Quick answer: Cusco sits at 3,399 m (11,152 ft), high enough that many visitors feel headaches, breathlessness and poor sleep in the first 24–48 hours. The best ways to prevent altitude sickness in Cusco are to go down to the lower Sacred Valley (about 2,800–2,900 m) on arrival, take the first days slowly, drink water, avoid alcohol early on and, if your doctor agrees, consider acetazolamide. Severe symptoms such as confusion or breathlessness at rest are an emergency: descend and get medical help.
Why Cusco hits people harder than Machu Picchu
Most travellers fly from Lima, near sea level, straight to Cusco: a jump of more than 3,000 m in about an hour. Machu Picchu itself is around 1,000 m lower than Cusco, at about 2,430 m. So the altitude problem on a Peru trip is usually Cusco, not Machu Picchu. See our Machu Picchu elevation guide for the full altitude profile.
Symptoms of altitude sickness
| Type | Symptoms | What to do |
|---|---|---|
| Mild AMS | Headache, tiredness, nausea, poor appetite, dizziness, poor sleep | Rest, hydrate, don’t go higher until symptoms ease |
| Moderate AMS | Worsening headache not relieved by painkillers, vomiting, more breathlessness | Rest, consider descending, seek medical advice |
| HAPE (fluid on the lungs) | Breathlessness at rest, cough, chest tightness, extreme tiredness | Emergency: descend immediately and get medical help |
| HACE (brain swelling) | Confusion, clumsiness, severe headache, drowsiness | Emergency: descend immediately and get medical help |
Symptoms usually start 6–24 hours after arriving at altitude.
How to prevent altitude sickness in Cusco
1. Sleep lower first
Instead of staying in Cusco on night one, transfer straight to the Sacred Valley (Urubamba, Ollantaytambo or Pisac, around 2,800–2,900 m). Spend one or two nights there, visit Machu Picchu (lower still), and return to Cusco at the end of your trip, already acclimatised.
2. Take the first day easy
Walk slowly, avoid steep stairs and big hikes, and nap if you need to. Plan high excursions such as Rainbow Mountain (over 5,000 m) or Humantay Lake for later in the trip.
3. Drink water, limit alcohol
Dehydration makes symptoms feel worse. Avoid alcohol and heavy meals for the first day or two.
4. Coca tea
Mate de coca is offered in almost every Cusco hotel. Many people find it helps mild symptoms, though evidence is limited. It may show up on drug tests.
5. Ask your doctor about medication
Acetazolamide (often sold as Diamox) can help prevent altitude sickness in some travellers when started before arrival. It’s prescription-only and has side effects, so talk to a doctor or travel clinic before your trip. Ibuprofen or paracetamol can ease headaches.
6. Know your own risks
Fitness does not protect against altitude sickness. Previous altitude problems, heart or lung conditions, or pregnancy are reasons to get medical advice first.
A sample acclimatisation plan
| Day | Where | Altitude |
|---|---|---|
| 1 | Fly Lima → Cusco, transfer to Sacred Valley | ~2,850 m |
| 2 | Gentle sightseeing: Pisac, Ollantaytambo, Moray | ~2,850 m |
| 3 | Train to Aguas Calientes | ~2,040 m |
| 4 | Machu Picchu, then train back to Cusco | 3,399 m |
| 5–6 | Explore Cusco; day hikes once you feel good | 3,399 m+ |
Treks that go higher than Cusco
- Classic Inca Trail: Dead Woman’s Pass at 4,215 m. See Inca Trail vs train.
- Salkantay Trek: crosses a pass at about 4,600 m.
- Rainbow Mountain (Vinicunca): over 5,000 m.
For any of these, spend at least two or three days around Cusco first.
Frequently asked questions
How long does it take to acclimatise to Cusco?
Most people feel noticeably better after 1–3 days.
Is it better to stay in Cusco or the Sacred Valley first?
The Sacred Valley, because it’s several hundred metres lower and makes acclimatising easier.
Can I take Diamox for Cusco?
Possibly; ask your doctor. It isn’t suitable for everyone.
Does oxygen help?
Many hotels offer oxygen, which can relieve symptoms temporarily, but it doesn’t replace rest and descent if symptoms are severe.
This guide is general information, not medical advice. If you have health conditions or severe symptoms, see a doctor.
Keep reading
- Machu Picchu Elevation: Altitude Guide
- Lima to Machu Picchu: How to Get There
- Best Time to Visit Machu Picchu
Hi, I am Emam Hasan — founder and editor of BrokeMountain. I oversee this blog’s hiking, camping and outdoor gear guides, making sure every article is well-researched, accurate and genuinely helpful for your time on the trail. Enjoy it!
