Hyperbaric Oxygen Therapy: Benefits, Evidence, and What to Expect

The benefits of hyperbaric oxygen therapy (HBOT) are best established for the conditions it was built for: carbon monoxide poisoning, decompression sickness, delayed radiation injury and selected non-healing wounds such as diabetic foot ulcers, which the Undersea and Hyperbaric Medical Society (UHMS) lists among its 14 recognized indications. Breathing near 100% oxygen at 2.0 to 3.0 atmospheres absolute (ATA) raises the oxygen dissolved in plasma roughly 10 to 15 times, but for off-label uses such as brain injury, stroke and long COVID the trials are small, sham-controlled results are mixed, and most treatment is cash pay.

What Is Hyperbaric Oxygen Therapy?

Hyperbaric oxygen therapy (HBOT, also written HBO2 or HBO therapy) involves breathing pure or concentrated oxygen inside a pressurized chamber. The word “hyperbaric” simply means “higher than normal pressure.” During a session, the atmospheric pressure inside the chamber is raised to 1.3 to 3.0 times normal sea-level pressure, and you breathe close to 100% oxygen for a set period, typically 60 to 90 minutes [1].

The concept isn’t new. Compressed air therapy dates back to the 1600s, and physicians began using pressurized oxygen for decompression sickness in the early 1900s. What has changed is the breadth of clinical applications. Over the past two decades, research into HBOT has expanded well beyond diving medicine into wound care, neurology, immunology, and sports performance [2].

Today HBOT is delivered in hospital wound care centers, emergency and diving medicine units, and a growing number of outpatient and wellness clinics. The hyperbaric oxygen therapy treatment guide covers the basics in brief, and the national directory of HBOT clinics lists providers by state and city.

How Pressurized Oxygen Works: Henry’s Law in Action

Under normal conditions, nearly all the oxygen in your blood is bound to hemoglobin inside red blood cells. Hemoglobin is already about 97% saturated at sea level, so simply breathing more oxygen at normal pressure doesn’t increase delivery much. Pressure is what changes the equation.

Henry’s law states that the amount of gas dissolved in a liquid is directly proportional to the pressure of that gas above the liquid. When you increase atmospheric pressure inside a hyperbaric chamber, oxygen dissolves directly into your blood plasma, cerebrospinal fluid, lymph, and interstitial fluids, bypassing hemoglobin entirely [3].

At 2.0 ATA breathing 100% oxygen, the dissolved oxygen in plasma increases roughly 10-fold. At 3.0 ATA, it can increase 15-fold or more. This dissolved oxygen can reach areas with compromised blood flow, swollen tissues, or damaged capillaries where red blood cells simply cannot go [3].

This is also why HBOT differs from breathing extra oxygen through a nasal cannula or mask at normal pressure, which is called normobaric oxygen. The comparison of HBOT and normobaric oxygen therapy explains where each one fits.

This mechanism produces several downstream effects:

• Angiogenesis: the growth of new blood vessels into hypoxic tissue [4]
• Reduced edema through vasoconstriction that paradoxically still increases oxygen delivery
• Enhanced white blood cell function, improving the body’s ability to fight infection [5]
• Upregulation of stem cell mobilization from bone marrow [6]
• Reduced inflammatory cytokines and suppression of NF-kB signaling [7]

Most of these effects were measured in laboratory, animal or small human studies. They explain why HBOT helps in established indications such as wound healing and infection, and they are the rationale, not the proof, for many off-label uses.

What are the benefits of hyperbaric oxygen therapy?

The main benefits of hyperbaric oxygen therapy are faster healing of oxygen-starved tissue, stronger infection control and the removal of gas bubbles or carbon monoxide from the blood. The strength of evidence depends on the condition. It is strongest for the UHMS-recognized indications and thinnest for wellness and anti-aging uses.

The table below summarizes each use, its regulatory status and the evidence behind it, using the studies cited throughout this page.

A useful rule of thumb follows from the table. When a condition is on the UHMS list, hospital-based care and insurance coverage are the norm. When it is not, HBOT is usually cash pay, the evidence comes from a handful of trials, and a careful provider will say so plainly.

