Breathwork

[Jim001]

Anyone have experience with any of the popular breathing exercises, such as the Wim Hof Method, Yogic Pranayama, or Holotropic breathwork? I've dabbled into it just a little and found it relaxing, but I worry the intense breathing could give me post-exertional malaise of my diaphragm, and I also worry that the intense effects could exacerbate my illness.

 

[mango]

I've done a lot of pranayama and other yogic therapeutic breathing exercises over the years. Some advanced practices over a long period of time, as well. I started long before I got ME. Breathing practices haven't made me any less ill, and I don't find them helpful for symptom relief either.

Yes, I'd say you are right to be cautious. Pranayama is very powerful, its effects can be very intense -- on a bodily level, as well as the mind and emotionally. Can be a very challenging practice even for otherwise healthy people. There are risks, so the guidance of an experienced, skillful and compassionate teacher is definitely needed.

 

[hellytheelephant]

I have always found breathing exercises will crash me, but I think it would be different for everyone.

 

[Dechi]

I like meditation but breathing too deep makes me dizzy, so no fun.

 

[Sasha]

In another thread, @zzz posted this interesting article from The Atlantic:

Unlocking the Mysteries of Long COVID

As zzz said:

It's a great summary of what's been learned to date, and includes a number of illustrative case histories. It also makes a strong case tying long COVID to dysautonomia, and notes the similarities and differences between long COVID and POTS, ME/CFS, EDS, and other illnesses that feature dysautonomia. New treatment possibilities are also discussed.

And @Helene said:

My impression was the article had some excellent parts but also a lot about the success of simple breath works as a treatment.

Not sure what to make of it?

I was also interested by the stuff on breathing. Here it is (broken up for ease of reading):

Amissing piece of the puzzle, the Mount Sinai teams soon found, was right in front of them: breathing. Everyone knew, of course, about severely sick COVID‑19 patients on ventilators. What the researchers and doctors at Mount Sinai hadn’t realized was that even mild cases might be affecting respiration after the acute phase of the disease.

Evidence began to accrue that long-COVID patients were breathing shallowly through their mouths and into their upper chest. By contrast, a proper breath happens in the nose and goes deep into the diaphragm; it stimulates the vagus nerve along the way, helping regulate heart rate and the nervous system.

Many of us breathe through our mouths, slightly compromising our respiration, but in patients with post-acute COVID syndrome, lung inflammation or another trigger appeared to have profoundly affected the process. In these cases, patients’ breathing “is just completely off,” McCarthy told me.

Over the summer months, Chen’s and Putrino’s teams refined their treatment approaches, observing and analyzing all the while. They addressed patients’ disparate symptoms (such as new food sensitivities, or roaming pain) with dietary changes, stress-management techniques, and individually tailored rehab.

In addition, they introduced a science-based breathwork program, designed by a new company called Stasis, to try to restore normal breathing patterns in the sickest patients. Jessica Cohen used it over the summer to help recover from her setback. For Caitlin Barber, breathwork came in the fall, more than half a year into her ordeal.

One night in April, Josh Duntz woke up with an idea and scribbled “breathwork” in his bedside notebook. He reached out to David Putrino.
The Stasis program is deceptively simple and strikingly low-tech: It involves inhaling and exhaling through your nose in prescribed counts in the morning and at night.

The protocol was developed by Josh Duntz, a Navy Special Operations veteran, and his co-founder, Dan Valdo. During a decade in the Navy—he left in December 2019—Duntz had become obsessed with physical and mental performance under stress. “It was quite literally the difference between life and death,” he told me.

Trying breathwork himself after a workout partner introduced him to it, Duntz noticed immediate improvement in his endurance runs: He could run for longer with a lower heart rate, and without getting tired. He dug into the emerging science of breathing and became a convert.

By luck, Duntz knew Putrino; the two had been working together on a project prior to the pandemic. In the spring, he heard about the persistent breathing problems of COVID long-haulers.

One night in April, he woke up with an idea and scribbled “breathwork” in his bedside notebook. “So I reached out to David to say, ‘I think this could work and here’s why.’ ” A piece had clicked into place for Duntz: Similar symptoms (fatigue, shortness of breath, racing heart) occur in people who have low carbon-dioxide levels in their blood—a condition known as hypocapnia, which can be triggered by hyperventilation, or shallow, rapid breathing through the mouth.

Duntz wondered if perhaps these long-COVID patients, so many of whom suffered from dizziness and tachycardia, were also breathing shallowly, because of either lung inflammation even in mild cases or viral damage to the vagus nerve. The theory seemed plausible to Putrino: Oxygen is key to our health, but carbon dioxide plays an equally crucial role, by balancing the blood’s pH level.

Mount Sinai was able to launch a breathwork pilot program swiftly because of “how desperate people were—the hospital was so overwhelmed,” Duntz said. The program also didn’t have to pass FDA clearance.

After a week, everyone in the pilot program reported improvement in symptoms like shortness of breath and fatigue. (No double-blind randomized controlled trial has yet been conducted, so it is not possible to know what percentage of the improvement was due to the placebo effect.) The patients’ responses were “game-changing,” Putrino told me.

The key was the realization that the diaphragm and the nervous system had to be coached back to normal function before further reconditioning could start. “You cannot rehabilitate someone when their symptoms are completely out of control,” Putrino said. Although patients still faced an unfolding array of unpredictable symptoms, breathwork helped get them to a “place where the healing can start.”

