Breathwork Safety: Dizziness and Overbreathing, Medical Conditions, Water and Driving, and When to Stop

The short version

Gentle, comfortable breathing practices are low risk for most healthy people. The problems come from forcing the breath, practicing very fast or very deep breathing, holding the breath, or doing any of this in the wrong place. NCCIH says relaxation techniques are generally considered safe for healthy people, with occasional negative experiences. [1] If something feels wrong, stop. Overviews of the practices are on breathing and relaxation basics and gentle practices.

Dizziness and overbreathing

Overbreathing (hyperventilation) is rapid, deep breathing. It lowers carbon dioxide in the blood, which causes many of its symptoms. MedlinePlus lists feeling lightheaded, dizzy, weak or unable to think straight; feeling you cannot catch your breath; chest pain or a fast, pounding heartbeat; dry mouth; muscle spasms in the hands and feet; and numbness and tingling in the arms or around the mouth. [2]

You can overbreathe without noticing, especially when anxious or trying to breathe "deeply." The NHS version of belly breathing says to let the breath flow without forcing it. [3] If you feel these symptoms, return to ordinary gentle breathing, sit down, and stop the exercise. MedlinePlus describes pursed-lip breathing (puckering the lips as if blowing out a candle and breathing out slowly) as a way to help with the right amount of carbon dioxide when a provider has said anxiety is the cause. [2]

Relevant medical conditions

Breathing practices should not replace treatment. Talk with your clinician first if you have any of these:

• Asthma or other lung disease. A Cochrane review found breathing exercises may improve quality of life for adults with mild to moderate asthma, with moderate to very low certainty and no adverse-effect outcome counted. [4] The NHS says asthma is mainly treated with inhalers, and gives steps for an asthma attack: sit up straight, try to stay calm, and use your reliever inhaler. [5] Do not swap breathing exercises for prescribed inhalers.
• High blood pressure. Slow breathing gave a modest drop in blood pressure in a meta-analysis, but NCCIH says to follow your prescribed treatment plan. [6][1]
• Epilepsy, psychiatric conditions, or a history of abuse or trauma. NCCIH reports rare cases where relaxation techniques caused or worsened symptoms. [1]
• Panic or anxiety disorders. Breathing can help but is not a substitute for assessment and treatment; see breathing for stress, sleep and panic.
• Pregnancy. See therapies in pregnancy and ask your prenatal clinician.

Rapid breathing for the first time may be a medical emergency, MedlinePlus says, and it can have causes including heart problems, infection, lung disease or bleeding. [2]

Water, driving and other unsafe settings

Water. Do not practice fast breathing, breath-holding or long pauses in a bath, shower, pool, lake or sea. The American Red Cross, YMCA of the USA and USA Swimming say hyperventilating before underwater swimming and extended breath-holding in water are dangerous and potentially deadly, because they can cause loss of consciousness (hypoxic blackout), and that water depth is not a factor. [7] A UK drowning-research group says it can occur in any depth of water. [8] In a controlled experiment, hyperventilation lengthened breath-holds but left oxygen levels lower. [9]

Driving, machinery and standing. Because overbreathing can cause lightheadedness and weakness, [2] do not practice anything beyond gentle ordinary breathing while driving, operating machinery, or anywhere a faint would cause injury. This is a precaution drawn from those symptoms, not a rule from a study. Practice seated or lying down.

Intense methods. Fast-breathing and holotropic methods are described on the intensive breathwork page; we give no protocols for them.

When to stop

Stop the practice if you feel lightheaded, faint, tingling or numb, have chest pain or a pounding heartbeat, or feel anxious, panicky or out of control. [2][1] Resume normal breathing. If symptoms continue, get medical care. If you stop and feel better, try a gentler pace or a different relaxation method such as those on relaxation techniques.