FDA-Approved Conditions

The FDA regulates hyperbaric chambers as medical devices and clears them for specific uses, while the Undersea and Hyperbaric Medical Society (UHMS), the main professional body for hyperbaric medicine, publishes the list of indications it considers supported by evidence. The UHMS currently recognizes 14 indications for HBOT [8]:

• Air or gas embolism
• Carbon monoxide poisoning
• Gas gangrene (clostridial myositis and myonecrosis)
• Crush injuries, compartment syndrome, and acute traumatic ischemia
• Decompression sickness (the bends)
• Arterial insufficiencies: central retinal artery occlusion and selected problem wounds, including diabetic foot ulcers
• Severe anemia when transfusion is not possible
• Intracranial abscess
• Necrotizing soft tissue infections
• Refractory osteomyelitis
• Delayed radiation injury (soft tissue and bone)
• Compromised skin grafts and flaps
• Thermal burn injuries
• Idiopathic sudden sensorineural hearing loss

The FDA’s consumer update, Hyperbaric Oxygen Therapy: Get the Facts, lists a closely matching set of cleared uses and states that the agency has not cleared HBOT for COVID-19 or for conditions beyond that list [19]. The FDA has also warned that some centers promote HBOT for uncleared uses such as cancer, Lyme disease, autism and Alzheimer’s disease, and it advises patients to seek treatment at a facility accredited by the UHMS.

Of these indications, wound healing is one of the most common reasons people are referred. HBOT has become a standard adjunctive therapy in many hospital wound care centers, where it is added to debridement, offloading and infection control rather than used alone. A Cochrane review by Kranke and colleagues (2015) found that HBOT increased the rate of diabetic foot ulcer healing at 6 weeks, but the benefit was not evident at 1 year, and the authors rated the trials as flawed [9]. The guide to HBOT for wound healing covers that evidence in more depth.

Emergency indications are handled differently. People with severe carbon monoxide poisoning, decompression sickness or serious burns are treated in hospital chambers through the emergency system, not booked into an outpatient clinic. A full walk-through of each cleared use is in the guide to FDA-cleared indications for HBOT.

Off-Label Uses With Growing Evidence

Off-label means a use outside the UHMS list and the FDA-cleared uses. A physician can legally offer HBOT for these conditions, but insurers rarely pay, and the evidence comes mostly from small trials run by a few research groups.

Traumatic Brain Injury and Concussion

HBOT for brain injury is one of the most actively researched off-label applications. The rationale is that brain tissue damaged by trauma can develop chronic hypoxia and neuroinflammation that persists long after the initial injury. By raising dissolved oxygen in these regions, HBOT is thought to reactivate stunned neurons and stimulate repair mechanisms [10].

A 2013 randomized crossover trial by Boussi-Gross and colleagues treated 56 people with persistent post-concussion syndrome 1 to 5 years after a mild traumatic brain injury. After 40 sessions at 1.5 ATA, both groups showed significant improvements in cognitive function and quality of life, while no change was seen during the untreated control period. Brain SPECT imaging showed increased activity in previously hypoperfused regions [10].

Military research has produced mixed results. A phase I study by Harch and colleagues (2012) gave 16 service members with blast-induced post-concussion syndrome 40 sessions at 1.5 ATA and reported improvements in symptoms, PTSD scores and cognitive testing, but the study had no control group [11]. A larger double-blind trial in 72 service members, published by Miller and colleagues in JAMA Internal Medicine (2015), found that HBOT at 1.5 ATA showed no benefit over sham compressions, and both chamber groups improved more than usual care alone [18].

That split explains much of the debate about brain injury protocols. The comparison of the Efrati and Harch HBOT protocols sets out how the two main research groups differ, and the traumatic brain injury treatment guide covers the wider range of rehabilitation options.

Stroke Recovery

Stroke leaves behind a region of tissue called the ischemic penumbra, where neurons are metabolically impaired but not dead. HBOT research suggests that some of these cells can be reactivated. A 2013 randomized crossover trial by Efrati and colleagues reported improved neurological function and quality of life after 40 sessions of 90 minutes at 2.0 ATA in patients 6 to 36 months after a stroke, well outside the traditional window for stroke recovery [12]. The trial compared treatment with a no-treatment period rather than a sham, so a placebo effect cannot be ruled out.

Long COVID

One of the more recent applications involves long COVID, particularly cognitive symptoms, fatigue, and exercise intolerance. A 2022 randomized, double-blind, sham-controlled trial from Israel by Zilberman-Itskovich and colleagues randomized 73 patients to 40 sessions of HBOT at 2.0 ATA or sham. The HBOT group improved more in global cognitive function, attention, energy, sleep, psychiatric symptoms and pain interference, and brain MRI showed increased perfusion in regions associated with those improvements [13].

