Is breathwork safe? Who should check first

Is breathwork safe? It depends on the kind

"Breathwork" covers very different things. A few minutes of slow breathing at your desk is one thing. A long session of fast breathing and breath holds, meant to bring on strong sensations or emotions, is another.

I went looking for a clear list of who should stay away from breathwork. What I found was messier than I expected. Hospital health articles, a lifesaving charity and an epilepsy charity all say something, and they overlap in places and disagree in others.

I also couldn't find an official national health service page that lists reasons not to do breathwork in general. The NHS breathing-exercise page I opened gives simple slow-breathing steps and no cautions. That doesn't mean there are none. That page just doesn't cover them.

So this post does something smaller and honest. It tells you what each source actually says, so you can take better questions to your doctor.

What should you do first?

1. If you have a medical condition, take medicine regularly, are pregnant or aren't sure, ask your doctor before anything beyond easy, slow breathing.
2. Choose gentle: no breath holds, no forced fast breathing, no long or deep sessions to begin with.
3. Sit or lie down. Never stand, drive or go near water.
4. Stop if you feel dizzy, faint, have chest pain, strong tingling, panic or distress. Breathe normally and rest.
5. For intense methods such as holotropic breathwork, work with a trained facilitator and tell them about your health first.

Is breathwork safe in or near water?

If there is one safety rule to remember, it's this one. Breathing fast and deep (hyperventilating) and then holding your breath is the combination to be careful with. Fast breathing lowers the carbon dioxide in your blood, and carbon dioxide is what tells you it's time to breathe. With that signal turned down, you can pass out with no warning at all.

That's why the Royal Life Saving Society UK says not to hyperventilate before holding your breath. Blackout can come without warning, in water of any depth. RLSS UK guidance GS005 A case report from Australia tells of two young men who passed out after breathing fast before an underwater swim. Both recovered fully. Kumar and Ng, MJA 2010

So the easy rule is: keep fast breathing and breath holds out of water, out of the bath and out of the car, and don't do them standing up. Sit or lie down, because feeling dizzy is possible. Slow, gentle breathing is a different story, and a lovely thing to do once your doctor is happy with it.

Who should not do breathwork, or check first?

Epilepsy

The Epilepsy Society, a UK charity, explains that deep breathing is sometimes used during a routine EEG (a brain wave test), and says there is a small chance it triggers a seizure. It also says staff won't ask you to do it if you're anxious about it. Epilepsy Society

That page is about a hospital test, not slow breathing exercises, so I wouldn't read more into it than it says. If you have epilepsy, ask your own neurologist or epilepsy nurse about any breathing practice, especially fast breathing.

Pregnancy

Cleveland Clinic's article on holotropic breathwork (a long session of fast breathing, usually with a facilitator) says it's not recommended during pregnancy or breastfeeding. Cleveland Clinic, holotropic breathwork

That's about a fast, intense method. I didn't find a source I opened that covers gentle slow breathing in pregnancy, so I'm not making a claim about it. Talk to your midwife or doctor.

Heart, blood pressure, medication and other conditions

The same Cleveland Clinic article lists people to check with a provider first: a history of heart problems, high blood pressure, recent injury or surgery, regular medication, panic attacks, psychosis or seizure disorders. Cleveland Clinic, holotropic breathwork

That comes from an article about an intense method. Cleveland Clinic's general breathwork article is milder. It says breathwork is accessible to anyone regardless of age or other medical conditions, as long as you pick a technique that suits you, and it advises beginners to start with simple techniques. It also says holotropic breathwork shouldn't be tried without a trained facilitator. Cleveland Clinic, breathwork

Asthma and lung conditions

A big Cochrane review of breathing exercises for adults with asthma covered 22 trials and 2,880 people. It looked only at mild to moderate asthma, and the authors said they couldn't assess the effect in severe asthma. Adverse effects weren't one of the things they measured. Cochrane, Santino et al. 2020

So there is some research on breathing exercises in mild to moderate asthma, and none in that review for severe asthma. If you have asthma or another lung condition, ask your doctor or asthma nurse which exercises suit you. Don't swap breathing for your prescribed medicine.

Trauma, strong emotions and mental health

Cleveland Clinic says intense breathwork can bring up strong feelings such as sadness, anger and fear, and recommends using it alongside ongoing therapy so anything that surfaces can be processed. It lists panic attacks and psychosis among reasons to check with a provider. Cleveland Clinic, holotropic breathwork

I didn't find a source I opened that tells people with anxiety, trauma or other mental health conditions what to avoid in slow breathing. If you have a history of trauma or panic, choose gentle methods, keep your eyes open if closing them feels uncomfortable, and speak to your therapist or doctor.

The research in a nutshell

How strong is the evidence? Mixed. The water warning is the strongest and best explained. The rest comes from provider advice and health articles, which don't always agree with each other.