Chapter 2

The Buteyko Method

The Buteyko Method was developed in the 1950s by Russian doctor Konstantin Buteyko. His method has been practised by hundreds of thousands of people for a variety of conditions including asthma, blood pressure, sleeping difficulties, anxiety, stress, panic attacks and depression.

As a young doctor, Buteyko spent many months sitting at sick patients’ bedsides observing their states of health. He noticed that each person’s breathing got heavier as his or her health deteriorated. As their illnesses advanced, he saw that his patients breathing movements from their chests and tummies increased, that their breathing became more audible, that their breaths became faster and that they sighed more and breathed through their mouths. In time, he was able to predict the onset of death just by observing their breathing.

This raised a fundamental question for Buteyko: was it his patients’ sickness that contributed to their heavy breathing or was it their heavy breathing that contributed to their sickness?

At the time, Buteyko suffered from severe hypertension that was going from bad to worse. He began experimenting by breathing less and quietening his breathing. Within a short while, the pains that he had experienced for months went away.

Over the following decades, Buteyko extensively researched this subject and had a dedicated laboratory to further his findings. His method was brought to the West in 1990 and is now taught in many countries.

Breathing, such a vital factor for life, must meet certain conditions. Severe overbreathing can be fatal if sustained over a short period. Therefore, it is plausible to accept that negative health effects will result from less severe but still excessive breathing over a long period.

Normal breathing volume

The number of breaths per minute during normal breathing is about 10 to 12. Each breath is approximately 500 ml. This provides a healthy volume, as described in any university medical textbook, of five to six litres of air per minute. Normal breathing is quiet, still, calm, relaxed and regular.

Persons suffering from anxiety and depression breathe a volume greater than normally accepted amounts. For example, an average sized person with anxiety might breathe 15 to 20 breaths per minute, with each breath larger than the normal 500 ml. Interspersed with this is a number of sighs. Assuming that each breath is 700 ml, the average breathing volume for this person is 10 to 15 litres of air per minute. In food terms, this is akin to eating six to nine meals each day!

Chronic overbreathing

Chronic overbreathing basically means that we habitually breathe more air than what our bodies require. In many ways, this is similar to a person developing the habit of overeating.

Breathing is similar. If we breathe more than what our bodies require over a 24-hour period, the habit takes hold. Dr Stephen Demeter confirms this when he states, “Prolonged hyperventilation (for more than 24 hours) seems to sensitize the brain, leading to a more prolonged hyperventilation.”⁽¹⁾

What increases breathing volume?

Breathing increases as a result of modern living. Factors such as strong emotions, time urgency, tension, anger, stress, anxiety, overeating, processed foods, a belief that taking big breaths is good, lack of exercise, excessive talking and high temperatures within the home all contribute to overbreathing.

How to recognise habitual overbreathing

At this point, you might think that you don’t overbreathe. For most people, overbreathing is subtle. It is hidden, which is why it often goes undetected. The typical characteristics of people attending my clinics include:

Breathing through the mouth;
Audible breathing during rest;
Regular sighs;
Regular sniffing;
Irregular breathing;
Holding of the breath (apnoea);
Taking large breaths prior to talking;
Yawning with big breaths;
Upper chest movement;
Movement of shoulders while breathing;
Lot of visible movement;
Effortful breathing;
Heavy breathing at night.

How many apply to you? Do you sigh? Do you breathe through your mouth? Do you wake up with a dry mouth in the morning? Does your breathing get faster or chaotic when you are stressed?

Carbon dioxide

Carbon dioxide or CO₂ is a gas created from our metabolic process as an end product. The human lungs require 5% CO₂ or 40 mmHg. If we breathe too heavily, CO₂ is exhaled or washed from our lungs. A loss of CO₂ from the lungs results in a reduction of CO₂ in the blood, tissues and cells.

The release of oxygen from red blood cells depends on the partial pressure or quantity of carbon dioxide in your lungs/arterial blood. When one is overbreathing, carbon dioxide is removed from the body, causing the oxygen to “stick” to haemoglobin within the red blood cells. This prevents its release into tissues and organs. This bond, discovered in 1904, is known as the Bohr Effect.

