By Patrick Ussher
https://www.patrickussher.com/
Video transcript:
I am starting a new therapy for my ME/CFS and I have to say that I am optimistic about it. It’s called intermittent hypoxic hyperoxic therapy (IHHT). I know that’s a bit of a mouthful, but it’s a therapy which I believe makes sense for ME/CFS. If you can successfully adapt to this therapy, your baseline stamina should improve, your post-exertional malaise threshold should improve, you should have fewer crashes, and be able to live a more active life safely.
In today’s post, I’ll explain more about this therapy:
- The principles that underpin it
- Why it might help ME/CFS
- My hopes for what I might gain
Who I Am
My name is Patrick Usher and I am the author of Understanding ME/CFS and Strategies for Healing. In the book, I break down some of the latest research into ME/CFS and Long COVID, and discuss treatment strategies I have tried to improve my own quality of life. You can find links to the book and a free sample chapter below.
Why IHHT?
Recently I traveled to Romania for 60 sessions of hyperbaric oxygen treatment. Sadly, that was a disappointment and didn’t lead to improvement. Nevertheless, I am moving on to the next treatment.
IHHT has not yet been studied in ME/CFS, but there is one paper that looked into it for Long COVID. I will make another post on that study. Despite the lack of direct research, there is a stronger rationale for IHHT than for hyperbaric oxygen.
ME/CFS involves:
- Reduced oxygenation capacity in the body
- Lowered anaerobic threshold
- Poor stamina
- Cellular and mitochondrial issues
All of this reduces exercise capacity and makes recovery from activity difficult. If a therapy could change the baseline functioning of these problems, it could help reduce crashes, allow for more safe activity, and support healing.
Principles of IHHT
IHT is based on physiological adaptations seen in people living at high altitude. At sea level, oxygen is about 21%. In the Swiss Alps at 1,500–3,000 m, it drops to 15–14%. Higher up—5,000–6,000 m—it can fall to 10%.
When people live at altitude, the body adapts:
- More red blood cells are produced to carry oxygen
- Oxygenation capacity increases
- Blood vessels dilate and new capillaries form
IHHT mimics these effects without having to live on a mountain.
How It Works
IHT involves breathing through a mask in cycles:
- Low oxygen (hypoxic) for several minutes
- High oxygen (hyperoxic) for several minutes
A session lasts 30–60 minutes. The goal is to adapt to breathing oxygen concentrations as low as 10–12%, equivalent to being on Mount Kilimanjaro. Therapy often begins more gently, at around 15% (about 3,000 m).
The hyperoxic recovery periods (e.g., 30% oxygen) may enhance antioxidant production at the cellular level. The result is improved baseline stamina and anaerobic threshold, allowing for more activity with fewer crashes.
Addressing Concerns
Some might argue that 30–40 minutes of hypoxic air is not the same as living at altitude. However, the therapy allows very low oxygen levels, far lower than most people would actually live at. This “dose” can make the effect significant despite the short duration.
Scientific Support
Rosalba Courtney, a breathing instructor in Australia, describes IHHT as increasing the efficiency of oxygen uptake, transport, and utilization. Reported adaptations include:
- Stimulation of heart and lung function
- Growth of new capillaries
- Increases in red blood cells, hemoglobin, and myoglobin
- Enhanced mitochondrial function
All of these point toward improved stamina and reduced need for oxygen during normal activity.
My Hopes
For me, stamina is the key issue. It is the capacity that allows for independent living. I can manage short stretches but daily activities still often lead to crashes. A therapy that reduces these down periods would make a huge difference.
Even if IHHT does not provide permanent change, at-home devices may allow long-term adaptation. While expensive (often €15–20,000), I have found some more affordable options, such as from Hearn Balance or suppliers in China.
Next Steps
I am beginning therapy in a clinic in Bucharest. I plan to do as many sessions as my body tolerates over the next couple of months. If I respond well, I will invest in a home device and continue through the winter.
Russian doctor Arcadi Prokopov has recommended about 8 months of therapy for chronic Lyme patients, which may also apply to ME/CFS.
I will keep you updated on my progress. Expect follow-up posts after one month, two months, and beyond. I also plan to bring in expert interviews and patient experiences.