A BRIEF OVERVIEW OF THE CHEMISTRY OF RESPIRATION AND THE BREATHING HEART WAVE

Title: A BRIEF OVERVIEW OF THE CHEMISTRY OF RESPIRATION
Date: 02/08/2008

A BRIEF OVERVIEW OF THE CHEMISTRY OF RESPIRATION
AND THE BREATHING HEART WAVE
Peter M. Litchfield, Ph.D. in California Biofeedback. Vol. 19, No. 1 (Spring 2003)

Respiration: Chemistry and Mechanics
“Respiration” is behavioral-physiologic homeostasis, a form of self-regulatory behavior, which constitutes a
transport system for customized delivery of atmospheric oxygen to each and every tissue based on their specific
metabolic requirements, including the transport of metabolic carbon dioxide from the cells to outside air. The
“mechanics” of respiration constitute “breathing,” the use of the lungs for moving oxygen, carbon dioxide, and other
gases to and/or from the blood. The “chemistry” of respiration constitutes the physiology of moving oxygen from
the lungs to the cells, and carbon dioxide from the cells to the lungs. Optimizing respiration means good “chemistry
through good “mechanics.”
In this overview, “breathing mechanics” have reference to breathing rhythmicity (holding, gasping, sighing),
breathing rate, breathing depth (volume), locus of breathing (chest and diaphragm), breathing resistance (nose and
mouth), and collateral muscle activity for breathing regulation (muscles other than the diaphragm). “Breathing
chemistry” has reference to the ventilation of carbon dioxide through these breathing mechanics in the service of
establishing adaptive respiratory chemistry. Respiratory chemistry can be monitored by measuring changes in
exhaled carbon dioxide, to be discussed later, so as to ensure that the learning of breathing mechanics is truly in the
service of respiration.
Good breathing “mechanics” rather than good respiratory physiology, has unfortunately become almost the
exclusive focus of breathing training and learning, often along with insistence on tying it to “relaxation” training
regimens in the context of specific philosophical and/or professional agenda. As a result, it is not surprising then,
that at least 50 percent of therapists and trainers who teach breathing actually deregulate respiratory chemistry by
inducing “overbreathing” with their instructions to trainees, not realizing that they are inducing system-wide
physiological crisis through the establishment of hypocapnia, i.e., carbon dioxide deficit. Unfortunately, based on
this kind of thinking, myths and misunderstandings about “good” breathing often constitute the “working
knowledge” of professionals and lay audiences alike. Here are some of them:
Good breathing means relaxation.
No. Good breathing is important in all circumstances, whether relaxed or not.
Learning good breathing requires relaxation.
No. This would mean that during most life circumstances, breathing is maladaptive.
Diaphragmatic breathing is synonymous with good breathing.
No. In many instances one may begin to overbreathe as a result of switching from chest to diaphragm.
Good respiration is all about the mechanics of breathing.
No. Good breathing means ventilating in accordance with metabolic requirements.
Diaphragmatic, deep, slow breathing means better distribution of oxygen.
No. Mechanics may look letter perfect, but oxygen distribution may be poor.
Underbreathing, with the result of oxygen deficit, is common.
No. To the contrary, overbreathing is common.
Good breathing translates into optimizing respiratory physiology, and contrary to popular thinking, learning to
breathe well does not simply mean deep, slow, diaphragmatic breathing in the context of learning how to relax.
Adaptive breathing means regulating blood chemistry, through proper ventilation of carbon dioxide, in accordance
with metabolic and other physiologic requirements associated with all life activities and circumstances: relaxation or
stress, rest or challenge, fatigue or excitement, attention or open-focus, playing or working. Deregulated breathing
chemistry, i.e., hypocapnia (CO2 deficiency) as a result of overbreathing, means serious physiological crisis
involving system-wide compromises that involve physical and mental consequences of all kinds, to be examined
later in this overview. Evaluating, establishing, maintaining, and promoting good respiratory chemistry are
fundamental to virtually any professional practice involving breathing training. Good breathing chemistry
establishes a system-wide context conducive to optimizing health and maximizing performance.
2
Breathing training is invariably included as an important component of relaxation training, but surely does not in
and of itself constitute relaxation. Breathing may be fully optimized, and hopefully is, during times of stress and
challenge where relaxation is neither possible nor adaptive. Once good breathing chemistry and breathing
mechanics are in place, relaxation training may then also include the establishment of stable high-amplitude
breathing heart waves, i.e., parasympathetic (nervous system) tone, otherwise known as the respiratory sinus
arrhythmia (RSA) and as one of the frequency ranges (HF) of what is known as heart rate variability (HRV).
