The 3 Training Phases
Click any phase card to see full details
Phase 1
Adaptive Phase
Establish hypoxic tolerance · Initiate HIF signaling · Resting only
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Cycles4 cycles
Low O₂4:00 min
High O₂3:00 min
Session Time~28–35 min
Hypoxic Exposure~16 min
Duration4–8 weeks
Frequency2–3×/week
MovementNo — resting only
Phase 2
Conditioning Phase
Increase hypoxic volume · Strengthen adaptation · Resting only
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Cycles5 cycles
Low O₂4:00 min
High O₂2:00–3:00 min
Session Time~35–40 min
Hypoxic Exposure~20 min
Duration4–6 weeks
Frequency2–3×/week
MovementNo — resting only
Phase 3
Optimized Phase
Peak stimulus · Movement eligible · Not for first-time users
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Cycles (Resting)6 cycles
Cycles (Movement)4–5 cycles
Low O₂4:00 min / 3:00 (mov)
High O₂2:00 min / 3:00 (mov)
Session Time~36–50 min
Hypoxic Exposure~24 min
FrequencyPathway dependent
MovementYes — after qualification
Session Settings
Criteria to Advance to Next Phase
Progression Flow
How patients move through the program — from first session to Optimized Phase
🆕 New Patient — All Conditions — All Fitness Levels
↓
Phase 1
Adaptive Phase
4 cycles · 4 min Low O₂ · 3 min High O₂ · ~28 min · Resting only · 4–8 weeks
Hypoxic: ~16 min/session
Freq: 2–3×/week
✓ Gate 1 — Must pass ALL to advance to Conditioning Phase (3 consecutive sessions)
Time to Hypoxia: 60–150 seconds (Ideal Zone)
Low Phase SpO₂: 82–86%
Time to Recovery: ≤30 seconds
Safety Events: 0 (1 acceptable, but must reach 0 consistently)
Clinician review required · Condition pathway selected at this point
✗ Criteria not met → Continue Adaptive Phase · Address failing metrics
Phase 2
Conditioning Phase
5 cycles · 4 min Low O₂ · 2–3 min High O₂ · ~35–40 min · Resting only · 4–6 weeks
Hypoxic: ~20 min/session
Freq: 2–3×/week
✓ Gate 2 — Must pass ALL to advance to Optimized Phase (3 consecutive sessions)
Time to Hypoxia: 60–150 seconds (Ideal Zone)
Low Phase SpO₂: 82–86%
Time to Recovery: ≤30 seconds
Safety Events: 0 (1 acceptable, must reach 0 consistently) · HR stable · All cycles completed
Clinician must confirm before advancing
✗ Criteria not met → Continue Conditioning Phase · Do not advance
Phase 3
Optimized Phase — Resting
6 cycles · 4 min Low O₂ · 2 min High O₂ · ~36–50 min · NOT for first-time users
Hypoxic: ~24 min/session
✓ Movement Version Eligibility (same criteria as Optimized entry, confirmed stable)
0 Safety Events across 3 consecutive Optimized resting sessions
Recovery Time consistently ≤30 seconds
Clinician confirms movement eligibility
Steady-state movement only — no intervals
Phase 3 — Movement Version
Optimized Phase — Movement
4–5 cycles · 3 min Low O₂ · 3 min High O₂ · Steady-state movement only
⚠ Movement amplifies dose
Respect load
Bridge Protocol — Any Phase
EWOT / High O₂ Only
Patient cannot tolerate Low O₂ · Acute flare · Recovery day (Athletic pathway)
Not a permanent
alternative to IHHT
The 4 Readiness Metrics
Click any metric card to expand details
1
Time to Hypoxia
Time for SpO₂ to drop ≤90% after Low O₂ starts
IDEAL ZONE ✔
60 – 150 seconds
Controlled, steady entry. Strong stimulus without excessive stress.
→ Supports progression if other 3 metrics also pass consistently
FAST RESPONSE
< 60 seconds
SpO₂ drops rapidly. High responsiveness. Common early on.
→ Stay in current phase. Consider On-Ramp if continues beyond session 5
LOWER SENSITIVITY
> 150 seconds
Slow drop — indicates adaptation OR mild dose.
