Have a timer ready!
Take a small breath in and a small breath out and hold your breath using a timer.
Hold your breath only as long as you comfortably can. You can wait until you feel your first “tug” in your throat or diaphragm area (which is a response from a brain signal sent to your body asking it to take a breath in). Your breath at the end of the CP should not be strained, but remain as even as prior to breath hold.
Healthy person breathes 3-6 L/min
Asthmatic (between attacks) - 10-20 L/min
Asthmatic (during attack) - >20 L/min
HYPERVENTILATION IS BREATHING
IN EXCESS OF THE BODY’S NEED
Control Pause versus Asthma Symptoms and Recommended Practices
Unblocking your nose
Take a small breath in (2 seconds) and a small breath out (3 seconds), then pinch your nose to hold your breath. Move your head up and down or sway your body from side to side for as long as you can hold your breath. When you feel a moderate to strong desire to breathe, release your nose and try to breathe through the nose If possible for about 1 minute to recover.
Repeat 5-6 times until the nose is clear.
Do this exercise any time you realise you are breathing through your mouth because your nose is blocked.
Do not hold your breath too long if your asthma is very severe and you
feel very uncomfortable while holding your breath
Take 20 minutes out of your day, ideally in the morning and again before you go to bed to do this exercise. You need a timer, a comfortable chair (or meditation cushion), and a quiet space.
Start by sitting in an upright, comfortable position.
Take your Pulse for 30 seconds. Multiply by 2 and record it (gives you beats/minute)
Take your CP and record it.
Start by breathing calmly through your nose and take a few minutes to consciously relax.
Become aware of the breath entering and exiting your nostrils and try to breathe gently into your tummy (i.e. your tummy should gently go out as you inhale and relax towards your spine as you exhale).
After some breaths begin counting your natural inhalation and exhalation.
Once you have established the natural rhythm of your breath, try to shorten your inhalations by 20-30% until you feel a slight need for air.
Continue with reduced breathing for 4 minutes.
Take a rest for a few minutes, breathe normally but calmly.
Take your CP again, and resume.
Repeat 2-5 cycles
Measure your Pulse and CP again a few minutes after the practice.
If you have done the reduced breathing exercise correctly, your pulse should have slowed down by 2-4 seconds and your CP should be 10-20% higher than at the beginning. You will also feel warmer, have more saliva in your mouth, and feel more relaxed. All these are signs that the CO2 levels have increased, causing your nervous system to relax.
If you feel any of the following, relax & resume normal breathing until you feel comfortable doing the exercises:
tension in your abdomen or neck muscles
panic or anxiety
Be gentle in your approach!
My own experience with the Buteyko Method
After picking up yet another upper respiratory infection, my asthma was so bad that I was literally sofa bound for almost three weeks. The shortness of breath and heaviness in my chest was so intense that even a walk to the bathroom seemed like a heroic effort. 40 mg of Prednisone did little to alleviate my symptoms and I was literally counting the hours between rescue inhalers so I wouldn't overdose on them. I went online desperate for help and came across a breathing therapy I had previously dismissed because it was so counter to everything I had ever learned about breathing in the past. My training in Astanga and Vinyassa yoga in my pre-asthma days encouraged deep breathing, the stronger the breath the better. And here I was being told to do exactly the opposite - to breathe less!!! At this point, however, I had nothing to lose.
I began doing what I could - many short breath holds of 3-4 seconds every half a minute or thereabouts. Lo and behold, within a short while my wheezing and chest tightness subsided. Encouraged, I continued to practice, and within ONE DAY I was no longer in need of my rescue inhalers! I went from using my Ventolin every 4 hours and Atrovent every 6 hours to zero within one day. Needless to say I started to incorporate the Buteyko exercises into my every day, and within a short while I was out walking again, albeit slowly at first, counting my steps (more on that later).
For the first time since my asthma diagnosis I felt a sense of control and empowerment over my breathing. I learned how to stop asthma attacks right at their onset. I regained my ability to walk without terror that I might have a severe attack of breathlessness. I was able to build up my fitness again, being gentle and diligent with myself. And I enrolled myself in the certification course to learn as much about Buteyko as I could, with the goal of helping myself and others in the same boat.