Respiratory Chemistry: The Role of Carbon Dioxide in Oxygen Distribution
Blood is circulated with great precision to specific body sites based on their local and immediate metabolic
requirements. Higher metabolism in more active tissues and cells generates higher levels of CO2 resulting in
immediate local vasodilation (relaxation of smooth muscles with the result of increasing the diameter of the vessels),
thus setting the stage for supplying the required oxygen and glucose to the associated tissues, such as to specific
regions of the brain while thinking.
Higher levels of CO2 also lead to an immediate drop in blood and extracellular fluid pH levels through the
formation of carbonic acid, thus obliging the hemoglobin to more readily distribute its oxygen to meet local
metabolic requirements. Lower levels of CO2, as a result of lower metabolism, lead to blood vessel constriction
(e.g., reduction in the diameter of the coronaries) and to higher levels of blood and extracellular fluid pH (less
carbonic acid), thus permitting oxygen and glucose to go elsewhere where metabolic requirements are greater. In
the simplest of terms, this is the biochemistry of healthy respiration.
Deregulated Respiration: Effects of Carbon Dioxide Deficit on Physiology
The most serious form of breathing deregulation is overbreathing, an all too common and serious state of
behavioral-physiologic affairs. Overbreathing is undoubtedly one of the most insidious and dangerous
behaviors/responses to environmental, task, emotional, cognitive, and relationship challenges in our daily lives.
Overbreathing can be a dangerous behavior immediately triggering and/or exacerbating a wide variety of serious
physical and mental symptoms, complaints, and deficits in health and human performance.
Overbreathing* means bringing about carbon dioxide (CO2) deficit in the blood (i.e., hypocapnia) through excessive
ventilation (increased “minute volume”) during rapid, deep, and dysrhythmic breathing, a condition that may result
in debilitating short-term and long-term physical and psychological complaints and symptoms. The slight shifts in
CO2 chemistry associated with overbreathing may cause physiological changes such as hypoxia (oxygen deficit),
cerebral vasoconstriction (brain), coronary constriction (heart), blood and extracellular alkalosis (increased pH),
cerebral glucose deficit, ischemia (localized anemia), buffer depletion (bicarbonates), bronchial constriction, gut
constriction, calcium imbalance, magnesium deficiency, and muscle fatigue, spasm (tetany), and pain.
*Note: “Overbreathing” is a behavior leading to the physiological condition known as hypocapnia, i.e., carbon dioxide deficit.
“Hyperventilation,” although nomenclature synonymous with hypocapnia in physiological terms, is often used as a clinical term to describe a
controversial psychophysiologic “syndrome” implicated in panic disorder and other clinical complaints.
Effects of Overbreathing on Cerebral O2:
Vasoconstrictive effects
Reduction of O2 Availability by 40 Percent
(Red = most O2, dark blue = least O2)
In this image, oxygen availability in the brain is reduced by 40% as a
result of about a minute of overbreathing (hyperventilation). Not only is
oxygen availability reduced, but glucose critical to brain functioning is
also markedly reduced as a result of cerebral vasoconstriction.
3
Blood is distributed based on metabolic requirement. Overbreathing is excessive ventilation of carbon dioxide,
excessive because CO2 levels in the blood no longer accurately reflect metabolic level; the ratio of metabolic CO2
to expired CO2 has shifted in favor of exhaled CO2. The consequence is a miscalculation of local metabolic
requirements that leads to less than the required amount of vasodilation, or to vasoconstriction, and thus to
potentially serious deficits of oxygen (hypoxia) and glucose (hypoglycemia) as well as of other required nutrients
for the optimal functioning of a wide variety of tissues and physiological systems (e.g., brain, heart, and lungs).
This misinformation about metabolism also triggers constriction of other smooth muscles, e.g., in the bronchioles
and the gut, thus potentially exacerbating both asthma and irritable bowel syndrome.
Carbon dioxide deficit means a reduction in carbonic acid and a corresponding shift of blood and extracellular fluid
pH in the alkaline direction, i.e., above the normal range of 7.38 – 7.40; alkalosis is an immediate consequence of
hypocapnia. Paradoxically, this results in an increase in oxygen saturation in the blood, because hemoglobin does
not encounter pH levels that accurately reflect current metabolic requirements and is thus less inclined than it would
otherwise be to release its oxygen; the pH level does not properly reflect metabolic requirements. Thus, although
oxygen saturation is maximized, oxygen distribution is withheld where in fact metabolic needs significantly exceed
those reflected by the reduced CO2 levels resulting from overbreathing.
The coupling of vasoconstriction and "disinclined" hemoglobin (because of higher pH levels) means significant
compounding of oxygen distribution problems where oxygen deficits (hypoxia) are considerably greater than those
brought about by vasoconstriction alone, e.g., deficits, in effect, that may exceed 50 percent in the brain. Combining
these effects with glucose deficit in the brain, in the heart, and in other physiological systems can precipitate,
exacerbate, and even originate serious consequences, including physiological and psychological complaints,
symptoms, and syndromes of numerous kinds (see below).