It is worth noting that during normal conditions, 75% of your intake of oxygen is exhaled while breathing a healthy volume of four to six litres per minute. Even during intense exercise, it is estimated that 25% of our oxygen intake is exhaled. Breathing a volume greater than normal does not increase the amount of oxygen in your blood, as it is already 97–98% saturated.

The Bohr Effect simply explained

Healthy people have quiet and unnoticeable breathing. While they are resting, you cannot see or hear their breathing.

Quiet breathing ensures optimum partial pressure of carbon dioxide within your lungs, blood, tissues and cells. The release of oxygen from your blood depends on the presence of carbon dioxide.

Overbreathing causes a loss of carbon dioxide from your lungs, blood, tissues and cells.

This results in less oxygen being released from your blood into your tissues and organs. The more you breathe, the more your body is being starved of oxygen.

Breathing through your mouth, sighs, sniffing, noticeable breathing, hearing your breathing during rest or having a low Control Pause (explained later) indicates that you are starving your body of oxygen. Your brain is being starved, resulting in anxiety, depression and stress.

The calmer and quieter you breathe, the larger your blood vessels open, enabling better circulation and distribution of oxygen throughout the body, including the brain.

Oxygenate your brain- breathe less.

Dilation of blood vessels and airways

Carbon dioxide relaxes the smooth muscles that surround the airways, arteries and capillaries.

With a normal breathing volume of 5 litres of air per minute, the partial pressure of carbon dioxide amounts to 40mmHg. Each 1 mmHg drop of arterial CO₂ reduces blood flow to the brain by 2%.⁽²⁾
In other words, oxygenation of your brain significantly decreases when you breathe heavily.

The heavier you breathe, the more you feed your hyperventilation or overbreathing related problems. Have you ever noticed that you get light-headed after taking a number of big breaths? Have you ever noticed being very tired in the morning after a night’s breathing through the mouth? How tired are you after a day’s talking? Do you notice that, as you get stressed, your breathing gets faster, resulting in a mental block and difficulty in making worthwhile decisions? Heavy breathing feeds anxiety and stress.

Overbreathing causes depression, stress and anxiety

Lower carbon dioxide within the blood causes a constriction of the carotid artery, the main blood vessel going to the brain. The extent of constriction depends on genetic predisposition but has been estimated by Gibbs (1992) to be as much as 50% for those with anxiety and panic attacks.⁽³⁾
This finding is also supported by Ball & Shekhar (1997).⁽⁴⁾

Other researchers, including Balestrino and Somjen (1988)⁽⁵⁾ and Huttunen et al. (1999)⁽⁶⁾, have demonstrated that CO₂ reduces cortical excitability. Cited in Normal Breathing: the key to vital health, “ breathing too much makes the human brain abnormally excited due to reduced CO2 concentrations. As a result, the brain gets literally out of control due to appearance of spontaneous and asynchronous (‘self-generated’) thoughts.” Balestrino and Somjen (1988) in their summary directly claimed that, “The brain, by regulating breathing, controls its own excitability.” ⁽⁷⁾

Dr Robert Fried, professor of psychology, states that “the first stage of chronic graded hypoxia (insufficient oxygen), which has repeatedly been shown in the case of chronic hyperventilation, is depression of mood and activity. ⁽⁸⁾

Cardiologist Claude Lum comments that “Hyperventilation presents a collection of bizarre and often apparently unrelated symptoms, which may affect any part of the body, and any organ or any system.”⁽⁹⁾ He further labels hyperventilation syndrome as the fat file syndrome, noting that patients go from doctor to doctor in an attempt to get help for their symptoms. However, because chronic hyperventilation is overlooked in most instances, the patient might be told after a series of tests that there is nothing wrong with him or her, thus increasing the size of the patients’ file and further adding to his or her anxiety.

In the late Professor Buteyko’s words, “Exhaling Carbon Dioxide from the organism brings about spasms in bronchi, vessels and intestines, etc. This reduces oxygen supply, leading to oxygen deficiency, making one’s breath heavier, thus completing the vicious circle.”

What is the fat file syndrome?

