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IHHT - with breathing to more energy?

You may have come across the term IHHT before. Do you know what it is and how it can help you get more energy? Find out more in this article.


IHHT - with breathing to more energy?

Maybe you have heard the term IHHT (Interval Hypoxia Hyperoxia Therapy) before? Maybe you then wondered if IHHT really allows you to lie on the couch completely relaxed and incidentally do something for your energy level?

In this article we will explain to you what IHHT is, how it is performed and what it actually costs. You will learn more about the effects of IHHT and who can use it. Last but not least, you'll get a tip from us on how to best prepare for the therapy.

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Table of Contents
• What is Interval Hypoxia Hyperoxia Therapy (IHHT)?
• IHHT procedure, duration and costs
• How does IHHT work?
• Who can use IHHT?
• How can you strengthen your mitochondria?
• Bibliography

What is Interval Hypoxia Hyperoxia Therapy (IHHT)?

Origins of IHHT: IHT and altitude training
Interval Hypoxia Hyperoxia Therapy is also known as Intermittent Hypoxia Hyperoxia Therapy or training. It starts in the area of energy metabolism and is therefore a kind of cell training or oxygen therapy. Central to IHHT are the different oxygen concentrations that are inhaled during the procedure.
To understand the background and the origin of IHHT, it is worthwhile to first take a look at its close relative and predecessor, interval hypoxia training (IHT).

In principle, IHT simulates altitude training at an altitude of about 2,000 meters. There, the air is, as they say, "thinner." This ultimately means that although the air at these altitudes has the same oxygen content as at sea level (20.95%), the air pressure up there is lower. So the higher you go up the mountain, the lower the air pressure and the less oxygen you take in through breathing (lower oxygen partial pressure).

This is noticeable! At airy heights, we find it harder to breathe and move. The resulting lack of oxygen is called hypoxia.
Hypoxia and hyperoxia
Hypoxia is by definition a lack of oxygen in the body and tissues, which leads to various adaptation mechanisms that can have a positive effect on energy supply. However, to induce hypoxia, one does not necessarily have to go to the mountains. One can also simulate it by breathing in a low level of oxygen through a mask. In addition to the phases with moderate hypoxia, in which little oxygen is inhaled, there are also phases in IHT in which oxygen is inhaled in the usual concentration (normoxic phases). Thus, there is alternation between the two phases. Hence the name interval hypoxia training.

IHHT can be seen as a further development of IHT and should lead to a faster recovery after hypoxia1,2. IHHT involves replacing periods of normal oxygenation with periods of high oxygenation. As a result, the patient breathes in more oxygen than usual and the body is supplied with more oxygen than usual. Consequently, exactly the opposite of hypoxia takes place here, namely hyperoxia. As with IHT, IHHT also alternates between the two phases.

IHHT procedure, duration and costs

As already mentioned, you do not have to climb to dizzying heights for IHHT, but you can relax and spend the therapy lying or sitting down. As it is best for you personally.

During an IHHT session, you will wear a breathing mask through which the appropriate amount of oxygen (O2) will be inhaled. Since IHHT is about hypoxia and hyperoxia, you will not breathe in air with the usual oxygen percentage of 20.95% through the breathing mask, but alternately low oxygen air (hypoxia: 9–18% O2) and high oxygen air (hyperoxia: 30–40% O2).
While you lie or sit completely relaxed and breathe in the oxygen via the breathing mask, your heart rate variability (HRV), i.e. the fluctuations in your heart rate, is also measured for observation purposes. In addition, a pulse oximeter is also applied, either on the finger or earlobe.
In addition to heart rate, or pulse, it also measures oxygen saturation (SpO2) in the arterial blood. It indicates how much oxygen is bound to the red blood pigment hemoglobin.

Under normal conditions in everyday life, your SpO2 is about 98%. During hypoxia, when little oxygen is inhaled, IHHT generally aims for an SpO2 of less than 90%. Depending on your health condition, your physical capacity and the available equipment, a range of 80-75% can also be achieved. During the following hypoxia, the phase with a lot of oxygen, values above the usual 98 % are aimed for. Accordingly 98-100 %.
A hypoxia phase of 5 to 7 minutes is always followed by a hyperoxia phase. It is somewhat shorter at 2 to 4 minutes. The cycle of hypoxia-hyperoxia is repeated 3 to 5 times in total.

