Breathing and Carbon Dioxide Tolerance
“Shortness of breath,” “difficulty breathing,” “breathing hurts,” “can’t catch my breath,” “the air feels stuck,” “I can’t get a deep breath,” “I can’t get enough oxygen.” These and others are common complaints if you talk to someone with Ehlers-Danlos Syndrome (EDS) or Hypermobility Spectrum Disorder (HSD), POTS, Chronic Fatigue Syndrome (ME/CFS), Mast Cell Diseases, and many other conditions.
Bringing these concerns to doctors often results in “well, your oxygen levels are normal, your spirometry results are normal, and your lungs sound normal.” In spite of their years of training, doctors are rarely educated in the science of breathing beyond these simple diagnostic tools. As far as they’re aware, there’s no real problem and nothing to do about your breathing issues.
Fortunately, the science of breathing has become popularized and trendy, thanks to the excellent work of Patrick McKeown and James Nestor. These lovely fellas have taught us that most of us are breathing improperly, which can cause or exacerbate certain health issues, and (perhaps more importantly) that there’s something we can do about it!
The topic of breathing is vast. This blog post focuses very narrowly on the relationship between carbon dioxide + oxygen + breathing + how we feel - and a few simple practices to improve this.
What We’re Doing Wrong
Many of us have low carbon dioxide tolerance and labored breathing because:
We’re breathing too rapidly and too heavily;
We’re breathing through the wrong orifice (our mouths), and keeping our tongues in the wrong spot;
We’re not taking full advantage of all of our breathing muscles, especially our diaphragms (stay tuned for another post about these breathing mechanics!).
Proper Breathing Techniques
Learning to breathe more optimally has changed my life. Below are a few basic principles you can incorporate into your day to improve the effectiveness, efficiency, and comfort of your breathing:
Breathe through your nose (instead of your mouth) during the day and while sleeping. If you’re a mouth breather and need to train yourself to breathe through your nose when you sleep, you can put a small piece of paper medical tape on your lips. I recommend first putting the tape on your hand and removing it and putting it back and removing it a few times before putting it on your lips. This will make the tape a bit less sticky and more comfortable to remove in the morning.
Check your tongue position. Your tongue should rest gently on the roof of your mouth, just behind your teeth, except when you’re talking or eating.
Slow down your breathing. Many of us are overbreathing (AKA chronically hyperventilating), which means that we’re breathing more air than our bodies require. Keep reading to understand why it’s important to NOT overbreathe.
Breathing and Carbon Dioxide
The amount of carbon dioxide in the body controls autonomic breathing. When the amount of carbon dioxide in your body reaches a certain level, it triggers the body to take a breath. We have the power to change that trigger point - the point at which our bodies get the signal to take another breath. The goal is to lower the body’s sensitivity to carbon dioxide; in other words, to increase the amount of carbon dioxide the body can tolerate before it gets triggered to take another breath.
Why is it important to do this?
I always thought that breathing was simple. Oxygen goes in as fuel, carbon dioxide goes out as waste. The more oxygen and the less carbon dioxide, the better, right? Well, it turns out that carbon dioxide actually plays an important role in absorbing oxygen.
Hemoglobin is the molecule in your red blood cells that carries oxygen from your lungs to your cells. When your doctor measures your blood oxygen levels, this what they’re looking at.
Your cells use the oxygen to do various things that keep you alive, eventually binding it with carbon to form carbon dioxide.
Hemoglobin carries the carbon dioxide from your cells back to your lungs so you can breathe it out.
So what’s the important role that carbon dioxide plays? It turns out, the presence of carbon dioxide is what makes hemoglobin drop off the oxygen that it’s carrying!
Hemoglobin is very smart for a molecule, but it is just a molecule. The presence of carbon dioxide means “I must be somewhere that needs oxygen.” The hemoglobin starts to release the oxygen it’s carrying and pick up carbon dioxide for the trip back.
So what happens when we have a low tolerance for carbon dioxide?
The lower our carbon dioxide tolerance, the more we have the automatic urge to breathe, resulting in overbreathing.
When we overbreathe, too much carbon dioxide is washed from the whole system of lungs, blood, tissues, and cells.
When carbon dioxide levels in the blood are too low, the bond between oxygen and hemoglobin has more trouble letting go. This means that the body can’t access the oxygen in the blood as easily, which leads the body to be poorly oxygenated.
A single deep breath gives us a hit of oxygen, but too much breathing as our steady state actually makes oxygen harder to access efficiently! The better and more efficiently we are able to fuel our bodies with oxygen, the stronger we will feel, the less pain and anxiety we will experience, and the healthier we will be. To efficiently access our blood oxygen, we need a tolerance for carbon dioxide.
How do I know my carbon dioxide tolerance?
Testing your carbon dioxide tolerance is simple and quick, and will allow you to assess your progress over time. Patrick McKeown refers to this test as the BOLT score. Ideally, this test should be performed in the morning just after waking. Here’s how it works:
Rest quietly for a few minutes.
Take a normal, silent breath in through your nose.
