Cusco and Machu Picchu 2026: the guide I wrote after ignoring my own

Complete Cusco and Machu Picchu 2026 guide: how to acclimatise to altitude, where to buy Machu Picchu tickets, the Sacred Valley, the Inca Trail and the best neighbourhoods of Cusco.

The spreadsheet I made before going to Cusco had 47 points. Altitude sickness medication (acetazolamide, ibuprofen, paracetamol), acclimatisation strategy by day, altitude of each itinerary point, warning signs of acute vs. chronic altitude sickness. I researched everything with the seriousness of someone preparing to climb Everest.

I arrived in Cusco, dropped the bags at the hotel, climbed the stairs to the third floor and lay on the bed completely breathless for twenty minutes. Altitude sickness, day 1, hour 2. Exactly what I had studied you should not do — climbing stairs on the first day.

The solution was what the lady at the market recommended when I went out looking for coca: hot coca tea, stillness, and not being an idiot for the rest of the day. It worked. The next day, San Blas.

Altitude sickness — what you really need to know

Cusco is at 3,400m. Mexico City, which already feels high, is at 2,240m. The difference is brutal for the body. The symptoms of altitude sickness — headache, nausea, difficulty breathing, insomnia — appear in most visitors in the first 24-48 hours. They don't depend on fitness. Marathon runners get altitude sickness. 70-year-old grandmothers don't. It's genetics and acclimatisation.

The basic rules I am this time actually going to follow: 1. First 24 hours: move slowly, don't climb unnecessary stairs, no physical activity 2. Drink plenty of fluids (water, coca tea — no alcohol for the first 24h) 3. Eat little and light 4. You will sleep badly the first night — this is normal

Acetazolamide (Diamox) helps accelerate acclimatisation if taken 24h before arriving. It requires a prescription. If you have the chance, discuss it with your doctor before the trip.

Machu Picchu — the logistics nobody tells you about

Machu Picchu entry tickets are purchased online through the official Peruvian government system (machupicchu.gob.pe). Daily capacity is limited and tickets sell out weeks or months in advance during peak season (June-August). This is not a travel guide exaggeration — it is literally true. If you travel in July and have not bought your ticket before arriving in Peru, you may not get in.

There are four different circuits within the site (Circuit 1-4), and when buying you must choose a time slot (morning or afternoon). Circuit 1 (the short panoramic route) includes the postcard view. Circuit 2 (the long route) allows you to see more ruins and has fewer people.

If you want to climb Huayna Picchu (the pointed mountain in the background of every Machu Picchu photo) or Machu Picchu Mountain, these are additional tickets with very limited quota that sell out even faster.

The Cusco-Aguas Calientes train (operated by PeruRail or Inca Rail) departs from Poroy station (near Cusco) or from Ollantaytambo in the Sacred Valley. The journey takes between 1h30 and 3h30 depending on the departure point. Prices are high by Latin American standards — €50-120 one way depending on class and operator. Book in advance.

The Sacred Valley — the day that should be mandatory

The Sacred Valley is the stretch of the Urubamba river between Pisac and Ollantaytambo, 30-60 minutes by car from Cusco. It has three stops that deserve real time.

Pisac has the most honest craft market in Cusco — the sellers are the weavers and craftspeople themselves, not intermediaries. And on the hillside above the village, a complex of Inca ruins that most Valley visitors don't climb. The walk up takes 90 minutes and is worth every step.

Ollantaytambo is the best-preserved Inca fortress in the Andes. Here the Incas defeated Hernando Pizarro in 1537 — the only battle the Incas won against the conquistadors during the invasion. The agricultural terraces, irrigation channels, and giant blocks of the Temple of the Sun at the top: all of it is virtually intact.

San Blas and the lunch with no sign

On the second day in Cusco, after the night of coca tea and stillness, I set off without a plan towards San Blas. I climbed up Siete Culebras alley without knowing exactly where I was going, passed three carpentry workshops making gilded frames by hand, and at the second corner to the right of Plaza San Blas found a door half-open with the smell of stew.

No menu. No sign. Three tables and a woman who asked if I wanted lunch. Quinoa soup, herbed chicken with native potatoes, chicha morada. All for 12 soles (under €3). It was the best lunch of the trip.

The spreadsheet hadn't planned for it. It would have been point 48.