Altitude Sickness in Ecuador — How to Adjust to Life Above 8,000 Feet

Nobody warns you properly about altitude. You fly into Cuenca feeling great, grab your bags, walk up a flight of stairs at the airport, and suddenly you're gasping like you just ran a 5K. Welcome to 2,560 meters — roughly 8,400 feet above sea level. Quito is even higher at 2,850 meters (9,350 feet). For reference, Denver sits at 5,280 feet and people complain about that.

This is the thing that catches almost every new arrival off guard. It's not dangerous for most people. But it will absolutely wreck your first few days if you don't prepare for it.

What Altitude Actually Does to Your Body

At 8,400 feet, the air has about 25% less oxygen than at sea level. Your body isn't broken — there's just less of what it needs in every breath you take. Your heart rate goes up, your breathing gets faster, and your body starts making more red blood cells to compensate. That adjustment takes time.

The locals call it soroche. You'll hear that word a lot.

Symptoms You'll Probably Experience

Most people arriving from sea level to Cuenca or Quito will notice at least some of these in the first 2–5 days:

• Headache — the most common symptom, usually a dull pressure behind the eyes or at the temples
• Fatigue — you'll want to nap at 2 PM even if you slept well
• Shortness of breath — especially going up stairs, hills, or walking faster than a stroll
• Insomnia — you're exhausted but can't sleep, or you wake up at 3 AM wide awake
• Mild nausea — food doesn't appeal to you the way it should
• Dizziness — especially when standing up quickly
• Irritability — the altitude equivalent of being hangry

These aren't signs that something is wrong. They're signs that your body is doing exactly what it's supposed to do — adjusting. For most people, the worst of it passes in 48–72 hours. Full acclimatization takes 1–3 weeks.

Who Gets Hit Hardest

Here's the uncomfortable truth: there's no reliable way to predict who will struggle. Fit 30-year-olds sometimes get flattened while 70-year-olds breeze through. But some factors increase your risk:

• Coming from sea level — if you live in Miami, Houston, or anywhere on the coast, you have zero altitude adaptation. Someone from Denver or Mexico City will adjust faster.
• Age 60+ — your cardiovascular system is less elastic, so it takes longer to compensate. This doesn't mean you can't live at altitude — millions of older adults do — but give yourself extra time.
• Heart or lung conditions — COPD, heart failure, pulmonary hypertension, or severe anemia make altitude genuinely risky. Talk to your doctor before coming, not after.
• Sleep apnea — altitude worsens it significantly. Bring your CPAP and expect to adjust the pressure settings.
• Obesity — extra weight means your body needs more oxygen at baseline, so the reduction hits harder.
• Arriving by air — flying directly from sea level to Quito or Cuenca gives your body zero transition time. Driving up from the coast over several hours is easier.

What to Do Before You Arrive

Start hydrating 24 hours before your flight. Not coffee. Not beer. Water. Your body needs to be well-hydrated before it starts working overtime at altitude. Aim for clear urine before you board the plane.

Consider acetazolamide (Diamox). This is the gold standard medication for altitude sickness prevention. It works by making your blood slightly more acidic, which tricks your body into breathing deeper. Start taking 125mg twice daily the day before you arrive and continue for 2–3 days after arrival. Side effects include tingling in your fingers and toes, more frequent urination, and carbonated drinks tasting flat.

You can buy acetazolamide at any pharmacy in Ecuador without a prescription. It costs $2–5 for a course. Brand name is usually Diamox or Edemox. Ask the pharmacist for acetazolamida — they'll know exactly what you need.

Pack ibuprofen. Studies show that 600mg of ibuprofen taken 6 hours before arriving at altitude reduces headache incidence. It's not as effective as acetazolamide, but it helps and has fewer side effects.

Your First 72 Hours — The Survival Playbook

Day 1: Take It Easy (Seriously)

Your flight lands. You feel fine. You want to explore, unpack, hit the mercado. Don't. Or rather, do it slowly.