Below I will give you an introduction to the Buteyko Method, and encourage you to try it. If you are unsure of where to start, find a practitioner who can guide you and tailor a program to your needs. The next section will be the short version so you can get right to the punch. If you wish to learn more about it, read on or go to www.buteykoclinic.com. It was through the heroic efforts of Patrick McKeown in Ireland that I learned Buteyko, and I feel incredibly grateful for his amazing dedication in teaching this method, which he sees as being effective for 90% of all asthmatics. That is quite a remarkable success rate, don't you think?
Note: I am giving you the Buteyko Method’s explanation of how the method works. I am actually unsure that the explanation is 100% accurate, and am still trying to understand the complexities of respiration chemistry to make sense of it. I will discuss this further elsewhere. However, the exercises have helped a lot of asthmatics, regardless of how it ultimately works.
What is the Buteyko Method?
The Buteyko Method is named after the late Russian physician, Dr. Konstantin Pavlovich Buteyko (1923-2003) who discovered, during his bedside visits with patients, that the sicker people were the heavier they breathed. He asked the question is “over breathing” (often referred to as chronic hyperventilation) the result of illness, or is the illness caused by chronic over breathing?
In the early 1950’s Dr. Buteyko was diagnosed with a severe form of medication resistant hypertension and was given 12 months to live. He began analysing his own breathing patterns, and asked himself if he could change his condition by reducing his breathing. He experienced immediate results - within minutes some of his symptoms disappeared (such as his headache and kidney pain). With perseverance he was able to permanently reduce his breathing and with that his “incurable” hypertension disappeared for good.
These positive results led him to a lifetime of research on patients, particularly asthmatics. He concluded from his research that asthmatics (as well as many other people with other health conditions) are chronically breathing too much, or hyperventilating, even when they are not experiencing an asthma attack. You might be surprised to know that the average healthy person takes in about 3-6 Litres of air every minute. An asthmatic takes in an average of 10-20 Litres of air between attacks, and over 20 Litres during an attack.
THINK OF OVERBREATHING ANALOGOUS TO OVEREATING - SOMETHING MOST OF US CAN RELATE TO!
The Buteyko Method works by
re-educating your body/respiratory centre
to change the habit of chronic hyperventilation
What causes over breathing?
One of the main things is STRESS. And that is something most of us have in spades! In our fast paced, instant bad news on TV or the internet society, who is not stressed out? Stress automatically, whether you are aware of it or not, causes you to breathe too much. This is the body’s way of getting ready to run away from danger - except we don’t run! We stay sitting in front of our computer or TV and breathe away a lot of our beneficial CO2 without even knowing it.
Other things that can cause over breathing are:
- overeating and eating processed foods
- stuffy environments (like a heated room in winter)
- sedentary life style (exercise increases CO2 levels)
- the belief that big breathing is good for you
But doesn't breathing less mean I won't get enough Oxygen?
In short, no.
The reason for this has to do with something known as the Bohr Werigo Effect (named after the physicians who discovered it) and basically has to do with the way oxygen is made available to your body’s tissues. The higher your CO2 levels, the more O2 is released to the tissues by it's carrier in the blood stream, haemoglobin. Thus, no matter how much O2 you breathe in, if your CO2 levels are too low, your tissues will actually receive less. O2.
A further consideration is that when people practice the Buteyko method their O2 saturation levels remain constant. (measured by pulse oximetry). You would have to be incredibly short of breath to reduce your O2 levels.
Effects of chronic over breathing:
The reason we hand a person who is having a panic attack, and therefore hyperventilating, a paper bag to breathe into is the same reason why changing your breathing patterns are effective to restore health. It has to do with the fact that when we hyperventilate we lose CO2 from our bloodstream and from our lungs. CO2, as it turns out, is not just a waste gas. CO2 causes relaxation of your airways and blood vessels. Now you can see why having low CO2 levels is not a good idea for an asthmatic. The less CO2, the more your airways restrict. So when you are having an asthma attack and trying desperately to get more air into your lungs, the more your CO2 levels drop, and the more your airways tighten up. Admittedly, the most counterintuitive thing to do during an asthma attack is to breathe less, but that is exactly what will help rebuild the CO2 levels and relax your airways. That is the reason why I was able to get off my rescue inhalers within a day of practicing multiple short breath holds!
Buteyko breathing exercises are designed to re-establish healthy levels of CO2 in the body. I will get into the complexities of this later on for those of you who want to know more details. I have some doubts that this is the only mechanism by which the Buteyko method works, and there are some conflicting data about this in the research literature, BUT, even if we do not know exactly how it works, the fact is that many asthmatics have benefited from this method, and many have become symptom and medication free as a result.
