TETANY IN BREATHWORK: WHAT IS IT & WHY DOES IT HAPPEN
respiratory alkalosis hands in cramp
What the heck is tetany and why do I get it?
In today’s blog we are moved to write a piece about respiratory alkalosis aka tetany, aka lobster claw hands (though it can also happen in the feet and around the mouth/lips and jaw).
As breath workers, we are increasingly interested in the science around the effects of rapid inhalation/exhalation practices done through an open mouth. When we breathe this way, we are reducing oxygen delivery through the body, which happens as a direct result of “off gassing” too much Co2. We need carbon dioxide as it acts as the ‘transportation system’ carrying oxygen to the vital organs, across the blood brain barrier for clarity of thought and brain function, and in general to supply our cells with the energy that we need from moment to moment.
When we breathe in a circular connected open mouth way, either intentionally through a breathwork practice, or unintentionally through definitional breathing habits, a significant amount more carbon dioxide is being exhaled. This then reduces the capacity of the CO2 to deliver oxygen where it needs to go which can create a number of physiological sensations in the body. One of the most common of those as seen in CCB (conscious connected breathwork) is the cramping in the hands, which can be extremely uncomfortable and distressing for some people. This sesnsation may also be experienced in the feet and around the mouth. Tetany typically starts with tingling sensations in these parts of the body, which if not down-regulated (intentionally slowed and returned to gentle nose breathing) can rapidly escalate to severe and painful cramps. It may also occur in arousal situations where our breathing pattern changes so it's helpful to know this so that you can begin to guide yourself back to regulated nose breathing through this awareness.
My original interest in looking into this more was stirred when a student doctor came to one of my sessions and experienced pretty severe tetany; one of the more common side effects which should always be framed by your facilitator before starting a session.
As a result of her experience and her interest in the physiological aspects of breathwork, she emailed me about a week after the session, letting me know and that she had discovered that the more extreme experiences of tetany usually arise as a result of these significantly decreased carbon dioxide levels in the blood, which in turn causes oxygen to bind in the red blood cells which also affects the albumin binding of calcium,. This then creates a range of sensations which many people can experience in breathwork such as those already mentioned - tingling in the hands, feet, or around the month, tremors and shaking, severe cramps in the hands, feet or mouth, numbness, rapid body temperature changes, light headedness, muscle twitching and occasionally light nausea.
It’s always interested me that some people rarely or never experience this, whereas for others, the discomfort is often intolerable and very distressing. On reading more, I came to also consider the effects of diet and hydration on these levels in our ‘normal’ base rate balance of oxygen/carbon dioxide/calcium/bicarbonate levels in the blood, and the relational imbalance in electrolytes that may explain why for some people this side effect is worse than it is for others.
This balance can also be influenced and affected by existing health conditions such a sleep apnoea, ongoing high levels of stress, PTSD or anxiety, and a history of dysregulated breathing (many people don’t know they may be doing this) which is another reason why it is so crucial that breathwork facilitators are trained and fully aware of the contra-indications in these practices. Without having full awareness, the implications are potentially very serious.
Contra-indications for some breathwork practices may include: pre-existing heart conditions, schizophrenia or bipolar disorder, C-PTSD, epilepsy & seizures, high blood pressure, low blood pressure with fainting history, unstable pregnancy, and recent major surgery. For a more extensive list, please visit our waiver HERE. Those with COPD are also advised to exercise caution.
It’s not all about reasons to be fearful though! The body does a great job of trying to bring itself back into balance on a daily basis, and in healthy people, conscious connected breathing and other techniques (such as Seven Directions Breathwork, Wim Hof, Soma Breath, Holotropic Breath, Transformational Breath etc) have proven to be incredibly beneficial in creating powerful health benefits and lasting wellbeing through the ability to use the breath to access and improve immunity, and to release and heal sub-conscious somatic trauma. The most important factor is that the facilitator is well trained and gives you this full information before any Breathwork session begins.
Breathing within the context of a normal contained breathwork session will not create significant or prolonged problems for most people, in fact, the opposite is true and the benefits are well researched and documented with an ever expanding body of research supporting this assertion. The body’s natural CO2/O2 balance returns to ‘normal’ within a short period of time after a breathwork session, leaving most people completely comfortable within ten minutes of returning to normal breathing patterns. Regulating oneself or being guided to do so is part of ethical breathwork practice.
As sleep and nutrition can also play their part, here are some simple ways you can ensure that your electrolyte balance is good, which may help reduce the likelihood of experiencing the discomfort of respiratory alkalosis.
Eating a healthy diet, and staying hydrated make a difference. Choosing foods high in nutrients and potassium can help combat electrolyte deficiencies. Nutrients and potassium are primarily found in fruits and vegetables, as well as some other foods, such as:
carrots
bananas
dates & apricots
beans
spinach
broccoli
baked sweet potato/baked potato
bran
Steps you can take to prevent dehydration include:
drinking 8 to 10 glasses of clean/filtered water per day
drinking water before, during, and after your session.
using electrolyte replacement drinks before or after your session
avoiding sodas or juices, which have a high sugar content and can make dehydration worse
limiting caffeine, which is found in sodas, tea, and coffee
If you know you’re one of those susceptible to tetany, perhaps make sure you prepare yourself before your next session with some of these foods, and by hydrating really well prior to breathing (but don’t come with too much water in the stomach immediately before the session!).
Also, remember you can always self regulate your breathing during a session as well, and an experienced facilitator will know how, and what, to recommend in this case.
Perhaps this painful and tight feeling in your hands is not just about what you’re “holding onto” in life, but is as much about your existing electrolyte levels and your personal relationship with Co2/o2 and the dance they do with calcium! That said, the enquiry into what you may be holding onto is always a useful one in any personal growth work right?
