Contraindications to Breathwork
Authors: Martin McPhilimey BSc (Hons). MSc. MRes @Performance Through Health and UK Breathwork Association (UKBA)
There are a few considerations when it comes to breathwork. We have found over time, that a gentle nasal conscious-connected breath is a safe practice for everyone. However, for high ventilation breathwork, there are a few contraindications. Please read this document carefully.
Introduction
High Ventilation Breathwork is the scientific term encompassing a broad spectrum of breathwork practices found within breath communities and ancient traditions. These practices utilise an increased rate or depth of breathing as a form of meditative, explorative, or awareness-based breathwork. While the intensity and type of breathwork may vary among techniques, schools, or individuals, they generally generate breathing patterns that surpass metabolic needs at a resting state, leading to respiratory alkalosis. The alteration in both breathing patterns and biochemistry across the body and brain induces physical, mental, and emotional changes, accompanied by certain contraindications.
This document is designed to educate breathwork facilitators and coaches on potential contraindications and associated health risks. It is not intended as medical advice but rather aims to provide the underlying reasons for the existence of potential contraindications and the rationale behind them.
Individuals interested in participating in high ventilation breathwork should undergo a health screening that addresses the contraindications outlined below. Those with absolute contraindications should refrain from engaging in high ventilation breathwork unless they obtain written consent from a physician and a medical waiver that exempts the facilitating individual. It is essential to emphasise that these waivers do not absolve the facilitator of their responsibility for due diligence in ensuring safety and providing a duty of care.
Relative contraindications are conditions under which a person can proceed with caution. Protocols should be implemented to ensure that individuals with relative contraindications are subject to additional observation or follow specific breathing guidelines to promote a safer experience.
Absolute Contraindications
1. Cardiovascular disease including angina, previous heart attack or stroke
Reason:
Reduced Oxygen Delivery to the Heart: High Ventilation Breathwork can lead to a hypocapnia, where the levels of carbon dioxide in the blood are reduced. This can result in vasoconstriction of blood vessels, including those supplying the heart. In individuals with cardiovascular diseases, this can further compromise oxygen delivery to an already stressed heart.
Increased Strain on the Cardiovascular System: High Ventilation Breathwork can lead to a shift in intrathoracic pressure and this shifts in blood pressure, potentially causing a strain on the cardiovascular system. For individuals with a history of heart conditions, this added stress may exacerbate their condition and increase the risk of adverse events.
Risk of Arrhythmias: Rapid and deep breathing can disrupt the balance of electrolytes in the body, potentially leading to arrhythmias (irregular heartbeats). People with cardiovascular diseases are often more susceptible to arrhythmias, and breathwork could trigger or worsen this condition.
Potential for Vasoconstriction: High Ventilation Breathwork-induced hypocapnia may cause vasoconstriction, narrowing the blood vessels. In individuals with compromised blood flow due to cardiovascular issues, this constriction can further reduce the delivery of oxygen to vital organs, including the heart.
Increased Oxygen Demand: Breathwork can increase oxygen demand in the body. For individuals with cardiovascular diseases, particularly those with compromised cardiac function, this increased demand may put additional strain on an already compromised system.
2. High Blood Pressure (not controlled with medication) or Low Blood Pressure with a fainting history
Reason:
Blood Pressure Fluctuations: High Ventilation Breathwork can lead to a decrease in carbon dioxide levels in the blood, potentially causing vasodilation and a drop in blood pressure. For individuals with uncontrolled high blood pressure, this sudden decrease may exacerbate their condition and increase the risk of complications.
Risk of Fainting: High Ventilation Breathwork can reduce cerebral blood flow, leading to dizziness and fainting. Individuals with a history of fainting may be more susceptible to this effect, and engaging in breathwork that intensifies these symptoms could increase the risk of injuries from falls.
Increased Cardiovascular Strain: High ventilation Breathwork may increase the workload on the cardiovascular system, which could be problematic for individuals with hypertension. The heart must work harder to compensate for changes in blood flow and oxygen levels, potentially putting additional stress on the cardiovascular system.
Potential for Arrhythmias: Like individuals with cardiovascular diseases, those with high blood pressure may be more prone to arrhythmias. Hyperventilation-induced changes in electrolyte balance and heart rhythm could pose a risk for individuals with this condition.
Impact on Medication Efficacy: Individuals taking medication for high blood pressure may find that hyperventilation alters the normal physiological response to these medications. This can affect the effectiveness of the medications and lead to uncontrolled blood pressure levels.
3. Diagnosis of aneurysm in the brain or abdomen
Reason:
Increased Risk of Rupture: High ventilation Breathwork can lead to a decrease in carbon dioxide levels in the blood, which may result in cerebral vasoconstriction. For individuals with a brain aneurysm, this vasoconstriction could potentially increase the risk of rupture by altering the pressure dynamics within the blood vessels.