• Drink 3+ liters of water throughout the day. Keep a bottle with you at all times. You're losing moisture through your lungs at a much higher rate than normal because you're breathing faster.
• No alcohol for the first 48 hours. At altitude, one beer hits like three. Alcohol also dehydrates you and suppresses your breathing drive — the opposite of what your body needs right now.
• Eat light meals. Heavy, fatty food requires more oxygen to digest. Stick to soups, fruit, bread, rice. Ecuadorian locro de papa (potato soup) is actually perfect — warm, light, hydrating.
• Walk, don't climb. Cuenca's centro is relatively flat. Stick to that. Avoid the Turi lookout, the Cajas road, or anything that involves steep stairs on Day 1.
• Nap if you need to. But don't sleep all day — you need to stay hydrated and keep your body moving gently.

Days 2–3: The Hump

This is typically when symptoms peak. You might wake up with a headache, feel foggy, or get winded walking to breakfast.

• Continue aggressive hydration. If your urine isn't pale yellow to clear, you're not drinking enough.
• Drink coca tea (té de coca). Available at most restaurants, hotels, and cafes in the highlands. It's made from coca leaves — the same plant cocaine comes from, but the tea is about as dangerous as chamomile. It's completely legal in Ecuador, widely consumed, and genuinely helps with headache and nausea. Ask for agüita de coca or mate de coca. Some hotels in Quito leave it in the lobby for arriving guests. Note: if you're flying to the US soon after, stop drinking it at least 48 hours before — it can trigger a positive drug test, though the amounts are trace.
• Take acetazolamide if you haven't been. It's not too late to start. Even beginning on Day 2 helps.
• Don't push through symptoms. If you have a headache, rest. Your body is not being lazy — it's building new red blood cells.

Days 4–7: Turning the Corner

Most people start feeling noticeably better by Day 4. The headache fades. Sleep improves. You can walk up a hill without stopping to catch your breath. You're not fully acclimatized yet — that takes 2–4 weeks — but the acute symptoms are behind you.

Now you can gradually return to normal activity levels.

When to Go to the Emergency Room

Mild altitude sickness is uncomfortable but not dangerous. Severe altitude sickness can kill you. Know the red flags:

• Severe headache that doesn't respond to ibuprofen or acetaminophen — this is different from the dull pressure of mild soroche
• Confusion, disorientation, or difficulty walking straight — signs of high-altitude cerebral edema (HACE)
• Persistent vomiting — you can't keep fluids down, which means you can't hydrate
• Severe shortness of breath at rest — not from walking upstairs, but from sitting still
• Crackling sound when breathing or pink/frothy sputum — signs of high-altitude pulmonary edema (HAPE)
• Bluish tint to lips or fingernails — oxygen levels are critically low

If any of these happen, go to the emergency room immediately. In Cuenca, Hospital Monte Sinaí (Av. Miguel Cordero and Agustín Cueva) or Hospital Santa Inés (Av. Daniel Córdova Toral 2-113) both have good ERs that see altitude cases regularly. In Quito, Hospital Metropolitano or Hospital de los Valles in Cumbayá. Don't wait to "see if it gets better."

The definitive treatment for severe altitude sickness is descent. Going down 1,000+ meters resolves symptoms rapidly. From Cuenca, that means driving toward the coast — even getting to Yunguilla or Girón (about 45 minutes south and lower) can make a dramatic difference.

The Long-Term Adjustments Nobody Mentions

Surviving the first week is one thing. Living at altitude permanently means adapting to some ongoing realities.

Exercise Capacity

Your VO2 max is permanently reduced at altitude — roughly 3% for every 1,000 feet above 5,000 feet. If you were a runner at sea level, you'll be slower here. Period. A 9-minute mile at sea level becomes a 10:30 at altitude.

Start at 50% of your normal intensity and add 10% per week. Most people reach their new baseline after 4–6 weeks. Runners, cyclists, and gym regulars: check your heart rate. You'll be 10–15 bpm higher for the same effort level for the first few weeks.

Cuenca has several gyms and running groups. Hit Fitness on Av. Solano or Snap Fitness on Ordoñez Lasso both have good facilities. The running path along the Río Tomebamba is flat and popular — start there, not on the hills.

