Appendix

APPENDIX A – Tetany and Cramping from Breathwork

In theory sometimes we can say that the cramping and tetany may be caused by stuck energy or holding on to things in life which may be true. Also we have witnessed people experience tetany and cramping and “breakthrough” this experience by continuing to intensely breathe. However we also wanted to explore the scientific approach and explanation to what is happening. One being true does not necessarily mean the other is false in fact both explanations can happen simultaneously and be true. One thing to note is that if you or a participant experiences tetany there is nothing to fear.

What is Tetany?

Tetany is defined as the involuntary contraction of muscles that occurs when CO2 decreases significantly in the body. 

Tetany is characterized by cramping, tightening, tingling, paralyzing, or numbing sensations of the hands and/or feet. It is a very common occurrence during Breathwork. It is temporary and it will go away on its own once you return to a normal breathing pattern. 

What Causes Tetany?

Remember as we increase breathing rates and exhalation during breathwork practice we are expelling more CO2, thereby reducing the amount of CO2 in our body. Forcing the exhale can increase the intensity of tetany.

• Tetany occurs when the rate or volume of breathing eliminates more CO2 then the body can produce.

• Low CO2 causes tetany because it reduces cellular calcium and increases bloodPH. 

• Sodium leaks into nerve cells and makes them hyper-excitable, resulting in tingling   

            and – when more extreme – muscle spasms in the extremities and around the  

            mouth. 

Tetany is more likely in people with underlying mineral imbalances, including:

• Low magnesium – more likely during pregnancy or lactation, use of diuretics, or high alcohol consumption 

• Low potassium 

• Parathyroid hormone (PTH) deficiency 

• Excess phosphate

• Low calcium

• Electrolyte deficiencies due to long-term inhaler use (i.e., for asthma or COPD)

As a facilitator what can we do to help avoid this?

• Tetany is not necessarily a bad thing but may be uncomfortable and in some cases can cause severe cramping (although rare).

During a breathwork session: slow down the breathing, reduce the forcefulness or duration of exhales (just lightly “let go” of breath), move/massage hands or other body parts experiencing tetany or extend the length of the exhalation (double the count or skip a round so an exhale would be both the exhale for that count, the following inhale and exhale count as well). Is there a deeper meaning behind the experience? The answer is maybe. 

We found through experience that some people experience tetany and some don’t. Some people continue to breathe through the experience and completely release the tetany by breathing deeper. Some possible explanations are that the participant may be holding on to something ( a grudge, self judgment, anger, etc) and could be a good opportunity to bring awareness to those feelings. Also people who feel they always need to be in control may feel a sense of losing control of their hands. This can be scary for some but also a good opportunity to explore those feelings and/or fears.

We encourage people to try to breathe through the experience, even lean into it and see what comes up but always at their own comfort level. Sometimes a breakthrough is right beyond one of these experiences. Alternatively there are a few things they can do to alter their experience.

What else can be done or recommended:

Prior to breathwork experience:

• Consider whether any of the above mineral imbalances may be applicable, get them to talk to their healthcare practitioner and see if they can correct the imbalance or supplement (not your responsibility but you can direct them to seek advice).
• Get checked for these imbalances if high-risk (e.g., pregnant or lactating, on diuretics, high alcohol intake, long-term inhaler use).

During the Experience:

• Slow down your breathing and reduce your exhale volume or just extend it (slow it down)
• Remember you are safe and that it is a temporary experience
• Massage, stretch, shake and move your body as you feel it coming on (hands, arms, feet etc)
• Try your best to surrender and trust yourself to breathe through it.
• Bring your awareness to any specific areas, sensations or feelings to see what might come up for you ( a memory, a message an insight etc)

To increase CO2 levels quicker, breath holds, breathing into your hands or a paper bag may help to restore increased CO2 in combination with reducing the breathing rate.

APPENDIX B – FAQ

What Does It Mean to Be Sympathetic Dominant, and Is Intense Breathwork Safe for Them?

