You not only need a visa for China but in addition also a travel permit for Tibet. Risk of getting problem with altitude sickness is a bit higher if you go by car. Because you will go up to more then 4000 meter within a day or two, whereas you will be “only” at 3600 meter if you fly to Lhasa.
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LOT higher chances of AMS when going overland , since every night is higher than Lhasa enroute.
Another near guarantee for AMS is going directly from Shigatse or gyantse to EBC , as suggested above.
You have no use of a regular Chinese tourist visa : it will not get you in to Tibet , and it will be scrapped when you enter from Nepal. You enter on a group permit , and this can only be arranged by a travel agent , with a tour & guide included.Edited: 6:27 am, August 31, 2011
As other posters have noted, you are probably better off flying from Kathmandu to Lhasa and returning to Kathmandu overland. That's what we did in 2006. Also as mentioned above you only need a Tibet permit, no Chinese visa. We worked with an agency in Kathmandu ( Yeti Travels) who worked with a Tibetian owned agency in Lhasa ( C & S ). The agency will make the arrangements for flights, the ground portion and the permit. We arrived on a Sunday, the agency got the permit on Monday and we flew to Lhasa on a Tuesday. We are in our mid 60's and started a Diamox regimin on Sunday. We had only minor altitude effects. The only mistake we made was not scheduling a day at the Everest Base camp. Otherwise it was an excellent trip.
Diamox regimen here : http://korta.nu/5c3a . afaik not a single reputable medical site recommends starting earlier than 24 hours before flying in - the only thing you have a chance to influence is more side effects by starting earlier. The 50+ group cope slightly better at altitude .
4 of us did the trip as described in braager b's post in June with tibettour.org a different company and a division of Sichuan China International Travel Service.
Great trip in a modern Toyota Landcruiser. Altitude sickness was a minor problem only at Everest Base Camp - you definitely must go there. We took Diamox. Can't understand why some are saying it's better to fly. Although coming from Nepal you do climb a lot faster than from Lhasa.
We had huge problems with Tibet travel permit - and remember you CANNOT travel inside Tibet solo. You must be on an organized tour and get your permit through a government registered travel agency - even if it is organized only for 2. We had to wait until the evening before boarding the train from Xian to Lhasa to obtain our permits. And half way through our trip the border was closed to new arrivals.
Best of luck.
"Can't understand why some are saying it's better to fly."
Sleeping elevation is the key factor in altitude sickness, and all nights coming from Kathmandu are higher than Lhasa.
"...Everest Base Camp - you definitely must go there."
Not on a tight itinerary from Ktm - drastically different from starting with good basic acclimatization first from Lhasa. People die now and then on the Ktm-EBC-Lhasa run , which is at surreal distance from safety guidelines ( http://korta.nu/5c3a ) - last one I heard about was in late May. Shigatse below 4000) directly to EBC (5000+) is also a really, really bad idea - irrespective of lucky outcomes in some groups.
Even the basic Ktm-Lhasa tour is challenging for many : we met a greyish group in Lhatse that had little success with their breakfast , or anything else. None in our group had any real problems - but we all came from high altitude treks .
I guess every individual is different (in terms of the severity of AMS).
I just returned from my Tibetan trip (Aug 2011). Like BluePhantom did, my friends & I engaged an agent in Nepal (Visit Nepal-Tibet Treks) and the agent arranged everything for us - including obtaining the permits within 3 days!
We flew to Lhasa from Kathmandu. Spent 3 days & 2 nights in Lhasa before setting off for Shigatse via Gyantse. We do not have much problem with AMS, (we didn't even took any medication), not even in EBC. But of course we suffer minor headache for the 1st day in Lhasa. The only advise we got from our Tibetan guide is to rest a lot and drink loads of water.
Yes , every individual is different - similar to the outcome when you go against diving tables. In both cases you can have people who are relatively unaffected , or dead. You can easily find reliable descriptions of deaths at EBC after fast ascents in medical litterature , apart from postings by travellers or other good sources on the ground ( …typepad.com/life_on_the_tibetan_plate/2011/… ) : see for example the classic High Altitude Medicine Handbook. Itineraries are also seldom identical : what was left out by # 6 is that they took the train in .
The "loads of water" advice is potentially very dangerous , btw : high water intake leads in the end to hyponatremia , which drives cerebral and other edema , exactly what you try to avoid. Hyponatremia can both be the single factor leading to cerebral (and pulmonary ) edema , or a contributing factor. This is why The Himalayan Rescue Association among other medical sources warn against this strategy. See also http://korta.nu/mythsEdited: 9:28 pm, September 08, 2011
Not only you need a visa, but also you need a group visa which states entry date and departure date and with whom you travel and must leave China together at specific place.
From Nepal overland to Tibet is not recommended, too high you know.
Beside a visa you also need TTB travel permit and other permits, you must be with a guide and show them with your visa at the border when checking in China.
I personaly recommend you firstly fly to other city but Tibet, say Guangzhou or Chengdu, which mean you will get a normal visa with more flexiblity. Then get a TTB permit from local agency then head to Tibet.