Children generally acclimatize at the same rate as adults but may not communicate symptoms clearly
- Schedule more rest periods
- Ensure consistent hydration (flavored water may encourage kids to drink more)
- Pack familiar snacks as appetite may decrease
- Consider Sacred Valley-first approach
Seniors and Travelers with Health Conditions
- Consult physicians well in advance of travel
- Request a doctor’s note for any prescription altitude medications
- Allow extra acclimatization days
- Consider oxygen-enriched hotel rooms
- Research the locations of medical facilities near your accommodation
Adventure Travelers and Trekkers
- Arrive at least 3 days before any trek begins
- Build in pre-trek acclimatization hikes around Cusco
- For Inca Trail hikers: be aware the trail reaches 13,828 ft (4,215 m) at Dead Woman’s Pass
- For Salkantay trekkers: the pass reaches 15,213 ft (4,637 m)
- Train cardiovascularly before your trip
Travelers with Respiratory or Cardiac Conditions
- Consult with both your specialist and a travel medicine physician
- Consider a staged approach (Lima → Sacred Valley → Cusco)
- Research supplemental oxygen options in advance
- Some conditions contraindicate travel to high altitude – get medical clearance
Frequently Asked Questions About Cusco’s Altitude
Q: How high is Cusco above sea level? A: Cusco sits at 11,152 feet (3,399 meters) above sea level.
Q: Is Cusco higher than Machu Picchu? A: Yes, Cusco (11,152 ft/3,399 m) is significantly higher than Machu Picchu (7,972 ft/2,430 m), which is why many travelers experience altitude sickness in Cusco but feel better at Machu Picchu.
Q: How many days do I need to acclimate in Cusco? A: Most travelers need 2-3 days to acclimate properly in Cusco before engaging in strenuous activities or traveling to even higher elevations.
Q: Does fitness level affect altitude sickness? A: Surprisingly, physical fitness has little correlation with altitude sickness susceptibility. Even elite athletes can experience symptoms if they ascend too quickly.
Q: Is it better to visit Sacred Valley or Machu Picchu first? A: Both are at lower elevations than Cusco, so visiting either first can help with acclimatization. The Sacred Valley (particularly Ollantaytambo) makes a logical first stop since it’s on the way to Machu Picchu.
Q: Is coca tea legal and does it really help? A: Coca tea is legal and widely consumed in Peru. While scientific studies are limited, many travelers report it helps alleviate mild altitude symptoms. However, it may result in a positive drug test for several days after consumption.
Q: Can children visit Cusco safely considering the altitude? A: Yes, children generally adapt to altitude similar to adults. However, they may not clearly communicate their symptoms, so parents should monitor them closely.
Q: What’s the best time of year to visit Cusco to minimize altitude discomfort? A: Altitude sickness occurs year-round, but the dry season (May-September) offers more predictable weather, which can make the acclimatization process more comfortable.
Q: Can I take Diamox (Acetazolamide) without a prescription in Cusco? A: While it’s available over the counter in some Cusco pharmacies, it’s best to consult with your doctor before your trip, as the medication has contraindications and side effects.
Q: How does Cusco’s altitude compare to other popular tourist destinations? A: Cusco is higher than most major tourist destinations, including Mexico City (7,382 ft/2,250 m) and Denver (5,280 ft/1,609 m), but slightly lower than La Paz, Bolivia (11,975 ft/3,650 m).
Local Insights: A Cusqueño’s Perspective on Altitude
[THIS SECTION TO BE COMPLETED BY YOU WITH PERSONAL INSIGHTS]
As a local, I’ve observed thousands of tourists adjusting to our city’s elevation. Here are some authentic observations and tips that guidebooks may not mention:
- Local perspective on weather patterns and altitude effects
- Insights on which neighborhoods have more gradual inclines
- Traditional remedies passed down through generations
- How locals build and maintain altitude adaptation
- Best local restaurants that serve altitude-friendly foods
- Lesser-known viewpoints that don’t require steep climbs
Conclusion: Embracing Cusco’s Heights Safely
Cusco’s high altitude is an integral part of what makes this ancient Inca capital so unique and breathtaking. The thin mountain air, while challenging to some visitors, has shaped the culture, architecture, and way of life in this remarkable city for centuries.
By understanding the effects of altitude, preparing adequately, and following the guidelines outlined in this article, you can minimize discomfort and fully immerse yourself in all that Cusco has to offer. The key is respect—both for the environment and for your body’s adjustment process.
Remember that acclimatization is a personal journey. Some travelers adapt quickly, while others need more time. Listen to your body, stay hydrated, take it slow initially, and don’t hesitate to seek medical help if needed.
With proper preparation, Cusco’s altitude becomes nothing more than a footnote in an unforgettable journey through one of the world’s most culturally and historically rich destinations. The ancient stones of this Inca city have witnessed centuries of visitors coming and going—all breathing the same thin mountain air that you will experience.
Welcome to Cusco—where the altitude may take your breath away, but the beauty will capture your heart.
[Author’s Note: This article was written with insights from a Cusco local. Sections marked for completion should be filled with authentic local knowledge, current medical facility information, and recent accommodation recommendations.]