The proposed mechanism involves reversing endothelial dysfunction and microclot formation, both of which may contribute to tissue hypoxia in long COVID. That mechanism has not been confirmed, the FDA has not cleared HBOT for COVID-19 or its after-effects [19], and larger independent trials are still needed. The overview of HBOT for long COVID and the long COVID treatment guide cover the other options people combine it with.

Sports Recovery and Performance

Professional athletes have used HBOT for years to speed recovery from soft tissue injuries, fractures, and post-surgical healing. The evidence here is less robust than in wound care or brain injury research, and the mechanisms, enhanced oxygen delivery, reduced edema and collagen synthesis, are stronger than the clinical data.

A review by Babul and Rhodes in Sports Medicine (2000) noted that teams in the NHL, NFL, NBA and MLS use HBOT as an adjunct for sports injuries, yet very little had been published on its benefits, and most clinical studies of soft tissue injury were limited in sample size and design [14]. Athletes weighing it can compare the data in the guide to HBOT for athletes.

Anti-Aging and Telomere Biology

A widely cited 2020 study by Hachmo and colleagues gave 35 healthy adults aged 64 and older 60 daily HBOT sessions and measured their blood cells before and after. Telomere length in T helper, T cytotoxic, natural killer and B cells increased by over 20%, and the share of senescent T helper cells fell by about 37% [15].

The study had no control group, measured blood cells rather than health outcomes, and several authors reported ties to a commercial HBOT company. Longer telomeres in blood cells have not been shown to extend lifespan or prevent age-related disease, so this remains an early research finding rather than a treatment benefit.

What a Session Looks Like

A typical HBOT session includes 60 to 90 minutes at treatment pressure plus time to pressurize and depressurize. If you’ve never been inside a hyperbaric chamber, here’s what to expect.

You’ll arrive at the clinic wearing comfortable, 100% cotton clothing, or change into a cotton gown the facility provides. No electronics, lighters, hair products, or petroleum-based lotions are allowed inside the chamber because of the elevated oxygen environment. The technician or attending physician will review your medical history and check your ears for any conditions that might impair pressure equalization.

There are two main types of medical chambers, plus a lower-pressure soft chamber used outside hospitals:

Monoplace (Single-Person) Chambers

These are clear acrylic tubes that fit one person. You lie down, and the entire chamber is pressurized with oxygen. Most hospital-based wound care programs use monoplace chambers at pressures between 2.0 and 2.4 ATA.

Multiplace Chambers

These are large, room-like chambers that can accommodate multiple patients plus a technician. Patients breathe oxygen through a hood or mask while the chamber is pressurized with compressed air. Military, hospital and research facilities often use multiplace chambers, and they suit people who feel claustrophobic in a tube.

Mild Hyperbaric Chambers (Soft Chambers)

Mild hyperbaric chambers are portable, inflatable chambers that operate at lower pressures, typically 1.3 to 1.5 ATA. They are often used in wellness clinics and home settings. They cannot reach the pressures of medical-grade hard chambers, and they typically use oxygen concentrators rather than 100% oxygen, so the effective oxygen delivery is lower.

The UHMS describes mild hyperbaric treatment as unproven and states that its 14 recognized indications should be treated in hard chambers at 2.0 ATA or more. The brain injury study often cited for lower-pressure HBOT, a multicenter observational project reported by Mozayeni and colleagues (2019), actually used 1.5 ATA with 100% oxygen and had no control group [16]. The guide to mild HBOT versus clinical HBOT compares the two in detail.

During the Session

A standard session runs in three phases:

1. Descent: pressure rises gradually over 5 to 10 minutes while you clear your ears.
2. Treatment: you rest at the prescribed pressure for 60 to 90 minutes, sometimes with short air breaks.
3. Ascent: the chamber depressurizes over 5 to 10 minutes before the door opens.

During descent you may feel fullness or pressure in your ears, similar to flying or scuba diving. Techniques like swallowing, yawning, or the Valsalva maneuver (gently blowing against pinched nostrils) help equalize the pressure.

Once at treatment pressure, you simply rest. Many patients read, listen to audiobooks, or sleep. The treatment phase lasts 60 to 90 minutes, depending on the protocol. Finally, the chamber gradually depressurizes over 5 to 10 minutes during “ascent.”