Alkalosis, i.e., increased pH due to reduced levels of CO2, leads to yet further compromises. Extracellular fluid
alkalosis increases cellular excitability and contractility (e.g., neuronal excitability in the brain) and thus actually
increases oxygen demand, anaerobic metabolism, and antioxidant depletion (caused by excitatory amino acids).
And, in fact, yet further worsening matters, alkalosis inhibits the negative feedback normally associated with lower
pH levels that limit the production of metabolic acids themselves (e.g., lactate), and hence yet further compromises
performance. Blood alkalosis leads to migration of calcium ions into muscle tissue, including both smooth (e.g.,
coronary, vasocerebral, bronchial, gut) and skeletal tissue, resulting in increased likelihood of muscle spasm
(tetany), fatigue, and pain. And, platelet aggregation is increased, thus elevating the likelihood of blood clotting.
Overbreathing is an insidious and unconscious habit, one that is not readily detectable. Overbreathing may be
precipitated at stressful times of the day, during times of defensiveness and emotionality, during information
overload, or upon the commencement of ordinary tasks through self-initiation or instructions from authority. Some
individuals overbreathe with little provocation and may do so chronically, all day without knowing it. And,
unfortunately overbreathing is even induced (often) and reinforced by professionals who teach breathing mechanics
(e.g., diaphragmatic training) in the name of relaxation, improved health, and better performance. Good chemistry
is fundamental to optimal behavioral-physiologic homeostasis, basic to optimizing health and performance.
Chronic Deregulation: Compensatory Behavioral-Physiologic Activity and its Price
Bicarbonates are required for controlling acidosis (when blood becomes less alkaline than normal, less than 7.38),
i.e., neutralizing acids, brought about through physical activity (e.g., lactic acid) as well as through other physiologic
activities (e.g., ketoacidosis as a result of diabetes). Chronic hypocapnia resulting from overbreathing ultimately
leads to compensatory renal unloading of bicarbonates (inhibition of bicarbonate reabsorption in the kidneys), which
lowers blood and intracellular pH toward normal levels, but in the end neither completely renormalizing nor
stabilizing pH levels. Unfortunately, chronic compensatory behavior may ultimately seriously compromise
buffering capabilities, resulting in reduced physical endurance and greater susceptibility to fatigue.
In addition to the loss of bicarbonates, there is also significant loss of magnesium (and phosphates) a deficiency that
may ultimately lead to an imbalanced magnesium-calcium ratio critical to muscle functioning, resulting in increased
likelihood of muscle fatigue, weakness, and spasm.
4
Although the blood pH, i.e. alkalosis, is reduced as a result of this compensatory behavior, and hemoglobin
distributes its oxygen more consistently with metabolic requirements, smooth muscle constriction and its
consequences remain a chronic condition (e.g., cerebral vasoconstriction, coronary constriction, bronchial
constriction, and gut constriction).
Note: Individuals suffering with diabetes may overbreathe as a means to controlling ketoacidosis, i.e., reducing levels of carbonic acid. This is
why biofeedback for “relaxation training,” for example, was contraindicated for such individuals. Normalizing CO2 levels implicit in relaxation
training, without proper attention to matter of chemistry, might well result in acidosis. The “price” for compensatory overbreathing behavior,
however, is high and nevertheless needs to be seriously addressed.
Overbreathing: Effects on Health
Overbreathing, based on the chemistry of breathing described above, can trigger or exacerbate physical and
psychological complaints such as: shortness of breath, breathlessness, chest tightness and pressure, chest pain,
feelings of suffocation, sweaty palms, cold hands, tingling of the skin, numbness, heart palpitations, irregular heart
beat, anxiety, apprehension, emotional outbursts, stress, tenseness, fatigue, weakness, exhaustion, dry mouth,
nausea, lightheadedness, dizziness, fainting, black-out, blurred vision, confusion, disorientation, attention deficit,
poor thinking, poor memory, poor concentration, impaired judgment, problem solving deficit, reduced pain
threshold, headache, trembling, twitching, shivering, muscle tension, muscle spasms, stiffness, abdominal cramps
and bloatedness. It is little wonder, then, why surveys have found that up to 60 percent of all ambulance calls in
major US cities are the result of overbreathing!