→ If other metrics solid, may signal readiness to progress
Cycle 1 reading of 0 seconds = sensor calibration artifact. Rely on Cycles 2+.
Adaptive
Conditioning
Optimized
Same threshold all phases
2
Low Phase SpO₂ Average
Avg SpO₂ during Low O₂ phases only — the dose-strength score
IDEAL ZONE ✔
82 – 86%
Strong adaptation stimulus. Well tolerated across patient types.
→ Confirm other metrics. Support readiness if consistent
MILD STIMULUS
87 – 90%
Session may be too mild to drive meaningful adaptation.
→ Stay current phase. Consider stepping up once metrics stabilize
TOO AGGRESSIVE
≤ 80–81% avg
Excessive stress. Higher safety event risk. Protocol too strong.
→ Do NOT progress. Review On-Ramp or Adaptive settings
82–86% is the optimal zone for HIF activation without significantly increasing safety event risk.
Adaptive
Conditioning
Optimized
Same threshold all phases
3
Time to Recovery
Time for SpO₂ to return to ≥95% after High O₂ starts
STRONG RECOVERY ✔
≤ 30 seconds
Excellent bounce-back. Body handling session load very well.
→ Supports progression when combined with other passing metrics
ACCEPTABLE / WATCH
31 – 45 seconds
Recovery okay but not yet consistent enough to advance.
→ Repeat phase until stabilized across 2–3 consecutive sessions
SLOWER RECOVERY
> 45 seconds
Not bouncing back quickly. Check sensor placement too.
→ Hold level. Check sensor. Do NOT progress
This is the single best indicator of readiness for more load. If not improving after 4–6 sessions, flag for clinician review.
Adaptive
Conditioning
Optimized
Same threshold all phases
4
Safety Events
Auto-switch to High O₂ when SpO₂ hits ≤80% safety floor
IDEAL ✔
0 events
Session completed within safe limits. Clean, controlled session.
→ Document normally. This is the target every session
ACCEPTABLE / STAY
1 event
Dose was close to the edge but manageable this session.
→ Stay current level. Must reach 0 consistently before advancing
TOO MUCH STRESS
≥ 2 events
System intervened multiple times. Dose too aggressive right now.
→ Reduce protocol intensity. Review On-Ramp. Do NOT progress
Safety Events are not failures — they are the system protecting the patient. Never frame them negatively to the patient.
Adaptive
Conditioning
Optimized
Same threshold all phases
✔ ADVANCE — 3 or 4 of 4 pass
Consistent across 3 consecutive sessions. Clinician reviews and confirms before advancing to next phase.
✗ HOLD — 1 or 2 of 4 pass
Continue current phase. Identify and address the failing metric(s) before reassessing.
Condition Pathways
Click any condition to see full protocol details
Neuropathy
Peripheral · Diabetic · Nerve-related sensory symptoms
MechanismHIF → angiogenesis → new capillaries to hypoxic nerve tissue
Frequency3–4× per week
SpO₂ Target82–86% — never below 82%
Key NoteVerify sensor quality every session
Weight Loss / Metabolic
Weight management · Metabolic syndrome · Insulin resistance
MechanismAppetite regulation, insulin sensitivity, lipid reduction
Frequency3× per week minimum
SpO₂ Target82–86%
Key NoteConsistency > intensity. 8+ weeks for metabolic benefit
Chronic Fatigue
CFS · Post-viral · Long COVID fatigue · Persistent low energy
MechanismMitochondrial biogenesis without exercise demand
Frequency2–3× per week — rest days matter
SpO₂ Target82–86%
Key NoteMost conservative. 6–8 Adaptive sessions min
Athletic Performance
Athletes · Active individuals · Enhanced endurance or recovery
MechanismAltitude training adaptations — VO2 max, RBC production
Frequency4–5× during training blocks
SpO₂ Target82–86%
Key NoteOnly pathway where Adaptive may be abbreviated
Fibromyalgia
Fibromyalgia · Widespread pain · Central sensitization
MechanismSirtuin gene → anti-inflammatory cascade
Frequency2–3× per week — 48h between sessions
SpO₂ Target83–86%
Key Note6–8 Adaptive sessions before first readiness assessment
Protocol & Mechanism
Say to Patient
Clinical Caution
Communication Scripts
Click any script to expand — use these verbatim or as close as natural conversation allows