Treatment
IHHT explained clearly
You have heard about IHHT or received a recommendation for it. Perhaps you hope it will help you manage more in everyday life again. At the same time, the idea of breathing air with alternately lower and higher oxygen levels through a mask raises questions. What is this change intended to achieve? Who might benefit? And how would you tell whether treatment is actually helping?
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Which questions should be addressed before deciding?
For medical assessment, it matters what actually limits you. Do you stop a walk because of pain, lack of strength, breathlessness or unusual fatigue? How long has this been happening, and how do you respond to exertion? These differences affect further investigation. Being able to walk a shorter distance does not, on its own, explain the cause.
If a new or worsening reduction in your ability to manage activity has not yet been assessed, you may first need an examination at your GP practice or by another appropriate specialist. Heart and lung conditions and your medicines also matter when assessing suitability. If you develop sudden severe breathlessness or chest pressure, please do not wait for an IHHT appointment: call 112.
Understanding
A closer look
OrthoCoast offers IHHT. Before you decide, we want to establish with you what specific goal it would serve and whether the procedure fits your health circumstances. Reduced capacity for activity does not always have the same cause. Treatment should therefore not be based on a wish for more energy alone.
What does IHHT mean?
IHHT stands for intermittent hypoxic–hyperoxic training. Intermittent means that different phases alternate repeatedly. During the hypoxic phase, the air you breathe contains less oxygen than normal room air; during the hyperoxic phase, it contains more. The air mixtures are delivered through a breathing mask, and treatment usually takes place at rest. You do not need to hold your breath or breathe particularly deeply or quickly.
Here, ‘training’ describes a targeted stimulus from the changing oxygen supply, not strength or endurance exercise. Even though you are not physically exerting yourself, your body responds to the altered air you breathe. Assessment of suitability by a doctor and monitored treatment are therefore part of the procedure.
IHHT is not the same as long-term prescribed oxygen therapy for a lung condition. You must not replace or alter such treatment with IHHT on your own initiative.
What is the idea behind alternating oxygen levels?
Oxygen plays an important role in energy production in our cells. Mitochondria are involved: small structures within cells that provide much of their usable energy. The body also has systems that detect and respond to changes in oxygen supply. IHHT is intended to stimulate these adaptive responses through time-limited changes. The aim is therefore not to give the body as much oxygen as possible.
When reading about the procedure, you will often encounter terms such as ‘cell training’ or ‘mitochondrial training’. These are intended to illustrate the biological approach. However, the underlying processes are more complex than the image of a battery being recharged. Such explanations do not establish that damaged mitochondria in your body will be specifically replaced or that symptoms will definitely disappear as a result.
Whether the adaptations being studied can be used therapeutically is a separate question. Your decision depends not only on what appears possible at cell level, but on whether a noticeable benefit can be expected in your particular situation. A greater fall in oxygen levels is not automatically more helpful.
Further information
Which goals might IHHT support?
Being able to walk further again, feeling more capable after illness or getting more from rehabilitation: goals like these lie behind clinical research into IHHT. Perhaps you also know the feeling that your available energy is no longer enough for everyday life. It is worth looking carefully at what limits you: pain, lack of stamina, breathlessness or fatigue? This affects the contribution IHHT might make to your treatment.
One area of interest is physical capacity. In a study involving people with stable coronary artery disease, better exercise tolerance and more favourable blood pressure readings were observed after IHHT. IHHT is also being studied in older people as an addition to adapted exercise. This view of the whole person matters in orthopaedic treatment: alongside the painful joint or back, we consider what affects your overall capacity for activity.
Another research area is metabolism. In people with metabolic syndrome, a combination of factors such as raised blood pressure, unfavourable blood lipid levels and impaired glucose metabolism, favourable changes in some blood lipid levels have been described. Possible effects on chronic, low-grade inflammatory processes are also being investigated. These are interesting avenues of research; a reliable anti-inflammatory effect cannot yet be established from the results available. A changed laboratory result alone does not demonstrate relief of back or joint pain.
There is also a small study specifically on back pain: within a combined rehabilitation programme, pain and movement limitations decreased more in the short term with additional IHHT than with the comparison treatment. For Long COVID, a controlled study during inpatient rehabilitation also reported encouraging results. People receiving additional IHHT improved their walking ability more and reported less fatigue and better quality of life.
These findings provide a reason to discuss IHHT individually as a possible addition. The size of any benefit and how long it lasts are still being investigated. Whether and how IHHT may be suitable for you also depends on the underlying condition. If exertion triggers a marked deterioration only hours later or the following day, a separate medical assessment is important; the results described do not apply automatically to that situation. Together, we establish a specific goal and discuss how you would recognise improvement. This might, for example, be managing an everyday walk more easily. You can then decide whether IHHT could have a useful place in your treatment plan.
What generally happens during a session?
At OrthoCoast, we use MITOVIT and ReOxy systems for IHHT. Before starting, suitability and the individual response to the procedure are assessed medically. This includes your symptoms, existing conditions, medicines and the goal of treatment. A device-based assessment of your response to lower-oxygen air can help adjust settings. It complements the medical assessment and the necessary investigation of your symptoms.