The significance of the effects of this little known but thoroughly documented physiology can be put into
perspective knowing that surveys suggest that 10 to 25 percent of the US population suffers from chronic
overbreathing, and that over half of us overbreathe on frequent occasion! The following is a quotation from a book
chapter written by Dr. Herbert Fensterheim (Chapter 9, Behavioral and Psychological Approaches to Breathing
Disorders, 1994), a highly respected and internationally prominent author and psychotherapist, and it points to the
fundamental importance of evaluating respiratory chemistry, i.e., overbreathing, in the mental health professions,
regardless of a practitioner’s school of thought or treatment paradigm:
“Given the high frequency of incorrect breathing patterns in the adult population, attention to the symptoms of
hyperventilation [overbreathing] should be a routine part of every psychological evaluation, regardless of the specific
presenting complaints. Faulty breathing patterns affect patients differently. They may be the central problem,
directly bringing on the pathological symptoms; they may magnify, exacerbate, or maintain symptoms brought on by
other causes; or they may be involved in peripheral problems that must be ameliorated before psychotherapeutic
access is gained to the core treatment targets. Their manifestations may be direct and obvious, as when overbreathing
leads to a panic attack, or they may initiate or maintain subtle symptoms that perpetuate an entire personality
disorder. Diagnosis of hyperventilatory [overbreathing] conditions is crucial.”
Chronic vasoconstriction, magnesium-calcium imbalance, buffer depletion, and alkalosis (higher levels of blood and
extracellular pH levels) as a result of overbreathing may in predisposed individuals trigger or exacerbate: phobias,
migraine phenomena, hypertension, attention disorder, asthma attacks, angina attacks, heart attacks, cardiac
arrhythmias, thrombosis (blood clotting) panic attacks, hypoglycemia, epileptic seizures, altitude sickness, muscle
weakness and spasm, sexual dysfunction, sleep disturbances (apnea), allergy, irritable bowel syndrome (IBS),
repetitive strain injury (RSI), and chronic fatigue.
In an important recent review article on the subject of hypocapnia (CO2 deficit) in the New England Journal of
Medicine (J. Laffey and B. Kavanagh, 4 July 2002), the authors say:
“…extensive data from a spectrum of physiological systems indicate that hypocapnia has the potential to propagate or
initiate pathological processes. As a common aspect of many acute disorders, hypocapnia may have a pathogenic role in the
development of systemic diseases” (pages 44 and 46). And, they go on to say, “Increasing evidence suggests that
hypocapnia appears to induce substantial adverse physiological and medical effects” (page 51).
Long-term vasoconstriction may also lead to ischemia in the brain and the heart (anemia in cells not adequately
supplied with oxygen), result in reduced neurotransmitter synthesis that contributes to the onset of depression and
other psychological syndromes, and chronically lower the threshold for most of the complaints listed above, e.g.,
chronic vasoconstriction and increased systemic vascular resistance may reduce the threshold for elevated blood
pressure or precipitate angina attack in predisposed individuals.
5
It is estimated that the primary complaint of one third of all patients in general medical practice is fatigue, a
condition that may actually be brought on and/or exacerbated by buffer depletion resulting from overbreathing, and
a condition (fatigue) in and of itself that can be assessed through CO2 measurement (capnometry) to be described
later in this overview. On this basis alone, some prominent physicians in both Europe and America assert that
capnometers, like blood pressure devices, should be on the desktop of every general and family practitioner.
It is estimated that more than a third of all those who suffer with asthma overbreathe, a condition potentially leading
to immediate bronchial constriction and asthma attack. The “struggle” to breathe and fear of “not getting enough
air” can easily lead to “panicky” breathing where vicious circle overbreathing may result in a progressive worsening
of hypocapnia-induced bronchial constriction and increased airway resistance. Teaching good breathing mechanics
to people with asthma through diaphragmatic breathing can very significantly improve breathing efficiency by
increasing volume, reducing rate, establishing rhythmicity, and eliminating collateral muscle movement not required
for good breathing. In effect, it reduces the “struggle” to breathe by introducing an effortlessness form of breathing
that also provides for a sense of mastery over the debilitating effects of the condition. This training, however, can
itself easily result in overbreathing through a combination of the “success” of the method itself (increased efficiency,
volume) and the continued motivation “to get enough air,” and where neither the therapist nor the patient are
familiar with overbreathing and its effects.
Documented medical savings of 45 percent over a five year period in heart attack patients following only six
breathing training sessions, led to legislation in Holland that all cardiac rehabilitation centers offer breathing training
to patients. Unfortunately, this little known research and its highly practical implications remain relatively unknown
to most professionals working in American cardiac rehabilitation centers, where the importance of behavioral
respiratory physiology has simply not been introduced. The importance of breathing training in cardiovascular
health is yet further supported by the article in the New England Journal of Medicine (page 50), where the authors
point out that “hypocapnia has been clearly linked to the development of arrhythmias, both in critically ill patients
and in patients with panic disorder.”
