Why a Seasonal HBOT Reset Week can sustain brain health, energy, and cellular repair

Why a Seasonal HBOT Reset Week can sustain Brain Health, Energy, and Cellular Repair

For many people, completing a Hyperbaric Oxygen Therapy (HBOT) protocol – with 20 sessions as a meaningful first phase and 40–60 sessions as the optimal range for deeper biological remodeling – is truly transformative. Cognitive clarity improves, fatigue fades, sleep deepens, inflammation drops, and many finally feel their system “switch back on.”

But a common question arises:

Do the benefits last forever, or should HBOT be repeated?

The honest answer is that while the initial protocol drives deep biological changes, life stressors, aging, illness, and metabolic pressure accumulate over time. This is why many clinics and researchers now recommend a Seasonal Reset Week - a short, focused series of HBOT sessions performed every 6–12 months - to maintain and reinforce the long-term effects.

This article explains why this approach makes biological sense, how it aligns with published HBOT science, and what a seasonal reset can realistically achieve.

1. What HBOT Actually Does 

During HBOT you breathe 100% oxygen at increased pressure (usually 2.0–2.4 ATA (Atmospheric pressure)). This dramatically raises dissolved oxygen in the bloodstream and triggers hyperoxia-driven cellular signaling.

Across mechanistic and clinical studies, HBOT has been shown to:

Stimulate angiogenesis (new microvascular growth)

Repeated hyperoxia activates HIF-1α and vascular endothelial growth factor, promoting microvascular repair and improved tissue oxygenation. Study 1

Improve mitochondrial function

HBOT supports mitochondrial biogenesis (formation of new mitochondria), which likely leads to enhanced ATP production, particularly in metabolically stressed tissues (Study 2). Study 2

Reduce systemic inflammation

HBOT down-regulates inflammatory cytokines such as IL-1, IL-6, and TNF-α while increasing anti-inflammatory IL-10. Study 3

Enhance neuroplasticity and cognitive performance

HBOT improves cerebral blood flow, structural connectivity, and cognitive function in people with post COVID-19 cognitive symptoms. Study 4

Influence cellular aging

A groundbreaking human trial demonstrated that a 60-session HBOT protocol increased telomere length by 20–30% and reduced senescent T-cells, essentially clearing out "zombie" immune cells that can no longer fight disease but instead cause harmful inflammation. Study 5

Ovarian recovery

Although fertility is not a traditional indication for HBOT, early research shows promising biological effects on “oocyte quality and number, embryo quality, normal fertilization, and available embryo rates” in women with reduced ovarian response, . Study 6

Because most of these changes rely on accumulation, the initial loading phase needs to be long – typically 40–60 sessions.

What we see in our clinic

For many individuals, the first 15–20 sessions correspond to an activation phase, after which the following  benefits are often noticed:

• improved energy
• clearer thinking
• better sleep quality
• reduced brain fog
• greater stress tolerance

Biologically, this early phase supports:

• increased oxygen availability
• initial mitochondrial activation
• short-term anti-inflammatory signaling
  
  

However, the literature suggests that deeper, more durable adaptations, such as new capillary formation, long-lasting neuroplasticity, and stable mitochondrial remodeling tend to emerge with higher cumulative exposure.

This reflects a two-stage biological response:

• Sessions 1–20: Activation phase
  The system is primed. Oxygen delivery improves, metabolic pathways respond, and adaptive processes are initiated.
  
  
• Sessions 21–40+: Remodeling phase
  Structural changes accumulate: microvascular networks expand, brain connectivity reorganizes, mitochondrial efficiency stabilizes, and biological effects become more durable.
  
  

HBOT exhibits a cumulative exposure effect, with therapeutic responses generally increasing as the total number of sessions rises. An initial series of sessions can help initiate oxygen-dependent physiological processes, and subsequent treatment blocks may support continued adaptation, reflecting the ongoing nature of vascular and cellular remodeling.

2. How Long Do HBOT Benefits Last?

While HBOT induces durable biological shifts, studies typically follow patients only for several months.

Long COVID symptoms

A longitudinal follow-up of a randomized controlled trial found that improvements in quality of life, sleep, psychiatric symptoms, pain severity, and pain interference in patients with long COVID seen shortly after a 40-session HBOT protocol remained stable even one year later. Study 7

Telomere/Cellular Aging trial

Telomere lengthening and reduced senescence were still present at follow-up but long-term decay curves were not measured.Study 5

Pain and inflammatory conditions

Some patients in chronic pain studies required a second course months later when symptoms partially returned.Study 8
The implication is clear:

HBOT creates lasting benefits, but they exist within a dynamic biological environment that continues to change with time, stress, aging, and lifestyle.

Thus, a structured maintenance approach is reasonable.

In Research

Most clinical HBOT trials evaluate protocols of 40–60 sessions. Depending on the study, follow-up data are gathered 1-12 months after the last HBOT session.