During treatment, you breathe through a mask. The monitored procedure includes checking oxygen saturation and pulse. Oxygen saturation describes the proportion of the red blood pigment, haemoglobin, that is carrying oxygen; a sensor can estimate it through the skin. It is different from the oxygen concentration in the air you breathe. The two values are related, but they are not interchangeable.
The readings are assessed alongside how you feel. They are not an instruction to achieve the lowest possible value. How treatment will be arranged for you and how much time to allow for the appointment should be discussed before starting. A study protocol is not automatically a suitable treatment plan for you.
What does biofeedback mean in IHHT?
In this context, biofeedback means that measured bodily responses help control the treatment. Suitably equipped systems can adjust the supplied air mixture within set limits according to the measured response. This matters because people can respond differently to the same oxygen supply, and an individual's condition can vary from day to day.
Automatic control does not, however, replace supervision. A device can record measurements, but it cannot recognise every instance of discomfort or medically assess your symptoms. Nor does an oxygen saturation curve directly show how well your mitochondria are working or whether treatment helps you in daily life. Please tell us how you feel during and after treatment.
How do you recognise progress that matters to you?
A better reading during treatment does not yet answer whether it helps you in everyday life. That requires a goal agreed beforehand. Perhaps a particular walk matters to you, or being able to manage a daily activity more reliably again. Such observations should relate to your starting point and be reviewed over time.
IHHT does not replace an individually tailored approach to movement or necessary treatment of the underlying condition. Whether exercise is appropriate for you, and in what form, depends on your symptoms and response to exertion. Persistent discomfort or deterioration after a session should be discussed with a doctor before treatment continues.
What to expect and next steps
Which symptoms should you report during treatment?
Studies have described effects including drowsiness and mild dizziness. Treatment should therefore not be regarded as free of side effects. Tell the supervising team immediately if you feel unwell, become dizzy or develop palpitations, breathlessness or pain. You do not have to endure symptoms to achieve a supposed training effect.
An existing condition can change the assessment or make treatment unsuitable. This is particularly true if a heart or lung condition is unstable. Whether treatment is appropriate cannot be decided from an online list alone. Changes in your health between appointments must also be taken into account.
What can you prepare for your consultation?
Please bring your current medication list or medication plan and existing reports relevant to your symptoms to your scheduled appointment at the practice. Note which activities are difficult and what has already been investigated or treated. If you have received an IHHT recommendation elsewhere, the reasoning behind it is helpful.
Also tell us if exertion causes a marked deterioration later, rather than only immediately. This should not lead to blanket advice simply to increase activity. Please do not change prescribed medicines or oxygen therapy yourself to prepare for the appointment.
Your contact and the next steps
Your medical contact for IHHT at OrthoCoast in Wolgast is Priv. Doz. Dr. med. habil. Richard Kasch, a specialist in orthopaedics and trauma surgery. During a consultation, you can discuss an existing recommendation and your expectations.
You do not need to decide about treatment during the appointment. After a recommendation in our own consultation, you can use the agreed follow-up route later. Another consultation is then not needed solely to arrange the appointment. If your symptoms or important medical circumstances have changed in the meantime, please clarify this with us before treatment.
What matters for your decision
How are costs clarified?
First, we discuss the aim, potential benefits, limitations and alternatives. We then address the planned scope of the service and the costs. If you have German statutory health insurance and wish to pay yourself for a service your insurer does not cover, you receive a cost estimate beforehand. We provide the service only after you have confirmed in writing that you wish to have the treatment and will cover the costs.
If you are privately insured, reimbursement depends on your individual policy. Before starting, we recommend using a cost estimate to clarify with your insurer which costs will be covered, and obtaining written confirmation if reimbursement is unclear. You are responsible for making these arrangements with your insurer. We explain the planned services and expected costs. A medical recommendation or a cost estimate is not a promise of reimbursement by your insurer.
Our doctors in this specialty
Here you can get to know Richard Kasch, who provides IHHT care at our practice. Before treatment, we discuss your questions and goals.
Frequently asked questions
Is IHHT the same as altitude training?
There is a shared principle: the oxygen supply is changed. With IHHT, however, breathing phases with less and more oxygen alternate while you rest. Exercise programmes at altitude are different. Their results cannot automatically be applied to IHHT.
Can IHHT explain my fatigue?
No. IHHT is not an investigation for diagnosing fatigue. Before deciding on treatment, there must be sufficient clarity about the symptoms present and whether another investigation or treatment takes priority.
How many sessions are appropriate?
There is no single number suitable for every patient. The goal, your health, how well you tolerate the treatment and your progress need to be considered together. Before starting, ask when benefit will be reviewed and under what circumstances treatment should be changed or stopped.
Can I drive myself home after treatment?
Please clarify this before the appointment in light of your health circumstances. If you are drowsy, dizzy or otherwise affected afterwards, do not drive yourself. Tell the team before leaving the practice so that the next steps can be agreed.
Your next step