Louise’s personal account:

“For example, because I am prone to worry and overthink things, I get myself worked up into a right state about my symptoms. At different times, I was convinced that I had a brain tumour, MS, a heart problem, bowel cancer, etc. I had blood test after blood test, an ECG test, a scan, and nothing was found to be wrong. My whole family and my doctor, and probably most of my friends, think I’m a hypochondriac... but I knew that something was not right. I just didn’t make the connection to my breathing, so my symptoms went on and on and I felt like I was going mad. For lots of people, reading your book will be a real epiphany... and they might need some reassurance early on that they’re not alone and not mad after all, and that a lot of their symptoms will go away. Not worrying about the symptoms immediately reduces stress levels and hence breathing.”

Stress, anxiety and anger causes overbreathing

According to the famous physiologist Walter Cannon, stress activates the fight or flight response. Meeting deadlines, financial pressures, time urgency, marital issues, the pressure of rearing children and wanting to do well in our work, as well as many other factors, add to stress levels.

Stress ensures survival of the species

Stress is a natural reaction that we have developed throughout our evolution to ensure the survival of our species. Invariably, stress is our body undergoing chemical change in response to environmental conditions. Thousands of years ago, our main threat was from wild animals.

When confronted, we had two options to deal with it. The first was that we fought the animal. The second was that we ran away from it as fast as we could. As our bodies were required to perform intense physical activity, our physiology changed in the following ways:

Our breathing volume increases;
Our heart rate increases;
Adrenaline is pumped into our system;
Our pupils dilate;
Blood is diverted from our internal organs to our arms and legs;
Diarrhoea may occur (lightens our weight before flight);
Our blood coagulates in case of injury.

However, today our society and environment have changed at a far greater pace than what our bodies can adjust to. We respond to the stresses of today with the same reaction as we had thousands of years ago. We are in a traffic jam rushing to get to a meeting. The fight or flight response is activated but there is no need for it. Our heart rate increases, blood is diverted to our skeletal muscles, our breathing increases—we are primed for physical activity yet we are sitting still. The result is that we are running on the inside and sitting on the outside.

The heavy breathing arising from the fight or flight response results in a washing out of carbon dioxide from the lungs. This causes a narrowing of blood vessels, thus reducing blood flow to the brain. In addition, the release of oxygen from blood cells is less; the result of an inhibited Bohr Effect. This in turn increases self-generated, and more random, thoughts. With uncontrolled thought activity, we feel unable to cope with our everyday activities, further increasing our stress. A vicious circle has commenced, with stress increasing our breathing and this in turn increasing our stress.

How to correct it

Only by bringing your breathing volume to normal levels can you deal with the physiological aspects of stress and anxiety.

Long-term stress is exhausting and is known to result in many illnesses. It increases breathing volume, causing carbon dioxide to be washed from the lungs.

Remember: The more you breathe in, the more your breathe out.

The more you breathe out, the more CO₂ is washed from the lungs.

As CO₂ is washed from the lungs, the partial pressure of CO₂ is reduced in the blood, tissues and cells.

Prolonged overbreathing resets the respiratory centre in the brain to tolerate a lower partial pressure of CO₂.

Therefore, even when the initial stress is removed, the heavy breathing habit is maintained as a result of chemoreceptors in the brain being reset.

An anxious person may attend many psychotherapists, counsellors, psychologists and psychiatrists in an effort to get to the root of his or her condition. However, unless chronic overbreathing is addressed, he or she will be at a significant disadvantage in making progress.

Level and correct breathing volume allows normalisation of the partial pressure of carbon dioxide within the lungs, thus improving oxygenation of the brain and resulting in far less brain cell excitability.

How many of the following symptoms of hyperventilation do you have?

Neurological: light-headed feeling, poor concentration, memory lapses, faintness, headache, anxiety, tension, racing mind, numbness and tingling, tremor, depression, apprehension, irritability, brain fog, panic attacks, disrupted sleep, detachment from reality and stress.
Heart: palpitations, a racing heartbeat, pain in the chest region and a skipping or irregular heartbeat.
Respiratory system: wheezing, breathlessness, coughing, chest tightness, frequent yawning, snoring and sleep apnoea.
Gastrointestinal: Esophagal reflux, heartburn, aerophagia.

Other general symptoms include mouth dryness, fatigue, bad dreams, sleep disturbance, nightmares, dry itchy skin, sweating, cramping, spasm, increased urination such as bed wetting or regular visits to the bathroom during the night, diarrhoea, constipation, general weakness and chronic exhaustion.

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