For example, a randomized controlled study found that a 40-session HBOT protocol led to significant improvements in post-concussion symptoms, cognitive performance (including memory and processing speed), and emotional and behavioral outcomes such as anxiety, depression, PTSD symptoms, sleep quality, and overall quality of life. Notably, these improvements were persistent nearly three months after the final treatment, suggesting a disease-modifying effect rather than a purely transient response. Study 9

Similarly, a longitudinal follow-up of a randomized controlled trial found that improvements in quality of life, sleep, psychiatric symptoms, pain severity, and pain interference seen shortly after a 40-session HBOT protocol remained stable even one year later. Study 7

In clinical practice

In real-world clinical practice, we often see patients undertaking a ~20-session course followed by a longer break. At present, no studies have directly tested a ~20-session course followed by a break and an additional ~20+ sessions. That said, this does not mean that a 20-session program is ineffective.

Across dozens of studies, HBOT consistently induces numerous mechanistic changes as mentioned above. Most of them are known to accumulate with repeated exposure rather than appear all at once. Study 10

A ~20-session course can initiate meaningful physiological change Study 10. While we have no empirical proof yet, there is strong mechanistic evidence that additional sessions - even after a break - likely build upon and reinforce these mechanisms, rather than restart them from zero.

Implications

Taken together, the evidence suggests that HBOT creates durable, highly beneficial biological adaptations, but they exist within a dynamic environment that continues to change with time, stress, aging, and lifestyle.

For this reason, a structured, staged approach to HBOT is both biologically plausible and clinically reasonable, even though it has not yet been tested as a standalone protocol in controlled trials.

3. Why a Seasonal Reset Week Makes Biological Sense

A Seasonal Reset Week - as we define it - consists of 5–7 HBOT sessions completed within one week, performed every 6–12 months after the initial loading phase.This approach is anchored in biological mechanisms and patterns observed in cumulative HBOT protocols:

(A) Angiogenesis and Microvascular Remodeling Decline Gradually

Microvascular density increases with HBOT, but vascular remodeling is not permanent – especially in:

• aging adults
• individuals with metabolic syndrome
• those under chronic stress or poor sleep
• people exposed to infections or inflammation

Study 11. A short reset of HBOT sessions may therefore help re-engage these oxygen-driven angiogenic cues, supporting capillary health in systems where vascular remodeling naturally declines with age or chronic stress, helping maintain capillary health.

(B) Neuroplasticity Needs Ongoing Stimulation

Neural networks remodel with HBOT, but neuroplastic gains can attenuate over time without continued stimulation–similar to detraining effects in exercise science.

A reset week provides intermittent “re-activation” of:

• perfusion changes
• white-matter plasticity
• cognitive network strengthening

These imaging-based changes provide a biological basis for HBOT-related brain network remodeling, but – as with other forms of neural rehabilitation – ongoing or repeated stimulation may be needed to sustain gains over time. Study 11

(C) Mitochondria Benefit From Periodic Hyperoxic Stress

Like HIIT or strength training, intermittent mitochondrial stress increases metabolic efficiency.

HBOT’s hyperoxic stimulus upregulates:

• antioxidant response genes
• mitochondrial biogenesis pathways
• ATP production efficiency

A randomized trial in humans also found that HBOT exposures increased mitochondrial respiration and mass markers, paralleling improved aerobic performance Study 2. Reset weeks maintain these adaptations without requiring another 40–60 session course. 

(D) Immune Aging and Inflammation Are Dynamic

Even though the telomere trial (Study 5) showed significant rejuvenation after 60 sessions, immunosenescence is not a static process.

Seasonal resets help sustain:

• lower chronic inflammation (IL-6, TNF-α)
• healthier T-cell populations
• better oxidative stress control

Because chronic inflammation and immune aging progress over time Study 12, a Seasonal HBOT reset week may help sustain lower levels of systemic inflammation, healthier T-cell populations, and better oxidative stress control – aligning with HBOT’s documented anti-inflammatory mechanisms.

4. What a Seasonal HBOT Reset Week Looks Like

Based on mechanistic evidence, our clinical observations and practical limitations, we recommend the following structure for a Seasonal HBOT Reset Week:

Frequency:
Every 6–12 months after completing the initial sessions.

Protocol:

• 5–7 sessions
• 2.0 ATA
• 60–90 minutes
• Completed within one week

Goals:

• Refresh angiogenesis signaling
• Support cognitive performance and clarity
• Maintain mitochondrial efficiency
• Reinforce anti-inflammatory and antioxidant pathways
• Counteract aging, stress, or illness

Who benefits most:

• Individuals who felt significant benefits from their loading phase
• High-stress professionals
• People with post-infectious fatigue or cognitive vulnerability
• Anyone noticing “slight regression” months after finishing the initial protocol

5. Why We Recommend the Seasonal Reset Model at Our Clinic

We do not promote constant HBOT or unscientific “forever packages.”
Instead, we follow a structured, evidence-aligned model:

1. Initial phase: ~20 sessions to activate key biological pathways
2. Optimization phase: progression toward 40–60 sessions when deeper remodeling is the goal
3. Re-evaluation: metabolic, mitochondrial, and inflammatory reassessment at 3–6 months
4. Seasonal Reset Week: a focused, efficient way to maintain and extend results

This approach respects both the science and the individual, avoids overtreatment, and acknowledges that long-term health is dynamic and that HBOT is most effective when used strategically.