Breathwork and Relaxation Safety Quick Reference

Urgent: when to get help now

• Sudden or severe trouble breathing. MedlinePlus advises going to the emergency room or calling the local emergency number (such as 911) if breathing difficulty comes on suddenly or seriously interferes with your breathing and even talking, or if someone completely stops breathing. [1]
• Blue, grey or very pale lips or skin, gasping, or not able to get words out. The NHS lists these among signs needing immediate emergency help. [2]
• Someone has fainted. MedlinePlus says to call 911 or the local emergency number if the person does not become alert quickly (within a couple of minutes). [3]
• Rapid breathing for the first time. MedlinePlus says this may be a medical emergency. [4]
• Mental health crisis (US). The 988 Suicide & Crisis Lifeline is available 24/7/365; you can call, text or chat. [5]

Do not use a breathing exercise to manage these situations. Breathing practice is not a substitute for emergency care.

Stop signs during practice

Stop and return to normal breathing if you feel lightheaded, dizzy, weak or unable to think straight, if you feel numbness or tingling in the arms or around the mouth, or if you feel you cannot catch your breath. These are listed by MedlinePlus as symptoms of overbreathing. [4] Then sit or lie down. The NHS suggests lying down until dizziness passes and getting up slowly, [6] and, if you feel about to faint, lying down with your legs raised or sitting with your head lowered between your knees. [7]

The NCCIH notes that people occasionally report increased anxiety, intrusive thoughts or fear of losing control with relaxation techniques. [8] If focusing on your breath makes you anxious, stop and see when focusing on breath makes you anxious. If low mood or anxiety persists, seek help from a qualified health professional. [8]

Places and times never to practise

Never practise breathing exercises while driving, riding, climbing a ladder, using machinery or at heights. The NHS names driving, climbing a ladder and using heavy machinery as things not to do while dizzy. [6]

Never practise overbreathing or breath-holding in the bath, pool or any water. A public health case review described two healthy young men who became unconscious underwater after intentional hyperventilation. [9] Guidance says hypoxic blackout does not correlate with water depth and can occur in any depth of water. [10] A children's hospital notes underwater breath-holding challenges on social media are not taking place in a controlled environment with necessary precautions. [11] See breath-holding risks and shallow water blackout and driving, water and heights.

What this site does not teach

We give no instructions for breath-holding, breath retention, hyperventilation or deliberate overbreathing, forceful or rapid breathing patterns, or breathwork combined with cold or water. We describe such practices only critically. On yoga breathing, the NCCIH advises newcomers to avoid extreme practices including forceful breathing. [12] Pages: intensive breathwork and documented injuries and deaths.

Who should check with a clinician first

Ask a clinician before starting if you have any of these: asthma, COPD or other lung conditions; heart conditions; high or low blood pressure; epilepsy or seizures; pregnancy; glaucoma; psychosis, bipolar disorder or other psychiatric conditions; panic disorder; a history of trauma; or an eating disorder.

Sources support part of this list. The NCCIH reports rare cases of certain relaxation techniques causing or worsening symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma. [8] For yoga it names severe high blood pressure and glaucoma among conditions that may call for modifications. [12] Detailed pages:

• Heart conditions or blood pressure
• Asthma, COPD and other lung conditions
• Epilepsy or seizure history
• Psychiatric conditions: psychosis, mania and dissociation
• Heart, pregnancy, epilepsy, glaucoma and more
• Anxiety or panic history

Medicines and care

Never stop or change medicines because of a breathing practice. For example, the NHS advises only stopping panic disorder medicines if your GP advises it. [13] For asthma, the NHS says to use your reliever inhaler during an asthma attack. [14] Tell your health care providers about the complementary approaches you use. [15] See telling your doctor about breathwork.

Sessions, teachers and groups

The NCCIH says credentials for complementary health practitioners vary tremendously from state to state and discipline to discipline. [15] A single regulator for breathwork facilitation is not described in the sources we read. Look for consent, no pressure to continue, no medical claims and screening before intensive sessions. See facilitator red flags, consent, touch and boundaries, group sessions and retreats and emotional release and distressing experiences.

More detail

Breathwork safety: dizziness, medical conditions and unsafe settings, overbreathing and hyperventilation, hyperventilation, panic or emergency?, dizziness, tingling and fainting, warning signs and when to stop and when breathlessness needs medical care.