As an aside, the Buteyko method can also help people with COPD, emphysema and other chronic lung ailments, as well as those suffering from chronic sinus problems, people with sleep apnea, anxiety, insomnia, fatigue, and high blood pressure. It works by the same mechanisms - relaxation of blood vessels and airways, as well as the central nervous system.
So let’s get started!
Keys to the Buteyko Method:
Always breathe through your nose
Practice reduced breathing* until you have changed your habit of chronic over breathing
**Reduced breathing exercises to follow - pick those you can do, depending on your current state of health.
Ok, that may sound easier said than done if you are a typical asthmatic with chronically congested sinuses and often feeling short of air. So let’s take it one step at a time.
Proper breathing is always gentle, diaphragmatic, barely visible and barely audible and with your mouth closed
Breathing through your nose:
Why is breathing through your nose so important? The bottom line is that if you breathe through your mouth your asthma will be a lot worse and your nose will continue to be stuffed up.
The nose is there for breathing, smelling and to protect the lungs - it was designed that way. First of all, air that goes through the nose into the lungs is filtered, warmed and humidified. That way the lungs, which are warm and moist, receive air that is cleaner and adapted to its environment.
The nose filters the air by two mechanisms. The first is via the small hairs inside your nose that capture little particles. The second is via an accumulation of Nitric Oxide (NO) in the sinus cavities. In recent years it has been discovered that NO is produced in the sinus cavities and acts as a sterilising gas for any pathogens entering the nose. NO has another very beneficial property - it unclogs the sinuses (more on that later).
Unfiltered air that enters the lungs through mouth breathing is loaded with allergens - for example pollen, pollution particles and dust. In addition the viral, fungal and bacterial load the lungs are exposed to is hugely amplified. And the bad news is that these allergens and pathogens can stay in your lung tissue for up to 120 days! This is what makes your asthma symptoms worse and predisposes you to catching every cold going around.
So how do you start to unblock your nose? First you need to know that mouth breathing is often a habit. Unless you have polyps or a deviated septum you should be able to follow the ensuing exercise and over time become a nose breather.
If you cannot breathe through your nose for a minute after doing the following exercise, please see an ENT (ear-nose-throat specialist) to make sure you do not have polyps or a deviated septum, which may need to be addressed first.
Taping up your mouth at night:
If you are a habitual mouth breather, or you snore, or you wake up wheezing or with a dry throat chances are you are sleeping with your mouth open. Try taping up your mouth at night. This may sound a bit weird but it is amazingly effective and thousands of other people are doing it. It sounds scarier than it actually is. Use a few inches of hypo-allergenic, porous paper tape (like 3M micropore tape), fold the ends under and stick it on your arm first to make it less sticky. When you are ready to go to sleep place the tape over your lips - make sure your lips are completely closed. It will stop you from accidentally sleeping with your mouth open, and if you are a mouth snorer, your partner will thank you forever too! Mornings will find you much more alert and energised, and over time your asthma and sinus problems will diminish.
Do not tape up your mouth if you are feeling nauseous or have been drinking alcohol. Also do not put it on children under 5 or any child that cannot remove tape on their own.
For children taping up the mouth can be unacceptable and should not be done if the child is afraid of it. You can try tying a scarf around the head or using a hat with a chin strap. Make sure whatever you use is comfortable and cannot hurt the child. Avoid the child getting too hot and stuffy, as that can cause overbreathing. Another alternative could be ordering this special strap.
Additional tips for sleeping:
If your sinuses are partially blocked before you go to sleep, do the unblocking the nose exercise described above, and consider using a neti pot or the Neilmed sinus rinse kit to flush your sinuses out with a buffered saline solution before bed (mix 1/2 tsp. Sea salt and 1/2 teaspoon baking soda into one cup of distilled or sterilised warm water to make your own buffered saline solution) .
Try to sleep on your left side (this reduces breathing). Do not sleep on your back.
Do not eat within 3 hours prior to bed time (eating will increase your breathing)
If you are having trouble breathing through your nose with the tape in place, try not to take it off and practice reduced breathing (see below).
Practice 15 minutes of relaxation, and, if comfortable with it, reduced breathing prior to sleeping.
