To hold or not to hold? Is breath holding detrimental or beneficial to your body?

Do you hold your breath while typing, emailing or texting? Apparently, this is such a common occurrence, that Linda Stone, a writer and speaker, had coined a phrase “screen apnea”, which means temporary cessation of breath or shallow breathing while working or playing in front of screens. This kind of unconscious breath holding messes up the normal balance between oxygen, carbon dioxide and nitric oxide gasses, the body becomes more acidic, and the sympathetic nervous system (fight-or-flight response) gets activated. Unconscious breath holding has long been known to be detrimental to our health. Conditions like sleep apnea (repeated breathing interruption during sleep), left untreated, increases the risk of various health problems, including high blood pressure, stroke, diabetes, depression, headaches and worsening of ADHD.

However, intentional breath holding is a whole different story. This is known as intermittent hypoxia (IT) and it describes mild oxygen deprivation via breath holding. “Several arguments suggest that hypoxic exposure may also lead to some positive adaptations of the human body, able to protect him from several pathological conditions.” (2) Just like athletes train their bodies and their breathing capacity for bigger and bigger challenges necessary in their sport, we can pre-condition our respiratory systems to handle wider swings in blood gas balance for the purpose of making our systems more resilient. “Hypoxic preconditioning relies on complex and active defenses that organisms have developed to counter the adverse consequences of oxygen deprivation. […] Based on these data, hypoxic conditioning (consisting of recurrent exposure to hypoxia) has been suggested as a potential non-pharmacological therapeutic intervention to enhance some physiological functions in individuals in whom acute or chronic pathological events are anticipated or existing. In addition to healthy subjects, some benefits have been reported in patients with cardiovascular and pulmonary diseases as well as in overweight and obese individuals.” (2)

It is curious that people who live in the mountains (and, therefore, regularly breathe air that has lower oxygen concentrations), appear to be among the healthiest populations. For example, one study concluded: “After controlling for urbanization, temperature category and behavioral and demographic factors, male and female Americans living <500 m above sea level had 5.1 and 3.9 times the odds of obesity, respectively, as compared with counterparts living ⩾3000 m above sea level.” (3) In another example, researchers at the University of Colorado School of Medicine have found that people living at higher altitudes have a lower chance of dying from ischemic heart disease and tend to live longer than others. Benjamin Honigman, MD, professor of Emergency Medicine at the CU School of Medicine said: “Lower oxygen levels turn on certain genes and we think those genes may change the way heart muscles function. They may also produce new blood vessels that create new highways for blood flow into the heart.” (4)

Panoramic view of Boulder, Colorado from the top of a Mountain

Yogis knew that conscious breath holding was beneficial a long, long time ago. Patanjali Yoga Sutra 2.50 describes pranayama as ability to control three main parts of the breath – exhalation (bahya vrtti), inhalation (abhyantara vrtti), and breath hold (stambha vrtti). As a result, “the veil that obscures clear perception is destroyed” (Sutra 2.52). Specifically, Sutra 1.34 states that “the mind obtains serenity through prolonged exhalation and suspension of breath”. But if you ever tried holding your breath out for an extended period of time, you probably discovered that, often, it’s not that pleasant. In fact, many people report feelings of agitation, suffocation, and general un-ease. Physiologically, this is due to diligent work of chemoreceptors in your body and brain.

Your body is very sensitive to the levels of CO₂ in your system, because CO₂ regulates pH balance (between acidity and alkalinity) in your blood and tissues, which is necessary for homeostasis. “For example, when arterial CO₂ pressure (normally ∼40 mmHg) is elevated by only 1 to 3 mmHg, ventilation doubles [you start breathing twice as fast]. In contrast, arterial O₂ pressure (normally ∼100 mmHg) changes up to 20 mmHg are virtually ignored by the system.” (5) Once the chemoreceptors in the peripheral nervous system sense a slight drop in the CO₂ levels, they send the signal to the brain stem over the glossopharyngeal nerve and the vagus nerve, which quickly triggers increases in breathing rate. Generally, there is not a lot of wiggle room when it comes to CO₂ fluctuations in our blood. However, our chemoreceptors could be conditioned toward more or less tolerance. Deep water divers train their chemoreceptors to tolerate higher levels of CO₂ for longer periods by holding their breath under water. Panic attack and anxiety suffers might unknowingly train their chemoreceptors to be more intolerant.

