Buteyko Breathing

The perfect person breathes as if they are not breathing.

- Patrick McKeown

What Is Buteyko Breathing?

 

young woman breathes fresh frosty air outdoors

Buteyko is a method of breathing that decreases the respiration rate, that is reducing the amount of breaths taken each minute to slow the breathing and ensure that inhalation occurs solely through the nose. It emphasises the effortless quiet breathing completed by healthy individuals. This method uses the addition of a controlled pause following exhalation to train the respiratory system to take in less air and calm the breath. Buteyko breathing is similar to other yogi breathing techniques as it directs the breath aligning the mind and body. It utilizes a controlled pause which is timed to better understand the respiratory capacity and manipulate the oxygen dissociation curve to attain maximal health benefits.

 

History

In 1956, Dr. Buteyko observed that healthy and unhealthy people have different breathing patterns. He noticed that less salubrious people tend to breathe with their mouths open and have an increased respiration rate. These observations were more concerning during sleep. Dr. Buteyko developed a breathing technique that focussed on controlling the ratio of inhalation to exhalation to teach individuals to manage their breath. This technique has been shown to help those suffering from asthma, panic attacks, and sleep disorders.

 

Hyperventilation

Often, when we are stressed, we are told to take a deep breath. When this occurs we tend to increase the speed of our inhalation and inhale through our mouths. This quick shallow breath pulls from the upper chest and eliminates more oxygen than it inspires. Breathing from the upper chest tends to be loud with an obvious rise in the chest cavity. During this quick breath we prevent proper gas exchange. The clearance of carbon dioxide causes us to continuously increase our inhalation speed leading to hyperventilation. Thus initiating the sympathetic nervous system’s stress reaction causing us to panic. When this stage of panicked hyperventilation takes place we feel as though our lungs are devoid of oxygen. We are instructed to breathe into a paper bag. This helps to increase the carbon dioxide in the lungs, replacing what was lost and correcting the pH of the blood. As this happens, your respiration rate will slow and your breathing will return to normal. The idea of hyperventilation as the root cause for carbon dioxide insufficiency is the main claim made by Dr. Buteyko’s Carbon Dioxide Theory of Disease.

 

Carbon Dioxide Theory Of Disease

Dr. Buteyko developed his breathing method around a theory on carbon dioxide and disease. He believed that chronic illness and disease is caused by chronic hyperventilation (breathing too frequently and too quickly makes you exhale more than you inhale) that shifts the pH of the blood causing adverse physiological effects. Dr. Buteyko researched the complex metabolic reactions that occur at the cellular level and determined that the lack of carbon dioxide as a result of unconscious hyperventilation limits the Krebs cycle; vital in producing energy and maintaining homeostasis within the body. The lack of carbon dioxide makes it impossible for the Krebs cycle to occur and severely limits the body's ability to produce energy. Dr. Buteyko’s carbon dioxide theory states that it is this chemical reaction that leads to disease and thus, he began developing a breathing technique to better prevent hyperventilation. 

 

The Importance Of Carbon Dioxide

Carbon dioxide is an important metabolic byproduct for the body. Even though it tends to be described as a waste product, it plays an essential role in many body functions.  Having too much or too little carbon dioxide can pose a threat to the brain and lungs. Oxygen and carbon dioxide work together and in direct opposition to one another to maintain and regulate homeostasis within the body. 

 

Oxygen Dissociation Curve

Oxygen is carried to the body tissues in a special molecule called haemoglobin on the red blood cells. The haemoglobin-oxygen dissociation curve indicates the optimal ratio of oxygen within the blood for the body to work efficiently. This curve can be shifted rightward or leftward from prime position to elicit physiological effects. Schmidt et al. (1988) found that ergometer training (ie: Cardiovascular training on a rowing machine) five times a week for at least forty-five minutes resulted in higher haemoglobin oxygen affinity. This indicates that there will be a greater binding rate of the oxygen to the haemoglobin, allowing the muscles and organs to have a more abundant oxygen supply. Anyone who has used a rowing machine will recognize the feeling of being out of breath and know that slow breaths through the nose are the best way to catch your breath. These deep slow breaths allow maximum oxygen intake and oxy-haemoglobin binding. 

 

Why Does Buteyko Work?

The physiological adaptations caused by this breath holding technique are still debated within the scientific community. Research indicates that the carbon dioxide theory is not likely to be the reason for the physiological changes. Furthermore, studies have shown that the resting carbon dioxide levels do not change in individuals who practice Buteyko consistently. There are several alternate theories that explain why the Buteyko method works to decrease hyperventilation and improve the respiration of individuals. For asthmatics, it is common for an asthma attack to cause intense anxiety, this anxiety in turn makes it even more difficult for the individual to regain their breath. The controlled pause and continued practice of breathing technique have been shown to decrease the anxiety that asthmatics feel, enabling them to remain calm and regain their breath. The relationship between anxiety and breath control is the main theory for the efficacy of Buteyko breathing.