What’s Happening:

The individual’s nervous system is stuck in a heightened fight-or-flight state, characterized by an overactive sympathetic branch of the autonomic nervous system. This leads to symptoms like increased heart rate, shallow breathing, anxiety, tension, and difficulty relaxing, often stemming from trauma, chronic stress, or dysregulation. Some sympathetic-dominant people may crave intense experiences as a form of emotional bypass—to “feel something” or escape numbness—but what they often truly need is slowness, presence, and safe reconnection with the body.

How It Relates to Breathwork:

Breathwork can either regulate or exacerbate this state. Gentler techniques promote parasympathetic shifts (rest and digest), while intense styles (e.g., Breakthrough or Fire Breath) may initially overwhelm by amplifying activation, potentially leading to emotional flooding, dissociation, panic attacks, re-traumatization, hyperventilation without integration, or difficulty grounding if not managed carefully. However, when guided well with safety and trust, it can be incredibly powerful—releasing trapped energy, completing old stress cycles, and activating the ventral vagal system (social engagement and connection) afterward.

What the Facilitator Can Do:

• Screen participants beforehand for trauma history, anxiety, or sensitivity.
• Recommend starting with mechanics-focused sessions (e.g., rhythm resets, slow conscious breathing, NGSE, or heart coherence) or gentler Flow experiences to build regulation.
• For intense sessions, keep them short (15-20 minutes), prioritize NGSE (gentle, nasal, slow, expansive breathing), and include grounding/integration (e.g., eye contact, slow breathing, movement, nature, or journaling).
• Frame the session to empower choice: “It’s OK to stop or adjust your pace.”
• If intense activation or overwhelm lingers post-session (e.g., sustained anxiety, racing heart, or emotional flooding): Recommend immediate parasympathetic practices like physiological sighing (double inhale + long exhale), 4-7-8 breathing, or slow coherent breathing (e.g., 4-6 breaths per minute). Encourage grounding activities (walk in nature, gentle yoga, hands on heart/earth), hydration, rest, and journaling insights. Normalize it as nervous system processing; suggest shorter future sessions and pendulation between activation and grounding. If symptoms persist beyond 24-48 hours, advise consulting a trauma-informed professional.

Handling Intense Reactions Like Anxiety, Overwhelm, or Panic Where the Participant Wants to Stop

What’s Happening:

The nervous system is reaching its threshold, surfacing stored trauma, suppressed emotions, or unprocessed stress. Physiological sensations (e.g., dizziness, chest tightness, numbness, tingling, lightheadedness) from hyperventilation or CO₂ drops can feel scary (though not dangerous in most cases). The ego may resist surrender due to fear of the unknown, losing control, or confronting pain.

How It Relates to Breathwork:

Breathwork amplifies internal awareness and energy release, which can trigger these reactions in longer journeys. Hyperventilation lowers CO₂, causing symptoms like tingling or panic, but this is typically not dangerous—though frightening—and often signals a need for integration rather than continuation.

What the Facilitator Can Do:

• In the moment: Slow the breath immediately (“You’re safe; breathe gently through the nose”), switch to NGSE in Ether Breath cadence (double exhale), or rest in stillness. Anchor with body awareness (“Feel your hands on your heart; wiggle your fingers”). Validate (“You’re doing amazing; it’s normal for things to come up”) and offer choice (“You can stop anytime”). Use subtle check-ins or appropriate grounding touch for co-regulation.
• After: Debrief gently, normalize the experience (“Every journey is perfect”), and recommend integration (walk, journaling, water).
• Pre-frame: “You might feel amazing, cry, or uncomfortable—all are welcome. You have control to slow down or stop.”
• If intense reactions linger post-session (e.g., ongoing anxiety, panic echoes, or emotional waves): Guide continued slow nasal breathing (e.g., extended exhales or box breathing), grounding (barefoot walking, body scans), and self-soothing (humming, gentle movement). Encourage rest, hydration, and processing via journaling or sharing with a trusted support. If it feels like re-traumatization or doesn’t ease within a day, recommend professional trauma support.

