Breath Holds and Maximum Pauses: Health Effects and Uses
(This is Part 6 of Module 10. Learn Buteyko breathing exercises)
Dr. KP Buteyko often used the term "maximum pause" for the CP (Control Pause) or stress free breath holding time test done only until initial stress or discomfort. This fact may cause serious misunderstanding when Buteyko words in Russian ("the maximum pause") are directly translated in English. The traditional Western and Russian meaning and definition of the "maximum pause" is breath holding for as long as possible and, if we are talking about the Buteyko method, all these breath holds are done after one's usual exhalation. For most people, including Buteyko students during their initial stages of learning, the maximum pause is about 2 times longer than the control pause, as we can see it in the Buteyko Table of Health Zones.
Warning. Strong air hunger and similar effects can be produced during very shallow breathing (sometimes called "VSB") without any breath holds at all. This effect takes place when a student starts to breathe about twice less.
Maximum pauses, long breath holds and modern Buteyko teachers
The use of breath holds and extended breath holds (more than the CP) considerably varies among modern Buteyko teachers. Some Russian doctors did not and do not use any breath holds at all, while for followers of Sasha Stalmatsky, long breath holds and maximum pauses are very important or crucial parts of teaching the method. Furthermore, they often use AMP (absolute maximum pauses) which are done using special techniques, like Valsalva maneuver (attempts to forcibly exhale while keeping the mouth and nose closed), fist clenching, stomping, jumping, etc. to prolong breath holding.
Unfortunately, due to poor knowledge of the method and physiological effects of breath holds, some Buteyko practitioners do more harm than good to certain groups of their students (see examples below).
Effects of maximum pauses and long breath holds on arteries and arterioles
There are many situations, when MP and AMP must not be done. Let us look at the causes of possible problems with long breath holds. Breath holding causes a fast rate of accumulation of CO2 and reduction in O2 in the lungs. Hence, the arterial blood gets more CO2 and less O2. Hypercapnia and hypoxia produces 2 opposite effects on smooth muscles of blood vessels: vasodilation due to local hypercapnia and hypoxia and central vasoconstriction caused by the release of norepinephrine and epinephrine that bind to alpha-receptors in most arterioles (in heart and skeletal muscles, epinephrine binding to beta-2 receptors causes vasodilation). Since norepinephrine and epinephrine are stress hormones, this vasoconstrictive effect is also influenced by psychological stress (in opposition to relaxation).
In the 1960’s, when Buteyko was working in the respiratory laboratory, he and his colleagues conducted numerous studies about the effects of inhaled gases with various compositions on the tone of blood vessels (Buteyko et al, 1964a, 1964b, 1965, 1966a, 1966b). He found that the body could maintain its physiological processes normally when changes in the composition of the inspired gas were gradual. Sudden changes in blood gases could lead to vasoconstriction, significantly increased heart rate and blood pressure, while in normal conditions, breath holding leads to the "diving reflex" when blood is diverted mainly to the brain and heart, and one's heart rate drops. In the case of vasoconstriction, it can last for many hours causing maladaptive response to breath holding due to sudden changes in a gas composition. As a result, blood vessels can loose their sensitivity to CO2 and this can be a serious concern for some breathing training students.
In order to achieve positive cardiovascular or circulatory effects, Dr. Buteyko taught his susceptible students how to gradually change one’s breathing without disruptive or sudden variations in blood gases. The reduced breathing exercise was the main tool for ventilation reduction and the level of air hunger was light. Here the situations when certain groups of people can experience various problems due to long pauses and sudden changes in the gas composition of the blood while learning the Buteyko breathing technique and other breathing methods.
When and how long breath holds can cause serious problems
• In a person with hypertension, even the CP test results in increased blood pressure often, depending on the severity of the condition, causing unpleasant symptoms. Such a practical result was received in many hypertensives (i.e., Kohn & Cutcher, 1971). Moreover, some of them had a systolic blood pressure increase from about 200 to 260 mm Hg during maximum pauses, making the whole procedure of doing the maximum pause dangerous (Ayman & Goldshine, 1939). Indeed, in rare, but possible cases of undetected serious organic defect in the heart muscle, the maximum pauses may cause severe complications, including physical damage to the heart muscle.
