Landing at 2,850 m: what to expect in your first 24 hours
You will probably feel something. A headache in the late afternoon, breathlessness on a flight of stairs, a strange broken night. That is normal, it passes, and there are about five decisions that determine whether day one is mildly odd or genuinely unpleasant.
The short version
- Quito is at 2,850 m (9,350 ft). There is about a third less oxygen in each breath than at sea level.
- Symptoms usually start 6 to 12 hours after you arrive, not immediately. Feeling fine at the airport means nothing.
- Most people are much better by the second evening. This is why two nights beat one.
- The three things that help most are free: go slowly, skip the alcohol, sleep badly without panicking.
- Do not go up to Cotopaxi or the TelefériQo on your first morning.
What is actually happening
The air at 2,850 m has the same proportion of oxygen as at sea level — about 21%. What changes is the pressure pushing it into your blood. At Quito's elevation, each breath delivers roughly two thirds of the oxygen you are used to.
Your body notices within minutes and starts compensating: you breathe faster and deeper, your heart rate rises, and over the following days your kidneys adjust your blood chemistry and you begin producing more red blood cells. That adjustment is called acclimatisation, and the uncomfortable gap between arriving and finishing it is what people call soroche.
It has almost nothing to do with fitness. Marathon runners get it. It has more to do with genetics, how fast you ascended, and what you do in the first day.
Your first 24 hours, hour by hour
- Hour 0You land and feel fine. Almost everyone does. The airport is at 2,400 m, lower than the city.
- Hour 1The drive up to the Old Town. You may notice a mild pressure behind the eyes. Drink water.
- Hours 3–6Stairs feel unreasonable. You are breathing harder than the effort deserves. This is normal and not a sign of anything wrong.
- Hours 6–12If you are going to get a headache, it arrives here. Usually dull, frontal, worse when you bend over. Often with a slight nausea and no appetite.
- Night 1The worst part for most people. You wake repeatedly. Your breathing may pause and then catch up in a rush — that is periodic breathing, it is normal at altitude, and it alarms people who have never felt it.
- Morning 2Often the low point. Headache may still be there. Do something gentle and flat today.
- Evening 2Most people turn the corner here. Appetite returns, the headache lifts, sleep improves.
- Day 3Normal, or close to it. Now Cotopaxi is a reasonable idea.
What is normal, and what is not
This is the part worth reading properly, because Quito itself is rarely dangerous — but the day trips out of Quito go much higher, and that is where mild discomfort can become something that needs attention.
| Expected, and it passes | Stop and get help |
|---|---|
| Dull headache that responds to paracetamol or ibuprofen | Severe headache that will not respond to painkillers |
| Breathless walking uphill or on stairs | Breathless while sitting still, or a cough with frothy sputum |
| Poor appetite, mild nausea | Repeated vomiting |
| Broken sleep, waking with a start | Confusion, unusual drowsiness, behaving oddly |
| Feeling slightly slow or clumsy | Unable to walk a straight line heel to toe |
The right-hand column describes the early signs of high-altitude cerebral and pulmonary oedema. Both are rare at Quito's elevation and both are serious. The treatment is to go down, immediately, and to get medical help. That inability to walk heel-to-toe in a straight line is the single most useful test there is — if a travelling companion cannot do it and is behaving strangely, that is not tiredness.
Tell us at reception if you are worried about someone. We would far rather be asked at eleven at night than find out in the morning.
The five decisions that actually matter
1 · Do nothing on the first afternoon
The strongest predictor of a bad first night is a busy first day. Walk somewhere flat, sit in a courtyard, have a long lunch. The Old Town is not going anywhere, and it is built on hills.
2 · Skip the alcohol for the first day or two
Alcohol hits noticeably harder up here, dehydrates you, and suppresses your breathing while you sleep — exactly when you need it working hardest. One celebratory drink on arrival is the most common reason people have a miserable first night.
3 · Drink more water than feels necessary
The air is dry and you are breathing harder, so you lose more water than you notice. That said, there is no benefit to forcing litres of it. Drink steadily and check that your urine stays pale.
4 · Eat, even without appetite
Loss of appetite is one of the first symptoms, and skipping meals makes the headache worse. Something light and carbohydrate-heavy is easier than a heavy dinner.
5 · Accept that night one will be poor
Knowing that the broken sleep and the odd breathing pattern are expected takes most of the fear out of them. Sleeping pills are a bad idea at altitude, because they suppress the breathing drive you are relying on.
Coca tea, oxygen and medication — honestly
Coca tea. A local tradition and a mild stimulant. It may make you feel a bit better and it is pleasant. There is no good evidence it prevents altitude sickness. Drink it because you like it, not as a strategy. Note that it can produce a positive result on some drug tests.
Oxygen. Widely offered in Andean hotels and clinics. A few minutes of it will make you feel better for a few minutes. It does not speed up acclimatisation.
Acetazolamide. This is the one with real evidence behind it. It genuinely speeds acclimatisation and reduces symptoms, and it is what mountaineers use. It is a prescription medicine, the dose depends on you, and it is not right for everyone — people with a sulfa allergy in particular. Talk to your own doctor before you leave home, and if you do take it, expect tingling in your fingers, needing to urinate more, and fizzy drinks tasting strange. Those side effects are normal and harmless.
We cannot advise you on medication and will not try. What we can do is tell you where the nearest pharmacy and clinic are, which is two minutes and ten minutes from our door respectively.
The day-trip trap
Quito at 2,850 m is the gentle part. Look at where people go from here:
- TelefériQo — 4,100 m, reached in a fifteen-minute cable car
- Quilotoa — 3,900 m at the crater rim
- Cotopaxi refuge — 4,864 m, on foot, on sand
- Papallacta — 3,300 m, though you spend it in hot water, which is easier
Going from a sea-level city to 4,100 m inside 24 hours is a genuinely bad idea, and the cable car makes it deceptively easy. Give these two full days at least. If your stopover is short, put the high excursion on your last day, not your first.
And if you are heading to the Galápagos or the Amazon afterwards, the good news is that you are descending. Nothing about your Quito acclimatisation will trouble you at sea level.
Who should talk to a doctor before booking
Most people need no medical advice for 2,850 m. Some should ask first: anyone with significant heart or lung disease, uncontrolled high blood pressure, sickle cell disease, a history of severe altitude sickness, or a pregnancy. This is a conversation for your own doctor, who knows your history, and it is worth having before the tickets are bought rather than after.
Why two nights beat one
Look back at the timeline. On a single night in Quito, you arrive, feel the headache come on in the evening, sleep badly, and leave at dawn feeling worse than when you landed — and your memory of Quito is a headache.
With two nights, you spend the second day quietly, turn the corner on the second evening, and leave on the third morning feeling normal. It is the difference between enduring the city and enjoying it, and it costs one night.
A courtyard, a slow afternoon, and nobody rushing you
The single best thing you can do on day one is very little, somewhere pleasant. Book direct for our lowest rate — and tell us it is your first day at altitude, so we can plan your arrival around it.
See our best dealsWhat we do here
We keep the first afternoon deliberately unstructured for guests arriving from sea level, we can point you to the nearest pharmacy and clinic, and we will happily rearrange a tour booking if day two turns out to be a write-off. If you are unsure whether something you are feeling is normal, ask at reception. We have this conversation most weeks and we would rather have it early.
If the Galápagos are next, read how the flights and the airport formalities work — the 04:30 start is easier on an acclimatised body.
This page describes what commonly happens and is not medical advice. If you are unwell, see a doctor. Quito has excellent private clinics and we can direct you to the nearest.
Take this with you
The warning-signs table is worth having on paper if you are heading higher.