Participant is Experiencing Tinnitus During or After Breathwork

What’s Happening:

Tinnitus is a persistent ringing, buzzing, pulsing, or hissing in the ears, often related to auditory system issues but heavily influenced—and amplified—by nervous system factors like stress, anxiety, dysregulated breathing, and overactive sympathetic responses. During or after breathwork, some may experience temporary sensations mimicking tinnitus (e.g., pressure in the inner ear, altered blood flow, heightened awareness making existing tinnitus seem louder), usually transient and tied to blood gas shifts or sensitivity.

How It Relates to Breathwork:

Breathwork regulates the nervous system, potentially easing tinnitus long-term by shifting to parasympathetic states (reducing stress hormones like cortisol, improving circulation, and supporting emotional regulation). However, intense styles (e.g., Fire Breath, rapid breathing, strong retentions, or hyperventilation) may temporarily exacerbate or mimic it through inner ear pressure changes, blood flow/O₂/CO₂ fluctuations, or increased sensory awareness—especially in sensitive systems.

What the Facilitator Can Do:

• Recommend gentler practices like Earth Breath (slow, grounding at low BPM) or Ether Breath (double exhalation) to soothe the system.
• Start with slow, controlled breathing (4-6 breaths per minute), avoid aggressive holds or hyperventilation initially, and focus on exhale lengthening for vagus nerve activation.
• Include post-session grounding (body scans, hums) and breathing mechanics/CO₂ tolerance work.
• Advise participants with existing tinnitus to monitor sensations and adjust intensity.
• If tinnitus feels amplified or persists post-breathwork (e.g., louder ringing lasting hours/days): Suggest daily relaxation breathing (e.g., 4-7-8, diaphragmatic, or box breathing) to reduce stress amplification. Encourage mindfulness, sound masking (gentle background noise/music), hydration, and neck/shoulder relaxation. Long-term, parasympathetic-focused practices like slow belly breathing can help manage perception; if it worsens significantly, refer to an ENT or tinnitus specialist.

Vertigo or Dizziness Symptoms in Breathwork

What’s Happening:

Vertigo involves spinning, dizziness, or lightheadedness from a mix of factors: oxygen-CO₂ imbalance (hypocapnia leading to vasoconstriction and reduced brain/inner ear oxygen), blood pressure drops, vestibular system sensitivity (especially in those with conditions like BPPV or Meniere’s), nervous system resets (sudden parasympathetic shifts feeling destabilizing after chronic stress), energy movements (e.g., Kundalini unblocking), psychological/emotional releases (e.g., dissociation as protection), dehydration, low electrolytes, fasting, or postural/movement triggers.

How It Relates to Breathwork:

Deep, rapid breathing disrupts blood gases and circulation, affecting the inner ear and balance. Longer journeys can trigger these as the body shifts states, unblocks energy, or releases emotions, feeling destabilizing if from chronic stress.

What the Facilitator Can Do:

• Prevent by easing in slowly, using nasal breathing to regulate CO₂, grounding (eyes open, focus on a point), ensuring hydration/electrolytes, and modifying to gentler techniques (e.g., box or diaphragmatic breathing). Suggest lying down.
• If occurring: Slow breathing, ground with body awareness, and validate.
• For sensitive participants, avoid sudden movements and monitor for underlying conditions.
• If vertigo/dizziness lingers post-breathwork (e.g., ongoing unsteadiness or spinning): Recommend gentle diaphragmatic breathing, neck stretches/rolls, hydration, and rest in stable positions. Suggest vestibular-friendly integration like slow walking, gaze stability focus, or mindfulness to reorient. If persistent or severe (beyond 24 hours), advise seeing a vestibular specialist or PT for targeted exercises.