Warning. There are poorly educated Buteyko practitioners, who teach to their students with heart disease (e.g., hypertension) to practice maximum pauses and long breath holds, while producing these negative cardiovascular GI effects. Later, such students may have weeks or months of headaches, nausea, poor sleep, feeling weak, etc., while these practitioners often present these symptoms as a "cleansing reaction".
• Similar negative cardiovascular effects can lead to the appearance of migraine headaches in those people who are predisposed to such symptoms.
• People with frequent panic attacks can experience their negative symptoms because of the CPs or longer pauses and mild or strong air hunger.
As another possible negative effect, long pauses and strong air hunger could cause greatly increased blood flow due to hypercapnic vasodilation. As a result, people with some serious pathologies can experience negative symptoms.
• Many acute gastro-intestinal problems (gastritis, gastric ulcers, Crohn's disease, inflammatory bowel disease, irritable bowel syndrome, intestinal ulcers, etc.) can dramatically worsen due to the suddenly incoming blood intensifying peristalsis. Flare-ups, opening of healed lesions, intensive wear of mucosal surfaces, causing such symptoms as gases, cramps, thirst, and diarrhea, all are possible complications.
• Patients with extensive damage to kidneys' nephrons can experience so sudden an increase in blood flow to kidneys, that remaining working nephrons may be overburdened with the extra work to clean large amounts of the blood. Their possible congestion could result in the kidneys' failure.
• Long breath holds can cause metastasis in people with malignant tumors (or cancer). Indeed, long pauses can be considered as light internal massage, due to their strong impact on microcirculation. Malignant cells can travel to neighboring lymph nodes, leading to the development of cancer in those people who do not increase their usual CPs. (Increase in the CP up to 35-40 s would indicate more normal work of the immune system and its ability to destroy malignant cells.)
• Patients with acute brain trauma will experience an increase in intracranial pressure (the pressure inside the skull). Moreover, should their blood have recently coagulated and therefore not yet formed a firm protective layer, this layer can be broken (due to larger pressure from underlying fluids) causing more bleeding and severe complications.
• Patients with recent bleeding cuts and other acute skin injuries will have dilation of small blood vessels and increased blood flow. That will cause additional bleeding. If the cut or injury has just started to heal, opening of healed areas due to increased pressure from underlying blood layers is possible.
• A blood clot, due to thrombosis in veins, can get loose and block a blood vessel leading to some organ causing severe problems or death.
• Maximum pauses, strong air hunger and high CPs (e.g., 30-35 s) can cause problems for people with transplanted organs due to increased sensitivity of the immune system in relation to foreign cells leading to rejection of donated organs.
• Spontaneous abortion of the fetus is possible, if the pregnant mother practices strong air hunger or long breath holds. The immune system, in case of serious initial toxicity of the fetus, may decide that it is easier to abort the fetus than to rebuild, repair and readjust polluted tissues of the fetus.
Cases with severe bleeding
In very rare situations (e.g., immediately after a dental or other surgery, or after a brain trauma, or after getting a bleeding cut) any breath holding, any sudden increase in carbon dioxide levels, or strong air hunger during RB could cause sudden dilation of small blood vessels and increased bleeding.
Hyperventilation has another extremely useful value in terms of survival of different animals. As it is known, arteries are hidden deeply under the skin in order to prevent bleeding, should a cut or severe open injury occur. Wise Nature anticipated such an unlucky turn of events. Moreover, Wise Nature also provided animals with hyperventilation in order to prevent excessive blood losses and possible death. There are medical studies that discovered that medical doctors could not draw a blood sample from the fingers of their patients who voluntarily hyperventilated. That was a normal result since low carbon dioxide values constrict small blood vessels, hence, greatly reducing their blood flow.
