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Does Buteyko breathing really work?

Does Buteyko breathing really work?

Developed by Russian doctor Konstantin Buteyko in the 1950s the Buteyko Method is a system aiming to restore the levels of healthy CO2 in the body through breathing exercises. It has been found beneficial among individuals with cancer, high blood pressure, anxiety, asthma, allergies, snoring and sleep apnea.

I got certified as a Buteyko instructor in 2017 and in this article I answer some of the most frequently asked questions on the Buteyko Method (BM).


The Benefits

What are the benefits of practicing the BM?

By restoring optimal levels of CO2 in the body the BM promotes healthy function in our cells, tissue, organs and systems.

Our body’s organs depend on sufficient supply of oxygen to function. Due to the Bohr effect this can only be achieved through healthy levels of CO2 – as CO2 & O2 work synergistically. To that extent optimal organ function relies on healthy levels of CO2.

Knowing that, it may come as no surprise that K. Buteyko noticed early in his career as a doctor, a lot of chronically ill patients breathing poorly.


How does the BM improve breathing?

The way we breathe depends on our posture and our respiratory biochemistry. The Buteyko Method focuses on the later, through exercises that aim to restore optimal levels in the 3 blood gases: Nitric Oxide, Carbon Dioxide and Oxygen.

No matter how good your posture is if you breathe like an asthmatic armadillo you will suffer the consequences.

The benefits of the Buteyko training can be amplified however when combined with yoga.


Can the BM help with asthma or other respiratory issues?

The Buteyko Breathing has been found in research to benefit adults (ref1, ref2) and children (ref) with asthma as well as those with Obstructive Sleep Apnea (ref). These findings however, do not pay justice to the numerous cases of individuals that have benefited from the practice.

Once someone understands the logic behind the Buteyko Method he will not seek further proof to believe in its importance.


The Criticism

How long does it take to see results from practicing the BM?

Positive results from the Buteyko practice in most cases are evident within 2-3 weeks. In my experience there are 3 reasons this is not always the case:

1 Breathing is not compromised at first place.

There are instances when the symptoms of other imbalances overlap with those of dysfunctional breathing. If you implement a breathing protocol without any breathing issues chances are you will see little to no benefit in your symptoms. For that purpose an initial assessment is important.

2 The exercises practiced are not appropriate.

For any protocol to have an effect, it needs to provide the appropriate stimuli. If you follow a Buteyko exercise which is too easy for you, chances are you will not see much effect from it.

3 Compliance is poor.

Sometimes 90% (or even 99%) is not enough. While some individuals will see results by adopting 50% of the recommendations others will need to be 100% compliant.


Are there any risks or side effects associated?

NO. The reason is very simple. The cornerstone of BM is to incrementally increase the exposure of an individual to CO2 so he becomes more tolerant to it over time. Our body is very sensitive to CO2 and thus will resist its build up way before it reaches moderate levels (used in lab experiments), let alone dangerous levels. Anyone that argues otherwise has not done any breathwork and speaks theoretically.


Is it a complete breathwork system?

The Buteyko Method has 2 primary weakness as a breathing system:

1 Not addressing sufficiently breathing biomechanics.

2 Not incorporating enough exercises at a high Heart Rate.

That is due to the fact that K. Buteyko worked primarily with sick individuals. Oxygen Advantage includes some breathing exercises relevant for athletes.


Are there any scientific studies or research supporting the effectiveness of the BM?

Research on asthma (ref) and Eustachian tube dysfunction (ref) has indicated that the Buteyko Method and the Control Pause are beneficial for patients with compromised breathing.


The Application

Can it be combined with other forms of exercises or training?

Absolutely. I will argue that, for best results the Buteyko Method HAS TO be combined with one or more physical exercises. Which one depends on one’s status of physical health and the goals. Good candidates are: yoga, pilates and cardiovascular training.


How can I get started?

The best way to get started with the Buteyko Method is understand the principles and adopt a 10-20 mins protocol appropriate for your level of respiratory capacity and goals. If the exercises you adopt don’t meet the above 2 critical you are unlikely to see any benefits.


My opinion in a nutshell


3D approach to Breathing Biomechanics

The Biomechanics of Breathing

The biomechanics of breathing involve the function of all the primary and secondary respiratory muscles that are involved in respiration. These can be grouped into the respiratory tract, respiratory support muscles, the abdominal muscles.




The respiratory tract

Yoga practices can affect the function of both upper and lower airways. Neti kriya, a cleansing technique, allows the bathing of the nasal passage. Ujjayi breathing can reduce dead space in the lungs and increase this way, the surface of oxygen diffusion to the bloodstream. While many asanas facilitate the delivery of air in one part of the lungs by restricting it in another, allowing this way the utilization of the entire organ. Finally, the diaphragm which seats at the bottom of the lungs can also get stronger through breathing exercises and/or asanas.