James Nestor in his book Breath: The New Science of a Lost Art writes: “People with anorexia or panic or obsessive-compulsive disorders consistently have low carbon dioxide levels and much greater fear of holding their breath. To avoid another attack, they breathe far too much and eventually become hypersensitized to carbon dioxide and panic if they sense a rise in this gas. They are anxious because they are overbreathing, overbreathing because they’re anxious.”(6) In a study conducted by the professor of Psychology Alicia Meuret, participants were able to prevent their panic attacks by breathing slower and consciously increasing their CO_2. “The treatment works by normalizing the baseline levels of carbon dioxide in the blood, Meuret said, making people less prone to hyperventilation and giving them the tools they need to reverse an attack.” (7) It might work in similar ways for anxiety (8) and asthma (9).

Even if you don’t suffer from anxiety, asthma or panic attacks, it is useful to gradually train the sensitivity of your chemoreceptors to increase the resilience of your system and to calm your mind. In yoga, we do it by working on extending our exhalations and holding the breath out for progressively longer periods of time, just like the Yoga Sutra 1.34 suggested.

Here are some basic steps that you can follow yourself, or teach to your students:

Step 1: Learn to finish your exhalations

Time and time again we see students cut their exhalations short in a hurry to take the next breath in. This happens often in a yoga practice if we move faster than our breathing rhythm, and our movement ends faster than our exhale. To counteract that, we need to slow our movement down to match our breath and become more intentional about bringing our exhalations to their natural end before we take the next breath.

Step 2: Lengthen your exhalation

You can control the length of your exhalation by creating a restriction of the air flow in the throat (Ujjayi breath) or actively controlling the engagement of your respiratory musculature (abdomen, intercostals and diaphragm).

Step 3: Let go of effort at the end of exhalation

The quality of your exhalation will determine the quality of the pause after the exhale. If your exhalation is very active with multiple respiratory muscles engaged, you will be more likely to keep that engagement as you hold your breath out, making the pause more active and more difficult. It will also more likely to make you feel agitated. If you manage to let go of muscular engagement at the end of the exhalation and simply rest in that pause as a place of respite, you are more likely to hold the air out longer and feel more peaceful while doing it.

Step 4. Rest in the pause after exhale until the first urge to inhale

When you practice holding your breath out, be sure to inhale at the first urge. If you hold your breath out past the urge, you will likely feel agitated. To lengthen your breath hold you can anchor your mind on something else, like your heart beat or any other physiological sensation, or just imagine yourself resting peacefully. There is no competition here, you are not trying to beat your previous record, but instead you want your body to become more comfortable with breath holding, which won’t happen if you hold beyond your capacity. If you end up gulping air in your next inhalation, you’ve pushed the hold too far and need to back off a bit.

Practicing prolonged exhalation with suspension of breath can be an effective tool to calm and focus your mind, if you approach it gradually and from the perspective of curiosity and exploration, rather than competition and accomplishment. Our goal is to find a sense of peace and stillness in that pause after exhale.

 References

1. Are You Breathing? Do You Have Email Apnea? by Linda Stone
2. Hypoxic Conditioning as a New Therapeutic Modality by Samuel Verges, et al.
3. Association of elevation, urbanization and ambient temperature with obesity prevalence in the United States by J D Voss, et al.
4. Living at high altitude reduces risk of dying from heart disease: Low oxygen may spur genes to create blood vessels by Science daily
5. Chemoreceptors and Chemoreflexes by S.Mitchell, … J.L. Feldman, in Encyclopedia of Neuroscience, 2009
6. Breath: The New Science of a Lost Art by James Nestor

7. To Stave Off Panic, Don’t Take a Deep Breath by Stephanie Pappas

8. Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group by D S Pine, et al

9. Emotionally Triggered Asthma and its Relationship to Panic Disorder, Ataques de Nervios, and Asthma-Related Death of a Loved One in Latino Adults by Karinna Vazquez, et al.
10. Restoring Prana by Robin Rothenberg