The duration of a single IHHT session depends on the length of the individual phases and the number of cycles. It is always possible to adjust it to your individual condition. The total length per session therefore varies between 30 and 50 minutes. A total of at least 10 sessions is recommended, although it has proven to be best to have 2 sessions per week.

The cost of IHHT therapy varies significantly. The price depends on the place where the therapy is carried out, on your initial condition, on the goal and therefore also on the total therapy duration. For about 60 € you can already get a trial session in some practices. Further sessions can often be booked as a package of 5 or 10. Here the IHHT costs per session are about 70-100 €.

How does IHHT work?

IHHT can lead to various physical adjustment mechanisms in the longer term. Depending on the mechanism, this can take a few hours, days or even week3.

Regeneration of mitochondria
The focus of IHHT is definitely the mitochondria. What are mitochondria again exactly? Simply explained, mitochondria are the powerhouses of your cells and critical to your energy metabolism. Without them, the supply of energy in the form of adenosine triphosphate (ATP) would be very limited. In some cells with very high energy demands, there are even up to 100,000 mitochondria. You can imagine that if the function of these small cell organelles is limited and they work dysfunctionally, this can lead to enormous impairments in everyday life.

Mitochondria can self-replicate by direct division [4]. Should damage to mitochondrial DNA (mtDNA) occur, mitochondria become dysfunctional. That is, they no longer function properly. When the dysfunctional mitochondria divide, more dysfunctional mitochondria are then created. And that leads to further limitations in your energy supply5.

Damage to your mitochondria may be due to your lifestyle. For example, lack of sleep, poor diet, excess stress, or lack of exercise are all reasons for damaged mitochondria. On the other hand, aspects such as environmental toxins, viral infections, medications, and the normal aging process can also affect mitochondrial function4.

How do you notice that your mitochondria no longer perform what they once could, or actually could? It becomes clear especially with symptoms such as regular and persistent fatigue, low resilience, lack of energy and exhaustion.

But how can IHHT help in the area of mitochondria and energy supply?
IHHT can be seen as a way of mitochondrial therapy. Through the different administration of oxygen, sometimes a little, sometimes a lot, the mitochondria are exposed to stress. Not all mitochondria survive this, but only the well-functioning ones. The dysfunctional mitochondria die as a result. At the same time, this allows new young mitochondria to form1,6,7,8.
Further adaptation mechanisms
The lack of oxygen, i.e., hypoxia, triggers a number of other mechanisms in the body through the regulatory protein HIF (hypoxia-induced factor)3. These adaptations are primarily based on HIF responding to the low oxygen supply to maintain oxygen balance. HIF does this by, first, making more oxygen available by producing more red blood cells that carry oxygen to cells. In addition, new blood vessels are formed through which the blood can flow with oxygen.

Second, HIF also reduces oxygen consumption by switching from oxidative metabolism (oxidative phosphorylation) to other ways of producing energy that do not require oxygen.

Other potential benefits of IHHT may include improvement in the fitness of your cardiovascular system, LDL cholesterol, body fat percentage, cognitive abilities, and your subjective well-being1,5,7,9.

Who can use IHHT?

In a nutshell, almost anyone can use IHHT2. From young to old and from healthy to exhausted. The beauty of intermittent hypoxia-hyperoxia training is that it can be adapted to your ability. The duration and the intensity of the load can be chosen individually. In addition, the therapy is continuously monitored by means of measurements.

Since IHHT is not a sport where you move and sweat, the training can also be a therapeutic approach for various diseases and indications. Examples are burn out, permanent fatigue and lack of energy, chronic diseases and lipometabolic disorders.

Of course, IHHT can also be used to enhance performance in sports10 or, in older age, to improve cognitive performance5,6.

How else can you strengthen your mitochondria?

