Conscious breathing at altitude
It all begins with an idea.
“I even read a study which compared climbers who climbed Everest. The ones who were in the habit of breathing coherently didn’t need supplementary oxygen, whilst those who didn’t breathe coherently did.”
I was into the third session of Dr. Richard Brown and Dr. Patricia Gerbarg’s Breath-Body-Mind Fundamentals course, which teaches ancient and modern techniques to relieve stress and improve physical and emotional well-being, and as Dr. Brown spoke I felt my eyebrows raise.
Convinced by the power breathwork has to improve our lives, I’d spent much of the past year delving further into the subject, taking Yoga teacher training courses, reading what was out there and experiencing my well-being improve through breathing.
And yet, I wondered, could something as easy to control and natural as the breath have such paradigm-shifting benefits at altitude?
According to McKeown*, almost half of those attempting to climb above 4,000 metres will develop one or two symptoms of Acute Mountain Sickness, the most common of which are a headache, nausea, vomiting, lack of appetite, fatigue and sleeping difficulties
after a rapid ascent of more than 400 metres per day. Could breathing be an answer to helping to avoid those symptoms?
My first high altitude trek was three weeks away, and so I decided to find out.
My friend Hamish and I would be heading to Nepal to hike the ‘Everest Three High Passes’ route, a 16 day trekking expedition which would involve climbing three mountain passes, Renjo-La (5420 metres) , Cho-La (5,420 metres) and Kongmala (5,500 metres) reaching a maximum height of 5,600 metres on Kala Patthar peak, and sleeping for 8 nights above 4,000 metres.
The main principle guiding me was simple: breathe through the nose wherever possible, and as far as possible, breathe slow. The messages I’d had from Brown and Gerbarg’s course, from my yoga courses and from all the reading I’ve done, was that breathing through the nose encourages diaphragmatic breathing, ensuring 10-20% greater oxygen for an equivalent breath through the mouth, amongst other benefits. **
We’d be measuring our breaths oxygen saturation rate daily with a pulse oximeter. Would making my breathing conscious make any difference?
On the trip I’d planned to encourage myself to breathe through my nose through two strategies:
Practice coherent breathing*** 1-2 times a day for 20 minutes (once at the beginning of the day before hiking and once at the end, to aim to move myself into a nose-breathing sleeping pattern).
To inhale only through the nose on any sections of climbing, counting breaths as I went****.
And what did I find?
Coherent breathing may have helped, but I can’t be sure.
I was able to follow my coherent breathing plan upon waking up and upon going to sleep each day, aside from 3 mornings where we rose between 3 and 5 am to climb (where I would breathe later in the day), and a period of 3 days when I had a blocked nose.
And I successfully avoided any symptoms of altitude sickness.
Whilst I was taking acetazolamide after reaching 3,400 metres, a drug which helps you to acclimatize by quickening your breathing rate, and we did follow the other advice of our guide to the letter (taking two acclimitisation days, drinking plenty of water, walking slowly and eating A LOT of garlic soup), I do feel that the breathing helped.
My pulse oxygenator readings indicated a saturation in line or marginally better than the average expected at different altitudes (although again a number of different factors may be behind this, including that readings were taken often between 4pm and 6pm in the afternoon, hours after I had last practised coherent breathing), although they were no better than Hamish’s scores, who had not been coherent breathing.
2. Breathing through the nose when walking up hill was hard but extremely helpful
You don’t have to move far in the Everest region to hear the phrase ‘bistari, bistari’, a phrase Nepali guides and sherpas use to remind climbers to move ‘slowly, slowly’. But how slowly?
It turns out, using nose breathing was the answer. Having trained myself up shorter climbs in the first few days, the first major test was Renjo La, a climb of over 1,000 metres of ascent from the village of Lumde. We set off in the morning, the bitter cold before sunrise encouraging faster movement than the slower pace we were meant to be maintaining. But as we moved up out of the valley, past frozen waterfalls and up over snowy yak pastures, I brought my attention to my breath, counting initially 4 counts on the nasal inhale and 4 on the exhale through the nose. Whenever I found the breathing too difficult I would slow my footsteps. We worked our way up to the first prayer-flag marked mini-pass, and I was surprised to find that I was in no way out of breath in the manner I usually be, having climbed a few hundred metres at home.
Having crossed the pastures the path steepened. As we moved up through boulder fields, exhaling through the nose felt too strained, and so I shifted to 4 counts inhale and 4 counts exhale through the mouth. Again, we paused for water and a snack. No breath shortage. And as we made our way to the top, the same again. I felt a quiet sense of achievement standing atop the pass, with my first main view of Everest, not out of breath and feeling, if anything, revitalised.
At points the steepness of the climb (for example climbing up using ropes on Cho La, the second pass), or the technical nature of it (climbing across uneven boulder fields on the way up to Kongmala, the third pass), made focussing on a 4 count nasal inhale feel less possible and out of reach - more than anything my mind was engaged in technique and so less able to focus on the breath, but on the whole I successfully used this strategy for all three passes and other major climbs.
As well as slowing me down, my breath had helped me enter a sense of flow, being in the present. As I counted 100 rounds of breathing, I constantly returned to my breath and found that, although moving slowly than I was used to, time moved more quickly.
3. Two more breathwork techniques helped me to adapt to the challenges high altitude trekking.
It was cold, and above 4,000 metres we were operating in environments where water taps froze mid flow, and water bottles mid hike. Waking up cold, I found using the yogic Pranayama technique of Bhastrika*****, helped me keep me warm and energised in the mornings and made getting out of the sleeping bag far easier.
And secondly, I’ve always found descending steep slopes challenging, and so employing Dr. Andrew Weil’s 4:7:8 technique at various intervals, particularly where sections became challenging, helped me to tackle those sections with a greater sense of calm and assuredness.
So what did I learn?
Without as long as a lead up time to practice the technique and in the absence of more evidence, I can’t necessarily confirm that coherent breathing helped me to increase my oxygen saturation and thereby avoid Acute Mountain Sickness, but it certainly did enable a sense of calm and purpose.
Perhaps more revolutionary was how grounding I found letting my breath guide how fast I walked, rather walking and letting my breath catch up. I climbed slowly, confidently and calmly, regaining energy for the rest of the day’s activities. And I felt more in touch with my body as I did so.
Perhaps bistari bistari (slowly slowly) isn’t too bad a thing after all.
* Patrick McKeown: The Oxygen Advantage, quoting ( Maggiorini M, Mountaineering and altitude sickness Ther Umsch 2001 June; 58 (6): 387-93)** As well as Patrick McKeown’s The Oxygen Advantage, read James Nestor’s Breath and Dr. Brown and Dr. Gerbarg’s The Healing Power of the Breath for the benefits of breathing through the nose. See also George Catlin’s Shut your mouth and save your life ***Coherent breathing is a breathing technique designed by Brown and Gerbarg in which the participant breathes at a rate of either 5 or 6 breaths per minute, with the focus being on making the breath calm and gentle, inhaling and exhale through the nose to activate the diaphragm. I’d been practicing coherent breathing 20 minutes per day for a month before the expedition.****To train myself to improve my breathing, I’d been walking once a day for 20 minutes aiming to breathe in and out through the nose, as recommended by Patrick McKeown in the Oxygen Advantage, at a rate of 6 breaths a minute for three weeks before the start of the expedition. ***** Bhastrika involves taking large, full inhales and exhales through the nose whilst raising and lowering your arms. For detailed guidance on how to perform this, read B.K.S Iyengar's Light on Pranayama. Not to be practised if you have recently had COVID-19, have had lung or respiratory difficulties, are pregnant or have high blood pressure