Located in Hadley, MA
Serving Amherst, Northampton & Western Massachusetts
Hyperbaric Oxygen Therapy: Everything You Need to Know
By Bruce I. Goderez, M.D.
Medical Director, Pioneer Valley Hyperbaric
What Is Hyperbaric Oxygen Therapy?
Hyperbaric Oxygen Therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber. To understand how it works, we need to understand a bit of basic physics and biochemistry.
Most of the oxygen in our blood is tightly bound to hemoglobin. Only a small fraction is dissolved in the serum. An even smaller amount diffuses into our tissues, which means that ordinarily there is only a trace of oxygen in most of our body. Oxygen is absolutely necessary for life, but it is also toxic and damages our tissues. The body has elaborate antioxidant systems to manage this oxidative damage, and we have all heard that it is important to keep our antioxidant vitamins at a good level (Vitamin C, Vitamin E, and others).
HBOT drastically increases the amount of oxygen dissolved in our serum, and therefore in our tissues, triggering a variety of healing processes—but we must remain within certain limits to avoid oxidative damage.
How Does HBOT Work?
An HBOT "dive" consists of a one-hour session in a sealed chamber pressurized to greater than 1.0 atmospheres (ATM), while breathing 100% oxygen. This procedure increases the dissolved oxygen in the blood substantially, which in turn increases the oxygen level in all our tissues.
The elevated oxygen level is broadly and powerfully anti-inflammatory—any condition that involves inflammation will respond at least to some extent. It triggers a number of other healing mechanisms:
• Improves circulation and can stimulate new blood vessel growth into injured areas
• Turns thousands of genes involved in the modulation of inflammation on and off
• Stimulates the immune system
• Mobilizes stem cells to injured areas
• Triggers additional healing processes we don't yet fully understand
It is believed that the pressure also directly triggers healing processes, independent of the elevation in dissolved oxygen.
Mild Hyperbaric Chambers at Pioneer Valley Hyperbaric
There are two types of hyperbaric chambers. At Pioneer Valley Hyperbaric we use only "mild" hyperbaric chambers—soft vinyl chambers that are limited to 1.3 atmospheres (ATM), which is 30% higher than the air pressure at sea-level.
These chambers are pressurized with room air, so you are not in a 100% oxygen environment. This means:
✓ No danger of fire, making treatment very safe
✓ You can take an electronic device into the chamber without danger
✓ Oxygen is extracted from room air by an oxygen concentrator (no oxygen tanks)
✓ Oxygen is delivered through a simple mask like those used routinely in hospitals
Our mild chambers provide effective treatment for many conditions while maintaining maximum safety and comfort.
FDA-Approved and Off-Label Conditions
There are 15 FDA-approved indications for HBOT, including decompression sickness, brain abscess, non-healing wounds, and others. These conditions are generally treated in hard chambers that can go to higher pressures, often in the hospital setting. Insurance will pay for treatment of FDA-approved conditions.
There is a much larger list of non-FDA-approved conditions that tend to get treated in mild HBOT chambers in the outpatient setting, including:
• Traumatic Brain Injury
• Post-Concussion Syndrome
• Musculoskeletal problems
• Chronic infections such as Lyme Disease
• Post-COVID syndromes
• Many others
Some of these conditions have solid evidence justifying the use of HBOT; others are based primarily on clinical experience.
HBOT is regulated by the FDA in the same way that it regulates medications, which means that physicians may prescribe it for non-approved "off-label" conditions just as we may use medications off-label. This is allowed since HBOT is quite safe if basic protocols are followed.
Safety Considerations and Potential Side Effects
COPD (Absolute Contraindication)
The only absolute contraindication which makes it impossible to do HBOT is Chronic Obstructive Pulmonary Disease (COPD). People with this condition may suffer serious lung damage when coming out of an HBOT session. Patients with any significant lung injury or progressive disease should be cleared for HBOT by a pulmonologist. Mild asthma is generally not a problem.
Barotrauma (Ear Pressure)
As you start an HBOT dive, the pressure in the chamber increases over the space of a few minutes from 1.0 ATM (sea-level) to 1.3 ATM. That is an increase of about 1/3 of an atmosphere, about the same change in magnitude that we experience when an airplane at cruising altitude lands.
There may be discomfort similar to what might occur in a landing aircraft, requiring yawning, swallowing, or chewing gum to help equalize the pressure in the middle ear. If there is a serious problem equalizing middle-ear pressure, it is possible to injure or even perforate an eardrum.