Participant Experiencing Tension Headaches during or Post Breathwork

What’s Happening:

Headaches stem from overbreathing causing hypocapnia (low CO₂ leading to brain vessel constriction and reduced blood flow), the Bohr Effect (impaired oxygen release to tissues despite high intake, causing fogginess/pain), muscle tension (e.g., unconscious jaw/neck/face clenching during intense sessions), or energetic/emotional layers (suppressed emotions rising, third eye/crown pressure from expanding awareness, or friction from forcing rather than allowing).

How It Relates to Breathwork:

Overbreathing in intense sessions blows off CO₂, constricting vessels and creating tension, especially with upper chest engagement or forceful techniques. Energetically, it may signal resistance or blockages surfacing.

What the Facilitator Can Do:

• Shift to nasal, gentle, slower breathing (e.g., box or Buteyko-style).
• Rebalance CO₂ with comfortable exhale holds.
• Encourage hydration, grounding (e.g., earth touch, walking), and technique evaluation (avoid overexertion).
• Invite relaxation over intensity and debrief on emotional aspects.
• If tension headache persists post-breathwork (e.g., lingering pain/throbbing): Guide CO₂-rebalancing breaths (gentle exhale holds), progressive muscle relaxation (jaw/neck focus), hydration, and rest. Suggest shoulder rolls, slow neck rotations, or dark/quiet environment. Long-term, daily diaphragmatic breathing reduces recurrence; if chronic, refer to a headache specialist.

Participant Yawning During Breathwork

What’s Happening:

Yawning signals a nervous system reset (shifting to parasympathetic activation, releasing tension), energy/emotional release (often from held areas like jaw, throat, or diaphragm), O₂/CO₂/pressure regulation (restoring homeostasis, cooling the brain), vagus nerve stimulation (stretching palate/throat/diaphragm for calming), or subconscious readiness (“I feel safe enough to process now”). Frequent yawning indicates the body-mind is prepared for deeper work or integration—it’s a natural pressure valve.

How It Relates to Breathwork:

Altered breathing states prompt yawns to restore homeostasis, especially after rhythmic or deep sessions. It’s a positive sign of regulation, not fatigue, and enhances calming pathways—one of the fastest ways to shift from stressed to relaxed.

What the Facilitator Can Do:

• Celebrate it (“Beautiful, that’s your body regulating”).
• Encourage leaning in (stretch jaw, sigh, shake).
• Use it as a cue for integration, noting it’s a fast path to relaxation. (No major post-session persistence issues typically; yawning often resolves naturally as regulation continues.)

Participant Constantly Shutting Down or Falling Asleep in Breathwork especially during Slow Cadences

What’s Happening:

This can be healthy parasympathetic settling (feeling safe leads to restorative rest) or dorsal vagal collapse/freeze (overwhelm causes shutdown/disconnection, not true relaxation). In freeze-prone systems, slowing breath removes the activation needed for presence, leading to drop-out. Conversely, structured intensity brings them “online”—emotions arise, thoughts organize, presence increases (textbook freeze-to-mobilization). Regulation here means appropriate energy and capacity to feel without dissociating—not always relaxation.

How It Relates to Breathwork:

Slow techniques may trigger collapse in trauma histories, feeling like shutdown. Faster, structured breathing (e.g., Catalyst) can regulate by re-engaging presence, emotions, and thoughts without bypass—counterintuitive but true for some, fitting trauma-informed principles where regulation isn’t always relaxation.

What the Facilitator Can Do:

• Normalize (“Some systems need activation before settling”).
• Use structured activation (e.g., Catalyst with clear rhythms, rounds) then pendulate to grounding (e.g., Earth Breath).
• Watch for the line between helpful intensity and avoidance (“Are you more present?”).
• Frame as learning the system’s needs: presence over softness. Avoid uncontained hyperventilation.
• If shutdown/freeze lingers post-session (e.g., dissociation, numbness, or disconnection): Recommend gentle activation pendulation (short structured breaths followed by slow grounding), body awareness practices, or light movement. Encourage rest in safe environments and journaling. If it feels like dorsal collapse persists, suggest trauma-informed support to build capacity for regulation.