Alcohol Tolerance

Your tolerance drops at altitude. Permanently. One glass of wine will feel like two. Two beers will feel like four. This isn't just the first week — it's ongoing. Many long-term expats in Cuenca comment that they drink significantly less than they did at sea level, partly because they don't need as much to feel the effects.

Sleep Changes

Some people experience periodic breathing during sleep at altitude — a pattern where your breathing speeds up, slows down, pauses briefly, then speeds up again. It's disconcerting if you notice it but not harmful. It usually fades over weeks to months. A cool room and slightly elevated pillow help.

Cooking at Altitude

Water boils at about 92°C (197°F) at Cuenca's altitude instead of 100°C (212°F). This means:

• Rice takes 5–10 minutes longer
• Dried beans need longer soaking and cook times — a pressure cooker is almost mandatory (every Ecuadorian kitchen has one)
• Pasta takes an extra 2–3 minutes
• Baking is a whole adventure — cakes rise faster then collapse, breads need less yeast and more liquid, cookies spread more. Search for "high altitude baking adjustments" and experiment. Or just buy bread from the panadería — Ecuadorians have been baking at this altitude for centuries and they're very good at it.
• Hard-boiled eggs need 14–15 minutes instead of 10–12

Skin and Dehydration

UV radiation is significantly stronger at altitude — you're closer to the sun with less atmosphere filtering UV rays. Cuenca sits near the equator AND at 8,400 feet. You will burn faster than you expect, even on cloudy days.

Wear SPF 50+ daily. Moisturize aggressively — the dry air at altitude saps moisture from your skin. Lip balm with SPF. Drink water even when you don't feel thirsty.

Specific Advice for Retirees and Older Adults

If you're 60+, moving to altitude deserves extra planning. You absolutely can live here — thousands of retirees do — but be smart about it.

• Get a checkup before you move. Specifically ask your doctor about altitude and your specific conditions. Bring a letter summarizing your medical history — you'll need it for IESS enrollment anyway.
• Consider a staged arrival. Spend a few days in Guayaquil (sea level) first, then a day or two at an intermediate altitude, then arrive in Cuenca. This gradual ascent reduces shock.
• Bring enough medication for 90 days. Don't count on finding your exact prescriptions immediately. Most medications are available in Ecuador, but names and dosages may differ.
• Get a pulse oximeter. They cost $15–25 at pharmacies here (or bring one from Amazon). Normal oxygen saturation at Cuenca's altitude is 92–96% — lower than the 97–99% you're used to at sea level. If you're consistently below 90%, see a doctor.
• Tell your landlord or neighbors. If you're living alone, make sure someone checks on you the first few days. This isn't paranoia — it's practical.

The Coastal Escape Plan

If altitude genuinely doesn't agree with you — and for some people, it never fully does — Ecuador's coast is at sea level with zero altitude issues. Salinas, Manta, Puerto López, and Bahía de Caráquez all have small but growing expat communities. Even Vilcabamba in Loja province sits at only 1,500 meters (4,900 feet), which is significantly easier than Cuenca or Quito.

Some expats split their time — highlands for the culture and climate, coast for weekends or months when they need a break. Cuenca to Guayaquil is a 3.5-hour drive, and the descent starts helping within an hour.

Coming Back from the Coast

Here's something nobody tells you: if you spend a week or more at sea level, you'll experience mild re-acclimatization when you return to Cuenca. It's not as bad as the first time, but you might notice a headache or fatigue for a day or two. Hydrate on the way back, take it easy that evening, and you'll be fine by the next morning.

The Bottom Line

Altitude sickness is temporary. Altitude adjustment is real. For the vast majority of people, the first 3–5 days are unpleasant but manageable, and within a few weeks you'll forget you're at 8,400 feet — until you walk up a steep hill and your lungs remind you.

Don't let altitude scare you away from Cuenca or Quito. But don't ignore it either. Hydrate, take it slow, have acetazolamide on hand, and give your body the time it needs. The highlands are worth it.