• Baxter Bell, MD

A Special Breath Practice for These Times: A COVID-19 Pranayama

It all started with a short video that came across my YouTube feed about a month ago. And a brief one at that, just 3:42 long. But despite its brevity, its content caught my attention immediately: a breathing technique that hospital staff in the UK were teaching to their patients with COVID-19 who had respiratory symptoms. It was fairly simple: take a big breath in, hold it in for 5 seconds, let it go. Repeat that 6 times and on the 6th round, cough once or twice into your elbow. Do another set of 6. Then, lie down on your belly, prone, with your chest and head slightly propped up with a pillow, and take slightly deeper breaths for about 10 minutes.


The reasoning for the prone practice being that more of our lung tissue is in the back half of the lungs, and if we are lying on our backs in bed, sick, this area gets compressed by gravity and not utilized fully, compromising our ability to get needed amounts of oxygen into our blood stream, and possibly increasing our chances of getting a secondary pneumonia. Lying on your belly and breathing opens that lung tissue up for use.


I then came across another video, made by a doctor in the US, describing essentially the same technique… something was brewing out there! He mentioned that these techniques seemed to be keeping hospitalized patients off the ventilators!


Right away, I saw that our yoga pranayama practice might enhance this technique. For example, the doctor who demonstrates the technique in the UK video mentions, offhandedly, that he got light headed while doing the technique. In all likelihood, he was hyperventilating a bit, due to the quick deep breath in and the causal breath out, and maybe also affected by over-gripping while holding the breath in for 5 seconds that I witnessed. I wondered if evening out the inhalation and exhalation and holding the breath more gently for 5 seconds might alleviate this unwelcome and possibly discouraging (to patients trying it) symptom, while still opening up the lungs? [Always alert to possible cautions with pranayama techniques, I’d suggest those with blood pressure issues to be more cautious about the “kumbaka” hold at the top of the inhalation, by monitoring their blood pressure before and right after the practice to make sure there is not an unusual spike in their numbers.]


And the second part of the practice sounded like a low supported sphinx pose, and with proper propping, could be done comfortably in bed or on a sticky mat. Lying on the belly is not always comfortable for all people, so creative propping might need to be explored to make this more doable for those people, and one might even break this up into two 5-minute sessions, with a Cat-Cow in between to relieve any symptoms in the spine.


And then, just last week, this article appeared in the New York Times, describing a new trend of having ICU patients with Covid19 lung involvement lie on their belly when on the respirator, and even prior to considering placing them on the breathing machines to try and avoid the need to do so. They call it “proning” and it is lowering the death rate in early investigations, as well as the need to place patients on ventilators.


With all this in mind, I started to practice the Part 1 technique in my morning meditation/pranayama practice in the following way: Inhalation for 5 seconds, gentle pause at the top of the inhalation for 5 seconds, exhalation out for 5 seconds, for five rounds of breath, and on the 6th breath, instead of a 5 second exhalation, 2 short, strong coughs. Repeat that again. Interestingly, although I had always been taught and read that holding the breath in after the inhalation (a kumbaka) was stimulating to the nervous system, I have found that this particular way of doing it was neutral in effect for me, and I actually feel pretty calm and relaxed after 2 cycles most days.


To experiment with Part 2, I had a pillow at my mat when doing my asana practice, and at the end of practice, set myself up in low sphinx with a pillow under the upper chest and the head supported on stacked fists, with a gentle lengthening of the in and out breath for 5-10 minutes, setting a timer so I did not have to worry about how long I had been practicing. I found this very accessible and actually quite calming and relaxing!


If, indeed, this 2-part technique of breath practice is potentially beneficial for the recovery of those who get COVID-19 respiratory symptoms, it might make sense for everyone to practice it ahead of time, as Dr. Munshi in the UK suggested, and be ready to use it more consistently if and when the need arises. Although the benefits are anecdotal at this time for Part 1 of the process, (the ICU use of prone breathing is being studied and already has evidence of value) it seems like the potential benefits of doing it far outweigh any negative side effects for the vast majority of people it could help.


Try it out yourself with my video below. I’d love to hear about your experience with the practice: what worked, how did it feel, what was challenging. If you find it of value, spread the word!


© 2020 Baxter Bell. All rights reserved.

Beautiful photos by Melina Meza Photography.
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