I began practicing breath holds to increase my energy and to have more confidence when surfing. I now know that they also played a vital role in improving my blood sugars.

The Benefits of Intermittent Hypoxia

Intermittent hypoxia training (IHT) can lower blood sugar independent of insulin. It also has been shown to improve insulin sensitivity, especially when it is paired with exercise. IHT also enhances immune function and reduces inflammation. Further, IHT can increase red blood cell count, improving your body’s oxygen-carrying capacity. This is essentially "natural blood doping," which helps enhance performance. Finally, IHT increases blood flow to the brain, improving focus and resiliency.

Hypoxia: It’s a Matter of Dose

In Principle 2, we discussed that tissue hypoxia is one of the root causes of diabetic complications. Therefore, it might seem counter-intuitive to suggest hypoxia training to people with diabetes. However, it comes down to dose. Chronic hypoxia, such as that caused by diabetes and obstructive sleep apnea, has many adverse side effects. When done correctly, however, IHT has many benefits, as stated above.

So what is the proper dose? A meta-analysis published in 2014 in the American Journal of Physiology concluded the following:

• 3-15 episodes per day

• SpO2 of approximately 82%-95%

Staying in those ranges will help you achieve the therapeutic advantages of IHT.

Breath Holds versus IHT

Intermittent hypoxia training does not necessarily involve breath holds. Many of the studies using IHT have utilized expensive equipment to reduce the oxygen content in the air that subjects inhaled. This can occur with very little stress to the body if carbon dioxide levels are kept constant.

However, you can get the same drops in oxygen saturation using breath-hold training (BHT), suggesting that similar results can be achieved. But, just keep this in mind. As a diabetic, the goal is to reduce stress, not increase it significantly. So, when performing breath holds you want to go easy and make sure you do not over-stress yourself, which would likely negate the positive effects of the practice.

A Final Word on Holding Your Breath

Practicing breath holds is the icing on the cake of Principles 1 & 2. It’s not completely necessary for people with diabetes, but it can be very beneficial if done correctly. However, because there are dangers to holding your breath, I always recommend working with a coach (see below). The next section provides some essential guidance for starting a breath-hold practice.

Practice Principle 3

WARNING

Holding your breath can be very dangerous. NEVER PERFORM BREATH HOLDS OF ANY KIND IN WATER! Many people try breath hold techniques in a pool and pass out. It is never safe to practice breath holds in the water where the consequences are fatal. Also, never perform breath holds while driving or operating any machinery.

Actionable Steps

• Use a pulse oximeter to monitor your blood oxygen saturation. Studies have shown that the therapeutic range for IH is between 82% - 95%. Going below this range could result in negative side effects.

• Start very slowly. This is not a competition. When you complete a breath hold, you should be able to recover normal breathing within 3 - 5 breaths.

• Consistency over intensity. Practice many small breath holds throughout the day rather than trying to push yourself by holding your breath as long as you can.

• Hold your breath while walking. Try holding your breath for 10 paces, then 15, then 20. See how many steps you can comfortably hold for while still being able to regain normal breathing after 3 - 5 breaths. Wear your pulse oximeter to ensure you do not drop your blood oxygen saturation too low.

One More Word of Advice

Although breath-hold training is generally safe, before starting, you must assess your general breathing fitness (see #2 here). Additionally, make sure you do not have any conditions that would make breath-holding unsafe (e.g., if you are pregnant).  

My recommendation is to begin with an instructor who can ensure breath holds are safe for you and who can provide you with basic breath-hold practices. There are many instructors available through the Oxygen Advantage, the Wim Hof Method, and Immersion Freediving. I also offer breath-hold lessons through Black Sand Yoga. Another good place to start is by reading the Oxygen Advantage, which outlines several different breath-hold techniques.