Like all processes in our bodies, mitochondria require many building blocks in the form of nutrients to function well. In addition to IHHT, a sufficient supply of nutrients would also be important. Because without building blocks, unfortunately, nothing can be built, so also no new energy. We at MITOcare have always paid special attention to the energy powerhouses of our cells. Therefore, you will find a separate category in our store for the support of your mitochondria.

Our product Mitochondria Formula Sport, for example, contains over 40 micronutrients and botanicals, making it a wonderful all-rounder for energy supply11. The product contains numerous vitamins, various amino acids, L-glutathione and more than 10 bioactive plant substances. Coenzyme Q10 and the specially fermented yogurt powder complete the product and make it a special blend that supports you in your athletic performance11.

11 The product Mitochondria Formula Sport contains the substances biotin, thiamine, riboflavin, niacin, pantothenic acid, vitamin B6, vitamin B12, vitamin C, manganese. They contribute to normal energy metabolism.

With bioactive B6 and natural vitamin C, the product PQQ Total contains important building blocks for the energy metabolism12. With 20 mg of PQQ and 20 mg of coenzyme Q10, it also contains vitamin-like compounds that are thus also found directly in the mitochondria.

12 The product PQQ Total contains the vitamin B6 and vitamin C. These contribute to a normal energy metabolism.


1 Afina, A. B., Oleg, S. G., Alexander, A. B., Ines, D., Alexander Yu, S., Nikita, V. V., Denis, S. T., Daria, G. G., Zhang, Y., Chavdar, S. P., Dmitriy, V. G., Elena, A. S., Irina, V. K., & Philippe Yu, K. (2021). The Effects of Intermittent Hypoxic-Hyperoxic Exposures on Lipid Profile and Inflammation in Patients With Metabolic Syndrome. Frontiers in cardiovascular medicine, 8, 700826.

2 Glazachev, O. S. (2013). Optimization of Clinical Application of Interval Hypoxic Training. Biomedical Engineering, 47(3), 134–137.

3 Prabhakar, N. R., & Semenza, G. L. (2015). Oxygen Sensing and Homeostasis. Physiology, 30(5), 340–348.

4 Meyer, J. N., Leuthner, T. C., & Luz, A. L. (2017). Mitochondrial fusion, fission, and mitochondrial toxicity. Toxicology, 391, 42–53.

5 Han, R., Liang, J., & Zhou, B. (2021). Glucose Metabolic Dysfunction in Neurodegenerative Diseases—New Mechanistic Insights and the Potential of Hypoxia as a Prospective Therapy Targeting Metabolic Reprogramming. International Journal of Molecular Sciences, 22(11), 5887.

6 Bayer, U., Likar, R., Pinter, G., Stettner, H., Demschar, S., Trummer, B., Neuwersch, S., Glazachev, O., & Burtscher, M. (2017). Intermittent hypoxic-hyperoxic training on cognitive performance in geriatric patients. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 3(1), 114–122.

7 Serebrovska, T. V., Grib, O. N., Portnichenko, V. I., Serebrovska, Z. O., Egorov, E., & Shatylo, V. B. (2019). Intermittent Hypoxia/Hyperoxia Versus Intermittent Hypoxia/Normoxia: Comparative Study in Prediabetes. High Altitude Medicine & Biology, 20(4), 383–391.

8 Voronina, T., Grechko, N., Shikhlyarova, A., & Bobkova, N. (2017). Intermittent hypoxic training as an effective method of activation therapy. Cardiometry, 10, 93–99.

9 Glazachev, O., Kopylov, P., Susta, D., Dudnik, E., & Zagaynaya, E. (2017). Adaptations following an intermittent hypoxia-hyperoxia training in coronary artery disease patients: A controlled study: Cardiopulmonary and metabolic adaptations after intermittent hypoxia-hyperoxia training. Clinical Cardiology, 40(6), 370–376.

10 Susta, D., Dudnik, E., & Glazachev, O. S. (2017). A programme based on repeated hypoxia–hyperoxia exposure and light exercise enhances performance in athletes with overtraining syndrome: A pilot study. Clinical Physiology and Functional Imaging, 37(3), 276–281.