A cold or allergy can make it harder to equalize the pressure, and some people may need to take pseudoephedrine (Sudafed) or an antihistamine before a dive. The rate of increase in pressure can be controlled by the person in the chamber or by an attendant, so if any discomfort occurs it is possible to stop the increase in pressure or lower it if needed while waiting for the ear pressure to equalize.
Claustrophobia
People with a tendency to claustrophobia may have difficulty, particularly with a smaller chamber. If being able to do HBOT is critical, it is possible to take anti-anxiety medications such as Ativan prior to a dive.
We must keep these warnings in mind, but the vast majority of people can do HBOT with no problem.
Oxidative Stress
Doing a one-hour HBOT dive involves a massive exposure to oxygen, which causes oxidative stress. That is, the oxygen can damage molecules in our body, including fat and protein. The body has antioxidant systems that protect the tissues and repair the damage.
During and after an HBOT dive, the body's reparative mechanisms ramp up to manage the oxidative assault, and the stimulation of our antioxidant systems by HBOT turns out to be one of the mechanisms that promotes healing. It is important not to exceed the body's capacity to prevent and repair oxidative damage.
Recommended Antioxidant Supplements During Treatment
We recommend taking antioxidant supplements while doing intensive HBOT treatment, particularly when doing many dives in a relatively short period of time. Following is a list of basic products—in addition to antioxidants we have included a multivitamin and fish oil as a prudent addition:
• Vitamin C: at least 1,000 mg twice daily
• Alpha lipoic acid: 250 mg once daily
• NAC (N-Acetyl Cysteine): 600 mg daily
• Curcumin: 500 mg daily
• Multivitamin: a broad spectrum product with all the trace minerals
• Fish Oil: At least 2,000 mg daily
*Note: Occasionally, usually after a large number of treatments, myopia (near-sightedness) may develop. This is usually reversible when treatment is discontinued.*
Treatment Protocols
Length of Sessions
Usually about one hour per session, up to 1½ hours in certain situations.
Some patients, particularly those with chronic infections such as Lyme Disease, may experience an exacerbation of symptoms after each dive, which may be a form of Herxheimer (die-off) reaction. If there seems to be an exacerbation of symptoms after a full dive, start with less time and work up as tolerated.
Chronic fatigue patients seem to be particularly sensitive and may have to start with pressure-only (no supplemental oxygen) and short dives, and work up as tolerated. Traumatic Brain Injury patients generally have no problem tolerating treatment.
Frequency of Dives
For most conditions we recommend daily 1-hour dives. The basic principle is that there is a cumulative benefit—that is, doing one dive per day for 5 days is more valuable than doing one dive per week for 5 weeks, even though the total time in the chamber is the same.
In some situations, two sessions daily may be recommended for periods of time. If so, they should be separated by at least 6 hours. However, take one day off per week. This is one of the precautions to avoid oxidative damage.
If logistics do not allow daily sessions, make an effort not to miss more than two days in a row. If you have to miss more time, just resume the protocol when you can.
Maintenance Treatment
In conditions that may respond to HBOT, but which will continue to progress over time—such as multiple sclerosis or chronic immune problems—it may be advisable to continue HBOT on a maintenance schedule after completing the initial block(s) of treatment. This would usually be 1-2 dives per week. This should be determined in consultation with your supervising physician.
Number of Dives
The standard protocol for Traumatic Brain Injury and many other conditions is a block of 40 dives as close together as possible, with the precautions mentioned above. Recommendations may vary depending on the condition being treated.
If a second block of treatments is recommended, take a break of one month between blocks. If the condition begins to deteriorate during that month, you may resume treatment after two weeks, but no sooner. When accumulating large numbers of dives in a relatively short period, it is particularly important to take antioxidant supplements.
In severe or progressive conditions, it may be necessary to do further blocks of treatment to reach maximum benefit. Alternatively, a maintenance schedule of HBOT treatments 1-2 times weekly might be appropriate. Anything beyond the first two blocks of 40 sessions should be done only in consultation with an experienced physician.
Acute Concussion Protocol
If a patient has a new concussion with actively evolving post-concussion symptoms and is fortunate enough to have access to a chamber, it is possible to reverse the symptoms and actually prevent most of the damage by immediately starting HBOT treatments.
The acute symptoms will usually be reduced after even one dive. If they start to worsen over the next hours or days, do another dive. When the symptoms no longer recur, do one more dive, at which point treatment is complete.