Impact on Blood Flow: Changes in blood flow can affect the dynamics within the blood vessels, including those in the abdomen. In individuals with an abdominal aneurysm, alterations in blood flow patterns could potentially pose a risk to the weakened vessel wall.
Risk of Aneurysm Dissection: The increased cardiovascular strain and changes in blood flow associated with high ventilation breathwork may contribute to the risk of aneurysm dissection. Individuals with a diagnosed aneurysm are generally advised to avoid activities that could potentially stress or compromise the integrity of the blood vessel walls.
Potential for Increased Intracranial Pressure: Hyperventilation can lead to a reduction in intracranial pressure, potentially affecting the pressure dynamics around a brain aneurysm. This alteration in pressure could be risky for individuals with a diagnosed aneurysm, as it may impact the stability of the aneurysm wall.
4. Uncontrolled Thyroid Conditions and Diabetes
Reason:
Impact on Thyroid Function: High ventilation breathwork can affect the balance of gases in the blood, including carbon dioxide. This alteration in blood gases may impact thyroid function. Individuals with uncontrolled thyroid conditions, such as hyperthyroidism, may be more sensitive to changes in metabolic and hormonal balance, and high ventilation breathwork could potentially exacerbate these issues.
Risk of Hypoglycaemia in Diabetes: High ventilation breathwork may lead to respiratory alkalosis, which can affect glucose metabolism. For individuals with diabetes, especially those on medications like insulin or certain oral hypoglycemics agents, there may be an increased risk of hypoglycaemia (low blood sugar) due to altered insulin sensitivity during breathwork.
Hormonal Interactions: Both thyroid function and diabetes management involve complex hormonal interactions. High ventilation breathwork-induced changes in blood gases and pH levels may influence these hormonal pathways, potentially impacting the delicate balance needed for proper thyroid function and glucose regulation.
Cardiovascular Strain: Individuals with diabetes often have an increased risk of cardiovascular issues. High ventilation breathwork-induced changes in blood pressure and heart rate could pose additional strain on the cardiovascular system, potentially increasing the risk of cardiovascular events in individuals with diabetes.
Medication Interactions: Some medications used to treat thyroid conditions and diabetes may interact with the physiological changes induced by high ventilation breathwork. It's important for individuals taking these medications to be aware of potential interactions and consult with their healthcare providers before engaging in breathwork practices.
5. Epilepsy and/or Seizures
Reason:
Potential Trigger for Seizures: High ventilation breathwork can induce changes in the levels of oxygen and carbon dioxide in the blood, which may trigger seizures in susceptible individuals. This phenomenon is known as high ventilation breathwork-induced seizures and can be a concern for those with a history of epilepsy.
Disruption of Electrolyte Balance: High ventilation breathwork can lead to a decrease in carbon dioxide levels, impacting the balance of electrolytes in the body. This disruption may contribute to an increased risk of seizures, especially for individuals who are already prone to seizure activity.
Altered Cerebral Blood Flow: High ventilation breathwork can affect cerebral blood flow, potentially leading to changes in brain perfusion. Individuals with epilepsy may be more sensitive to alterations in blood flow patterns, and this could increase the risk of seizures.
Individual Variability: The susceptibility to high ventilation breathwork-induced seizures can vary among individuals. What may be well-tolerated by one person might trigger seizures in another. Therefore, it is generally recommended that individuals with epilepsy or a history of seizures avoid activities that involve rapid and deep breathing.
6. Prior Diagnosis of Bipolar Disorder, Schizophrenia, or Previous Psychiatric Condition
Reason:
Potential Impact on Mental State: High ventilation breathwork-induced changes in blood gases, particularly a decrease in carbon dioxide levels, may influence mental and emotional states. For individuals with bipolar disorder, this could potentially trigger mood swings or exacerbate existing mood instability. Similarly, for those with schizophrenia or previous psychiatric conditions, alterations in mental states may be unpredictable and could lead to discomfort or distress.
Sensitivities to Stressors: Individuals with bipolar disorder and schizophrenia may be sensitive to stressors and changes in routine. The intense nature of high ventilation breathwork may be considered a stressor, and it could potentially disrupt the emotional balance or stability of individuals with these conditions.
Risk of Psychotic Episodes: High ventilation breathwork has been associated with symptoms such as dizziness, light-headedness, and changes in perception. In individuals with a history of psychiatric conditions, especially schizophrenia, these symptoms may pose a risk of triggering or exacerbating psychotic episodes. In psychoanalytic terms, this is fracturing of the Ego mind. Too much content coming from the unconscious in those who lack ego strength can cause neurosis or psychosis.