The supportive muscles

Muscles, fascia, and neurons all play an active role in supporting our respiratory function. While these tissues, cells and organs are not always classified as “respiratory”, failure of their function means compromised breathing.


Supportive muscles above the rib cage

Scalenes and sternocleidomastoid are 2 pairs of muscles sitting on either side of our neck. Their recruitment is often considered synonymous with upper chest breathing. It is my observation that when these muscles, alongside the trapezius, are tight there is zero movement possible in the upper chest and upper back, limiting this way the expansion of the lungs in this area.


Supportive muscles below the rib cage

Psoas and quadratus lumborum are 2 pairs of muscles on either side of the spine that attach posteriorly to the diaphragm. Having reviewed 1,000s of papers I am yet to see these 2 muscles mentioned in publications as respiratory or secondary respiratory muscles. There are 2 reasons why I think their structure and function are pivotal in breathing:

  1. As they both attach to the diaphragm, when they are tight, weak, or uneven (between the left and right side) they will restrict the way the diaphragm moves.
  2. Both muscles play an important role in our posture. A compromised posture will most likely cause restrictions in our breathing.   


Our posture

This is an area of the respiratory function that often does not get much attention. Think for a second of an old man bearing more weight on one foot, maybe having one shoulder higher than the other. Or a woman with pronounced scoliosis. How would these postural asymmetries affect the ideal symmetrical movement of the rib cage and diaphragm? Or someone with pronounced thoracic kyphosis. Do you see how the movement of his diaphragm will be restricted (ref)?


Diaphragmatic restriction due to kyphosis


It is my belief that yoga can improve the biomechanics of breath in most elements of this Venn diagram and it’s for that reason a lot of yoga practitioners with respiratory problems have benefited from practicing yoga without paying much attention to the volume of air they breathe which determines the biochemistry of respiration. At the same time, the benefits are amplified when someone pays equal attention to both qualities of breathing (ie. biomechanics & biochemistry).


Buteyko vs Yoga breathing

Buteyko vs Yoga Breathing

Both Buteyko and Yoga breathing techniques have benefited the health of many individuals and especially those with respiratory problems (ie. bronchitis & asthma). To the novice, the two systems may seem to contradict each other but I would argue there are many similarities between them.



While Pranayama is a component of the yoga tradition, which also consists of meditation and physical postures, Buteyko is a system solely focusing on breath training.


Pranayama vs Buteyko Breathing

So far there has been only one study from the University of Nottingham that compared the 2 systems (ref). The study was conducted among 90 individuals (69 of which completed the study) that suffered from asthma and were on corticosteroid medication. At the end of the study, which run for 6 months, the Buteyko group showed improvement in both symptoms and a reduction in bronchodilator use.


Buteyko vs Pranayama Corticosteroid Buteyko vs Pranayama symptoms

How do pranayama techniques compare with Buteyko breathing?

Pranayama techniques, primarily due to the lack of one reliable source, are practiced in different ways. Many practitioners use “Light on Pranayama” BKS Iyengar as a reference. Exercises can be performed in various degrees of difficulty by modifying the duration of the breath. It is beyond the scope of this article to explain how this can be achieved but to help you grasp the concept think of box breathing:

Version A:  Inhale for 2 sec, Hold for 2sec, Exhale for 2sec, Hold for 2sec. Perform x5 rounds.

Version B:  Inhale for 20 sec, Hold for 20sec, Exhale for 20sec, Hold for 20sec. Perform x10 rounds.

While most pranayama techniques are (unfortunately) instructed without much reference to the volume of air, by the time the duration of each cycle increases minute ventilation will unavoidably reduce. Reduction in minute ventilation is at the heart of the Buteyko Method which aims to prevent individuals from chronic and acute hyperventilation.

In the table below you can see a list of pranayama exercises. Those with a sign 〰️ can lead to hypercapnia, while the ones with an ❌ are likely to cause hypocapnia.

Hypercapnia is a key element of Buteyko training.


One of the hallmarks of yoga is Ujjayi breathing which often (and correctly in my option) it’s suggested to be performed at all times during asana. Given the different ways that ujjayi breath is practiced, it may appear to be diametrically opposite to Buteyko breathing.

Ujjayi breath is characterized by a sound produced during the exhalatio by the constriction of the throat. The sound, for some unknown to me reason, is sometimes exaggerated making the breath loud. In my opinion, ujjayi should be performed as follows:

Both the inhalation and the exhalation take place through the nose with the tongue at the top of the pallet. The inhalation is soft. During the exhalation, the back of the throat gently constricts allowing the elongation of the exhalation further than normal. The exhalation to inhalation ratio is 2:1 or much higher. The breath is quiet.