One may notice that in natural conditions wild and domesticated animals and humans over-breathe when they have, for example, bleeding cuts. Such over-breathing is done unconsciously due to the pain and vision of their own blood. Later, after coagulation, the breathing is gradually reduced and the pain is also less. In addition, should any further bleeding occur, the emotional shock and vision of the own blood can again generate heavy over-breathing. This mechanism again helps to start the initial stages of wound healing.
However, any excessive carbon dioxide increases can immediately cause an opening of coagulated and hardened layers due to increased pressure of the blood in the adjacent small vessels. That would result in additional blood losses.
The same ideas can be equally applied to the acute brain traumas. These considerations caused wide-spread appearance of prophylactic hyperventilation in the medical practice of neurologists to prevent acute bleeding (for reviews of this practice one may see Marion et al, 1995 or Yundt & Diringer, 1997).
Therefore, should you get any bleeding wound or cut (after a surgery or injury, follow your natural impulses and breathe hard! That relates to dental surgeries; tonsillectomy; operations on the brain, internal organs, skin; industrial and domestic accidents, etc., when bleeding or severe hemorrhage is possible or present.
Loss of CO2 sensitivity
A loss of CO2 sensitivity due to a single breath hold (or a series of consecutive breath holds) depends on numerous factors, including the duration of breath holding, and hereditary (cardiovascular or hypertensive predisposition), life-style and environmental causes. Some of them are: being deprived of deep stages of sleep, Ca deficiency, insufficient protein and/or arginine in the diet, overheating, any inflammatory condition, including malignant and benign tumors, and some very rare situations like near death experiences, when carotid bodies removed, and when there is a denervation of respiratory muscles.
Generally, students with lower CPs and weak heredity in relation to the cardiovascular system have higher chances of developing this abnormal circulatory response (vasoconstriction) to breath holding. It is usually manifested in headaches or migraine-type sensations, feeling weaker, possible nausea, thirst on lips, etc. A short nap (even 3-5 minutes) can often eliminate the maladaptive response, but mild after-effects are going to last until next night sleep. All other factors also play a role in this abnormal physiological reaction.
You can find more information about this effect and its treatment, in the digital book "Advanced Buteyko breathing exercises".
Other common negative effects of maximum pauses or long breath holds
While one may not necessarily experience a loss of CO2 sensitivity due to breath holding, many students, especially with low current CPs, can simply experience stress and an inability to control breathing after long breath holds even when they do not have any of predisposing factors (panic attacks, hypertension, pregnancy, etc.) described above. But most of them would not experience any negative effects due to, for example, the Control Pause test.
When the CP gets higher, the body's ability to tolerate maximum pauses and long breath holds gradually improves. Hence, longer breath holds can be practiced during later stages of learning (after some weeks or months of breathing training).
Common positive effects of maximum pauses or long breath holds
When the above cases are excluded, students can experience the positive effects due to long breath holds. As it is also known among free divers, who are generally a very healthy group of people, maximum breath holding has 4 stages: period of no respiratory sensations (the CP), period of struggle (from the CP to MP), period of bliss or euphoria due to the positive effects caused by the diving reflex (after the MP) and the last short period of stress or struggle. Such maximum breath holds do not lead to severe overbreathing and stress later. They do not cause loss of CO2 sensitivity. Furthermore, with some practice, students are able to practice reduced breathing or "switch" to reduced breathing after this one breath hold especially in cases, when they had hundreds or thousands shorter breath holds accompanied by reduced breathing later (the conditioned response due to past training).
Hence, certain training is required in order to consistently achieve these positive effects, while breathing sessions with strong air hunger and/or very long breath holds are most efficient for experienced students when there are no abnormal cardio responses.
How to check your reactions to maximum pauses and long breath holds
In most cases, student's personal sensations (or feelings) are correct indicators of bodily reactions and processes. In addition, in order to objectively check your cardiovascular responses, measure your heart rate (or pulse) some 2-3 minutes after the maximum pause or breath hold. If it is the same or even lower than prior to the breath hold, as it should be after Buteyko reduced breathing exercise (including very intensive reduced breathing sessions), your body accepts breath holding positively.
