Cusco sits at 3,399 metres above sea level. At that height the air holds roughly a third less oxygen than at the coast, and the body takes one to three days to adjust. That adjustment is soroche, or altitude sickness: headache, tiredness, breathlessness on stairs, sometimes nausea or a poor night’s sleep. It is normal, it happens to most people and it is easy to manage if you plan the first two days sensibly. This guide explains what to expect and how to order your itinerary so the altitude does not steal a single day.
This article is traveller guidance, not medical advice. If you have a heart or respiratory condition, are pregnant or take medication, consult your doctor before travelling to Cusco.
The altitudes that matter
| Place | Altitude | Compared with Cusco |
|---|---|---|
| Chinchero | 3,762 m | +360 m, the highest point of the one-day tours |
| Sacsayhuaman and Tambomachay | ≈ 3,700 m | +300 m, the upper part of the City Tour |
| Cusco (Plaza de Armas) | 3,399 m | — |
| Pisac (town) | ≈ 2,970 m | −430 m |
| Urubamba | ≈ 2,870 m | −530 m |
| Ollantaytambo | 2,792 m | −600 m |
| Machu Picchu | 2,430 m | −970 m |
- Rainbow Mountain (Vinicunca) 5,200 m+1,800 m
- Palcoyo viewpoint 4,900 m+1,500 m
- Humantay Lake 4,200 m+800 m
- Chinchero 3,762 m+360 m
- Sacsayhuaman ≈ 3,700 m+300 m
- Cusco, Plaza de Armas 3,399 mreference
- Pisac ≈ 2,970 m−430 m
- Urubamba ≈ 2,870 m−530 m
- Ollantaytambo 2,792 m−610 m
- Machu Picchu 2,430 m−970 m
- Lower than Cusco: easier on the body
- Slightly higher: short stops
- High mountain: at the end of the trip, after 2 or 3 days of acclimatisation
The reading is simple: the Sacred Valley is lower than Cusco, and Machu Picchu lower still. Anything you do in the valley is easier on the body than an afternoon in the city.
The altitude of every destination, in metres and feet, is in Cusco altitude, Machu Picchu and every destination.
What you feel and when
Symptoms do not appear as you step off the plane but six to twenty-four hours later. The usual pattern is a headache and tiredness the first afternoon, light sleep the first night and breathlessness on slopes for two or three days. It almost always clears on its own. What is not normal, and needs a doctor the same day, is breathlessness at rest, confusion, a cough with fatigue or a headache that gets worse instead of better. Cusco hotels keep oxygen and know who to call.
How to order the first days
The classic mistake is arriving in the morning and doing a long tour that same afternoon. This is the plan that works:
- Day 1, arrival: rest or a half-day City Tour. Eat lightly, drink water, walk slowly. If you feel fine in the afternoon, the Cusco City Tour is the ideal outing (here is when yes and when not): five hours, almost all by vehicle, with short walks at each site. Do not walk up to Sacsayhuaman on your first day. That same day you buy the Tourist Ticket at the first stop. We compare flying and the bus from Lima in Lima to Cusco: plane or bus.
- Day 2: Sacred Valley. You drop 500 metres for the whole day. Of the two routes, the VIP via Chinchero, Moray and Maras passes Chinchero first thing and then only descends; the classic via Pisac ends at Chinchero in the late afternoon. If you arrived yesterday and feel the altitude, choose the VIP.
- Day 3: Machu Picchu. If you sleep in Ollantaytambo or Aguas Calientes the night before, you arrive rested and at lower altitude. These three days, with times and tickets, are in our 3-day Cusco itinerary.
- Afterwards: the high routes. Rainbow Mountain (5,200 m), Humantay Lake (4,200 m) or any trek belong at the end of the trip, never at the start.
There is an even gentler variant: sleep in the Sacred Valley for the first two days instead of in Cusco. Pisac, Urubamba and Ollantaytambo are lower, and from any of them you can do the valley and Machu Picchu without returning to the city. Cusco comes at the end, once you are acclimatised.
Another easy plan for the first days is the food tour with a cooking class: everything happens in the city, with no hikes or climbs.
What really helps
- Water, lots of it. Two to three litres a day. The dry mountain air dehydrates you without your noticing.
- Eat little and often. Heavy digestion makes the headache worse. Soup, rice, quinoa, fruit.
- No alcohol for the first two days. One beer at 3,400 metres feels like three at sea level and ruins your sleep.
- Coca tea. Every hotel serves it and it eases mild dizziness and headache. Bear in mind it can show up on a drug test for several days afterwards.
- Sleep well. The first night is the worst. A heated hotel and a light dinner help more than any pill.
- Preventive medication. Acetazolamide speeds up acclimatisation and many travel doctors prescribe it; you start before arriving. The local pharmacies’ “soroche pills” are painkillers with caffeine: they relieve the headache but do not acclimatise you. Either way, decide with your doctor, not at the pharmacy counter.
Frequently asked questions
Can I do the City Tour on the day I arrive in Cusco?
Yes, if it is in the afternoon and you feel fine. It is half a day, almost all by vehicle, and the sites are covered on short walks. What you should avoid on the first day is a ten-hour tour or walking up to Sacsayhuaman.
Is it better to go to the Sacred Valley or Cusco first?
For the body, the valley first: it is 500 metres lower. If your flight lands in Cusco you can transfer to the valley the same day in an hour and a half, sleep there and leave the city for the end.
Are children and older people at greater risk?
Not especially, but they tire sooner and find it harder to say what they feel. With them, choose the VIP valley route, with short flat walks, and avoid anything above 4,000 metres.
How long does soroche last?
Mild symptoms usually clear within 24 to 48 hours. From the third day most travellers walk normally, although you will still feel short of breath on slopes for the whole stay.
Start gently
- Cusco Private City Tour, half a day, ideal for the afternoon you arrive.
- Sacred Valley tours, the best second day at lower altitude.
- Cusco city tours, for when you are acclimatised.
