Can Hyperbaric Oxygen Therapy Help Long COVID?

The 60 minutes Noral Lieberman spent in her hyperbaric oxygen chamber were rejuvenating.

Since developing long COVID in March 2020, Lieberman has experienced a range of life-altering symptoms like fatigue, trouble breathing, and cognitive impairments. Up until last August, she found no meaningful ways to improve her condition other than pacing her activity levels and being mindful not to exert too much energy.

Hyperbaric oxygen therapy was different, she said. She could feel the difference.

“I could breathe better, both in the chamber and after my sessions,” Lieberman told Verywell. “Right away, I knew this was helping me.”

Lieberman said she exited each session with a big smile on her face and an anxious excitement for her next appointment. But because the treatments can be pricey and difficult to access, her experience was short-lived.

What Is Hyperbaric Oxygen Therapy?

Hyperbaric oxygen therapy is a treatment in which patients breathe 100% oxygen, compared to the 21% oxygen we breathe normally from the air. Patients must wear an oxygen mask in a special chamber, which is usually shaped like a long tube or small airplane.

Throughout a session, patients may take a break to breathe normally every 20 minutes. During this drop in pressure, the patient experiences what researchers call the Hyperoxic-Hypoxic Paradox. The brain interprets the drop in pressure as a lack of oxygen, and emulates the physiological response to hypoxia, or lack of oxygen.

Typically—outside of a hyperbaric chamber—the brain signals for an increase in heart rate and breathing rate during hypoxia, and constricts blood vessels in the lungs. This allows for the body to optimize its use of available oxygen.

But when the brain initiates these signals when oxygen is abundant, like in a hyperbaric chamber, the lungs can expand their oxygen intake substantially. Ultimately, this can contribute to healing within tissues and improved breathing.

“We are increasing the brain’s capacity to repair,” Shai Efrati, MD, director of the world-leading Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center in Israel, told Verywell. “We are increasing the stem cells in the brain, improving the metabolism and mitochondria in the brain, and introducing a generation of new blood vessels in brain regions that need it the most.”

Why Does It Help Long Covid?

Efrati coauthored a recent study in Israel that evaluated the benefits of hyperbaric oxygen for patients with long COVID. The randomized controlled trial found that people who received the treatment experienced notable cognitive improvements, reduced psychiatric symptoms like depression and anxiety, and reduced feelings of pain and fatigue.

“For the first time, we have a treatment that is proven in a well controlled study that can repair the damaged tissue caused by COVID,” Efrati said.

For the study, 73 patients were randomized to receive either hyperbaric oxygen therapy or sham therapy for a total of 40 sessions, once a day, five days a week. Though the study ended in December, Efrati said participants seem to be maintaining the benefits.

Efrati compares long COVID’s impact on the brain to a wound that needs to recover. Wound recovery is gradual, and most don’t heal within a day. But, once the wound heals, “that’s it,” he added. “There is no need for additional treatment.”

Still, whether or not study participants will maintain benefits forever has yet to be seen. And, if hyperbaric oxygen therapy is widely approved for long COVID, some people could need more than 40 treatments depending on their individual situation, he said.

Breathing Better Can Be Expensive

Lieberman received hyperbaric oxygen treatment at a center called Restore Hyper Wellness, in the suburbs of Richmond, Virginia. Her treatment was paired with light therapy and cryotherapy, which were not part of the Israeli study.

For Lieberman, the treatment was more than just temporary relief. Benefits seemed to build upon each other after each appointment.

“It’s chaos to not know what’s happening inside,” Lieberman said. “When something works even a little bit, you come back for more.”

But she couldn’t come forever. After about two months and 12 sessions, Lieberman moved out of Richmond, relocating to Washington, D.C., where distance and financial barriers blocked her from completing further hyperbaric treatments.

“I would have kept going indefinitely,” Lieberman said. “But I don’t have access to the treatment anymore. I don’t have a car, and even if I did, I cannot drive because my cognition has been affected so much.”

She said she could not find a hyperbaric treatment provider anywhere in the D.C. area.

In Richmond, Lieberman paid about $500 a month for the treatments, which covered a package of visits. She did not use insurance and paid completely out of pocket.

Peter Staats, MD, MBA, medical advisor for COVID advocacy group Survivor Corps and president of the World Institute of Pain wrote in an email to Verywell that he sees the treatment as promising only if it can be provided in a financially viable way for the millions of long COVID patients who may need it.

Efrati did not comment on the cost of the treatment, though said that costs likely vary greatly across countries. The cost of hyperbaric oxygen therapy in Israel, where the study was conducted, would be different than in the U.S.

Cost Isn’t the Only Limitation of Hyperbaric Oxygen Therapy

Using hyperbaric oxygen therapy as a treatment for long COVID is a new idea and relatively understudied. According to Efrati, the main limitation to his study was that it was the first.

“Even though the results are very good, we always need some more data to characterize what is the exact protocol that will be best for any specific individual,” he said.

Further, not all hyperbaric oxygen therapy providers use chambers that are as robust as the ones used in the study. Efrati describes his study’s chambers as small airplane-sized structures that fit about 12 people. It is important to get treatment from a vetted, qualified provider that offers a chamber of similar size and criteria, he said.

Due to her ongoing financial and locational restraints, Lieberman doesn’t see herself returning to hyperbaric oxygen therapy anytime soon. But she is thankful for the opportunity to have tried it, and for the positive impact she feels it has had on her long COVID recovery.

She still experiences range of symptoms, but is now able to hold a job and do more daily activities. She does not credit all her progress to the therapy, though she said it made a noticeable impact.

“I really value that time that I had getting those treatments last summer, and I credit a lot of my long-term improvement to having access,” Lieberman said. “I’m focusing on gratitude and taking things one day at a time. But overall, I’m trending better.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.