 

Asthma

Asthma is a chronic condition where the airways narrow making it difficult to breathe. It is commonly controlled using long lasting corticosteroids and rescue inhalers that are fast acting (albuterol) and employed in emergencies when an asthma attack occurs. The sudden constriction of the airways generally begins with uncontrollable coughing and wheezing, once the rescue inhaler is administered the airways will begin to dilate allowing more air to flow into the lungs and the body to return to homeostasis. 

 

Breath Training: Asthmatic Children

Breath retraining has been used in yoga and meditations for centuries to refocus and rejoin the mind and breath. Connecting the mind and breath has positive physiological and psychological implications and has been shown to effectively control anxiety. A study from the Children’s Hospital in Germany (2021) analyzed the efficacy of implementing Buteyko breathing techniques as a treatment for children with asthma. They observed that breath retraining focuses on the patient’s breathing pattern as dysfunctional breathing and stated that it is this dysfunctional breathing that leads to hyperventilation as well as mental and physical health problems (Vagedes et al., 2021). After conducting a three-month Buteyko training program on thirty-two children diagnosed with moderate to severe asthma, they concluded that there were notable improvements in lung function. The children increased the time spent in the controlled pause indicating better control of their respirations. 

 

Asthma, Bronchoconstriction, And The Buteyko Method

Bruton and Lewith (2005) hypothesized that Buteyko breathing increases the breathing quality of asthmatics due to the extended pause decreasing the rate of respiration. The study found that the main benefit of Buteyko may actually come from its use of nasal breathing rather than mouth breathing. One cause of asthma attacks is the inhalation of an allergen, which causes bronchoconstriction. When the individual feels their airway narrowing, they inhale deeply through their mouth to get more oxygen, pulling in more allergens and strengthening the constriction of their airway. These actions lead to greater hyperventilation and a worsening of asthma symptoms. People with asthma tend to breathe through their mouths more frequently than healthy individuals. The increase of dry air into the airway may be a contributor to asthma attacks and the implementation of Buteyko breathing can retrain asthmatics to focus on nasal breathing. Thus limiting the number of asthma attacks they have and teaching them to control their breathing when one occurs. 

 

Let's Try Buteyko Breathing!

 

Group breathing deeply doing Buteyko breathing technique

The Buteyko technique uses a controlled pause. One is taken following exhalation, with each increase in five seconds of the pause being held indicating an improvement. With each successive week of training, the person will begin to feel as though their breath is lighter as they begin to take in more air and increase circulation within the body. Buteyko breathing consists of seven main exercises with several variations to each one. Choose the exercise that fits your life, comfort level, and goals the best. We will focus on the two most common Buteyko exercises that can be included in your daily routine or used during moments of stress and anxiety.

 

Nose Unblocking

The nose unblocking exercise is great for beginners and for those wishing to connect their minds and breath to reduce stress and anxiety.

 

Step 1. Sit in a comfortable position that you can hold for up to five minutes. Once relaxed, begin focussing on your breath. Gently rest your mouth in a closed position and breathe exclusively through your nose. 

 

Step 2. Take note of which nostril feels more congested and gently place your thumb and forefinger over that nostril sealing the airway. 

 

Step 3. Continue breathing through the single unblocked nostril. Pay attention to your breath, feeling the cold air entering your nostril and the warmed air leaving. Focus on the breath entering and exiting the nostril. Notice the way the hairs within the nostril move. Try to slow and soothe your breathing until the little hairs are not moved by the air. 

 

Step 4. Notice how your mouth and body feels as you continue to soften your breath. Does your mouth feel dry or wet? Do you have more saliva than normal? Do you feel warm or cold?

 

Step 5. Continuing to soothe the breath to the point where it is not noticeable that you are breathing will calm the sympathetic nervous system allowing the parasympathetic to take over and do the same to your mind and body. 

 

Step 6. On your next exhale, gently pinch your nose closed. This is the control pause phase of Buteyko.

 

Step 7. As you begin to feel like you need to take a breath, slowly release your nose and take a slow gentle breath in. After three to four minutes, the sympathetic tone will change and you will feel calm and connected.

 

Normalising Breathing

This exercise has several variations, choose the one that makes you the most comfortable. Variation one, consists of placing one hand on your stomach with the other on your chest. The second has your hands gently cup your face to feel your breath against your hands. The final variation uses a single finger to block each nostril in an alternating manner (very similar to alternate nostril breathing). 

The goal of the normalising breathing exercise is to use your hands as observational tools to feel how your breath moves through your body. 