Individual Variability: Responses to high ventilation breathwork can vary widely among individuals. What may be a positive or neutral experience for one person might have adverse effects on another, particularly for those with a history of psychiatric conditions.
7. Hospitalisation for Any Psychiatric Condition or Emotional Crisis Within the Last 10 Years
Reason:
Potential Triggers: Breathwork, especially techniques involving rapid and deep breathing, can induce altered states of consciousness and intense physiological responses. For individuals who have recently experienced psychiatric hospitalisation or an emotional crisis, these practices may act as potential triggers for distressing emotions or memories.
Sensitivity to Stressors: Individuals who have undergone recent psychiatric hospitalisation may be more sensitive to stressors, including changes in mental and emotional states. High ventilation breathwork, with its potential to induce rapid shifts in consciousness, may be overwhelming for those in a delicate mental health state.
Interaction with Medications: Many individuals who have been hospitalised for psychiatric conditions may be on medications that impact their mental and emotional stability. Engaging in high ventilation breathwork without professional guidance could potentially interact with these medications and affect their efficacy or contribute to adverse reactions.
8. Pregnancy
Reason:
Oxygen Supply to the Foetus: High ventilation breathwork can lead to changes in blood gases, including a decrease in carbon dioxide levels. While moderate changes in breathing patterns are generally well-tolerated, extreme high ventilation breathwork might impact the oxygen supply to the foetus. Ensuring a consistent and appropriate oxygen supply is crucial for foetal development.
Hormonal Changes: Pregnancy involves significant hormonal changes, and the body's response to high ventilation breathwork may be different during this time. Hormonal fluctuations can influence respiratory patterns and responsiveness to changes in carbon dioxide levels, potentially affecting the pregnant individual's experience with breathwork.
Impact on Blood Pressure: High ventilation breathwork can lead to changes in blood pressure, and pregnant individuals may already experience fluctuations in blood pressure due to pregnancy-related changes. Sudden changes in blood pressure can have implications for both the pregnant person and the developing foetus.
Risk of Dizziness or Fainting: Pregnant individuals may be more prone to dizziness or fainting, especially during certain trimesters. High ventilation breathwork-induced reductions in carbon dioxide levels can contribute to these symptoms. Fainting poses risks for both the pregnant person and the baby, and it's important to avoid activities that may increase this risk.
Stress on the Cardiovascular System: Pregnancy places additional demands on the cardiovascular system. Engaging in high ventilation breathwork that significantly alters heart rate and blood pressure may place extra stress on the cardiovascular system, which could be a concern during pregnancy.
In addition to the general contraindications for pregnancy, individuals with specific pregnancy complications, such as placental issues or a history of preterm labour, should approach high ventilation breathwork cautiously.
9. Detached Retina
Reason:
Intraocular Pressure Changes: High ventilation breathwork-induced alterations in blood gases, particularly a decrease in carbon dioxide levels, can impact blood flow and potentially lead to changes in intraocular pressure. For individuals with a detached retina, avoiding activities that could further impact intraocular pressure is generally recommended to prevent additional stress on the retina.
Risk of Increased Eye Strain: High ventilation breathwork can cause symptoms such as dizziness, light-headedness, and changes in vision. For someone with a detached retina, these symptoms could potentially exacerbate eye strain and discomfort, posing a risk of further damage to the compromised retina.
Importance of Eye Protection: Individuals with a detached retina often need to take precautions to protect their eyes and prevent additional trauma. Engaging in activities that may lead to dizziness or uncontrolled movements, as can happen with high ventilation breathwork, could increase the risk of accidental eye injuries.
10. Glaucoma
Reason:
Impact on Intraocular Pressure: High ventilation breathwork-induced changes in blood gases, particularly a decrease in carbon dioxide levels, can influence blood flow and potentially affect intraocular pressure. Elevated intraocular pressure is a concern for individuals with glaucoma, as it is a risk factor for optic nerve damage.
Potential Risk of Further Damage: Sudden changes in intraocular pressure can pose a risk for individuals with glaucoma, potentially leading to further damage to the optic nerve. Engaging in activities that may influence intraocular pressure, such as high ventilation breathwork, could potentially exacerbate this risk.
11. Any Other Medical, Psychiatric, or Physical Conditions Which Would Impair or Affect the Ability to Engage in Activities Involving Intense Physical and/or Emotional Release. This May Include Coming Off Recent Medications Such as HRT.
Reason:
Potential Interactions with Medications: Discontinuing or adjusting medications, including HRT, can lead to changes in the body's hormonal balance and overall physiological state. Engaging in activities that involve intense physical or emotional release may interact with these changes and could have unpredictable effects.