How can “simple” breathing training significantly influence the outcome of cardiovascular rehabilitation in patients
who overbreathe? Consider the following: A survey of studies on overbreathing and coronary constriction show a
reduction of blood volume by about 50 percent (a 23 percent reduction in coronary diameter), a significant reduction
in compromised individuals; and, extreme coronary constriction as a result of overbreathing has also been identified
in a subpopulation of patients. Increased platelet aggregation brought about by hypocapnia may precipitate blood
clotting, i.e., thrombosis. Buffer depletion resulting from long-term overbreathing, as described earlier, may also
significantly contribute to the onset of arrhythmias and other cardiovascular abnormalities. Increased vascular
resistance as a result of vasoconstriction and alkalosis brought about through chronic overbreathing may trigger
hypertension in predisposed individuals. Hypocapnia leads to cellular excitability and to increased contractility of
the heart, increasing oxygen demand while oxygen availability is sharply decreased. And, the upward pH shift
brings on calcium migration into muscle tissue, increasing the likelihood of arterial (coronary) spasm. Normalizing
breathing chemistry reverses these effects.
The New England Journal of Medicine article goes on to point out that clinically significant overbreathing in
pregnant women is commonplace, and that during childbirth, “…further lowering of the partial pressure of arterial
CO2 - even for a short duration - such as during anesthesia for cesarean section - may have serious adverse effects
on the fetus.” The implications of this statement are staggering when considering that some child-birthing
techniques used by many thousands of women (western) worldwide actually engaged women in the practice of
extreme forms of overbreathing during childbirth.
Overbreathing during wakefulness is seriously implicated as an important variable in the origin and in the onset of
sleep apnea. “Hypocapnia is a common finding in patients with sleep apnea and may be pathogenic,” according to
the same article in New England Journal of Medicine.
The seriousness of the effects of hypocapnia are made absolutely clear in the New England Journal of Medicine
review article, written for the express purpose of warning physicians about their use of hypocapnia as a means to
controlling symptoms and conditions resulting from injury and disease, as well as its widespread use in general
anesthesia. In fact, the impact of hypocapnia on cerebral blood flow and blood volume is so dramatic, according the
article, that almost 50 percent of emergency physicians and 36 percent of neurosurgeons actually induce hypocapnia
to control of life-threatening intracranial swelling resulting from head trauma or brain injury.
6
Overbreathing: Effects on Cognition
Cognitive and perceptual deficits are perhaps most clearly understood by newcomers to this physiology by
examining the effects of hypoxia on the behavior of pilots. Every pilot knows about the cognitive and perceptual
deficits resulting from the effects of hypoxia in high altitude chambers, including impaired decision-making,
perceptual motor skills, information processing, problem solving, task completion, memory, thinking, and
communication effectiveness. Serious cerebral hypoxia means that even the easiest of tasks become significant
mental challenges, e.g., simple navigational calculations during an engine-out procedure. In fact, overbreathing is
routinely monitored in fighter pilots while in flight. Particularly noteworthy, as is often emphasized by on-looking
observers, is the fact that these performance decrements go completely undetected by those actually suffering from
the hypoxia. Overbreathing at sea level and the resulting hypoxia produce precisely these same effects!
The potent impact of overbreathing on cerebral functioning is made clear in the recent article in the New England
Journal of Medicine in the description of the use of hypocapnia for controlling intracranial swelling in otherwise
life-threatening brain trauma circumstances: “Hypocapnic alkalosis decreases cerebral blood flow by means of
potent cerebral vasoconstriction, thereby lowering intracranial pressure.” The dramatic impact of overbreathing on
cognitive function is put into further perspective, when the authors describe the widespread and deliberate induction
of hypocapnia during general anesthesia (e.g., for reducing the need for sedatives), as follows:
“The causative role of hypocapnia in postoperative cognitive dysfunction is underscored by the finding that exposure to an
elevated partial pressure of arterial carbon dioxide [i.e., normalizing CO2 levels] during anesthesia appears to enhance
postoperative neuropsychologic performance.”
Cognitive, perceptual, and motor skill deficits, brought about by hypoxia (oxygen deficit) are yet further exacerbated
by cerebral hypoglycemia (glucose deficit, as a result of vasoconstriction) that may compromise brain functioning to
a yet greater degree. The potentially debilitating combination of cerebral oxygen and glucose deficits resulting
directly from overbreathing may seriously compromise and/or disrupt ability to attend, focus, concentrate, imagine,
rehearse the details of an action (e.g., golf swing), initiate performance, play a musical instrument, sing, engage in
public speaking, and perform all kinds of other complex tasks.
