Breathing Techniques That Work (Review)

“All chronic pain, suffering and diseases are caused
from a lack of oxygen at the cell level."
Prof. A.C. Guyton, MD, The Textbook of Medical Physiology*

* World’s most widely used medical textbook of any kind
* World's best-selling physiology book

Here are some proper breathing techniques that are used to gradually change automatic breathing patterns and improve body oxygen content. Note that one can spend months or years practicing some breathing techniques and exercises, but if his or her automatic (unconscious) breathing pattern remains the same, there are no improvements in health, symptoms, and quality of life. Hence, the goal is to achieve breathing retraining or permanent changes in automatic breathing.

There are also some other less known or less common breathing techniques. They include breathing techniques for labor or childbirth (Lamaze breathing techniques), breathing techniques for running, singing, speaking, swimming, meditation, stress, and many others. There is even a breathing technique to help horses. In addition, there are web pages devoted to reviews of respiratory trainers (such as Powerbreathe, Expand-A-Lung, PowerLung and Ultrabreathe). These breathing techniques are used to train inspiratory muscles, but the effects of these devices depend on methods and instructions for their application.

Breathing techniques compared

Note that the "Russian dominance" in this Table reflects the current situation related to popularity of some proper breathing techniques in Russia. For example, over 2,000,000 Frolov breathing devices were sold there during the first decade of the 21st century. In Russia, the Frolov breathing device can be bought in a pharmacy. Furthermore, Russia is probably the only country in the world where the general population believes and knows that the slower and less you breathe, the better your health is. This is due to the public activities and clinical work of leading Soviet physiologist Konstantin Buteyko, MD, PhD and about 600 Russian medical doctors who teach breathing techniques.

Lifestyle factor:	Body oxygen < 30 s	Body oxygen > 50 s
Energy level	Medium, low, or very low	High
Desire to exercise	Not strong, but possible	Craving and joy of exercise
Intensive exercise with nose breathing	Hard or impossible	Easy and effortless
Typical mind states	Confusion, anxiety, depression	Focus, concentration, clarity
Craving for coffee, sugar and junk foods	Present	Absent
Addictions to smoking, alcohol, and drugs	Possible	Absent
Desire to eat raw foods	Weak and rare	Very common and natural
Correct posture	Rare and requires efforts	Natural and automatic
Sleep	Often of poor quality; > 7 hours	Excellent quality; < 5 hours naturally

How to choose proper breathing techniques?

Proper breathing techniques should satisfy certain criteria in order to be useful for health of the breathing retraining student. One of the things to consider is that the general approach of any breathing technique should take our automatic or unconscious breathing pattern 24/7 into consideration, and not only suggest doing some breathing exercises.

In other words, what is the point of doing breathing exercises, if one sleeps with his mouth open and on his back every night? He can practice best breathing exercises for several hours every day, but he can still die from advance of cancer, heart disease, diabetes, asthma, bronchitis, or other chronic disease due to the Sleep Heavy Breathing Effect which is the main triggering factor leading to acute episodes (exacerbations) and deaths in the severely sick.

This Table explains why sick people have low body oxygen levels.

Minute ventilation rates (chronic diseases)

Condition	Minute ventilation	Number of people	All references or click below for abstracts
Normal breathing	6 L/min	-	Medical textbooks
Healthy Subjects	6-7 L/min	>400	Results of 14 studies
Heart disease	15 (±4) L/min	22	Dimopoulou et al, 2001
Heart disease	16 (±2) L/min	11	Johnson et al, 2000
Heart disease	12 (±3) L/min	132	Fanfulla et al, 1998
Heart disease	15 (±4) L/min	55	Clark et al, 1997
Heart disease	13 (±4) L/min	15	Banning et al, 1995
Heart disease	15 (±4) L/min	88	Clark et al, 1995
Heart disease	14 (±2) L/min	30	Buller et al, 1990
Heart disease	16 (±6) L/min	20	Elborn et al, 1990
Pulm hypertension	12 (±2) L/min	11	D'Alonzo et al, 1987
Cancer	12 (±2) L/min	40	Travers et al, 2008
Diabetes	12-17 L/min	26	Bottini et al, 2003
Diabetes	15 (±2) L/min	45	Tantucci et al, 2001
Diabetes	12 (±2) L/min	8	Mancini et al, 1999
Diabetes	10-20 L/min	28	Tantucci et al, 1997
Diabetes	13 (±2) L/min	20	Tantucci et al, 1996
Asthma	13 (±2) L/min	16	Chalupa et al, 2004
Asthma	15 L/min	8	Johnson et al, 1995
Asthma	14 (±6) L/min	39	Bowler et al, 1998
Asthma	13 (±4) L/min	17	Kassabian et al, 1982
Asthma	12 L/min	101	McFadden & Lyons, 1968
COPD	14 (±2) L/min	12	Palange et al, 2001
COPD	12 (±2) L/min	10	Sinderby et al, 2001
COPD	14 L/min	3	Stulbarg et al, 2001
Sleep apnea	15 (±3) L/min	20	Radwan et al, 2001
Liver cirrhosis	11-18 L/min	24	Epstein et al, 1998
Hyperthyroidism	15 (±1) L/min	42	Kahaly, 1998
Cystic fibrosis	15 L/min	15	Fauroux et al, 2006
Cystic fibrosis	10 L/min	11	Browning et al, 1990
Cystic fibrosis*	10 L/min	10	Ward et al, 1999
CF and diabetes*	10 L/min	7	Ward et al, 1999
Cystic fibrosis	16 L/min	7	Dodd et al, 2006
Cystic fibrosis	18 L/min	9	McKone et al, 2005
Cystic fibrosis*	13 (±2) L/min	10	Bell et al, 1996
Cystic fibrosis	11-14 L/min	6	Tepper et al, 1983
Epilepsy	13 L/min	12	Esquivel et al, 1991
CHV	13 (±2) L/min	134	Han et al, 1997
Panic disorder	12 (±5) L/min	12	Pain et al, 1991
Bipolar disorder	11 (±2) L/min	16	MacKinnon et al, 2007
Dystrophia myotonica	16 (±4) L/min	12	Clague et al, 1994

