Breath Holds and Maximum Pauses: Health Effects and Uses
(This is Part 6 of Module 10. Learn Buteyko breathing exercises)
Content of this web page:
Introduction
Maximum
pauses, long breath holds and modern Buteyko teachers
Effects of maximum pauses and long breath holds on arteries and arterioles
When and
how long breath holds can cause serious problems
Cases with severe bleeding
Loss of CO2 sensitivity
Common
positive effects of maximum pauses or long breath holds
Other common negative effects of long breath holds and maximum pauses
How to check your reactions to maximum pauses and long breath holds
Conclusions
Introduction
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. 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 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 practicing 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
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 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 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 "diving reflex" when blood is diverted
mainly to the brain and heart, and heart rate drops. In 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 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.
Warning.
There are poorly qualified Buteyko practitioners, who teach to their
students with GI problems to practice long breath holds and maximum pauses,
while producing these adverse GI effects. Later, such students may have
weeks or months of diarrhea, while their practitioners present these
symptoms as a "cleansing reaction".
• 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 increase in intracranial
pressure (the pressure inside the skull). Moreover, should their blood have
recently coagulated and therefore has 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 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
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
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 experience, carotid bodies removed, and 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 migraines 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.
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.
Other common negative effects of maximum pauses or long breath holds
While one may not necessarily experience loss of CO2 sensitivity due to
breath holding, many students, especially with low current CPs, can simply
experience stress and 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 is gradually improves. Hence, longer breath holds can be practiced during later stages of learning (after some weeks or months of breathing training).
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 remain high for many minutes (or hours) after the maximum pause or any other breath hold, you should not practice this breath holds and 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.
Conclusions
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.
References: CO2 Effects Web Pages
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 and oxygen transport are controlled by
alveolar CO2 and breathing
Oxygen Transport depends on
breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr
effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2
content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes
place due to anaerobic cell respiration caused by cell hypoxia. Hence,
antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by
breathing since hypoxia leads to or intensifies chronic inflammation through over-expression
of the hypoxia-inducible factor 1, while normal
breathing reduces these processes
Nerve stabilization takes place due to calmative or
sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells
is normal at high CO2, while hypocapnia causes muscular tension, poor posture
and, sometimes, aggression and violence
Brochodilation - dilation of
airways (bronchi and bronchioles) by carbon dioxide, and their constriction due
to hypocapnia
CO2: Best Natural Cough Suppressant
and "home remedy" since it calms urge-to-cough nerve receptors located in the
tracheobronchial tree and larynx
Blood
pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon
dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine
in the Brain, CO2 fixation, and other chemical reactions
CO2 myth
"CO2 is a toxic waste gas" myth
Breathing control
How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic?
Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and
Body Oxygen in Healthy, Normal and Sick People
Breathing
norms Parameters, graph, and description of the normal
breathing pattern
6 breathing myths 6
myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of
hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the
Sick. Table
1. Western scientific evidence about prevalence of CHV
(chronic hyperventilation) in patients with various chronic conditions
(34 medical studies)
Normal Minute Ventilation in
Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of
Normal People (24 medical publications)
HV and hypoxia
How and why deep breathing reduces oxygenation of cells and tissues of
all vital organs
Body oxygen test
How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy
Table 4. CP (body oxygen level) in healthy people (27 medical
studies)
Body oxygen in sick Table 5.
CP (body oxygen level) in sick people (14 medical studies)
Buteyko
Table of Health Zones with clinical description of most common zones
Morning HV Morning
hyperventilation effect or how and why critically ill people are most
likely to die during early morning hours
Back to: Learning Buteyko Breathing Exercises
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