Breaking the habit of over breathing and establishing healthy breathing habits:
In order to break the habit of hyperventilation you need to practice a combination of the exercises that follow on a daily basis. 1 hour total (can be broken up into 10-20 minute segments) of some type of reduced breathing every day over the course of months will re-set your respiratory centre to accept a healthy level of CO2 in the body. Check the table below to assess which level you are at and which exercises are appropriate for you.
There is a very handy measurement (which you should familiarise yourself with) which gives you a good way to monitor your progress. This is known as the Control Pause (CP), and measures the amount of time you can comfortably hold your breath on the exhalation.
Taking your Control Pause (CP)
You should take your CP every morning upon awaking as this reflects your true state of health. After using your inhalers your CP will (should) increase. There are many factors that affect your CP - for example it should increase after doing reduced breathing or after exercising (as both of these things will raise your CO2 levels), and it will decrease after eating or if you have a cold or your asthma is flaring up.
Taking your CP is a good alternate or adjunct to using a peak flow meter. The peak flow meter is a great tool for monitoring your asthma too - the disadvantage is that you reduce your CO2 levels each time you forcefully exhale into it, which can actually induce bronchial constriction. If you are using a peak flow meter, hold your breath for a while afterwards and practice reduced breathing (Exercise 2) for a few minutes to rebalance your CO2 levels and avoid any bronchial spasms. I have noticed a direct correlation between my peak flow and CP measurements and now feel quite comfortable only using my peak flow meter occasionally.
The table below indicates what your CP means in terms of your asthma symptoms and what you should be doing as a daily practice to increase it. It also shows you by how much you are over breathing and the corresponding CO2 levels in your alveoli.
Okay, now that you know how to take your CP and determine where you are at, let us go over the actual practice exercises.
Examples to help you reduce your breath:
Natural Breathing is 3 counts in, 3 counts out Imagine a feather beneath your nostrils
Reduced breathing is 2 counts in, 3 counts out staying completely still as you breathe
Common Pitfalls with Reduced Breathing:
This exercise can take a while to get right. The most common mistakes are to create tension in the abdominal muscles in trying to control your breathing. Any tension you create will counteract the exercise. So don't try too hard! Begin gently with relaxing. If you find the air shortage too hard to do or anxiety inducing, just do the same exercise without the breath reduction, but focus on the relaxation of your body and your breathing. Eventually you will get comfortable enough to introduce the breath shortage. You can also try this exercise lying down at first, or before you go to sleep at night.
Variations on Reduced Breathing Exercise:
If you find the reduced breathing exercise difficult to do you may want to practice one of the following variations, or alternate them.
Reduced Breathing with closed Nostril
Check which of your nostrils is partially blocked (one will usually be more blocked than the other) and close off the other one. You can do this by pressing with one finger against the side of the nostril, or you can tape that nostril up with paper tape. You can do this for 20 minutes or so while reading or watching TV. Don't forget to take the tape off when you go out!
Reduced Breathing with Cupped Hands
Another variation involves cupping your hands in front of your nose to create a small space into which to breathe. As your hands are very sensitive you can use them to detect how much airflow is reaching them from your nostrils. That way you can try to breathe ever more gently. The space will also accumulate your previously exhaled CO2, thereby raising your CO2 level intake on your next inhalation.
Variation on the Floor combined with Pranayama
This method was written about by Barbara Benagh, a yoga teacher who became severely asthmatic, and by combining the Buteyko method with pranayama techniques managed to get her asthma very much under control. You can read the article here: https://www.yogajournal.com/lifestyle/asthma-answers. I found her method very helpful when I felt stuck with the regular Buteyko practice, and having practiced yoga for many years myself, felt very much at ease with her exercises. They are also good to do when you are feeling tired as they are done lying on your back.
Walking with your mouth closed
There are two things that will increase your CP. The first is practicing reduced breathing and the second is exercise. If you are suffering with a lot of chest tightness and shortness of breath, or if your CP is <20 seconds, do not push yourself when you exercise. Gentle is best! Never push yourself to the point of needing to open your mouth to breathe or to the point of getting symptoms! Measure your CP before and about 30 minutes after your exercise session. If you have done it correctly your CP should be higher 30 minutes post exercise.
Go for a 20-30 minute walk where you walk with your mouth closed the entire time to create a slight need for air. In other words, walk at a pace that pushes you just enough to feel a slight air shortage, but never to the point that you need to open your mouth to breathe. If you do, take a rest until you can breathe gently through your nose again. Keep your breath calm, even and soft throughout. Do not push too hard, especially if you have a low CP (<20).