There is a fine line between vigilance and stress. In the transition from vigilance to stress, i.e., from positive
attentiveness to guarded defensiveness (fight-flight behavioral patterns), overbreathing may be immediately instated
with its debilitating effects occurring within less than a minute. This same kind of transition may occur when taskdemand
exceeds a certain level of complexity or when relationship challenge exceeds a certain level of emotionality:
overbreathing as a component of defensive posturing takes over. Task-induced overbreathing for example can
insidiously and unsuspectingly contribute to the degradation of human performance, insidious because the performer
is neither likely to be aware that overbreathing is taking place, nor have any idea whatsoever as to its effects.
Performers who are task-induced “overbreathers” are good candidates for breathing chemistry training.
The implications of overbreathing and its regulation for working with children and adults suffering with attention
deficits are significant. Low cerebral CO2 as a result of overbreathing shifts the EEG power spectrum downwards
and elevates the presence of theta EEG activity, the frequency domain of principal interest to neurofeedback
practitioners who seek to reduce theta activity in clients who suffer attention deficit disorder. Before beginning such
work it truly behooves practitioners to normalize the chemistry of breathing, a fundamental system-wide
physiological consideration, before beginning neurofeedback or other forms of behavioral-physiologic training.
Overbreathing: its Effects on Emotion
Cerebral hypoxia and cerebral hypoglycemia not only have profound effects on cognition and perception but also on
emotionality: apprehension, anxiety, anger, frustration, fear, panic, stress, vulnerability, and feelings of low selfesteem.
Cerebral (brain) oxygen and glucose deficits may trigger “disinhibition” of emotional states, i.e., release of
emotions otherwise held “in check.” Loss of emotional control, intensification of emotional states, and exacerbation
of debilitating stressful states of consciousness may result from overbreathing in challenging and adverse
circumstances, e.g., flying phobias and debilitating public speaking anxiety. Emotional discharge in challenging
environments itself may, of course, further exacerbate cognitive and other performance deficits.
7
Failure to understand the source of physical sensations resulting from overbreathing, e.g., light-headedness, tingling
of the skin, tightness of the chest, sweaty hands, and breathlessness, typically leads to a false interpretation of their
meaning. The incorrect, and usually negative, self assessment that may result, e.g., “I am losing control,” is likely to
elicit secondary emotional responses (e.g., fear) and further exacerbate the ones directly resulting from cerebral
oxygen and glucose deficits. And indeed, practitioners and trainers themselves, not familiar with the effects of
overbreathing, may unfortunately also misinterpret these secondary effects, taking them as evidence supporting their
own biases about the significance of the kinds of complaints reported by the client, e.g., “relaxation moves you
closer to yourself, and this makes you uncomfortable. Overworking is your way of protecting yourself.”
Sometimes overbreathing is deliberately induced for the very reason that it can trigger emotional memories and
states, e.g., rebirthing. Stanislav Grof’s Holotropic Breathwork, widely known for its use in triggering emotional
and memory release, is an excellent example of how overbreathing lowers the threshold for emotional expression.
Some breathing inductions used in natural child birth, for example, involve extreme forms of overbreathing, based
on the premise that disorientation reduces capacity to focus on pain; from a respiratory chemistry perspective,
however, this amounts to induction of system-wide crisis with potentially adverse effects on the infant.
Overbreathing: Effects on Performance
Compromising the blood buffering system (i.e., reduced capacity to regulate acidosis) means reduced physical
capacity and endurance, ranging from limiting athletes in their pursuit of achieving peak levels of physical
performance, to contributing to the incapacitation of individuals with fatigue and unable to perform the simplest of
tasks without exhausting their supply of buffers.
Incrementally increasing the workload on an exercise bike or treadmill increases metabolism, and hence the output
of carbon dioxide. Normal ventilation means that the CO2 exhaled is consistent with level of metabolism; there is
no overbreathing. Eventually, however, when buffers become depleted and can no longer neutralize lactic and other
acid byproducts, overbreathing becomes a short-term solution to the resulting acidosis, i.e., carbonic acid is reduced,
thus offsetting the build up of other acids. Monitoring CO2 levels during exercise on an exercise bike or treadmill
permits an observer to take note of this critical point, the point at which overbreathing is itself a compensatory
response to buffer depletion, the point at which physical exhaustion can be identified. And, as described previously,
chronic overbreathing itself may lead to buffer depletion, thus ultimately reducing physical capacity and endurance
to a point where simple exercise becomes equivalent to the maximum endurance effort of an athlete.
Buffer depletion physiology has very significant implications for performance and health. Running out of buffers
with exercise equivalent to walking to work, crossing a few streets to lunch, or preparing dinner for the family
means “physical” exhaustion doing the simple physical chores that define the daily routine of life. Overbreathing
may not only lead to buffer depletion but may then also become its own short-term solution to the resulting acidosis,
i.e., a vicious circle syndrome. This state of affairs can be observed by exercising on an exercise bike or treadmill
and noting the point at which there is a drop in carbon dioxide level, the point at which overbreathing is engaged.