When practiced like this, the ujjayi breath will lead to hypercapnia and thus cause an increase in body temperature, similar to all hypercapnic breathing exercises.


How to incorporate Buteyko in yoga?

To the extent that you want to support the oxygenation of your brain 🧠 and peripheral organs during your physical practice, you would benefit by breathing light from start to finish. Breathing this way is likely to cause a sense of air hunger, especially in classes where the pace is fast.


You can also incorporate hypoxic breathing in your practice depending on your level of experience and breathing capacity. It is always important to account for the challenges asanas cause to the breath during yoga.


The role of Control Pause in Yoga

Buteyko practitioners, like myself, like to use the Control Pause (CP) test as an approximation of clients’ respiratory capacity. CP can also be performed at the start of a yoga practice. Below is a list of factors that need to be considered:

• CP will tend to be lower later in the day

• CP will be affected by fluctuations in hormone levels. That is likely to be more pronounced in women.

• If the practitioner is seating on the floor (as opposed to a chair), limitations in his posture is likely to affect the CP negatively.


My take on Breathwork

The Buteyko method is a cornerstone of Breathwork. Not because I am a Buteyko instructor but simply because because its principles are in line the laws of respiratory physiology. Any breathing practice that ignores these principles are unlikely to have long term results as they are ignoring the laws of nature. At the same time the Buteyko Method is NOT complete (video) and yoga, both asana & pranayama can compliment everyones breath training.

Adopting only 1 of the 2 or considering them contradicting is in my opinion myopic. Merge the 2 practices and chances are you will see a significant benefit in your respiratory capacity. You can learn how to two can be combined in the Breathe Right 5d course.


Normal Respiratory Rate

What is a normal respiratory rate?

Our respiratory rate (RR) depends on our age, phase of the menstrual cycle, health state, and heart rate. Having a normal respiratory rate will partially indicate healthy respiratory function but will not be sufficient to identify one’s respiratory capacity.

In this article, you can find out the benefits and limitations of controlling your RR.


Respiration Rate 1.01

How do you check respiration rate?

Respiratory rate is measured at rest. In order for the measurement to be accurate, it is useful to sit in a chair still for a few minutes. One breath will compromise one inhalation, a possible pause, and one exhalation, possibly followed by a second pause.

What is a normal respiratory rate?

Respiratory rate is the number of breaths we take per minute. It’s one of the body’s vital signs, alongside blood pressure, heart rate, and body temperature. Normal respiratory rate will vary with age.

While 12-20 breaths per minute (bpm) are often used as the normal reference range (ref), it is not necessarily optimal. Optimal breathing is determined by minute ventilation, ie. the total volume of air we inhale per minute. For adults, normal minute ventilation is 6-8.4 L/min. With a tidal volume of 500 to 600mL, if you take 12 bpm your minute ventilation is 6-7.2L/min (500mL x 12 bpm), which is the volume of our lungs. If instead of 12bpm you take 20bpm (at 500mL tidal volume), your minute ventilation is: 10L/min. With that in mind:

Optimal respiratory rate range: 8-14bpm


What does respiratory rate indicate?

Respiratory Rate (RR) is one of the body’s vital signs, and as such changes in RR indicate improvement or deterioration in health. The other 5 vital signs are pulse rate, systolic blood pressure, level of consciousness, oxygen saturation, and body temperature.

What increases respiratory rate?

The respiratory rate will increase due to an increase in metabolic demands but also during anxiety, acidosis (referred to as Kussmaul’s respiration), asthma, COPD, dehydration, fever, heart conditions, lung conditions (including lung cancer), an overdose of aspirin or amphetamines. During pregnancy and the follicular phase of the menstrual cycle, RR also increases.

What decreases respiratory rate?

The respiratory rate will decrease when we are relaxed but also from alcohol consumption, brain conditions (including strokes and head injuries), consumption of narcotics (ie. marijuana), and sleeping apnea.


Respiration Rate and Breathwork

When you should focus on your respiratory rate?

Performing breathing exercises based on the respiratory rate offers some benefits, especially for beginners. Respiratory rate can:

• be measured independent of the body position

• be monitored by the practitioner as well as an observer

• be easily manipulated

So if you are starting out now with breathwork or have no experience with breath control:

Try to reduce your respiratory rate; it is likely to bring a profound sense of relaxation.

A lot of pranayama exercises, cadence breathing, as well as asana practices, focus on the number of breaths per minute. An exercise I developed to improve your concentration based on the manipulation of the RR is the following:


Why focusing only on respiratory rate is a bad idea?