Walking with breath holds
If your CP is above 15 you can start doing breath holds during your walk to create a moderate air shortage. While walking take a short breath in, and a short breath out before holding your breath (either by pinching your nostrils or closing off the back of your throat). Walk between 5-20 steps before resuming normal, gentle breathing. Gain control over your breathing within 2 breaths after your breath hold. Do not push yourself beyond a moderate air shortage - you may end up creating symptoms. After 30 - 60 seconds of normal breathing, repeat. Do about 6-10 sets.
Variation: Walking with closed nostril
Another way to reduce breathing while exercising is to block one nostril (try to block the one that is hardest to breathe through).
Note: People who have a CP <10 (i.e. very severe asthma) should not practice any prolonged breath holds. Also people with serious illnesses, such as cancer, epilepsy, schizophrenia, sickle cell anaemia, very high blood pressure need to be very cautious. Pregnant women during first trimester especially, should also avoid doing breath holds. If you have any doubts, please contact a Buteyko practitioner.
This exercise is particularly useful for children and teenagers, as well as for healthy adults with a CP > 20. In fact in children and teenagers this is often used as a progress monitoring tool as well as the practice itself. Reduced breathing and measuring CP may be a challenge to kids, and this is a great exercise for them, and keeps them motivated!
While walking hold breath on the out breath and count the number of steps you can walk before you experience a medium to strong air shortage. As above, pinch your nose or close off your throat after a short breath in and a short breath out, and hold the breath while counting off the steps. When you resume breathing, calm your breath as quickly as possible (if not possible to do within 2-3 breaths, you are holding your breath too long). Take a break for 60 seconds or so and repeat. Try doing 6 sets twice a day.
Children should practice 6 repetitions, two or three times daily. They should keep practicing until they have achieved over 80 steps, and then maintain that level doing 3 sets of STEPS once a day. After 60 steps their symptoms are stable. After 80 steps they have no more symptoms.
Multiple short breath holds
This exercise can be practiced by anybody, and is useful for building up your CP if it is very low, and to stop an oncoming asthma attack. This exercise will be able to calm down most symptoms of wheezing and coughing if done right at the onset. If your asthma is very unstable, this is the place to start! It will build up your CO2 levels.
Please note: if after doing this exercise for 5 minutes your asthma symptoms are not improving, or if your attack is severe, use your rescue inhalers. If rescue inhalers do not work within 15 minutes, seek emergency medical help immediately.
Take a small breath in, a small breath out and hold your breath for 3-5 seconds. Breathe gently through the nose for 30 seconds and repeat. You can do hundreds of breath holds throughout the day to build up your CP and control your symptoms.
What to expect when practicing reduced breathing:
Basically that is the Buteyko Method in a nutshell. You can expect to gain 3-4 seconds in your CP per week if you practice diligently. At around 20 seconds a lot of people seem to reach a plateau for a while. Don't despair - just keep doing it. Eventually, even if it takes months, your perseverance will pay off! Every time your CP goes up, your symptoms will lessen.
One thing you should be aware of is that when your CP increases by about 5 seconds, you may experience a DETOXIFICATION reaction. This is a good thing, although it may cause you a few days of increased symptoms and may be a bit uncomfortable. You may have loose stools, decreased appetite, increased thirst, a head cold, increased phlegm, fatigue, insomnia, a few moody moments or a headache. Just remind yourself it is your body’s way of coming back to health! Drink lots of warm water on those days, and start the morning with a glass of warm water with a small amount of sea salt dissolved in it. This will help clear out the phlegm.
Another thing to be aware of is that as your symptoms reduce as your CP increases, you may need less asthma medication. (You may also need less medication for other conditions, such as diabetes - so please work with your doctor on this to make sure you are doing everything safely). Work with your doctor and your Buteyko practitioner so that you can reduce your medications safely.
When you have had one month of
- no symptoms
- CP >40 sec
- no need for rescue inhalers
talk to your doctor to see if you can reduce some of your preventer medication.
As you wean off slowly you will experience a drop in your CP. Continue practicing until the same three criteria are fulfilled again, and then wean off a bit further. Many asthmatics before you have managed to become medication and symptom free - let’s pray that you can too!