 

Step 1. To begin, choose the variation you would like to try, and sit in a comfortable position. Finding a quiet space where you can hear your breathing may be beneficial to connect your mind to your breath and allow you to fully understand the changes in your breathing technique.

 

Step 2. Breathe quietly through your nose, focussing on your breath.

 

Step 3.

  • Variation 1:Place one hand on your abdomen and the other on your chest. Note how your chest and abdomen rise as you inhale and and lower as you exhale.

  • Variation 2: Gently cup your hands around your mouth and nose, rest the bottom of your palms against your chin and your forefingers against the side of your nose.

  • Variation 3: Lightly block one nostril with your thumb. Alternate nostrils by gently pinching both closed and releasing the previously closed nostril.

Step 4. Tune into your breath, paying attention to the cold air entering your nostrils and the warm air leaving. The human body can regulate blood circulation through respiration rate as the ratio of carbon dioxide to oxygen shifts.

 

Step 5. Slow each breath by extending the time it takes to inhale and exhale, continue down your breath until it begins to feel like you are not getting enough air. This should not feel stressful. Only slow the breath to a point where you are comfortable but want to take in a big breath.

 

Step 6. As you slow your breath observe how your hands rise and fall. Your goal is to have minimal movement within your abdomen and chest.

 

Step 7. Once your breath is no longer noticeable, continue breathing at this slow speed for three or four minutes.

 

Who Should Try The Buteyko Method?

Everyone! Buteyko breathing is a great method of connecting the mind, breath, and body, thus enabling a greater understanding of how we breathe, decreasing symptoms of anxiety, and calming the stress response. 

 

Buteyko And Athletics

In 2021, the Department of Sports Sciences and Medicine at Guru Nanak University completed a study of 40 competitive university-aged male football (soccer) players to understand how implementing the Buteyko method would affect their sports performance. The study used a six-week training program. Buteyko was implemented five days per week with two twenty-minute training sessions every day consisting of both a control pause and shallow breathing. Chaudhary et al (2021) found that Buteyko breathing improved the resting heart rate, aerobic endurance, resting blood pressure, and anxiety among all participants. The increases in aerobic endurance are significant for performance, as football is a demanding sport requiring optimal cardiovascular fitness and great endurance. These results also provide important implications for non-endurance athletes, as decreasing the resting heart and blood pressure rates are important for high intensity sports and overall health. 

 

Risks And Contraindications

Buteyko is a safe and effective method for controlling the breath rate and training the mind and body to breathe slowly and softly, preventing hyperventilation and disease outcomes. However, for some individuals hyperventilation may be a symptom of a greater medical problem. If you have been experiencing frequent hyperventilation that is not normal to you, check with your family physician before engaging in breath retraining. Acute hyperventilation can be symptomatic of a panic or anxiety disorder, heart attack, or even brain tumour. Buteyko may not be safe for individuals with blood pressure disorders. The controlled pause acutely increases blood pressure and could be dangerous for some individuals. Although Buteyko breathing is a proven therapy for asthmatics, it is important to speak with your doctor before changing your treatment plan or beginning Buteyko.

 

Buteyko: Frequently Asked Questions

 

How does the Buteyko breathing method improve your health and fitness?

Following a six-week Buteyko breathing training regimen, university-aged football players showed a significant increase in aerobic endurance with decreases in resting heart rate and blood pressure. This data shows that the Buteyko method has a significant and important effect on the health of the cardiovascular system which indicates that it can be beneficial for both highly trained athletes looking to enhance their aerobic performance and those just seeking to improve their cardiovascular health (Chaudhary et al., 2021).

 

What are the benefits of Buteyko breathing?

Buteyko breathing has a wide range of benefits including but not limited to; increased quality of sleep, increased aerobic endurance, decreased resting heart rate, decreased resting blood pressure, relief from asthma symptoms decreased anxiety and relief from panic attacks. 

 

Can Buteyko improve the quality of sleep?

Patrick McKeown is a leading expert in Buteyko breathing and he writes extensively on the way breathing affects sleeping patterns. He explains that the optimal respiration rate during sleep is six breaths per minute. Faster or slower respiration rates are connected to sleep and breath pattern disorders. Quicker breathing during sleep leads to hyperventilation, mouth breathing, and snoring. The use of Buteyko breathing reinforces slow rhythmic nasal breathing that can prevent sleep disruptions caused by disordered breathing.

 

Why should we breathe through our nostrils?