Therefore, proper breathing techniques should also have answers to the following questions:
- What is ideal breathing (or ideal unconscious breathing pattern) for maximum body oxygen content? Note that it is not enough to only think about the maximum oxygen content in the lungs or arterial blood. Oxygen is required in all body cells.
- Which breathing techniques improve or increase oxygen content in cells?
- What are the common breathing patterns and what are their effects on body oxygen content?
- What is the exact direction of the breathing techniques?
- What are the effects of lifestyle factors?

Some features of proper breathing techniques

* Out of several hundred Russian Frolov MDs, only a small group of these medical professionals considers the effects of lifestyle on breathing retraining.

The understanding of breathing techniques comes from the knowledge of breathing parameters in both sick and healthy people as well as the effects of breathing patterns on cells oxygen levels (see links to medical studies below).

Breathing techniques can improve one's health only if they make one's breathing pattern after the breathing session lighter and slower in terms of minute ventilation. In this case the student also increases their cells oxygen content, which is measured with the simple Control Pause (CP or body oxygen test - see details below). Hence, the personal goal is to achieve a slow and shallow (but diaphragmatic) breathing pattern manifested in high CP test results. In the long run, better morning CP results reflect efficiency of a proper breathing retraining technique.

Video: How to choose best breathing techniques and morning CP test

In relation to healthy lifestyle factors, the Buteyko breathing technique is the most advanced breathing technique, and only Hatha Yoga comes close. In relation to breathing exercises, the Buteyko method produces good results.

However, most students achieve a faster CP progress when using breathing devices, e.g., the Frolov breathing device or DIY breathing device. While there are now hundreds of MDs in Russia, who promote or endorse the Frolov device, very few of them understand and explain to their patients importance of correct life style factors.

Hence, the optimum breathing retraining program for a typical student with a chronic disease (less than 20 s for the body oxygen test) includes breathwork with a breathing device (that traps a part of exhaled air) and adherence to Buteyko lifestyle factors.

Yoga Benefits: How to get best benefits from this amazing ancient practice? Traditional yoga has been teaching us to breathe less, while modern yoga leaders confuse the public about correct breathing, ideal breathing, and effects of CO2.	Pursed lip breathing web page provides an overview of this breathing technique, health conditions addressed (mostly COPD, but many others too), detailed instructions, and its physiology, and effects.
Breathslim is a breathing device that is featured on the Breathslim website. The Breathslim device is an exact copy of the Frolov breathing device developed by Vladimir Frolov. Can it help with weight loss?	The Samozdrav breathing device is another patented Russian invention based on Dr. Buteyko's discoveries and CO2 effects. Its creators also worked for Soviet Cosmos (Outer Space Research), and they suggested 4 levels of learning...
Resperate is a FDA-approved portable device for slow paced breathing sessions. It had 10 clinical trials on patients with hypertension and could lead to moderate reduce blood pressure decrease...	Inspiratory Muscle Training (also known as IMT) can be done using various respiratory trainers of breathing devices, such as Powerbreathe, Expand-A-Lung, PowerLung and Ultrabreathe. They are all presented below.
Powerbreathe is a breathing device used, as the authors and creators claim, to train inspiratory muscles only. It is mostly used for sports performance, but there are medical applications as well.	Expand-A-Lung breathing resistance exerciser is a more recent breathing trainer used to strengthen respiratory muscles due to resistance that can be regulated.
PowerLung is a device that creates resistance during both inhalations and exhalations. PowerLung has some popularity, especially among athletes....	Ultrabreathe: Review of Ultrabreathe Breathing Device suggests that, as with other Western devices, there is one missing factor in training and analysis of effects.
Is etCO2 (end-tidal CO2) or capnography useful for breathing retraining? Can capnometers improve the effectiveness of breathing exercises or could it worsen the outcomes? Capnography and etCO2 web page....	*** Under construction *** (Further reviews will include Strelnikova breathing gymnastic and some other breathing techniques.)

Warning. There are numerous restrictions and contraindications for some health problems (anxiety, diabetes, hypertension, GI problems, and so on) in relation to specific breathing exercises. In addition, pregnant women, people with organ transplants, and some other groups of people should follow special guidelines in relation to their general breathing retraining progress. Finally, there are important preliminary requirements that make breath work safe and more effective (empty stomach, good thermoregulation, and so forth). All these factors can be found in the Learning Section of this website.

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

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