That was Barber’s experience. In early November, seven months after getting sick, she began doing the breathwork with her husband, inhaling through the nose for four counts and exhaling for six in the morning, and in the evening, inhaling for four, holding for four, and exhaling for four. (I tried these routines and found them surprisingly hard.) She immediately discovered that she could better calm herself during an episode when her heart began racing.

Dayna McCarthy at the Center for Post-COVID Care laid out the group’s theories about why the treatment is so helpful. Through breathwork, patients can consciously control their heart rate, she noted.

In addition, modulating the nervous system’s fight-or-flight response may help regulate the immune system. (Studies have shown that elevated stress hormones can lead to chronic inflammation.) And proper breathing is crucial to circulation in the lymphatic system, often described as the body’s highway for immune cells, which plays a role in eliminating toxins and waste.

I talked with Barber a few weeks after she started the breathwork. She had noticed a dramatic decline in her heart rate. “It doesn’t help with my mobility,” she said. But “for some reason, my symptoms”—of breathlessness, dizziness, and brain fog—“have noticeably lessened.” She had her period the week we talked, usually a time when her symptoms intensified, but that month they hadn’t.

I don't know whether anyone has looked into breathing in PwME. I'm wondering where you would find instructions for this sort of breathwork.

Any thoughts on this, @PhysiosforME?

 

[Trish]

A lot of relaxation and meditation methods have used this sort of regulated deep breathing for calming and helping to relax for decades. I think physios teach diaphragmatic breathing where appropriate. It's nothing new. I do it when I need to calm myself.
It has no effect on my ME.

 

[Sasha]

There's a set of 'Coronavirus recovery breathing exercises' here from John Hopkins about restoring diaphragmatic breathing. I find I'm not able to do diaphragmatic breathing when standing.

 

[Invisible Woman]

I don't know whether anyone has looked into breathing in PwME. I'm wondering where you would find instructions for this sort of breathwork.

Been there, done that. Under the guidance of a really good physio.

Some of the reasons for trying it at the time included-
- Not great posture - many hours hunched over laptop keyboards, and being below average height means I'm not properly supported by a standard chair- the seat is often too deep and a bit too high.
- IBS - one of the theories was that shallow breathing or hyperventilating can make a big difference to gut and vice versa as a sore and bloated tummy against a waistband that gets restricting as the day goes on hurts and so you don't breathe properly.
- i also had some chest complaints that might have affected my breathing patterns.

Made zero difference to my ME & this was something I did in the early stages of being ill.

I'm not saying it won't help anyone at all, it just won't make a significant difference to ME.

I would watch the breathwork. Like @mango says some of it can be surprisingly stimulating and that's not great for pwME.

This is where I can see a clear benefit for wearing a HR monitor if you give this a go. Just to make sure you don't get carried away.

 

[Invisible Woman]

There's a set of 'Coronavirus recovery breathing exercises' here from John Hopkins about restoring diaphragmatic breathing. I find I'm not able to do diaphragmatic breathing when standing.

The instructions here are......not that good, not detailed enough.

For example the sitting upright breathing should perhaps include -

• Sitting upright comfortably - use a support behind the lower back if you need it.
• Ideally knees bent at right angles - so height of chair is important & this will affect the energy use by muscles
• Feet flat on the floor & hip width apart - if you're too short put a telephone directory, if such a thing still exists, under your feet.

The idea is you should be able to hold the posture comfortably. If you can't you'll introduce strain or tension and this will affect the breath.

I also noticed that when the person was doing the breathing exercise lying in their front, the gap in the treatment table was under their chest. The idea here would normally be the chest is flat to the floor as this means slightly more constriction to the chest and encourages air to the belly.

For ladies with a larger bosom that might not be comfortable so you might need to use a support.

It's really fundamental to any of these exercises that you are comfortable while doing then and can happily stay in that position.

 

[hellytheelephant]

Did breathing exercises with a specialised teacher- crashed me for weeks...so be wary. It is not 'just' breathing, and is still exercise and can cause PEM.

 

[Mij]

I'm able to lie on my Back Magic for 5 minutes which opens up my chest and relaxes my shoulders. I don't deep breath while lying down, but try to relax and focus on slowing my breathing as much as possible. I feel very good/relaxed after.
I only use it in the evenings when my body has had a chance to loosen up a bit.


Of course not everyone can use this but it feels ok for me.

 

[Invisible Woman]

I'm able to lie on my Back Magic for 5 minutes which opens up my chest and relaxes my shoulders. I don't deep breath while lying down, but try to relax and focus on slowing my breathing as much as possible. I feel very good/relaxed after.

I think.muscle pain & stiffness that we experience can affect posture and that can have a knock on effect on breathing.

Tightening & rounding of the shoulders & slumping of the chest with the head slumping back on the neck & chin coming up and forward all naturally tend to restrict natural, relaxed airflow into the lower part of the lungs.

If it's possible, given severity of ME, to gently open up the chest and correct the posture in a relaxed way then that can automatically improve breathing.

If the posture is wrong and you feel as though you're sitting up straight with the chest open, even though you're not, then you'll have limited success.

One of the most important things my physio taught me about correcting my posture was resting in a properly supported position.