Professional and lay audiences both ponder the ways in which “stress” ultimately has its effects on health and
performance. What are the mediating variables that lead to behavior-physiologic deregulation? One important
contributing factor may be the way in which one encounters challenge: bracing or embracing, defensive-posturing or
life-engaging? The defensive or bracing mode often includes overbreathing (part of the “fight-flight” behavioral
configuration) that may lead to the fatigue symptoms and complaints associated with the effects of buffer depletion
and magnesium deficiency, along with the wide range of physical and psychological effects previously described.
The “fatigue” associated with overbreathing may be misidentified as “depression.” Exercise may be “prescribed”
when rest is in order, where exercise will actually exacerbate the problem and is contraindicated. Buffer depletion,
resulting from exercise and associated compensatory overbreathing, may in fact precipitate cardiac arrhythmias even
in otherwise healthy individuals. Rest will permit build-up of the buffers, but upon returning to a challenging
environment without breathing and other forms of self-management training, overbreathing is likely to be reinstated,
once again resulting in buffer depletion and a relapse of fatigue and associated effects of “stress.” Deregulated
respiratory chemistry constitutes a behavioral-physiologic mechanism that may directly account for some of the
effects of “stress” on homeostasis and self-regulation.
8
Respiratory Training: General Considerations
Fritjof Capra, famed physicist and systems theorist, states his position on the mindbody dichotomy so well when he
says, “the organizing activity of living systems, at all levels of life, is mental activity” (The Web of Life, 1996). In
other words, there simply is no dichotomy, that all of life is itself inherently “mindful.” Thus, in this thesis there is
no distinction between physiological or psychological crisis; defensive posturing or bracing and life-engaging or
embracing are “mindful” frames of physiological reference, comprising what might be described as “life” postures.
These “life” postures are fundamental operating-definition culture-based concepts as can be seen in Western
psychology where there is emphasis on defensiveness, and in Eastern philosophy and practice (e.g., meditation),
where there is emphasis on embracement of chi, i.e., life or breath. Both of these postures are profoundly reflected
in the chemistry and in the mechanics of respiration.
Breathing evaluation and training bring together differing western schools of thought and tradition, including
physiology, psychology, healthcare, and human performance with the promise of weaving them together with
Eastern thinking, traditions, and practice into an active, personal, and mindful participation in behavioralphysiologic
self-regulation for health and performance.
Seeing “physiology as mindful” carries with it an important implication: it is the “ego” part of the mind that
identifies itself as “separate” from the “body,” giving rise to the mind-body dichotomy through its indignant claim
on ownership of all of the mind, wherein the mind necessarily came to be viewed as “our” unconscious, rather than
as a property of the fundamental essence of life itself and in all of its forms. Accessing the body, then, for the
“mindful physiology” oriented practitioner, means accessing the mind: intuitions, images, feelings, archetypes, and
meaning itself. Accessing the mind through body sensitivity training is fundamental to what has come to be known
as biofeedback and is the basis for breathing evaluation and training. It is little wonder that breathing is a point of
physio-spiritual connection in Eastern philosophical thinking.
As Capra points out in his book, The Web of Life, the whole is not simply greater than its parts but actually provides
for the definition, the very identity, of the parts themselves. Overbreathing sets the stage for crisis, even for trauma,
and for a consciousness of defensive posturing and bracing. It engages state-dependent behaviors, even statedependent
personalities, which are protective in nature offering the prospect of safety in a threatening world;
overbreathing becomes a doorway into a different consciousness where one may disconnect, isolate, or flee, but pay
the price of behavioral physiologic deregulation. Changing consciousness, means changing the definition of
constituent physiological dynamics: rapid heart rate is a sign of stress in the context of defensiveness, whereas it is a
sign of joy in the context of embracement. Good respiratory chemistry and mechanics set the stage for
“embracement,” rather than defensiveness, as a “life” posture. Wellness is ultimately about embracing, about the
heart, about bringing together the mindfulness of physiology with the personal consciousness. Health is about
seeking, presence, and availability, not about ego and defensiveness. When naked, don’t overbreathe, be there.
Learning about the behavioral physiology of respiration offers the prospect of bringing easy to understand, highly
practical, and easy to implement educational applications of “mindful-physiology” to healthcare and human
performance practitioners everywhere. Everyone acknowledges some measure or responsibility for breathing, as is
evidenced by everyone’s use of the pronoun “I.” Breathing training is an ideal context in which to teach people
about the mindful nature of physiology, where self-regulation training for health and performance can make a
powerful impact on the practical thinking of large audiences within a short time. The theme is: “The whole body is
the organ of the mind, not just the brain. Our minds are the music that our bodies play to the universe.”