During most physical exercises (including yoga) you would benefit by reducing the volume of your breath so that it matches your metabolic needs. This is due to the role of CO2 in breathing. In this case, the focus should be on how much you breathe and not how often.

This is also the cornerstone of Buteyko breathing, which advocates reduced breathing aiming to avoid hyperventilation and improve breathing biochemistry. If you are not yet convinced think of the following 4 breathing disorders:

• Bradypnea: breathing abnormally slow.

• Tachypnea: an elevated respiratory rate. Fast breaths that are usually shallow.

• Dyspnea: shortness of breath, that can occur with a high, normal, or low respiratory rate.

• Hyperpnea: breathing deeply and labored.

Only 2 out of 4 problems can be addressed by focusing on the respiratory rate.

Even Cadence breathing can lead to Hyperventilation (ref).


While reducing the number of breaths per minute can be a great starting point, once confident start reducing the volume of air you breathe in order to become a better breather.

The Breathe Right course is developed to help you breathe better when you are not conscious of your breath.

K Buteyko

Buteyko Breathing for sinus infection

Sinusitis is caused by swelling or inflammation of the tissue lining the sinuses, leading to nasal blockage and breathing discomfort. Those seeking natural relief can use Buteyko Breathing for sinus infection as it will help them restore their respiratory hygiene and function.


What helps breathing with sinus infection?

Those suffering from sinus infections can find relief through the following methods:

1. Use decongestant essential oils

• peppermint oil, which also has anti-bacterial (ref), and anti-inflammatory properties (ref).

• eucalyptus oil (ref).

• lavender oil, which also has pain-relieving properties (ref).

• tea tree oil, that has antiviral, antifungal, and antibacterial properties (ref).

• oregano oil, which can stop bacteria from growing (ref).

• rosemary oil (ref).

• clary sage oil, which acts as an antimicrobial agent (ref).

2. Massage the maxillary sinuses

to encourage fluid drainage.

3. Have a hot bath

Apply a warm compress (towel or water bottle) or breathe over a humidifier as the heat will loosen up the mucus in the nasal cavity.

4. Practice hypercapnic breathing exercises

CO2 training will help keep your airways open.



Can breathing exercises help sinusitis?

The way we breathe determines our nose’s hygiene. Hyperventilation, mouth-breathing, and erratic breathing are types of dysfunctional breathing that promote inflammation in the sinuses and lead to a blocked nose. The Buteyko Method through the application of basic biochemical principles can help reduce inflammation and restore good respiratory function.

In order to unblock your nose, you need to increase your levels of CO2 and NO in your nasal cavity.

A quick way this can be achieved is by performing short breath-holds:

Inhale – Exhale – Pinch your nose for 60% of your max capacity – Inhale from the nose – take 3 recovery breaths – repeat x7

The longer the breath holds, the higher the build-up of CO2 and NO, while the more physically active you are CO2 will further increase. You can increase CO2 levels by moving your body from side to side on the spot or walking during the breath-holds. What matters most is to keep the recovery breaths short and nasal.


Does chronic sinusitis ever go away?

In contrast with acute sinusitis, chronic sinusitis is more likely to be caused due to chronic dysfunctional breathing patterns (ref). Increasing one’s Control Pause [video] to 30 sec will be a step in the right direction.

Sinusitis is considered chronic if it persists for 12 weeks or more. The symptoms may include:

  • Nasal congestion
  • Pus in the nasal cavity
  • Runny nose
  • headaches, tooth pain, bad breath
  • Fever

While the exercise with the short breath-holds described above can still be used, a more structured approach will be needed.


Can deviated nasal septum cause sinusitis?

If the septum has deviated far enough it may block the nasal passage increasing the chances of sinusitis. The more one uses his nose 👃🏼 the less likely it will be for the nasal passage to get blocked and fluids to back up in the sinus cavity. For that reason, even following an operation, it can be beneficial for the individual to practice some breathwork in line with the Buteyko Method, such as CO2 Breathing Therapy.

Can sinusitis affect your lungs?

While sinusitis is considered an upper respiratory infection (URI) it is sometimes linked with poor diaphragmatic recruitment or lung function. As the respiratory tract operates as a system consisting of different organs, the function of breathing muscles needs to also be considered in respiratory infections.

In a paper published on the 23rd of March 2020 (ref) 12 patients (7 men and 5 women) with SARS-CoV-2 and symptoms of acute respiratory distress syndrome at the Jinyintan Hospital showed improved lung function when alternating between pronated and supine position vs supine only.

Most importantly…

The way you breathe on a daily basis is going to play a significant role in the occurrence and severity of sinusitis. You can improve the way you breathe when you are not conscious of it with the 5 day online Breathe Right course.