Allow a normal, silent breath out through your nose.
Hold your nose with your fingers to prevent air from entering your lungs.
Time the number of seconds until you feel the first desire to breathe. You may feel the need to swallow, a constriction of your airways, or involuntary contractions of your breathing muscles in your abdomen or throat.
This is your BOLT score - it tells you how long your body takes before it reacts to the lack of air. A low breath-hold time indicates a greater tendency toward faster, upper chest breathing with no natural pause between breaths. (People with respiratory conditions often fall into this category).
How do I increase my carbon dioxide tolerance? Simple. Through breathing exercises. Below are a few exercises to get you started.
Bag breathing is an excellent breathing drill to improve your tolerance of carbon dioxide (check out this video of me bag breathing!).
Turn a Gallon Food Storage Bag inside out or use a Small Brown Paper Bag, and enclose the bag around your nose and mouth. Inhale and exhale through your nose until you feel the urge to take a “normal” breath.
In addition to increasing carbon dioxide tolerance, bag breathing can improve stamina, reduce anxiety, and boost recovery. It’s great to do throughout the day, upon waking, before going to sleep, before and/or after eating, before/during/after exercising or working, when you’re stressed out, when you need an energy boost, etc.
Breathe Light Breathing Exercise, Variation One
Sit up straight in a chair, cross-legged on the floor, or lie down on your back.
If sitting, imagine a piece of string gently pulling you upward toward the ceiling from the crown of your head.
Place your hands on your chest and belly, or in your lap
Observe your breath as it enters and leaves your nose. Feel the slightly colder air entering your nose and feel the slightly warmer air leaving your nose.
Begin to reduce the speed of each breath as it enters and leaves your nose. Breathing should be light, quiet, and calm.
Slow down your breathing so that you feel hardly any air entering and leaving your nostrils.
The goal is to create a feeling that you would like to take in more air. To create air hunger, your breathing now should be “less” than it was when you started.
If you feels tressed or lose control of your breathing, the air hunger is too strong. When this happens, take a rest for 20-30 seconds and start again. It is normal at the beginning to take periodic rests during this exercise.
Continue this practice for up to 4 minutes. Listen to your body. Consider starting with just 30 seconds, and slowly work your way up to 4 minutes.
Breathe Light Breathing Exercise, Variation Two
Sit up straight in a chair, cross-legged on the floor, or lie down on your back.
If sitting, imagine a piece of string gently pulling you upward toward the ceiling from the crown of your head.
Place your finger underneath your nose so you can monitor the airflow from your nose.
Bring your attention to the airflow on your finger.
As you feel the warm air on your finger, gently slow down your breathing.
Take a soft breath in through your nose and allow a gentle and prolonged breath out.
Breathe so softly that you feel hardly any air blowing onto your finger. Imagine that your finger is a feather and that your breathing is so soft that the feather doesn’t even flutter.
There is no need to hold your breath or try to restrict your breathing. The more warm air you feel, the harder you are breathing. Can you quiet and soften your breathing to the point where you feel hardly any air on your finger?
The goal is to create a feeling that you would like to take in more air. To create air hunger, your breathing now should be “less” than it was when you started.
If you feel stressed or lose control of your breathing, the air hunger is too strong. When this happens, take a rest for 20-30 seconds and start again. It is normal at the beginning to take periodic rests during this exercise.
Continue this practice for up to 4 minutes. Listen to your body. Consider starting with just 30 seconds, and slowly work your way up to 4 minutes.
Breathe Slow
Sit up straight on a chair or cross-legged on the floor.
Place your hands on either side of your abdomen, or on your lower two ribs.
As you breathe in, feel your ribs moving outward, and as you breathe out, feel your ribs moving inward.
If your BOLT score is more than 15 seconds, inhale through your nose for a count of 4 seconds and exhale through your nose for a count of 6 seconds. If your BOLT score is less than 15 seconds, inhale for a count of 3 seconds and exhale for a count of 3 seconds.
As you breathe in, feel your ribs moving outward, and as you breathe out, feel your ribs moving inward.
Continue this exercise for a few minutes. You may want to start with just 30 seconds or a minute until you feel comfortable.
What Happens When You Breathe Better?
Optimizing your breathing has a tremendous affect on your overall health and wellness, including:
You’ll feel better
You’ll sleep more
You’ll recover better
You’ll perform better
You’ll digest food better
You’ll concentrate better
Your sleep quality will improve
You’ll improve oxygenation of the heart, tissues, and organs
You’ll respond more effectively to stressors
Your overall fitness level improves
You’ll be more able to lose weight
You’ll experience less pain
You’ll have less brain fog
You’ll be less stressed
You’ll be less anxious
Fun Facts
If you’re like me and you’ve gone to the doctor complaining of distressed breathing only to be told my oxygen levels are normal and there’s nothing to do, here’s what your doctor isn’t telling you: Yes, your blood oxygen saturation levels are normal, but not enough oxygen is being released from the blood to tissues and organs, including your brain, leading to lethargy and exhaustion. Too much carbon dioxide has been expelled from the body.