Impact on Emotional Well-Being: Activities involving intense physical and emotional release can be emotionally demanding. For individuals with psychiatric conditions or those recently adjusting to changes in medication, such activities may pose an additional emotional strain, potentially affecting mental well-being.
Physical Health Considerations: Certain medical conditions or physical limitations may make intense physical activities unsafe or unsuitable. It's important to consider any pre-existing health conditions that could be exacerbated by activities involving intense physical or emotional release.
Relative Contraindications
1. Asthma
For individuals with asthma, we kindly request that you bring your inhaler to the session. Your safety and well-being are our priorities, and having your inhaler on hand will help us ensure a prepared and supportive environment during our time together.
Reason:
Bronchoconstriction Risk: High ventilation breathwork can lead to a decrease in carbon dioxide levels in the blood, potentially causing bronchoconstriction. In individuals with asthma, who already have sensitive airways, this bronchoconstriction can exacerbate breathing difficulties and trigger an asthma attack.
Increased Respiratory Rate: High ventilation breathwork involves rapid and deep breathing, which may lead to an increased respiratory rate. For individuals with asthma, this heightened respiratory activity can contribute to respiratory muscle fatigue, making it harder for them to maintain normal breathing patterns.
Potential Trigger for Asthma Attacks: Asthma attacks are often triggered by factors such as changes in airway responsiveness and exposure to irritants. High ventilation breathwork, by altering the balance of gases in the blood, can act as a trigger for asthma attacks in susceptible individuals.
Risk of Hypocapnia: High ventilation breathwork can lead to hypocapnia, a condition characterized by low carbon dioxide levels. In individuals with asthma, this reduction in carbon dioxide may lead to an imbalance in the body's acid-base status, potentially worsening respiratory symptoms.
Individual Variability: Responses to high ventilation breathwork can vary among individuals. While some may not experience significant issues, individuals with asthma may be more prone to adverse reactions, making it a prudent choice to avoid high ventilation breathwork.
2. Recent Surgeries:
For people who have had a recent surgery (3 – 6 months) they should consult their general physical before partaking in High ventilation Breathwork.
Reasons:
Impaired Healing Process: After surgery, the body requires time to heal, and engaging in intense physical activities such as high ventilation breathwork can potentially disrupt the healing process. Surgical sites need time to close and regenerate tissue, and vigorous movements may strain or reopen incisions.
Risk of Complications: Recent surgeries often involve some level of trauma to the body. Intense physical activities can increase the risk of complications, including bleeding, infection, or the formation of scar tissue. It's crucial to allow the body sufficient time to recover and reduce the likelihood of post-surgical complications.
Increased Strain on Surgical Areas: Certain surgeries may impact the respiratory or cardiovascular systems directly or indirectly. Engaging in high ventilation breathwork can place additional strain on these areas, potentially causing discomfort, compromising recovery, or exacerbating existing issues.
Potential for Dislodging Internal Structures: Some surgeries involve the placement of internal structures such as stents or grafts. Intense physical activities may have the potential to dislodge these structures or interfere with their proper functioning, posing a risk to the individual's health.
3. Presence of Acute Illness or Symptoms
Reasons:
Increased Physiological Stress: Engaging in high ventilation breathwork while experiencing acute illness or symptoms can add physiological stress to an already compromised system. The body is already working to combat the illness, and intense physical activity may divert resources away from the immune response, potentially prolonging recovery.
Risk of Exacerbating Symptoms: High ventilation breathwork involves rapid and deep breathing, which may be challenging for individuals with respiratory symptoms such as coughing, shortness of breath, or chest discomfort. Participating in such activities could exacerbate these symptoms and lead to increased discomfort or respiratory distress.
Dehydration and Fluid Loss: Illnesses often come with symptoms like fever, sweating, or vomiting, which can contribute to dehydration. High ventilation breathwork, with its increased respiratory rate, may further contribute to fluid loss. Dehydration can impede the body's ability to recover and may increase the risk of complications.
Potential for Contagion: Individuals with acute illnesses may be contagious, and participating in group activities like high ventilation breathwork could pose a risk of spreading the illness to others. It's considerate to avoid group activities during the acute phase of an illness to prevent transmission.
Individual Discomfort: Acute illnesses often come with general discomfort, fatigue, and malaise. Engaging in intense physical activity may be physically taxing and emotionally challenging for someone who is already feeling unwell, potentially leading to increased stress and a more prolonged recovery.
References
Cooper, B. G. (2011). Republished review: An update on contraindications for lung function testing. Postgraduate medical journal, 87 (1032), 724-733.
Sylvester, K. P., Clayton, N., Cliff, I., Hepple, M., Kendrick, A., Kirkby, J., ... & Butterfield, K. (2020). ARTP statement on pulmonary function testing 2020. BMJ Open Respiratory Research, 7(1), e000575.