If you heart rate increases and remains high for many minutes (or hours) after the maximum pause or any other breath hold, you should not practice this breath holds. Instead, use more gentle versions of breathing exercises to improve your body-oxygen content and normalize your breathing.
Note that many groups of students (e.g., people with hypertension) may have adverse reactions even to a CP test. Such students should temporary avoid the CP test and there is a special daily log for them in the "Downloads" Section.
Depending on variety of factors (health state, genetic factors, quality of sleep, morning CP, current health problems, ability to use the diaphragm at rest and during breath work, and many others), maximum pauses and other breath holds, even as short as one half of the CP, can cause various physiological reactions. In many cases, long pauses should not be used at all during initial stages of learning. As about the effects of long pauses and strong air hunger, cardiovascular responses play the main role in bodily circulatory adaptation to changes in blood gases. Measuring own pulse and analyzing body sensations help to prevent useless suffering, damage to own health, and quitting breathing training.
Note. On this site, you can get my PDF book that is called "Advanced Buteyko Breathing Exercises" (about 124 pages, 12 USD) or my Kindle book (on Amazon.com) with the same title. This book goes into details and provides a comprehensive overview of specifics and effects related to Buteyko exercises.
Reference pages: Breathing norms and medical facts:
- Breathing norms: Parameters, graph, and description of the normal breathing pattern
- 6 breathing myths: Myths and superstitions about breathing and body oxygenation (prevalence: over 90%)
- Hyperventilation: Definitions of hyperventilation: their advantages and weak points
- Hyperventilation syndrome: Western scientific evidence about prevalence of chronic hyperventilation in patients with chronic conditions (37 medical studies)
- Normal minute ventilation: Small and slow breathing at rest is enjoyed by healthy subjects (14 studies)
- Hyperventilation prevalence: Present in over 90% of normal people (24 medical studies)
- HV and hypoxia: How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
- Body-oxygen test (CP test) : How to measure your own breathing and body oxygenation (two in one) using a simple DIY test
- Body oxygen in healthy: Results for the body-oxygen test for healthy people (27 medical studies)
- Body oxygen in sick : Results for the body-oxygen test for sick people (14 medical studies)
- Buteyko Table of Health Zones: Clinical description and ranges for breathing zones: from the critically ill (severely sick) up to super healthy people with maximum possible body oxygenation
- Morning hyperventilation: Why people feel worse and critically ill people are most likely to die during early morning hours
References: pages about CO2 effect:
- Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
- The Bohr effect: How and why oxygen is released by red blood cells in tissues
- Cell oxygen levels: How alveolar CO2 influences oxygen transport
- Oxygen transport: O2 transport is controlled by vasoconstriction-vasodilation and the Bohr effects, both of which rely on CO2
- Free radical generation: Reactive oxygen species are produced within cells due to anaerobic cell respiration caused by cell hypoxia
- Inflammatory response: Chronic inflammation in fueled by the hypoxia-inducible factor 1, while normal breathing reduces and eliminates inflammation
- Nerve stabilization: People remain calm due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
- Muscle relaxation: Relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
- Bronchodilation: Dilation of airways (bronchi and bronchioles) is caused by carbon dioxide, and their constriction by hypocapnia (low CO2)
- Blood pH: Regulation of blood pH due to breathing and regulation of other bodily fluids
- CO2: lung damage: Elevated carbon dioxide prevents lung injury and promotes healing of lung tissues
- CO2: Topical carbon dioxide can heal skin and tissues
- Synthesis of glutamine in the brain, CO2 fixation, and other chemical reactions
- Deep breathing myth: Ignorant and naive people promote the idea that deep breathing and breathing more air at rest is beneficial for health
- Breathing control: How is our breathing regulated? Why hypocapnia makes breathing uneven, irregular and erratic.
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