Respiratory Training: Specific Considerations
Breathing chemistry training does NOT replace breathing mechanics training; the two together comprise true
respiratory training (i.e., getting O2 to the cells and CO2 back to the lungs). There is NO specific breathing
protocol, technique, or program that constitutes the “right one,” however, keeping respiratory chemistry in the
adaptive window is a critical consideration in most any kind of breathing training. There are numerous approaches
to teaching the mechanics of adaptive breathing that permit practitioners to integrate breathing evaluation and
training into their work based on professional background, expertise, experience. Unfortunately, however, in very
few cases is the chemistry of breathing included as a component of the training.
9
Breathing is a complex behavior. It is voluntary and involuntary. It is greatly influenced by emotion. It is
synchronized with complex speech behavior. Basic neurophysiological control of breathing originates in the
respiratory centers located in the brain stem, the pons and medulla, where breathing rate and volume are regulated
based on CO2 levels. While in a coma, breathing mechanics (rate and volume) track CO2 levels precisely. There
are other breathing centers throughout the brain including the limbic system (emotion), the speech areas of the brain,
and the frontal cortex (voluntary control). These other regulatory centers may interfere with adaptive breathing,
resulting in deregulated breathing, overbreathing that is often associated with breath holding, gasping, sighing, chest
breathing, rapid breathing, reverse breathing (contracting the diaphragm while breathing out), and so on. Training
for adaptive breathing chemistry, in most instances, means restoring regulated breathing through reinstatement of
the basic brain stem breathing reflex.
How is overbreathing identified? Without monitoring CO2 levels, there is simply no way of knowing. Use of the
capnometer is the only practical and technically reliable method for detecting it with certainty. Arterial carbon
dioxide (PaCO2) can be measured directly through invasive monitoring, or indirectly by means of measurement of
CO2 content in exhaled air. Measurement of CO2 at the end of exhalation, or at the “end” of the “tide” of the air
breathed out, is known as “end-tidal carbon dioxide,” or ETCO2, and is under normal circumstances highly
correlated with invasive arterial measurement. Capnometry is used in virtually every surgery room and critical care
unit in America, and is based on textbook physiology and highly reliable technology.*
The objective of breathing training while “at rest” is to restore proper breathing chemistry (CO2 levels), establish
breathing rhythmicity (reduction of holding, gasping, sighing), lower breathing rate, increase breathing depth, shift
the locus of breathing from chest to diaphragm, encourage nasal breathing, relax musculature during exhalation,
reduce collateral muscle activity, and establish a stable presence of high amplitude breathing heart wave activity
(parasympathetic tone, RSA). Training for good breathing chemistry involves learning how to:
(1) evaluate breathing both at rest and in the context of multiple kinds of challenge;
(2) teach the physiology and psychology of respiration;
(3) identify the sensations of overbreathing, and reinstate the basic brain stem breathing reflex;
(4) interpret physiological experience, e.g., deregulated vs. regulated breathing;
(5) train breathing mechanics: rhythmicity, volume, rate, resistance, and locus of control;
(6) instate prophylactic (deliberate) techniques for consciously disengaging or preventing overbreathing;
(7) configure new patterns of behavioral-physiologic defensive posturing, without overbreathing;
(8) establish “embracement physiology” where overbreathing is not a “mindful” component; and
(9) generalize new patterns of breathing that normalize chemistry in diverse life circumstances.
In summary, training involves: (1) education, (2) learning prophylactic techniques, (3) reinstating the basic
respiratory reflex mechanism, (4) learning new patterns of defensive posturing, and (5) learning to engage
“embracement” physiology by establishing new chemistry and its associated “physiologic mindfulness.”
Breathing evaluation and training may be useful for behavioral physiologic applications by healthcare providers and
patients, performance trainers and athletes/artists, corporate trainers and trainees, behavioral health professionals and
clients, human service providers and clients, consultants and self-improvement trainees, educators and students, and
academicians and researchers. Examples of performance training applications include: improving memory,
enhancing thinking and problem solving skills, improving concentration (playing an instrument), attention training
(e.g., attention deficit), reducing anxiety (e.g., public speaking, test taking), managing stress, managing anger,
decreasing fatigue, increasing alertness and readiness, reducing muscle tension, diminishing physical pain,
facilitating relaxation, facilitating disciplines of inner directedness (e.g., meditation), maximizing performance
training (e.g., flight training), natural child birth preparation, peak performance training (e.g., athletes and coaches),
and evaluating and improving physical condition.
*Measurement of End-Tidal CO2:
The presence of a “gas” is measured in terms of its pressure, and more specifically in terms of its relative pressure contribution to total
atmospheric pressure, i.e., its partial pressure. Total atmospheric pressure on a standard day at sea level is 760 millimeters of mercury (mmHg),
and is comprised of the partial pressures