Most people describe the experience as relaxing. The most common sensation is warmth during pressurization and slight cooling during depressurization. Many people drive themselves home and return to normal activity the same day.

Protocols: How Many Sessions Do You Need?

The number of HBOT sessions depends entirely on the condition being treated. Published protocols range from a single emergency treatment to 60 daily sessions:

• Wound healing: 20 to 40 sessions at 2.0 to 2.4 ATA, typically 5 days per week [9]
• TBI/concussion: 40 sessions at 1.5 ATA in the main trials, with some programs using up to 60 sessions at 1.5 to 2.0 ATA, 5 days per week [10]
• Long COVID: 40 sessions at 2.0 ATA, 5 days per week [13]
• Sports recovery: 10 to 20 sessions at 1.5 to 2.0 ATA, or acute sessions post-injury
• General wellness/anti-aging: 60 sessions at 2.0 ATA for the telomere protocol [15], with ongoing maintenance sessions varying by provider

Some people notice changes within 10 to 15 sessions. Neurological protocols are usually planned as 40 sessions or more because the trials measured outcomes after the full course, not partway through. A provider should explain at the start how progress will be measured and when the plan will be reviewed.

Emergency indications such as carbon monoxide poisoning and decompression sickness follow separate treatment tables and may need only one to a few sessions. The UHMS indications manual describes clinical HBOT as treatment at not less than 2.0 ATA for typically 90 to 120 minutes per session.

Risks and Side Effects

HBOT has a strong safety profile when administered by trained operators within established protocols. The most common side effect is ear discomfort from pressure changes, and serious complications are rare.

Common side effects:

• Middle ear barotrauma (ear pressure or pain), the most frequent complaint: in Plafki and colleagues’ series of 782 patients, more than 17% reported ear pain or discomfort and 3.8% had barotrauma confirmed on ear examination [17]
• Sinus pressure or congestion
• Temporary nearsightedness (myopic shift), which usually resolves in the weeks after completing treatment
• Mild fatigue after sessions, particularly early in a treatment course

Rare but serious risks:

• Oxygen toxicity seizures, which are rare at clinical pressures: the same series recorded 4 seizures in 11,376 sessions at 2.4 to 2.5 ATA, with no recurrences or lasting effects [17]
• Pulmonary barotrauma (lung injury from pressure), almost exclusively seen in patients with untreated air trapping conditions like bullous emphysema
• Claustrophobia in monoplace chambers, manageable with mild anxiolytics or the use of multiplace chambers
• Fire, because pure oxygen makes materials burn more readily, which is why facilities ban electronics, lighters and many cosmetics

Who should not have HBOT?

An untreated pneumothorax is the main absolute reason not to have HBOT. Other conditions call for a physician’s review before treatment starts.

Contraindications include:

• Untreated pneumothorax (collapsed lung)
• Certain chemotherapy agents (some, like doxorubicin and cisplatin, may interact with high-oxygen environments), and disulfiram
• Uncontrolled high fevers
• Severe congestive heart failure

People with ear or sinus problems, recent ear surgery, poorly controlled seizures or pregnancy should discuss timing with the hyperbaric physician. The full list of hyperbaric chamber side effects covers how each is managed.

Does insurance cover HBOT, and what does it cost?

Insurance usually covers HBOT only for recognized indications, and off-label HBOT is almost always cash pay. Medicare’s national coverage determination for hyperbaric oxygen therapy (NCD 20.29) lists covered conditions, including diabetic lower extremity wounds of Wagner grade III or higher that have not improved after 30 days of standard wound care [20].

Private insurers generally follow the UHMS list and require prior authorization. Coverage for brain injury, stroke, long COVID, sports recovery or anti-aging is rare, so ask for the full course price in writing before starting.

Cost depends on chamber type, pressure, region and the number of sessions in the plan. Hospital hard-chamber treatment billed to insurance is priced differently from outpatient soft-chamber sessions. Current ranges by setting are in the guide to HBOT cost, with state comparisons in HBOT cost by state.

