Intensive Breathwork: Hyperventilation-Based Practices, Breath-Holding, Holotropic Breathwork and Cold-Plus-Breathwork Claims

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Intensive breathwork means deliberately fast, deep breathing (hyperventilation), often followed by holding the breath, sometimes for a long time. These practices are popular online, and people sometimes combine them with cold exposure. This page describes them and weighs the evidence. It does not teach them, and we advise never practicing them in or near water. Gentler options are on gentle breathing and relaxation practices.

Hyperventilation-based practices

Hyperventilation is rapid, deep breathing, also called overbreathing. It lowers carbon dioxide in the blood, which causes many of its symptoms, including feeling lightheaded, dizzy or weak, numbness and tingling in the arms or around the mouth, muscle spasms in the hands and feet, and a pounding heartbeat. [1] Doing it on purpose produces the same effects, which some practitioners then interpret as a useful "release" or altered state.

A 2023 review of "high ventilation breathwork" said reports of benefit for trauma-related, affective and bodily conditions invite further research and rigorous clinical testing. [2] That is insufficient evidence of benefit, not evidence of harm or of safety.

Wim Hof-style breathing and cold exposure

The Wim Hof Method combines breathing, cold exposure and commitment. In a 2014 randomized study of 24 healthy volunteers, 12 trained for 10 days in meditation, breathing (cyclic hyperventilation followed by breath retention) and cold exposure. Their breathing practice caused intermittent respiratory alkalosis and low oxygen, raised adrenaline, and after a controlled injection of bacterial endotoxin they had lower levels of some inflammatory markers and fewer flu-like symptoms. The control group was untrained. [3]

A 2024 systematic review of the method found 8 trials. Results suggested possible reduction of inflammation, but exercise-performance findings were mixed, and the trials were small with high risk of bias in most. [4][5] The Warwick researchers who ran the review said the evidence for the breathing part alone is mixed. [5] Label: promising but limited for lab markers; insufficient evidence for health outcomes; the cold-exposure part adds its own risks (see hydrotherapy safety and cold-water immersion).

Prolonged breath-holding

Voluntary breath-holding, especially after hyperventilating, is the dangerous combination. In a 2023 experiment with 18 volunteers, 15 seconds of hyperventilation lengthened breath-holds (133 vs 111 seconds) but left lower oxygen levels afterwards, and oxygen dropped further across repeated holds. The authors noted this could heighten the risk of a blackout. [6]

The American Red Cross, YMCA of the USA and USA Swimming state that hyperventilating before underwater swimming and extended breath-holding in water are dangerous and potentially deadly, and they use the term "hypoxic blackout" because water depth is not a factor. [7] A UK drowning-research group likewise notes hypoxic blackout can occur in any depth of water. [8] Evidence of harm is established for this combination in water. Never practice breathwork in a bath, pool, lake, sea or shower, or anywhere losing consciousness would be dangerous.

Holotropic breathwork

Holotropic Breathwork is a named method that uses deliberate hyperventilation to reach altered states of consciousness. A 2025 study that tracked holotropic and conscious-connected breathwork sessions found lower end-tidal carbon dioxide from deliberate hyperventilation was correlated with the onset of altered states, and deeper states predicted self-reported improvements in well-being and mood afterward. [9] That describes what happens, and it is not a controlled trial of treatment. We searched PubMed for "holotropic breathwork" and for adverse effects and found no randomized trial or systematic review of its safety or effectiveness: proper evidence not found.

NCCIH notes rare reports of relaxation techniques causing or worsening symptoms in people with epilepsy, certain psychiatric conditions, or a history of abuse or trauma. [10] Intensive sessions can be emotionally intense, so this caution applies strongly to them. We did not find a regulator or professional-body page for holotropic facilitators, so we cannot describe training standards in any country; ask about training, screening questions, and whether medical conditions are discussed first.

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Who should avoid, and when to get help

Do not try these if you have epilepsy, a heart or lung condition, panic symptoms, are pregnant, or have a psychiatric condition without first talking with your clinician. See therapies in pregnancy. For tingling, dizziness or fainting, see breathwork safety. MedlinePlus says rapid breathing for the first time may be a medical emergency. [1]