Breathing exclusively through the nostrils ensures that the air inhaled is warmed before entering the airway. When you breathe through your mouth the air is not properly warmed, this can cause damage to the upper airway increasing coughing and irritation. Nasal breathing also forces all particles that are taken in through the air to travel through the mucous membrane. The is part of the innate immune system, it traps and destroys pathogens that are inhaled through the nose, protecting us from illness. The upper airways is primarily responsible for respiration during wakeful and sleeping breathing. Resistance within the upper airway is tied to obstructive sleep apnea and can develop into a fatal condition where respiration stops completely and an individual suffocates. By consciously breathing through the nose rather than the mouth while awake, you train the brain and body to breathe exclusively through the nose during sleep. This prevents sleep apnea and other restrictive airway disorders that can cause harm. 

 

What is a control pause?

The control pause occurs naturally after exhalation, the body pauses before inhaling more air in. You can practice your control pause by taking a small, quick breath in and following it with another out. As you feel your lungs beginning to empty as you breathe out gently pinch your nose closed and time how long you can hold your breath. When you feel like you have to take a breath then you are experiencing air hunger. This is the goal of the Buteyko method, to increase the amount of time you can spend in the control pause and lengthen how long it takes your body to reach the air hunger phase. Once you feel you have to take a breath, release your nose and breathe through it. Make sure you do not hold your control pause for too long, or you will take a big breath after releasing. This mimics hyperventilation and will negate your progress.

 

What is deep breathing?

Deep breathing requires full contraction of the diaphragm. This is a muscle located below the ribs and above the abdomen. When it contracts it flattens creating a pressure gradient that pulls air into the lungs, causing you to inhale. In a full deep breath, the diaphragm fully contracts allowing the lungs to completely fill with air. This requires a long slow breath. To practice deep breathing, place one hand on your chest and the other on your stomach. As you inhale, feel how your stomach expands as the lungs fill with air.  Remember, you do not want to hyperventilate, therefore, the breath must be slow and controlled. 

 

Additonal References

  1. Ask the Doctors. (2020, September 16). Breathing into a Paper Bag can Calm Anxiety Attack. UCLA Health. https://connect.uclahealth.org/2020/09/16/breathing-into-a-paper-bag-can-calm-anxiety-attack/
  2. Bruton, A. & Lewith, G.T. (2005). The Buteyko breathing technique for asthma: A review. Complementary Therapies in Medicine, 13, 41-46. doi:10.1016/j.ctim.2005.01.003Buteyko Clinic.com. (2021). What is the Buteyko Method. Buteyko Clinic International. https://buteykoclinic.com/breathing-exercises/
  3. Chaudhary, S., Khanna, C., Maurya, U.K., & Shenoy, S. (2021). Effects of Buteyko breathing technique on physiological and psychological parameters among university football players. European Journal of Molecular and Clinical Medicine, 8(2), 1790-1800.
  4. Christian. (2020, Dec. 9).Deep VS Shallow Breathing - Causes, Dangers, Benefits, Exercises, Buteyko Clinic International. https://buteykoclinic.com/deep-vs-shallow-breathing-causes-dangers-benefits-exercises/
  5. Courtney, R.. (2017). Strengths, weaknesses, and possibilities of the Buteyko breathing method. Biofeedback, 36(2), 59-63. 
  6. Fitzpatrick, M.F., McLean, H., Urton, A.M., Tan, A., O’Donnell, D., & Driver, H.S. (2003). Effect of nasal or oral breathing route on upper airway resistance during sleep. European Respiratory Journal, 22, 827-832. Doi: 10.1183/09031936.03.00047903
  7. McHugh, P., Aitchenson, F., Duncan, B., & Houghton, F. (2003). Buteyko breathing techniques for asthma: An effective intervention. The New Zealand Medical Journal, 116(1187). https://www.nzma.org.nz/journal/116-1187/710/
  8. McKeown, P. (2017, January 4). Buteyko Breathing Exercises in 3 Minutes by Patrick McKeown [Video]. Youtube. https://www.mrjamesnestor.com/breath-vids
  9. McKeown, P. (2021). Reducing Insomnia with Buteyko Breathing. Buteyko Clinic International.  https://buteykoclinic.com/reducing-insomnia/
  10. Schmidt, W., Maassen, N., Trost, F., & Boning, D. (1988). Training induced effects on blood volume, erythrocyte turnover and haemoglobin oxygen binding properties. European Journal of Applied Physiology and Occupational Physiology, 57, 490-498. https://doi.org/10.1007/BF00417998
  11. Shigemura, M., Homma, T., & Sznajder, J.I. (2020). Hypercapnia: An aggravating factor in asthma. Journal of Clinical Medicine, 9, 3207. doi:10.3390/jcm9103207
  12. Vagedes, J., Helmert, E., Kuderer, S., Vageded, K., Wildhaber, J., & Andrasik, F. (2021). The Buteyko breathing technique in children with asthma: A randomized controlled pilot study. Complementary Therapies in Medicine, 56,