How to Choose a Provider

A good HBOT provider has a physician trained in hyperbaric medicine, a chamber suited to your condition and a protocol it can back with research. When evaluating a provider, consider:

• Medical oversight: Is there a physician trained in hyperbaric medicine on staff? Look for board certification in Undersea and Hyperbaric Medicine, a subspecialty offered through the American Board of Preventive Medicine and the American Board of Emergency Medicine, and for technicians certified as Certified Hyperbaric Technologists (CHT).
• Facility accreditation: The FDA advises getting treatment at a facility inspected and accredited by the UHMS [19].
• Chamber type: For FDA-cleared indications and most off-label neurological protocols, you need a hard-shell chamber capable of reaching at least 2.0 ATA.
• Protocol knowledge: Ask about the specific pressure, duration, and number of sessions they recommend for your condition. Providers should be able to cite the research behind their protocol choices and say plainly when the evidence is thin.
• Safety systems: The facility should have fire suppression systems, continuous monitoring, and emergency depressurization capabilities.

Referrals usually come from wound care specialists, emergency physicians, neurologists or primary care doctors. If you are comparing outpatient options, the directory of hyperbaric oxygen therapy clinics shows providers by state and city. Regenerated.com is free for patients, listing order is not paid ranking, Featured slots are labeled and capped, and Verified means credential checks, not spend. Inclusion in the directory is not an endorsement, and the guide to Featured, Verified and organic listings explains each label.

The Bottom Line

HBOT is one of the few therapies with both a long clinical track record and an expanding evidence base. For UHMS-recognized indications like decompression sickness, carbon monoxide poisoning, radiation injury and selected diabetic foot ulcers, it is established hospital care and insurance typically covers treatment. For off-label applications like TBI, stroke, and long COVID, a small number of trials report gains, sham-controlled results are mixed, and coverage is rare.

The mechanism is simple: deliver more oxygen to tissues that need it, so the body’s own repair systems can work. Whether that translates into a meaningful benefit depends on the condition, the pressure, the number of sessions and the quality of the facility, so the questions in the provider section matter as much as the chamber itself.

Frequently asked questions

What are the main benefits of hyperbaric oxygen therapy?

The main benefits of hyperbaric oxygen therapy are faster healing of oxygen-starved tissue, better infection control and rapid treatment of decompression sickness, gas embolism and carbon monoxide poisoning. Breathing near 100% oxygen at 2.0 to 3.0 ATA raises dissolved oxygen in plasma roughly 10 to 15 times. Evidence is strongest for the 14 UHMS-recognized indications. Reported benefits for brain injury, stroke, long COVID and aging come from small trials and are not yet settled.

Is hyperbaric oxygen therapy FDA approved?

The FDA clears hyperbaric chambers as medical devices for a specific list of conditions, including decompression sickness, carbon monoxide poisoning, non-healing diabetic wounds, radiation injury, severe burns and sudden hearing loss. It has not cleared HBOT for COVID-19, cancer, Lyme disease, autism or Alzheimer’s disease, and it has warned about centers that promote those uses. Physicians can still offer off-label HBOT, but it is usually cash pay.

How many HBOT sessions do you need to see results?

Most HBOT courses run 20 to 60 sessions, usually 5 days per week. Diabetic wound protocols typically use 20 to 40 sessions at 2.0 to 2.4 ATA, and the main brain injury and long COVID trials used 40 sessions. Emergency uses such as carbon monoxide poisoning may need only one to a few treatments. Some people notice changes within 10 to 15 sessions, but trial results were measured after the full course.

Does insurance cover hyperbaric oxygen therapy?

Insurance usually covers hyperbaric oxygen therapy only for recognized indications. Medicare’s coverage policy, NCD 20.29, includes conditions such as Wagner grade III or higher diabetic foot wounds that have not healed after 30 days of standard care, and private insurers generally follow the UHMS list with prior authorization. Off-label uses such as brain injury, long COVID, sports recovery and anti-aging are almost always paid out of pocket.

Is a mild hyperbaric chamber as effective as a hard chamber?

A mild hyperbaric chamber is not equivalent to a hard chamber. Soft chambers usually reach 1.3 to 1.5 ATA and use an oxygen concentrator rather than 100% oxygen, so they deliver far less oxygen. The UHMS calls mild hyperbaric treatment unproven and says its recognized indications should be treated in hard chambers at 2.0 ATA or more. Mild chambers are mainly used for wellness, where evidence is limited.

What are the side effects of HBOT?

The most common side effect of HBOT is ear discomfort from pressure changes. In a prospective series of 782 patients, more than 17% reported ear pain or discomfort and 3.8% had confirmed ear barotrauma. Other effects include sinus pressure, temporary nearsightedness and fatigue. Oxygen toxicity seizures are rare, with 4 recorded in 11,376 sessions in the same series. An untreated collapsed lung is the main absolute contraindication.

Sources

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